Contraceptive use among transgender men and gender diverse individuals in the United States: Reasons for use, non-use, and methods used for pregnancy prevention.

Objectives: To describe contraceptive use for pregnancy prevention among transgender men and gender diverse (TGD) individuals assigned female or intersex at birth (AFIAB) and explore whether contraceptive use differs by testosterone use.

Study Design: We analyzed data from a cross-sectional, online survey of N = 1694 TGD individuals AFIAB recruited in 2019 through a community-facing website and a national community-engaged cohort study of sexual and/or gender minority (SGM) adults in the US. Descriptive and regression analyses characterized the current and ever use of contraceptive methods for pregnancy prevention, stratified by testosterone use, and described reasons for contraceptive use/non-use.

Results: Most respondents (71.0%) had used contraception before with 49.4% using it for pregnancy prevention. The methods that were most frequently ever used for pregnancy prevention included: external condoms (91.8%), combined hormonal contraceptive pills (63.0%), and withdrawal (45.9%). The methods most frequently currently used for pregnancy prevention included: external condoms (35.4%), hormonal intrauterine device (IUD) (24.8%), and abstinence (19.2%). Some reported formerly (n = 55, 6.6%) or currently (n = 30, 3.6%) relying on testosterone for pregnancy prevention. Only four of the 33 reasons for contraceptive use and non-use differed by testosterone use group. The most reported reasons for never using contraception were not engaging in penis-in-vagina sex (5.7%) or no sex with individuals who produce sperm (4.8%).

Conclusions: Most TGD individuals AFIAB have used contraception, and almost half for pregnancy prevention. The most used methods require minimal and/or non-invasive healthcare system interaction. Some respondents relied on testosterone as birth control, despite a lack of efficacy evidence.

Implications: TGD individuals use a range of birth control methods for pregnancy prevention and clinicians should not assume preferences for certain forms of contraception based on gender identity (e.g., estrogen avoidance). Clinicians should engage in patient-centered counseling and shared decision-making to provide high-quality contraceptive care to patients of all genders.