One of my frustrations with sexual education is that even with ‘good’ ‘inclusive’ sexual education resources, at best, we can expect trans people not to be totally excluded from conversations. While a lot of the resulting resources are important, and we should expect educators to not exclude trans people, I think this isn’t adequate. There is rarely, if ever, discussion of sexual education specific to trans experiences and trans bodies.
This is the first of what I hope will be many posts on trans specific sexual education.
The information in this post is predominantly based on information provided by the Uk Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists (FSRH). The statement from the FSRH was published on the 16 of October 2017. It is also based on a leaflet produced by the Terrance Higgins Trust, published June 2012. Where these sources are in conflict, I have taken the position of the FSRH to be correct, as their source is more recent and from a certified medical board.
If you are an AFAB trans person, and have not undergone hysterectomy or removal of your ovaries, you are still at risk of becoming pregnant when engaging in vaginal sex with a person who produces sperm.
This is still the case if you are on hormone replacement therapy. Testosterone therapy does not provide contraceptive protection, and you shouldn’t rely on being on T as your birth control.
GnRH analogues, commonly known as blockers and mostly prescribed to trans people under 18, also cannot be relied on as contraception prevention.
Not all transmasculine people go on hormone therapy, or want to go on hormones. In these cases, there is no method of contraception that is inappropriate for you because of your trans status. However, as your personal characteristics and medical history still need to be taken into account, you should speak to a medical provider.
Regular Contraception Options
Barrier methods, such as condoms, are of course an option to prevent conception. The sperm producing party undergoing vasectomy is also an option. However, some hormonal contraceptive methods are appropriate for use by people on testosterone.
While hormonal contraceptives containing estrogen should not be used by people on testosterone, contraceptive methods that only involve progesterone can be used. These methods include some pills, some patches, and progestogen-only injections.
As some pills and patches do contain both progesterone and estrogen, you should speak to a medical provider to make sure the method you choose is right for you.
A copper IUD (also known as the coil) is suitable for people on testosterone, as it does not release any hormones. You can read more about it on the NHS website here.
If you are on testosterone, you cannot use the vaginal ring (NuvaRing), as it releases estrogen.
Both oral emergency contraception options are usable by people on testosterone, as they are progesterone-based. Testosterone is not thought to affect the efficacy of these EC methods, and they are both thought to work without interfering with hormone treatments.