What to Know if You’re a Trans Man Who Wants to Get Pregnant

If you’re trans and considering getting pregnant, you’re in good company. Research suggests that a majority of trans men want to be parents in some capacity. 

Unfortunately, our culture does a good job of attempting to erase any experience of pregnancy that doesn’t fit traditional notions of womanhood. Add this erasure to other forms of transphobia and all of the other challenges around queer family building, and trans pregnancy feels out of reach for many people.

From a fertility perspective, there is nothing about being trans that negatively affects your fertility or pregnancy outcomes (contrary to what the medical community used to believe). Trans pregnancy is beautiful, and a right for those who want to pursue it.

I’ve supported hundreds of trans men through the process of getting or being pregnant in one way or another. In this article, we’ll go over what to know if you’re a trans man trying to conceive — from coping with gender dysphoria to the current recommendations for tapering off and then going back on testosterone after giving birth, options for feeding your baby, and how to set up your support system to help you through this whole process.

Coping with gender dysphoria

Something I see in my trans pregnant clients is, understandably, feelings of gender dysphoria that can make the emotional and mental health experiences of trying to conceive and pregnancy more difficult. Gender dysphoria refers to the psychological stress that someone can experience when their sex assigned at birth is incongruent with their gender identity. A fear of experiencing gender dysphoria is often a significant barrier to many trans people’s decision to attempt to carry a pregnancy.

We live in a world that insists that pregnancy is a “feminine” experience, which can make it challenging to walk through the world with your pregnant masculinity shining and strong. 

Here are some ideas that can support you if you’re experiencing feelings of gender dysphoria as you consider whether to attempt growing your family in this way:

• Be thoughtful about who you tell and what you say. No one is entitled to information about you, your body, and your family. You get to decide who you tell about your conception journey. You don’t need to justify or explain yourself to anybody.
• Surround yourself with images of other trans parents. When the world doesn’t reflect our experience back to us, we need to figure out how to affirm our own experiences. I recommend printing out images of trans pregnant people and parents and putting them up in your home to remind yourself that you aren’t the first, or the last, trans guy to consider carrying a baby. 
• Put intention into what you wear. When I was pregnant, I went to a secondhand store and bought a bunch of new button-down shirts two sizes up to wear throughout my pregnancy. If you have a job where you need to look professional, consider getting clothes that are several sizes larger and bring them to your local tailor so that they can fit your changing body. It matters that you feel good in what you wear. 
• Get professional help. Research shows that a well-trained therapist or counselor can make a difference in supporting people navigating gender dysphoria. FOLX Health offers a helpful guide for finding therapists who are trained and skilled in this area.
• Remember that you aren’t alone. You aren’t the first or the last trans man to have a baby. Try as much as possible to remember the large web of other trans men who have, are, or will grow their families in similar ways to you.

Trying to conceive

When trying to conceive, there are a number of things to consider, from going off testosterone to tracking your fertility.

Going off testosterone

First, I want to acknowledge that whenever we talk about people considering going off gender-affirming hormone therapy (GAHT), it’s a big deal, and can bring up so many feelings and questions. When considering going off GAHT, I recommend speaking to your hormone prescriber as well as mental health support providers about their recommendations for getting support physically and emotionally in this process. The decision to go off GAHT is complex for many, and it’s important to take the time to set up your support system around yourself to make this hormonal and emotional adventure as easy as possible.

Some people ovulate even while taking testosterone (T), but for most, supplemental testosterone suppresses ovulation. It is possible to get pregnant while taking testosterone, but because of unknown effects on the fetus, the recommendation is to stop taking testosterone if you choose to continue with the pregnancy.

Current recommendations suggest that trans men on T begin tapering off it about three to six months before beginning their TTC process. In a study of transgender men going off testosterone, some returned to regular ovulation after a few weeks, and others needed about six months. The average time was four months to return to pre-GAHT fertility levels. 

Tracking your fertility

As a trans person, your body may require a little more time to return to regular ovulation after going off testosterone. You can track your ovulation window through a number of different methods. If you are having trouble identifying your ovulation window after six or seven months off T, I recommend consulting with a trans-competent fertility provider in your area to help you along this process.

One other thing to be aware of is that there tend to be higher rates of PCOS in trans men compared with the general population. People with PCOS can and do get pregnant all the time, but some may need more support conceiving a pregnancy. If you know you have PCOS, you may consider consulting a fertility specialist sooner rather than later, especially if you are paying for donor sperm. 

Pregnancy and beyond

Now let’s talk about the experiences of finding trans-competent care during pregnancy, feeding your baby, and going back on testosterone after birth.

Pregnancy care

Finding a trans-competent provider, whenever possible, can have hugely positive impacts on your mental health and overall experience of pregnancy, birth, and postpartum. There’s research showing that affirming pregnancy care not only improves trans people’s experience of receiving care but also reduces the risk of negative health outcomes during pregnancy and postpartum. Here is a resource to support your finding an affirming provider in your area. 

Options for feeding your baby

Your options for feeding your baby depend on (1) what your preferences are, (2) whether or not you’ve had top surgery, and (3) what type of surgery you had. Depending on the type of surgery, how much glandular tissue was removed, and how the ducts healed post-surgery, your body may produce a small amount of milk after giving birth. Most people who have had top surgery don’t produce a full milk supply and rely on some amount of supplementation to feed their baby.

It’s important to state: there is no one right way to feed your baby. I strongly recommend the book Feed the Baby: An Inclusive Guide to Nursing, Bottle-Feeding, and Everything in Between, by queer lactation consultant Victoria Facelli, which walks you through your options for feeding your baby and discusses special considerations for trans folks who do and do not want to bodyfeed.

Going back on T after giving birth

Currently there aren’t official recommendations on when to go back on GAHT after giving birth. 

Those of us who work with trans people generally recommend waiting about three months after a vaginal/front hole delivery and four to six weeks after a C-section delivery to go back on T. This discrepancy exists because the soft tissue of the vagina/front hole heals more effectively under the presence of estrogen, and testosterone can actually interrupt the healing process of this body part. After a cesarean birth, the vagina/front hole doesn’t necessarily need that extra estrogen to heal, so people are able to return to their pre-pregnancy testosterone dose sooner.

If you’re bodyfeeding and considering going back on testosterone while nursing your baby, I recommend discussing the risks with your health-care provider and a trans-inclusive lactation consultant. Research around GAHT and bodyfeeding is sorely lacking, and there is a lot to consider, including your own mental and emotional health and the benefits of body milk for your baby.

Closing thoughts

Although it can feel like there’s so much to think about when considering getting pregnant as a trans man, I hope you can also tap into the reality that you are not alone in this process. There is such an amazing lineage of trans pregnant people and parents that you are part of.

My biggest recommendation? Surround yourself with community in whatever ways you can. Local diversity centers, online Facebook groups, or virtual communities like the one I run called PregnantTogether can offer deeply resourced ways to connect with other folks going through the same process you are.

I know it’s clichéd, but it does take a village to grow our families. In the modern world, sometimes these villages are online. Wherever you find your people, know that you aren’t alone as you go through this powerful process of becoming a parent.

The bottom line

• The biggest barrier to trans men who are trying to conceive or are pregnant is our society’s biases — but there are many people making the choice to carry a pregnancy nonetheless.
• Setting up your support system to cope with gender dysphoria and discrimination throughout the process is essential.
• It takes most people about four months off gender-affirming hormone therapy (GAHT) to resume ovulation.
• Options for feeding your baby depend on personal preference, whether or not you’ve had chest surgery and the type you had, and your plans for going back on GAHT.
• It’s recommended to wait about three months after a vaginal/front hole delivery and four to six weeks after a surgical delivery to resume GAHT.

We recognize that readers of ParentData identify in different ways — read more about our approach to gender-inclusive language here.

---

About our sponsor

Community Guidelines