Some providers compared continuing testosterone therapy during pregnancy to illicit drug use during pregnancy, perceiving it as a future risk to the child. Others suggested that testosterone use during pregnancy is selfish because it prioritizes the parent’s own health and well-being in the present over the potential health and well-being of their child in the future. Some providers even suggested that trans and nonbinary patients shouldn’t have children if they are unwilling or unable to pause testosterone therapy during pregnancy.

In contrast, the trans men and nonbinary people we interviewed described grappling with difficult and weighty decisions around pausing testosterone during pregnancy. These decisions often involved choosing between their own mental health and well-being against the potential health and well-being of their child. As one participant described their experience going off testosterone during pregnancy:

“My lows were miserable, depressed, to the point of suicidal. … I knew that going back on testosterone would help. I didn’t really know whether [my doctor] would be happy to re-prescribe me testosterone … and there was a fear there that it would be withheld from me … that they were going to say, ‘Well, sorry, you came off it, you’re not getting it back.’”

Despite it being fairly standard medical advice, there remains relatively scant empirical evidence guiding the practice of pausing testosterone therapy for trans men and nonbinary people during pregnancy and chestfeeding. There is also currently no published work on microdosing testosterone during pregnancy.

Instead, much of the medical literature on the potential developmental effects of “excess androgen” exposure in the womb focuses on pregnant people with polycystic ovary syndrome who have testosterone levels that generally fall between those for cisgender women and men. These studies center on the likelihood of the baby later developing intersex conditions, or having biological traits that do not fit binary definitions of male or female characteristics; later self-identification as lesbian or trans; metabolic and cardiovascular dysfunction, such as obesity; and neuropsychiatric disorders, such as autism and attention-deficit disorder. Most of these concerns have involved children categorized as female at birth.

People with polycystic ovary syndrome, however, are not routinely placed on testosterone blockers during pregnancy or discouraged from feeding their infants milk they produce.

In my review of our interviews and the medical literature, I became increasingly concerned that this focus on producing “normal” children fails to attend to both natural human diversity in cognitive processing, bodies and identities, and the mental health of trans and nonbinary parents. It may also echo eugenicist policies that attempt to eliminate human characteristics and communities that society deems inferior or bad. But people from these communities have done a great deal of work over the past several decades to ensure they are granted equal rights and protections.

Paradoxically, the desire to protect offspring from testosterone exposure during pregnancy and chestfeeding may become a method to prevent the reproduction of some of the very same characteristics held by trans and nonbinary parents themselves. As one participant noted:

“There’s a bunch of research around androgen exposure in utero and intersex conditions. … I did have complex feelings around working hard to not have an intersex child. … As someone who is a gender ‘other,’ to work hard to not create a different body that is a gender ‘other’ feels weird. It feels hypocritical.”

While concerns about “androgen excess” during pregnancy for trans men and nonbinary people parallel those for people with polycystic ovary syndrome, doctors treat these cases differently. This discrepancy in clinical approach indicates that there may be other pathways forward that don’t require stopping testosterone therapy completely.

I believe that careful attention to the physical and mental health and well-being of trans and nonbinary people before, during and after pregnancy is long overdue in medicine. Instead of approaching testosterone therapy during pregnancy as a binary yes/no question or a one-size-fits-all standard, investigating how various dosages of testosterone may affect all stages of pregnancy and chestfeeding could lead to better outcomes for both trans parents and their children.

This article is republished from The Conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Carla A. Pfeffer, Michigan State University. The Conversation has a variety of fascinating free newsletters.

Read more:
Transgender youth on puberty blockers and gender-affirming hormones have lower rates of depression and suicidal thoughts, a new study finds

I’m a pediatrician who cares for transgender kids – here’s what you need to know about social support, puberty blockers and other medical options that improve lives of transgender youth

Carla A. Pfeffer received funding from the Economic and Social Research Council for her work on the Transgender Pregnancy Project. The Trans Pregnancy Project team includes: Sally Hines (PI), Ruth Pearce, Carla A. Pfeffer, Damien W. Riggs, Elisabetta Ruspini, and Francis Ray White.