Transgender pregnancy
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Transgender pregnancy is the gestation of one or more embryos or fetuses by transgender people. As of 2023, the possibility is restricted to those born with female reproductive systems. However, transition-related treatments may impact fertility. Transgender men and nonbinary people who are or wish to become pregnant face social, medical, legal, and psychological concerns. As uterus transplantations are currently experimental, and none have successfully been performed on trans women, they cannot become pregnant.
Trans men
Among the wide array of transgender-related therapies available, including surgical and medical interventions, some offer the option of preserving fertility while others may compromise one's ability to become pregnant (including
Effect of masculinizing hormone therapy
Exposing a fetus to high levels of exogenous testosterone
Additionally, patients experiencing amenorrhea (a common side effect of HRT) may experience additional challenges in identifying early pregnancies due to the lack of regular menstrual cycling that could indicate a pregnancy if missed, for example.[5] For this reason, it is important for patients and healthcare practitioners to comprehensively discuss fertility goals, family planning and contraceptive options during gender-affirming care.[5] Many trans men who had planned pregnancies were able to conceive within six months of stopping testosterone.[6] Testosterone-induced changes to the reproductive tract may be partly or completely reversed after stopping HRT.
HRT for trans men eventually decreases fertility. Continued use of testosterone suppresses the
In a study of American trans men, 28.3% reported that they were afraid of not being able to become pregnant because of hormone therapy. Because some trans men want to carry children, it is important for providers to discuss fertility preservation options with trans male clients before prescribing HRT.[9]
Despite its effects on fertility, testosterone therapy is not an effective contraceptive. Trans men and nonbinary people who take testosterone may still become pregnant even if their periods have stopped.[2][10] Trans men may experience unintended pregnancy,[6][9] especially if they miss doses.[6]
Another important postpartum consideration for trans men is whether to resume testosterone therapy. There is currently no evidence that testosterone enters breast milk in a significant quantity.[11] However, elevated testosterone levels may suppress lactation and healthcare guidelines have previously recommended that trans men do not undergo testosterone therapy while chestfeeding (breastfeeding).[12] Trans men who undergo chest reconstruction surgery may maintain the ability to chestfeed.[13]
Mental health
Special consideration of the mental health of transgender people during pregnancy is important. It has previously been shown that transgender individuals often experience higher rates of suicidality than cisgender people and lesser degrees of social support from their environment and familial relationships.[14][15] Relatedly, many transgender individuals experiencing pregnancy reported that choices of healthcare providers were substantially impacted by the views of the healthcare worker, and many transgender people prefer midwifery services rather than experience labor and delivery in a hospital.
Some individuals reported having gender dysphoria and feelings of isolation due to the public reception of their gender identity and drastic changes in appearance which occur during pregnancy, such as enlarged breasts.[16] Some state feeling disconnected or alienated from their pregnant bodies. Both social gender dysphoria (related to perception by others) and physical gender dysphoria (perception of one's own body) can occur while a trans person is pregnant.[17][18]
Unintended pregnancy can also be dangerous to a trans person's mental health. According to a study of American transgender men between the ages of 18 and 45, 30.5% reported being afraid of pregnancy.[19] Unwanted pregnancy can cause severe gender dysphoria and suicidal ideation in trans people. One nonbinary person who performed a self-induced abortion stated,[20]
[I used] blunt force to [my] abdomen. Considered drinking poison, as my insurance did not cover an abortion. Luckily, I was able to get on state insurance which did cover the procedure, so it did not come to that. I 100% would have done it. Dying was a better alternative to forced pregnancy.
According to the National Transgender Discrimination Survey,
Sociocultural factors
Transgender people, including trans men and nonbinary people, are more likely than the general population to experience homelessness, food insecurity, intimate partner violence, and adverse child experiences. All of these can impact pregnancy outcomes. Additionally, trans people experience minority stress and may be at higher risk of substance use than the general population. Some also report avoiding medical care or mistrusting medical professionals because of discrimination.[21]
Medical discrimination
Some trans men who carry pregnancies are subjected to discrimination, which can include a variety of negative social, emotional, and medical experiences, as pregnancy is regarded as an exclusively feminine or female activity. Several studies indicate a lack of awareness, services, and medical assistance available to pregnant trans men.[16] Inaccessibility to these services may lead to difficulty in finding comfortable and supportive services concerning prenatal care, as well as an increased risk for unsafe or unhealthy practices.
Abortion
Unintended pregnancies can result in transgender men or nonbinary people considering or attempting self-induced abortion. Many transgender men report attempting a self-induced abortion because of lack of safe, effective abortion methods.[20] Studies differ on abortion rates in trans men. Different studies report that between 12%[9] and 21% of trans people's pregnancies end in abortions. Some trans people report choosing between abortion and suicide because pregnancy causes terrible gender dysphoria.[20]
Statistics
According to figures compiled by Medicare for Australia, one of the few national surveys as of 2020, 75 male-identified people gave birth naturally or via C-section in the country in 2016, and 40 in 2017.[22]
Non-binary people
Nonbinary people taking testosterone to
Non-binary people who have written or been profiled about their experiences of pregnancy include Rory Mickelson,[25] Braiden Schirtzinger,[26] and Mariah MacCarthy.[27]
Trans women
Pregnancy is not possible for transgender women as they lack a female reproductive system. As of 2019, uterus transplantation has not been successfully performed in transgender women.[28] The Danish transgender painter Lili Elbe died in 1931 from surgical complications following an attempt at such an operation.
Uterine transplantation, or UTx, is in its infancy and is not yet publicly available. As of 2019, in cisgender women, more than 42 UTx procedures had been performed, with 12 live births resulting from the transplanted uteri as of publication.[29] The International Society of Uterine Transplantation (ISUTx) was established internationally in 2016, with 70 clinical doctors and scientists, and currently has 140 intercontinental delegates.[30]
In 2012, McGill University published the "Montreal Criteria for the Ethical Feasibility of Uterine Transplantation", a proposed set of criteria for carrying out uterine transplants, in Transplant International.[31] Under these criteria, and because no research has been conducted in genetic males, only a genetic female could ethically be considered a transplant recipient. The exclusion of trans women from candidacy is justified by the lack of research to determine how to conduct the surgery, rather than an inherent bar.[32] In 2021, authors of the Montreal Criteria published a revised set of criteria in Bioethics with an ethical framework for consideration of genetic males' (and other genetic XY individuals') eligibility for uterine transplants.[33]
In 2020, Mikey Chanel, an intersex trans woman, allegedly managed to achieve pregnancy after being artificially fertilized following a diagnosis of persistent Müllerian duct syndrome. She was assigned male with XY chromosomes and external male reproductive organs, but discovered she had internal female reproductive organs after an X-ray, which diagnosed her with PMDS.[34][35][36] No further information was released. Since Chanel's announcement, many have suspected it to be a hoax, citing Chanel's inaccuracies of describing PMDS symptoms and her history of sensationalism and radical attempts at social media popularity. Chanel has since taken down her social media pages.
Society and culture
In 1583, an intersex person that had masculine gender expression reportedly became pregnant in Beaumaris, Wales.[37]
Unicode introduced "pregnant man" and "pregnant person" emojis in version 14.0, approved September 2021.[38] However, this came with some controversy, as some viewed it to be absurd.[39]
See also
- Transgender rights
- LGBT parenting
- LGBT reproduction
- Male pregnancy
- Engineered uterus
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- ^ King-Miller, Lindsay (March 13, 2020). "Not All Parents Are "Mom" Or "Dad"". Ravishly. Archived from the original on June 5, 2020. Retrieved June 4, 2020.
- ^ "I'm Pregnant, But I'm Not a Woman". www.advocate.com. 2018-11-13. Archived from the original on 2019-12-12. Retrieved 2020-03-10.
- ^ "Non-binary, pregnant and navigating the most gendered role of all: Motherhood". Washington Post. Archived from the original on 2019-09-14. Retrieved 2020-03-10.
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in the absence of sufficient research demonstrating safety and efficacy, uterine transplant in men and trans individuals fails to meet the first stipulation of Moore's Criteria for Surgical Innovation, which requires that novel surgical procedures have an adequate research background. It is on this basis that the Montreal Criteria exclude nongenetic female recipients. However, it certainly bears mentioning that there does not seem to be a prima facie ethical reason to reject the idea of performing uterine transplant on a male or trans patient. A male or trans patient wishing to gestate a child does not have a lesser claim to that desire than their female counterparts.
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- ^ Cliff, Martha (November 17, 2020). "Teenager raised as a boy announces pregnancy after discovery of female reproductive organs".
- ^ Agrawal, Saumya (November 18, 2020). "Trans teen who was raised as a boy is four months pregnant after finding she has ovaries and womb". Times Now News.
- ^ "A teen who was born with male genitalia has become pregnant after finding out that she also has working ovaries, a uterus, cervix and fallopian tubes". Yahoo News. November 16, 2020.
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