Queer Health: Trans Pregnancy
By Welcome to Queer Health. This column runs every week on Wednesday, and addresses readers’ questions about health and medicine, queerness, and how these two worlds intersect. Michelle is usually the author, although Natalie will collaborate as her interest and time allows. Occasionally, Queer Health will offer up an article on an intriguing topic or a bit of food for thought. Today, as it’s our inaugural column, we’ll be doing the latter. Please feel free to e-mail us questions at [email protected]. Otherwise, Michelle and Natalie will keep picking the topics Please keep in mind that we cannot offer medical advice, no one on this column is a trained medical professional, and all of the opinions found within these columns are just that, opinions. If you feel the need to attach photos to your e-mail, you should probably be seeing a doctor about that. Now, on to something completely different.
Over several years, I have witnessed a variety of families bring children into the world. A lot of these families seem to fit neatly into the heteronormative narrative of a man and a woman having biological children that were conceived in a night of drunkenness and birth control malfunction, if not passion. However, through out the last several years, I’ve been fortunate enough to have families that openly break that mould in a variety of ways. I have attended births of a poly triad, several lesbian couples, a gay couple with a family friend as their surrogate, and a quad in which three of the members found themselves pregnant at the same time! It was quickly apparent that it would behoove me to become better versed in the intersectionality of queer health, birth, and medical recommendations. There are books written on on baby making for lesbian and gay couples, surrogacy and donor insemination, and co-parenting in blended families.
A portion of the queer community that, much to my shame, I overlooked were trans men who have opted to not undergo a hysterectomy and preserve their ovaries and uteruses. It’s not hard to understand why I would be lacking in education regarding transgender men and pregnancy: Queer health issues are rarely addressed within formal medical education, and trans health issues even less so. While there does exist the World Professional Association for Transgender Health (WPATH), their most recent guidelines do not address pregnancy in transgender men or how to best achieve a health pregnancy in light of the unique hormonal situations that are present within the bodies of transgender men.
While testosterone does lower fertility, and thus decreases the chance of a pregnancy, it is not a reliable form of birth control. Anecdotally, accidental pregnancy in transgender men is a possibility acknowledged within the medical community, although there are no current case studies regarding transgender men and pregnancy in the Medline database. What we have seen is an increase in pregnant men going public with their stories. Two of the most well known recent celebrities are Scott Moore and Thomas Beatie. Both have undergone extreme scrutiny about their decision to have children, and they have highlighted the struggle that trans man planning on having children undergo when attempting to find a friendly healthcare provider.
I’m hopeful that these men and their willingness to discuss their experiences openly and with candor will encourage the medical and birthing community to take a hard look at our current practices. Instead of supporting ignorance and shunning people seeking care, here’s to hoping that we as a community continue to develop the necessary knowledge base to make evidence-based care an option for trans men who choose to carry a pregnancy to term.
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It does seem that medicine generally just doesn’t care that much about trans people. On the long list of doctors I’ve had, only one ever sat down and worked through the implications of taking hormone supplements for my entire adult life, and used those implications to inform her treatment decisions. The rest just shrugged and used standard practices (or, in two separate cases, simply refused me as a patient,) after admitting that they really didn’t know what was appropriate.
I suspect that it’s is a combination of squick and apathy, and that the subconscious reasoning runs something like: “I don’t even want to think about it. I’ll provide him/her/it with the standard practices, and if that’s not optimal, well… he/she/it just should have thought of that before he/she/it decided to become a freak.”
I imagine trans men, and particularly pregnant trans men, must have it even worse. I mean, to most people, they don’t even exist until observed, like some twisted version of Schrodinger’s Cat.
I’m glad to see you bring up issues around trans pregnancy. Trans medicine, in general, is so experimental and being pregnant while trans is so rare that it’d be hard to do real science.
There are also discussions to be had about trans women and pregnancy. Trans women who receive hormone therapy are still capable of conceiving children.
My personal story is one that I haven’t ever found anyone else telling. My partner and I decided that it would be most efficient and harmonious for me to transition (male to female) while she’s pregnant. I started hormone therapy after we conceived and made it through the first trimester and I’ll be living as a woman before the baby’s born.
My issues are certainly different from those of trans men but they’re tangentially related. We’re waiting to hear back about whether we’ll be welcome at a lesbian childbirth class. I would guess that there are lots of similar resources that trans men would have to navigate carefully.