Meeting the contraceptive needs of transgender and gender nonbinary individuals

Clinicians treating transgender and gender nonbinary individuals taking testosterone should open up a dialogue regarding contraception and ensure they are adequately meeting and assisting these patients with their reproductive needs.

In a symposium at the American College of Obstetricians and Gynecologists 2024 Annual Clinical & Scientific Meeting in San Francisco, California, from May 17-19, 2024, Lauren Abern, MD, FACOG, assistant professor of gynecology and obstetrics at Emory University, and Karla Maguire, MD, FACOG, associate professor at Dell Medical School at the University of Texas Austin, discussed ways to bridge the education gap regarding contraceptive care for patients in this population.¹ The talk also sought to arm clinicians with the most recent data in order to feel more confident facilitating conversations on the topic.

Contemporary OB/GYN (COG): You delivered a symposium on contraception for transgender and gender nonbinary individuals at ACOG 2024. Why is it important to address this topic?

Karla Maguire, MD, FACOG: I think it's important to talk about this at ACOG because, as ob-gyns, we tend to be one of the first doctors that people think of when they think of contraception, so it's really important for us to stay up-to-date on new practices and contraceptives, especially in different populations.

Lauren Abern, MD, FACOG: What's so nice about giving this talk at ACOG is we are able to reach a lot of people [who] practice in different locations, they have different patient populations…If even one more patient feels comfortable going to their doctor after our talk and feel a little more comfortable with asking for contraceptive care, then we've made a difference for that patient, and that's the most important.

COG: What do we currently know about the reproductive health needs for transgender and gender nonbinary individuals?

Abern: We know that trans and nonbinary individuals need contraception for different reasons, not only just to prevent pregnancy, but a lot of people might need menstrual suppression or menstrual management. There are a lot of contraceptive methods that we use in order to help them achieve menstrual suppression.

COG: We know that there is a need for education for transgender and gender nonbinary individuals taking testosterone when it comes to contraception. How can clinicians improve pregnancy prevention education? What does that conversation look like?

Maguire: I think the first thing with being a clinician is just making sure you stay up-to-date on what can be offered to this population, and knowing that the full array of contraceptive options is an option so you know what to talk to your patient about.

Abern: From a clinician standpoint, just really being able to spend time with your patient [and] talk about what they're looking for, what their needs are, why they are using contraception, what methods might be acceptable to them, [and] talking about the risks and benefits of each, the placement, and just really personalizing the care…Every person is different and every person has different needs, and just to be able to break down the different options and spending time counseling about them, you might be able to find something that works for one person, it might not work for another and vice versa. We see a lot of also just misconceptions out there, both from the clinician standpoint and the patient standpoint where people feel that ‘Oh, they're on testosterone, they can't use birth control pills,’ or we see a lot of that.

Maguire: [These] individuals already face many barriers to care, and I think educating clinicians helps decrease at least one of those barriers, which would be inexperience with providing contraception in this population.

COG: What are some of the barriers that transgender and gender nonbinary individuals face in accessing contraception?

Abern: There are so many barriers. We're hoping that even just presenting here and giving our talk that we can help — even if it's just one clinician — see things a little bit differently that that even if it helps one patient…A lot of barriers to care that are experienced [are] just a big one, which we have also mentioned is not having enough clinicians doing the work. Not having more education for clinicians to be able to provide the appropriate counseling for patients…A lot of this care is provided, and it doesn't have to be, but many people will go to an ob-gyn office and not everyone's comfortable going to an ob-gyn office. Is there a sign that says “women” on the entrance as someone's walking in? Distance to travel to get care or to find a clinician that's educated in transgender and nonbinary or binary health care to be able to provide appropriate care. We literally could spend so much time talking about these barriers.

This transcript has been edited for clarity and length.

References

Abern L, Maguire K, Harris M. Contraception for transgender and gender nonbinary individuals: a 2024 update. Presented at: The American College of Obstetricians and Gynecologists 2024 Annual Clinical & Scientific Meeting. San Francisco, CA. May 17-19, 2024.