Here you can find guidance on how to avoid a pregnancy for trans people and the people who love them[1]. Women on Web is available to all people who need help with preventing and ending unwanted pregnancies.
Preventing Pregnancies for People with Ovaries
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These recommendations are relevant for trans men, genderqueer or nonbinary people who were assigned female at birth.
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If you have not had a hysterectomy/oophorectomy, you may become pregnant if you engage in penis-in-vagina sex. Testosterone (T) and gonadotrophin releasing hormone (GnRH) analogues are not effective contraceptives.
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Contraception is recommended if you have ovaries and a womb, engage in penis-in-vagina sex with a risk of pregnancy and do not wish to conceive.
Contraceptive options
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Condoms and permanent sterilization are options for people of all genders who want to avoid pregnancy.
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Non-hormonal copper intrauterine devices (IUDs) are safe to use and do not interfere with hormonal therapies in the treatment of trans people (e.g., testosterone). An IUD may be difficult to insert if you are experiencing vaginal atrophy and can cause unpredictable vaginal spotting and bleeding, which may be unacceptable for you.
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Progestogen-only contraceptive methods [pills, injections, implants and intrauterine systems (IUS)] do not interfere with hormone therapies in the treatment of trans people.
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For some trans people, monthly menstruation may cause dysphoria; the use of testosterone can take several months to stop menstruation. For people who wish to stop or reduce vaginal bleeding, you can consider using a progestogen injection, implant or intrauterine system (IUS).
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Hormonal contraceptives that combine progestogen and estrogen are not recommended for trans people who take hormone therapies, because estrogen counteracts the effects of testosterone.
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Often, a tell-tale sign of pregnancy is a missed period. Keep in mind that it may be difficult to realize that you are pregnant if you do not menstruate.
Emergency Contraceptive Options
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Emergency contraception can prevent pregnancy after unprotected sex. If you had unprotected penis-in-vagina sex and are at risk of being pregnant, you can take emergency contraception.
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The emergency contraceptive pill, also called the ‘morning after pill’ (ulipristal acetate, levonorgestrel or mifepristone), can be used by trans people taking hormone therapy.
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The intrauterine device (IUD) or intrauterine system (IUS) can also be used as an emergency contraceptive if you are taking hormone therapy. An IUD/S may be difficult to insert if you are experiencing vaginal atrophy and can cause unpredictable vaginal spotting and bleeding, which may be unacceptable for you.
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Emergency contraceptive methods using estrogens are not recommended for trans people who take hormone therapies, because estrogen counteracts the effects of testosterone.
Hormone Therapy and Pregnancy
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Taking testosterone (T) does not provide adequate protection against pregnancy. It may reduce your ability to get pregnant in the future (see more information below).
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Taking gonadotrophin releasing hormone (GnRH) analogues to suppress ovarian function also does not provide adequate protection against pregnancy.
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If you are pregnant, it is important to stop taking testosterone. Testosterone may be teratogenic, meaning it may harm the development of the fetus. It is not a method for safe abortion.
For more information, click here.
Preventing Pregnancies for People with Testes
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These recommendations are relevant for transwomen, genderqueer or nonbinary people who were assigned male at birth.
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If you have not had an orchidectomy or vasectomy, and you engage in penis-in-vagina sex, you may cause a pregnancy. Estrogen(s), GnRH analogues, finasteride or cyproterone acetate do not reduce or block sperm production sufficiently to be considered effective contraceptives.
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Contraception is recommended if you have testes and a penis, engage in penis-in-vagina sex with a risk of pregnancy and do not wish to conceive.
Contraceptive options
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Condoms and permanent sterilization (vasectomy) are options for people of all genders who want to avoid pregnancy.
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Having sex with people who do not have ovaries is a way to prevent pregnancy.
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Estrogen hormone therapy may inhibit sperm production but does not provide adequate protection against pregnancy; you can still have enough sperm to cause a pregnancy.
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Taking other hormone therapies (e.g., gonadotrophin releasing hormone (GnRH) analogues, finasteride or cyproterone acetate) also does not provide adequate protection against pregnancy.
For more information, click here.
[1] These guidelines on based on the Faculty of Sexual & Reproductive Healthcare (FSRH), Contraceptive Choices and Sexual Health for Transgender and Non-binary People (2017) available here.
