If you want to get pregnant, you'll need to stop taking testosterone and wait until your provider says it's okay to start trying to conceive. Testosterone is not a method of birth control. Some people think that if you take testosterone you can't get pregnant, but this isn't true. Even AFAB people who have been taking testosterone for a while and who no longer have periods can get pregnant.
In a survey of 41 trans men who became pregnant and gave birth, 61% of the participants had used testosterone before becoming pregnant. Three quarters of these pregnancies were planned, meaning that a quarter of these pregnancies were unplanned. This highlights the fact that taking testosterone is not a method of contraception. Trans men and non-binary people in AFAB who have not had a hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries) should continue to use contraception if they have sex with the penis in the vagina and want to avoid pregnancy. Many trans men stop taking testosterone and conceive without medical assistance if they have penetrative sex with their partner.
While stopping testosterone can be a big challenge, almost all current approaches require it, unless pregnancy or fertility treatments are performed before the hormonal transition. You can get pregnant while you are taking testosterone. Although the chance of pregnancy is greatly reduced with the use of testosterone, the risk of pregnancy still exists. If you haven't had your uterus or ovaries removed and you don't want to get pregnant, you should use contraception when you have sex with a partner in which a pregnancy could occur. Alternatively, some case studies have found that transgender youth can engage in egg collection between puberty blockers and the onset of testosterone. If you are taking testosterone and think you may be pregnant, see your health professional as soon as possible.
Because testosterone tends to affect fertility while a person is taking it, if a person has already made the hormonal transition and wants to become pregnant or freeze their eggs, they will need to stop taking testosterone for a period of time. Some people (including some health professionals) mistakenly think that taking testosterone is a method of birth control. Some studies have shown that testosterone alters the composition of the ovaries, making them look similar to that of people with polycystic ovary syndrome (a condition commonly associated with infertility). Even though I've given birth to a baby after more than a decade of using testosterone, I still hear from medical providers who tell me that testosterone causes sterility. This means that trans men can take hormonal contraceptives, even if they are taking testosterone at the same time.
If you want to breastfeed but start taking testosterone again too soon, that could inhibit milk production. However, many people can get pregnant naturally or through in vitro fertilization after they stop taking testosterone. Many transgender men and people who are non-binary or of the gender queer AFAB (woman assigned at birth) take testosterone as a form of gender-affirming therapy. The idea that testosterone is a contraceptive is common: 16% of the trans men in the study reported that they were using it as a contraceptive, and 5.5% of them were recommended testosterone as a contraceptive by their healthcare provider. Most trans men who previously used testosterone conceived within six months, although 44% did use medical interventions such as fertility drugs and assisted reproductive technologies.
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