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Pregnancy is possible for transgender men who retain a functioning vagina, ovaries, and a uterus. Regardless of prior hormone replacement therapy treatments, the progression of pregnancy and birthing procedures are typically the same as those of cisgender women. However, trans men who carry pregnancies are often subjected to a variety of negative, social, emotional, and medical experiences, as pregnancy is regarded as an exclusively feminine or female activity. According to the study "Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning" by the American College of Obstetricians and Gynecologists, there is a lack of awareness, services, and medical assistance available to pregnant trans men. 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. Additionally, the study also exposed that some individuals reported having gender dysphoria and feelings of isolation due to the drastic changes in appearance which occur during pregnancy, such as enlarged breasts, and due to changes in public reception of their gender identity. Researchers also found that prior use of testosterone did not affect pregnancy.
Testosterone therapy affects fertility, but many trans men who have become pregnant were able to do so within six months of stopping testosterone. Future pregnancies can be achieved by oophyte banking, but the process may increase gender dysphoria or may not be accessible due to lack of insurance coverage. Testosterone therapy is not a sufficient method of contraception, and trans men may experience unintended pregnancy, especially if they miss doses.
Matt Rice, a transgender man, bore a son named Blake in October 1999 following random sperm donations from three cisgender male friends during a relationship with transgender writer Patrick Califia.
Thomas Beatie, another transgender man, has borne three children. He chose to become pregnant because his wife Nancy was infertile, doing so with cryogenic donated sperm and a syringe, at home. Thomas wrote an article about the experience in The Advocate. The Washington Post further broadened the story on March 25 when blogger Emil Steiner called Beatie the first "legally" pregnant man on record, in reference to certain states' and federal legal recognition of Beatie as male. In 2010, Guinness World Records recognized Beatie as the world's "First Married Man to Give Birth." Beatie gave birth to a girl named Susan Juliette Beatie on June 29, 2008. Barbara Walters announced Beatie's second pregnancy on The View, and Beatie gave birth to a boy named Austin Alexander Beatie on June 9, 2009. Beatie gave birth to his third child, a boy named Jensen James Beatie, on July 25, 2010.
Yuval Topper, an Israeli transgender man, gave birth to a child on December 28, 2011. Fernando Machado, a South American transgender man, gave birth to a child. The baby is a biological child between Machado and his trans wife Diane Marie Rodríguez Zambrano. More cases are documented in the United Kingdom and Australia. 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 there in 2016, and 40 in 2017.
Non-binary people with a functioning vagina, ovaries and uterus can give birth. Not all non-binary people (or trans people of any gender identity) medically transition through hormone replacement therapy (HRT) or any kind of surgeries due to various factors ranging from medical conditions, accessibility and/or expenses, but those that do have to interrupt their HRT in order to carry the pregnancy. Unintended pregnancies by non-binary people on testosterone therapy may be more common if they are on a low dose of testosterone. Non-binary parents choose parental titles such as "mom" and "dad", or utilize invented gender-neutral or non-binary titles.
Uterine transplantation, or UTx, is currently in its infancy and is not yet publicly available. To date, in cisgender women, more than 42 UTx procedures have been performed, with 12 live births resulting from the transplanted uteruses as of publication. The International Society of Uterine Transplantation (ISUTx) was established internationally in 2016, with 70 clinical doctors and scientists, and currently has 140 intercontinental delegates. Its goal is to, 'through scientific innovations, advance medical care in the field of uterus transplantation.'
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. Under these criteria, only a cisgender woman could ethically be considered a transplant recipient. The exclusion of trans women from candidacy may lack justification.
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- Califia-Rice, Patrick (2000-06-20). "Two Dads With a Difference — Neither of Us Was Born Male". The Village Voice. Retrieved 2008-03-22.
- Thomas Beatie: The First Man to Give Birth? The Washington Post.com OFF/beat blog March 25, 2008
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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. The principle of autonomy is not sex-specific. This right is not absolute, but it is not the business of medicine to decide what is unreasonable to request for a person of sound mind, except as it relates to medical and surgical risk, as well as to distribution of resources. A male who identifies as a woman, for example, arguably has UFI, no functionally different than a woman who is born female with UFI. Irrespective of the surgical challenges involved, such a person's right to self-governance of her reproductive potential ought to be equal to her genetically female peers and should be respected.