Transgender pregnancy

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Transgender pregnancy is the gestation of one or more embryos or fetuses by transgender people. Currently, the possibility is largely dependent on the individual's natal reproductive organs, with transition-related treatments impacting fertility. Transgender people who are or wish to become pregnant face medical, legal, and psychological concerns.

Trans men[edit]

Pregnant trans man Fernando Machado and his transgender wife, Diane Rodríguez.

Pregnancy is possible for transgender men who retain functioning ovaries and a uterus, such as in the case of Thomas Beatie.[1] Regardless of prior hormone replacement therapy treatments, the progression of pregnancy and birthing procedures are typically the same as those of cisgender women.[2] It has been shown that historical HRT use may not negatively impact ovarian stimulation outcomes, with no significant differences in the markers of follicular function or oocyte maturity between transgender men with and without a history of testosterone use.[3] However, some trans men who carry pregnancies 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. According to the study "Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning" by the American College of Obstetricians and Gynecologists,[4] 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.[5] Testosterone has been shown to be an ineffective form of contraception.[2][6] Exposing a fetus to high levels of exogenous testosterone is teratogenic. This is particularly impactful in the first trimester of development when many pregnancies haven’t been discovered yet.[7] Additionally, patients experiencing amenorrhea (a common side effect of exogenous testosterone exposure) 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.[7] 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.[7] Previous studies of pregnancies in women suggest that high levels of endogenous androgens are associated with reduced birth weight, although it is unclear how prior testosterone in a childbearing trans person may affect birth weight.[2] 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.[5] Testosterone therapy is not a sufficient method of contraception, and trans men may experience unintended pregnancy,[5][8] especially if they miss doses.[5] Unintended pregnancies can result in transgender men or nonbinary people considering or attempting self-induced abortion.[9] Delivery options include conventional methods such as vaginal delivery and cesarean section, and patient preference should be taken into consideration in order to reduce gender dysphoric feelings associated with certain physical changes and sensations.[2] According to the National Transgender Discrimination Survey, postpartum rates of suicide and depression in trans individuals has been found to be higher than the adult average.[10] This may be attributed to factors such as lack of social support, discrimination, and lack of adequate healthcare practitioner training.[10] 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 chest feeding.[12] Trans men who undergo chest reconstruction surgery may maintain the ability to chest feed.[13]

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 bilateral salpingo-oophorectomy and/or total hysterectomy).

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][10] 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.

Statistics[edit]

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.[15]

Non-binary people[edit]

Non-binary people with a functioning female reproductive system can give birth.[16] Non-binary people who are assigned female at birth are more likely than binary trans people to become pregnant since they are less likely to seek medical gender-affirming medical procedures that interfere with their fertility.[17][18]

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.[citation needed] Unintended pregnancies by non-binary people on testosterone therapy may be more common if they are on a low dose of testosterone.[5] Non-binary parents choose whether to be called "mom" or "dad", or to utilize newly-coined gender-neutral or non-binary titles.[19]

Non-binary people who have written or been profiled about their experiences of pregnancy include Rory Mickelson,[20] Braiden Schirtzinger,[21] and Mariah MacCarthy.[22]

Trans women[edit]

Transgender women do not have the anatomy needed for embryonic and fetal development. As of 2019, uterus transplantation has not successfully been performed in transgender women.[23] An attempt at uterus transplantation resulted in the death of Lili Elbe in 1931.[24][25][26]

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 uteruses as of publication.[27] The International Society of Uterine Transplantation (ISUTx) was established internationally in 2016, with 70 clinical doctors and scientists, and currently has 140 intercontinental delegates.[28] Its goal is to, "through scientific innovations, advance medical care in the field of uterus transplantation."[29]

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.[30] Under these criteria, only a cisgender woman could ethically be considered a transplant recipient. The exclusion of trans women from candidacy may lack justification.[31]

Society and culture[edit]

Unicode introduced "pregnant man" and "pregnant person" emojis in version 14.0, approved September 2021.[32]

See also[edit]

References[edit]

  1. ^ Beatie, Thomas (April 8, 2008). "Labor of Love: Is society ready for this pregnant husband?". The Advocate. p. 24.
  2. ^ a b c d Obedin-Maliver, Juno; Makadon, Harvey J (2016). "Transgender men and pregnancy". Obstetric Medicine. 9 (1): 4–8. doi:10.1177/1753495X15612658. PMC 4790470. PMID 27030799.
  3. ^ Adeleye, Amanda J.; Cedars, Marcelle I.; Smith, James; Mok-Lin, Evelyn (October 2019). "Ovarian stimulation for fertility preservation or family building in a cohort of transgender men". Journal of Assisted Reproduction and Genetics. 36 (10): 2155–2161. doi:10.1007/s10815-019-01558-y. ISSN 1573-7330. PMC 6823342. PMID 31435820.
  4. ^ Light, Alexis D.; Obedin-Maliver, Juno; Sevelius, Jae M.; Kerns, Jennifer L. (1 December 2014). "Transgender men who experienced pregnancy after female-to-male gender transitioning" (PDF). Obstet Gynecol. 124 (6): 1120–1127. doi:10.1097/AOG.0000000000000540. PMID 25415163. S2CID 36023275.
  5. ^ a b c d e Berger, Anthony P.; Potter, Elizabeth M.; Shutters, Christina M.; Imborek, Katherine L. (2015). "Pregnant transmen and barriers to high quality healthcare". Proceedings in Obstetrics and Gynecology. 5 (2): 1–12. doi:10.17077/2154-4751.1285.
  6. ^ Bonnington, Adam; Dianat, Shokoufeh; Kerns, Jennifer; Hastings, Jen; Hawkins, Mitzi; Haan, Gene De; Obedin-Maliver, Juno (2020-08-01). "Society of Family Planning clinical recommendations: Contraceptive counseling for transgender and gender diverse people who were female sex assigned at birth". Contraception. 102 (2): 70–82. doi:10.1016/j.contraception.2020.04.001. ISSN 0010-7824. PMID 32304766. S2CID 215819218.
  7. ^ a b c Krempasky, Chance; Harris, Miles; Abern, Lauren; Grimstad, Frances (2020-02-01). "Contraception across the transmasculine spectrum". American Journal of Obstetrics and Gynecology. 222 (2): 134–143. doi:10.1016/j.ajog.2019.07.043. ISSN 0002-9378. PMID 31394072. S2CID 199504002.
  8. ^ Light, Alexis; Wang, Lin-Fan; Zeymo, Alexander; Gomez-Lobo, Veronica (2018). "Family planning and contraception use in transgender men". Contraception. 98 (4): 266–269. doi:10.1016/j.contraception.2018.06.006. PMID 29944875. S2CID 49434157.
  9. ^ Moseson, Heidi; Fix, Laura; Gerdts, Caitlin; Ragosta, Sachiko; Hastings, Jen; Stoeffler, Ari; Goldberg, Eli A.; Lunn, Mitchell R.; Flentje, Annesa; Capriotti, Matthew R.; Lubensky, Micah E.; Obedin-Maliver, Juno (March 14, 2021). "Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States" (PDF). BMJ Sexual & Reproductive Health. 48 (e1): 22–30. doi:10.1136/bmjsrh-2020-200966. PMC 8685648. PMID 33674348. Retrieved 26 December 2021.
  10. ^ a b c "Injustice at Every Turn: A Report of the National Transgender Discrimination Survey" (PDF).{{cite web}}: CS1 maint: url-status (link)
  11. ^ Glaser, Rebecca L.; Newman, Mark; Parsons, Melanie; Zava, David; Glaser-Garbrick, Daniel (July 2009). "Safety of maternal testosterone therapy during breast feeding". International Journal of Pharmaceutical Compounding. 13 (4): 314–317. ISSN 1092-4221. PMID 23966521.
  12. ^ Gorton, Nick; Buth, Jamie; Spade, Dean. Medical therapy and health maintenance for transgender men: a guide for health care providers. ISBN 0977325008.
  13. ^ "Tips for Transgender Breastfeeders and Their Lactation Educators". Retrieved 2021-09-20.
  14. ^ Obedin-Maliver, Juno; Makadon, Harvey J (March 2016). "Transgender men and pregnancy". Obstetric Medicine. 9 (1): 4–8. doi:10.1177/1753495X15612658. ISSN 1753-495X. PMC 4790470. PMID 27030799.
  15. ^ Hattenstone, Simon (April 20, 2019). "The dad who gave birth: 'Being pregnant doesn't change me being a trans man'". The Guardian – via www.theguardian.com.
  16. ^ Toze, Michael (2018). "The risky womb and the unthinkability of the pregnant man: Addressing trans masculine hysterectomy" (PDF). Feminism & Psychology. 28 (2): 194–211. doi:10.1177/0959353517747007. S2CID 149082977.
  17. ^ Fischer, Olivia J. (2021-04-03). "Non-binary reproduction: Stories of conception, pregnancy, and birth". International Journal of Transgender Health. 22 (1–2): 77–88. doi:10.1080/26895269.2020.1838392. ISSN 2689-5269. PMC 8040674. PMID 34755150.
  18. ^ James, Sandy; Herman, Jody; Rankin, Susan; Keisling, Mara; Mottet, Lisa; Anafi, Ma'ayan (2016). "The Report of the 2015 U.S. Transgender Survey". {{cite journal}}: Cite journal requires |journal= (help)
  19. ^ King-Miller, Lindsay (March 13, 2020). "Not All Parents Are "Mom" Or "Dad"". Ravishly. Retrieved June 4, 2020.
  20. ^ "I'm Pregnant, But I'm Not a Woman". www.advocate.com. 2018-11-13. Retrieved 2020-03-10.
  21. ^ "Non-binary, pregnant and navigating the most gendered role of all: Motherhood". Washington Post. Retrieved 2020-03-10.
  22. ^ "I'm Nonbinary. I Loved Being Pregnant. It's Complicated". Narratively. 2018-09-03. Retrieved 2020-03-10.
  23. ^ Cheng, Philip J.; Pastuszak, Alexander W.; Myers, Jeremy B.; Goodwin, Isak A.; Hotaling, James M. (June 2019). "Fertility concerns of the transgender patient". Translational Andrology and Urology. 8 (3): 209–218. doi:10.21037/tau.2019.05.09. ISSN 2223-4691. PMC 6626312. PMID 31380227.
  24. ^ "Lili Elbe Biography". Biography.com. A&E Television Networks. Archived from the original on 6 January 2019. Retrieved 11 December 2015.
  25. ^ "Lili Elbe: the transgender artist behind The Danish Girl". This Week Magazine. 18 September 2015. Archived from the original on 26 December 2018. Retrieved 1 February 2016.
  26. ^ "The Danish Girl (2015)". HistoryVSHollywood.com. History vs Hollywood. Archived from the original on 26 December 2018. Retrieved 1 February 2016.[better source needed]
  27. ^ Jones, B. P.; Williams, N. J.; Saso, S.; Thum, M.-Y.; Quiroga, I.; Yazbek, J.; Wilkinson, S.; Ghaem‐Maghami, S.; Thomas, P.; Smith, J. R. (2019). "Uterine transplantation in transgender women". BJOG: An International Journal of Obstetrics & Gynaecology. 126 (2): 152–156. doi:10.1111/1471-0528.15438. ISSN 1471-0528. PMC 6492192. PMID 30125449.
  28. ^ "History of ISUTx".
  29. ^ "About - 'Vision'". ISUTx.
  30. ^ Lefkowitz, Ariel; Edwards, Marcel; Balayla, Jacques (2012). "The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation". Transplant International. 25 (4): 439–47. doi:10.1111/j.1432-2277.2012.01438.x. PMID 22356169. S2CID 39516819.
  31. ^ Lefkowitz, Ariel; Edwards, Marcel; Balayla, Jacques (Oct 2013). "Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation". Fertility and Sterility. 100 (4): 924–926. doi:10.1016/j.fertnstert.2013.05.026. ISSN 0015-0282. PMID 23768985. 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.
  32. ^ "Why is There a Pregnant Man Emoji?". 15 September 2021.