Birth control for trans folks and enbies

People of all gender identities, including trans folks, have lots of options when it comes to birth control. All kinds of queer folks use birth control. There is a trans sir riding the New York City subway with a pack of pills in his backpack. There’s a trans miss teaching class in Atlanta who just got a birth control shot. Then there’s the nonbinary Mx. in Santa Fe walking their dog—they love the IUD because they don’t have periods after a year of using it.

Trans people are taking birth control, and not just to prevent pregnancy. Trans people use birth control for many of the same reasons cisgender people do. Let’s break down some of the reasons trans folks use birth control.

Can trans people get pregnant or get their partners pregnant?

Pregnancy is a possibility if a trans person has ovaries and a uterus, and they have sex with a person who ejaculates sperm. Here’s a sex-ed refresher. Pregnancy can happen when there are three things present:

1. Egg
2. Sperm
3. Uterus

Gender-affirming hormone therapy like testosterone (for trans and nonbinary people assigned female at birth) or estrogen with or without a testosterone-blocker (for trans and nonbinary people assigned male at birth) is not birth control. These hormones do not prevent pregnancy. If you are on hormones and having sex with someone, do a double-check. Do you have the magic combo of egg, sperm, and uterus? If so, sex without birth control could lead to pregnancy.

Can trans men assigned female at birth use birth control?

Yes, trans people can use hormonal birth control. Enbies (that’s nonbinaries for you cisgender folks) can use birth control. A man with ovaries (or one ovary) and a uterus can absolutely use birth control. A common reason that someone with this anatomy might use birth control is to stop period bleeding. It can also make bleeding lighter. This is true even when someone identifies as a man or enbie.

There are a few types of birth control that can stop periods for trans people with ovaries and a uterus, which can have a lot of benefits, including reducing gender dysphoria. This is the emotional pain a person feels when their gender identity is not the same as the one they were assigned at birth. We know there is a link to gender dysphoria, anxiety, depression, and thoughts of suicide when people who identify as male have periods.

Can birth control stop period bleeding for trans folks?

Interested in taking birth control to stop periods? Here is what the research says about some birth control methods and how well they stop period bleeding:

1. Continuous use birth control pills and periods About nine out of ten people stop having periods by 12 months when taking birth control pills with no breaks in between packs.

2. The shot and periods About seven out of ten people stop having periods by two years. This is the same for the birth control shot you get in the office and the shot you get at home.

3. Hormonal IUDs and periods About five out of ten people stop having periods by one year. About six out ten people stop having periods after using the hormonal IUD by two years.

4. The birth control implant and periods About two out of ten people stop having periods by one year.

Does birth control treat health conditions for trans folks?

Yes, for people of all genders, birth control can treat some health conditions. People with fibroids or endometriosis might use birth control to help with heavy bleeding. Certain birth control pills can also be used to treat premenstrual dysphoric disorder (PMDD), which is a severe version of premenstrual syndrome (PMS). It is a mood condition that can be really hard to live with.

Some birth control methods stop ovulation. These can help with acne, polyendocrine metabolic ovarian syndrome (PMOS), and ovarian cysts. A bonus is that these birth control methods are linked to a reduced chance of some reproductive cancers.

Why do trans women assigned male at birth use birth control?

Trans women and nonbinary folks can use the birth control shot to feel and look more feminine. Some people assigned male at birth have also used the Depo shot as a part of their hormonal gender transition. In some cases, the birth control shot can give breast tissue a boost and reduce facial hair.

People who want to take estrogen hormonal therapy should not take birth control pills with estrogen. It is safer to use the pills, patches, and injections that are specifically prescribed for gender affirming care. They are a lower dose of estrogen than what is in birth control pills.

Trans women may choose a birth control method such as vasectomy or orchiectomy, a surgical procedure to remove the testes. Even while taking gender affirming hormone therapy, you may still produce sperm that can cause a pregnancy.

What do trans and nonbinary people need to know about birth control?

Gender, sexuality, and attraction can all be very fluid. Even if it’s not your situation now, birth control might be helpful for you in the future. Long-acting birth control like an IUD or the implant might be worth considering if you have insurance coverage now, but you aren’t sure if you’re going to have it later. It’s also an option if you’re doing a long stint of travel and can’t carry supplies. Some people are choosing IUDs because of the loss of funding for public health programs.

Maybe the most important thing that trans folks need to know about birth control is that any reason a trans person wants to use birth control is valid. Some people want to skip periods because of the physical and financial hassle of menstrual products. Sex workers may want to postpone or avoid their period altogether so that it doesn’t interfere with work. Literally whatever reason you have for using birth control is good enough. Talk to your clinician about how birth control could work for you.