FAQ | What to Expect When He's Expecting

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Fertility

Q: Does testosterone cause infertility?

A: Though testosterone therapy may stop your period, research suggests that testosterone has no known negative affect on the overall health or long-term fertility of one’s eggs (Light et al. 2014). This is why many reproductive health care experts will tell you that testosterone should not be used as a replacement for birth control. However, testosterone use may thin the lining of the uterine wall, making it much more difficult yet not impossible for one to become pregnant. Those who use lower doses of testosterone or those who many not follow a routine schedule (missing or skipping doses) may be more likely to accidentally become pregnant if not on birth control (Charlton et al. 2020). Continued testosterone use during pregnancy may result in developmental abnormalities of the fetus, and may result in miscarriage. Because of this, providers often recommend that those seeking to intentionally become pregnant should develop a plan to wean off of hormone replacement therapy before attempting to become pregnant, preferably after allowing menstruation to return which usually happens within six months of stopping testosterone. Research indicates that prior testosterone use has not been found to affect reproductive outcomes, nor does it necessarily suggest higher rates of pregnancy loss when compared to cisgender women (Leung et al. 2019) (Riggs et al. 2020). Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction.

Q: What do I do if I experience vaginal atrophy?

A: The decrease and thinning of vaginal muscles (also known as vaginal atrophy) is a condition caused by testosterone use. It can make vaginal penetration uncomfortable or even painful, and may lead to tearing or bleeding. However, this is a treatable condition (Mayo Clinic, 2021). One of the most common treatments is the use of vaginal moisturizers or water-based lubricants to ease discomfort. Dilation, a form of exercise which can help rebuild vaginal muscles, is also an option. Topical estrogen and medication are also available. Talk to your doctor about what is right for you!

Q: Does testosterone cause polycystic ovary syndrome (PCOS) or make it worse?

A: Polycystic ovary syndrome is a condition in which numerous small cysts develop on the ovaries. This condition has been known to increase the risk of infertility. The exact cause of PCOS is unknown. While limited research exists, one study found that testosterone use in trans men across a wide range of doses and over many years did not have correlation with causation or exacerbation of PCOS (Chan et al. 2018). If you are experiencing PCOS, talk to your doctor about a treatment that is right for you.

Q: What are my options if I don’t want to be pregnant but still would like to expand my family?

A: Luckily, many options are out there for those who aren’t interested in becoming pregnant but would still like to have children. One option for those who would rather not become pregnant is to find a surrogate who is willing to carry the pregnancy for you, whether that be a partner, family member, or even a stranger. Some individuals prefer that surrogates become pregnant through the process of IVF. IVF, or in vitro fertilization, is a technique in which eggs are removed from a person’s ovaries and fertilized with sperm in a lab before being implanted in an individual’s womb.

For more fertility resources relating to surrogacy and IVF, check out our Fertility Centers & Health Care resource page. Another great option to expand your family is through adoption. Recourses on adoption can be found in our Family Centers, Support Groups & Webinars resource page. Visit our Reproductive Education & Training page for more informative resources on fertility and family building. For more information on queer and trans family rights and law, visit our Legal Resources page. For conferences designed to educate and empower queer family building, visit our Conferences page. Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction. To hear the story of a trans man who was able to use his own eggs along with donor sperm to impregnate his partner, check out his oral history here!

Q: What are my options if neither my partner nor I produce sperm but would like to become pregnant?

A: Thankfully, reproductive options for individuals who don’t produce sperm have come a long way! Sperm donation involves the process of finding an individual who produces sperm and gaining their consent to use it in order to become pregnant. Often, people seek out sperm banks to find donor sperm, but donors can be found outside of clinical institutions as well. For those who feel uncomfortable with performing sexual intercourse in order to become pregnant, either IVF (in vitro fertilization) or IVI (at-home insemination) are great options. The Mosie IVI kit is an option championed by Trans Fertility Co.

For resources on sperm donation and IVF, please visit our Fertility Centers & Health Care resource page. Visit our Reproductive Education & Training page for more informative resources on fertility and family building. For more information on queer and trans family rights and law, visit our Legal Resources page. For conferences designed to educate and empower queer family building, visit our Conferences page. Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction. In this article clipping from 1982, you can learn about a trans man and his partner who sought out strangers to help them expand their family through sperm donation. Note that some of the language used in these clippings are outdated and may be upsetting to some, and so discretion is advised. To hear the story of a trans man who was able to use his own eggs along with donor sperm to impregnate his partner, check out his oral history here!

Q: Does PrEP (pre-exposure prophylaxis) or ART (antiretroviral therapy) affect fertility?

A: In a study of women who received ART (antiretroviral therapy), roughly 1/7 of whom were receiving regimens that contained TDF (tenofovir disoproxil), it was found that those taking TDF had slightly lower fertility rates than those who did not (Mugo et al. 2014). In a study of participants who did not have HIV but whose sexual partners had HIV, taking TDF or TDF/FTC (fumarate/emtricitabine) did not significantly affect fertility rates (Maskew et al. 2012). In another study, individuals taking dolutegravir during the process of conception were found to have an increased risk of developmental defects in their infants. However, these developmental risks were found to be low in frequency (Zash et al. 2018). If you are on PrEP or ART and wanting to become pregnant, or are considering starting PrEP or ART before attempting to conceive, talk to your doctor about what is right for you. For more information, visit the United States Government’s website on clinical information relating to HIV.

Q: Where can I find support around my fertility?

A: For resources offering clinical care relating to fertility, please visit our Fertility Centers & Health Care resource page. For emotional and educational support regarding the process of becoming pregnant, visit our Family Centers, Support Groups & Webinars resource page. For more options regarding clinical, non-clinical, and emotional support, visit our Directory of Trans-Affirming Care. Visit our Readings & Viewings page for further resources and information on transmasculine fertility and reproduction.

Pregnancy

Q: How do I navigate my safety as a pregnant man?

A: Navigating safety is an incredibly prominent concern for many transmasculine individuals considering or currently experiencing pregnancy. While there is no one right way to go about it, it can be helpful to hear how other individuals have navigated these choices in their own lives in order to inform your own decisions. In a study of transgender men who had experienced pregnancy, it was found that there were three most common strategies used in navigating safety when interacting with the people in their lives (Hoffkling et al. 2017). Each of these strategies involve compromise of some sort, and so it is important to weigh the costs and benefits of each.

The first strategy is to try to present and pass as a pregnant cisgender woman. In doing so, it is likely that you will receive an increase in support surrounding your pregnancy. This strategy often allows for more comfort and feelings of safety, as well as a decrease in the risk of transphobic violence. However, you must sacrifice your own gender identity and risk feelings of dysphoria in being misgendered and perceived as a woman.

The second strategy is to try to present and pass as a cisgender man and to hide one’s pregnancy. While this strategy may minimize dysphoria and transphobic violence, it also decreases affirmation and benefits surrounding your pregnancy. Transgender men who have taken this route cite hardships in not being allowed the physical and social support often given to pregnant individuals.

Finally, the third strategy is to be out and visible as a pregnant transgender man. This strategy allows individuals to feel affirmed in their identity and pregnancy, however, this puts individuals at more of a risk of transphobic violence. While many individuals live in incredibly affirming environments and may not ever experience transphobic violence during their pregnancy, the risk still exists and should be taken into consideration while making these decisions.

To hear more about the lived experiences of transmasculine parents, check out our Oral Histories page.

Q: How do I find masculine pregnancy attire?

A: There are several guides that may help in providing you with ideas for masculine pregnancy attire. Trans Fertility Co. offers this helpful article written by Arlo Dennis that gives some ideas on outfits for individuals who would like to either camouflage or embrace their pregnant bellies. Moss the Doula offers this helpful guide on their website as well, which provides direct links to different neutral-ish pregnancy clothes. However, many of them are marketed on their websites in a gendered way, and so discretion is advised.

Q: How do I seek respectful, inclusive prenatal care?

A: Seeking respectful, inclusive prenatal care is a concern for many individuals. For those who have the capacity to self advocate, calling clinics or doctors ahead of time and explaining your situation may help you receive more thoughtful and intentional care. By asking someone at the clinic to take the lead in informing their coworkers about you and what your needs are in advance, this may help give them time to prepare for your arrival and make whatever changes are necessary to provide you the best care possible. If you have a difficult time vocalizing your needs, you may want to consider asking a partner or a loved one to make the call on your behalf. It may also be helpful to recruit a partner or a loved one to accompany you to your appointments in order to help advocate for you and your needs.

For trans-affirming resources offering clinical care relating to pregnancy, please visit our Fertility Centers & Health Care resource page. For emotional and educational support regarding pregnancy, visit our Family Centers, Support Groups & Webinars resource page. For more options regarding clinical, non-clinical, and emotional support, visit our Directory of Trans-Affirming Care. For resources regarding substance use, visit our Pregnancy & Substance Use Resources page. For more information on queer and trans family rights and law, visit our Legal Resources page. To hear more about the lived experiences of transmasculine parents seeking pregnancy-related care, check out our Oral Histories page.

Q: Where can I find emotional support around my pregnancy?

A: For emotional and educational support regarding pregnancy, visit our Family Centers, Support Groups & Webinars resource page. For more options regarding clinical, non-clinical, and emotional support, visit our Directory of Trans-Affirming Care. For therapeutic or psychiatric help, visit our Mental Health Resources page.

Q: Where can I find support around abortion, miscarriage, or infant loss?

A: For emotional and educational support regarding pregnancy termination or loss, visit our Abortion, Miscarriage & Infant Loss Resources page. For abortion and pregnancy loss doulas, visit our Directory of Trans-Affirming Care under the “Doulas, Midwives & Perinatal Care” section.

Q: Is it safe to be on PrEP (pre-exposure prophylaxis) or ART (antiretroviral therapy) while pregnant?

A: It is recommended that individuals who may have been exposed to HIV while pregnant talk with their doctor about starting ART as soon as possible in order to prevent one’s fetus from contracting the virus (NIH’s Office of AIDS Research).

Research has found that people who became pregnant while using TDF/FTC (tenofovir disoproxil fumarate/emtricitabine) may continue taking it throughout their pregnancy. TDF/FTC has been found to prevent the acquisition of HIV at rates higher than 90%, and may provide protections for the fetus as well. The risk of contracting HIV during the process of conception, pregnancy, and up to 6 months postpartum may be higher, with the most common risk factors including non-protected sex with an individual whose HIV-RNA levels are detectable or not known, the use of injectable drugs, as well as recent contraction of an STI (sexually transmitted infection) (NIH’s Office of AIDS Research).

Regardless of whatever form of PrEP or ART you are interested in, it is important to get tested regularly and talk with your doctor about what is right for you before making any decisions. For more information, visit the United States Government’s website on clinical information relating to HIV.

Postpartum

Q: How can I prepare for postpartum mood disorders?

A: The postpartum stage, sometimes described as the fourth trimester, brings a whole set of experiences both positive and negative. Postpartum mood disorders such as anxiety or depression have been noted amongst many individuals who have recently given birth. During the internal anatomical processes of postpartum, hormonal shifts have been found to be the main culprit that cause this increase in mood-related disorders. To hear about the story of one trans man’s experience with postpartum anxiety, listen to his oral history here.

Having a plan as to caring for your mental health during the postpartum period can be a helpful way to ease concern, especially if you have a prior history of mood-related disorders. Visit our Mental Health Resources page for therapeutic and psychiatric help. For more emotional support, check out our Family Centers, Support Groups & Webinars resource page as well as our Directory of Trans-Affirming Care.

Transmasculine individuals who had been receiving HRT (hormonal replacement therapy) prior to pregnancy may benefit from re-initiating testosterone once postpartum, as many individuals cite gender dysphoria caused by bodily changes throughout pregnancy to contribute to feelings of distress (Oberhelman-Eaton 2021). However, individuals interested in chestfeeding their infant should consider the costs and benefits of initiating testosterone while lactating. See our page on frequently asked questions relating to Lactation for more information on the affects of testosterone on milk.

Q: Can I restart testosterone after giving birth?

A: Transmasculine individuals who had been receiving HRT (hormonal replacement therapy) prior to pregnancy may benefit from re-initiating testosterone once postpartum, as many individuals cite gender dysphoria caused by bodily changes throughout pregnancy to contribute to feelings of distress as well as postpartum mood disorders (Oberhelman-Eaton 2021). However, individuals interested in chestfeeding their infant should consider the costs and benefits of initiating testosterone while lactating. See our page on frequently asked questions relating to Lactation for more information on the affects of testosterone on milk.

Lactation

Q: Can I make milk after top surgery?

A: Research has found that post-top surgery, transmasculine individuals have varying abilities and desires to lactate. During pregnancy, there is a decent number of transmasculine individuals that have found their chests to grow to some degree, some back to pre-surgery size (MacDonald et al. 2016). This is often a shock to many who had been told by their surgeons that their surgical reduction was permanent. While many individuals are able to regrow mammary tissue after having had top surgery, the amount of milk they are able to produce varies widely on a case by case basis. Some individuals may not produce enough milk to feed their infant on their own or may not desire to chestfeed and should consider others options to feed their infant. For resources relating to milk production, visit our Lactation Resources page. To hear the lived experiences of transmasculine parents who have had to navigate how they would feed their babies, check out our Oral Histories page.

Q: What other options are available for feeding my infant outside of chestfeeding?

A: Many individuals have cited feeling judgment and distress over their lack of ability or desire to chestfeed. However, there are multiple options available nowadays to either replace or supplement natural milk supply, and the decision to chestfeed or to not chestfeed ultimately comes down to the parent and what is right for them and their family. A combination of any of the following options below can be considered in tandem.

Formulas have come a long way nutritionally, and should be embraced as an acceptable option for those who choose to utilize it (Institute of Medicine et al. 2004). While often discouraged from health organizations such as the FDA due to the risk of the spread of infectious disease or chemical contaminants, there have been transmasculine individuals who promote milk sharing as an option for those who are set on feeding their baby human milk. Pasteurizing donor milk is a method that mitigates these risks, in addition to the practice of proper storage and cooling techniques to ensure that the milk doesn’t go bad.

For individuals who still desire the skin-to-skin contact associated with chestfeeding but may not produce enough milk to fulfill their infant’s nutritional needs, the use of an at-chest supplementer allows the baby to latch and obtain milk from a bottle while still drawing whatever amount of milk is being produced by the body.

For resources relating to milk production, visit our Lactation Resources page. To hear the lived experiences of transmasculine parents who have had to navigate how they would feed their babies, check out our Oral Histories page.

Q: Can testosterone affect milk?

A: Historically, re-initiating HRT (hormone replacement therapy) has been advised against due to concern over the effects of testosterone on milk and how an infant may be affected by it (Hoffkling et al. 2017). There has been very little research conducted on this topic, but what research does exist suggests that it may not be as harmful as it has been assumed. A study of a transgender man who had re-initiated testosterone while chestfeeding found no adverse effects observed in the infant (Oberhelman-Eaton 2021). No changes in milk supply were recorded. Testosterone levels increased in the parent and in the milk throughout the study, but remained undetectable in the infant’s blood levels. While this is not definitive proof that testosterone is harmless in milk, it does offer some insight and can help guide transmasculine parents in making decisions about whether or not to restart testosterone whilst chestfeeding. Talk to your doctor about what is right for you.

Q: Does PrEP (pre-exposure prophylaxis) or ART (antiretroviral therapy) affect milk?

A: In a review of 26 studies regarding the use of TDF/FTC (tenofovir disoproxil fumarate/emtricitabine) in pregnant and lactating people, no safety concerns were identified (Mofenson et al. 2017). A study of women without HIV who used TDF/FTC found that a vast majority of their infants had undetectable levels of tenofovir in their blood (Mugwanya et al. 2016). A study of women with HIV who received a regimen of TDF/lamivudine (3TC)/efavirenz (EFV) found that none of their infants had detectable levels of tenofovir in their blood (Waitt et al. 2018).

Regardless of whatever form of PrEP or ART you are interested in, it is important to get tested regularly and talk with your doctor about what is right for you. For more information, visit the United States Government’s website on clinical information relating to HIV.

Parenthood

Q: How do I come out to the people in my child’s life?

A: Choosing how and when to come out to the people in your child’s life about your gender identity can be a difficult thing to navigate, and there is certainly no one right way to do it. Some individuals may choose to be open about their identity with select individuals or with everyone in their family’s lives and social spheres, whereas some may want to wait until their child is old enough to decide for themself who they’d like to tell. The decision as to who you come out to and when to do so is one that should be made after discussing and thinking through what is best for you and your family. Visit our Readings & Viewings page for further resources and information on transmasculine reproduction and parenthood. To hear about the lived experiences of transmasculine individuals and how they chose to navigate coming out in their family, check out our Oral Histories page.

Q: How do I teach my child about gender?

A: Teaching your child about gender and gender identity can be difficult, especially in deciding how to approach the topic at an age-appropriate level. For some ideas on how to incorporate discussions about gender in your child’s everyday life, visit our article sharing Three Ideas On How to Engage Your Children in Conversations About Gender. For more ideas on gender-creative parenting including baby shower ideas and an interview with a Two-Spirit gestational parent regarding their approach to gender in parenting practices, check out these resources by Trans Fertility Co. Visit our Readings & Viewings page for further resources and information on transmasculine reproduction and parenthood. To hear about the lived experiences of transmasculine individuals and how they chose to navigate gender in their family, check out our Oral Histories page.

Q: Where can I find parental support?

A: For emotional and educational support, check out our Family Centers, Support Groups & Webinars resource page. For therapeutic and psychiatric help and support, visit our Mental Health Resources page. Visit our Readings & Viewings page for further resources and information on transmasculine reproduction and parenthood.