Contraceptive Beliefs, Needs, and Care Experiences Among Transgender and Nonbinary Young Adults.

Purpose: This qualitative study explores the contraceptive health-care needs of transgender and nonbinary young adults assigned female sex at birth.

Methods: Qualitative interviews were conducted with 20 transgender and nonbinary young adults assigned female sex at birth (ages 22-29 years), recruited via online platforms and community agencies. Semistructured interviews elicited information on participants' gender and reproductive histories, health-care experiences, sexual practices, and contraceptive use and decision-making processes. Interviews were transcribed and coded using thematic analysis.

Results: Primary thematic domains centered on contraceptive experiences and needs, testosterone as contraception, and experiences with reproductive health care. Participants generally did not use hormonal contraception to prevent pregnancy; in situations where pregnancy was possible, participants relied on condoms. Some participants believed testosterone use would prevent pregnancy and subsequently did not use a contraceptive method. Participants described the lack of knowledge, among themselves and providers, of the impacts of testosterone on pregnancy risk and interactions with hormonal contraception. They described reproductive health-care experiences in which providers were unfamiliar with the needs of transgender and nonbinary patients; made assumptions about bodies, partners, and identities; and lacked adequate knowledge to provide effective contraceptive care.

Conclusions: Patient-centered reproductive care requires that providers be sensitive to the stress of gender-affirming care and engage with contraceptive counseling that addresses patients' behavior, risks, and reproductive functions. In particular, providers should understand and communicate the impacts of testosterone therapy on pregnancy risk.