Pregnancy in Transmasculine, Non-binary, and Gender Expansive Patients

Abstract

Abstract Purpose of Review Transgender, non-binary, and gender expansive (TNGE) patients may choose to become pregnant and will require pregnancy-related care. To date, there has been limited research on pregnancy in this community. This review article aims to collate and summarize the most recent literature and make recommendations for providing pregnancy care to TNGE patients. Recent Findings TNGE patients can successfully undergo fertility preservation before or after starting their gender transition and may be able to continue gender-affirming hormone therapy with testosterone (GAHT-T) during the process. GAHT-T is potentially teratogenic and should be discontinued in pregnancy; however, GAHT-T does not appear to affect birth outcomes in TNGE patients. Clinicians should be aware that pregnancy can have profound physical and psychosocial impacts on TNGE patients, and patients frequently identify a lack of knowledgeable providers and welcoming care settings as barriers to care. Postpartum TNGE patients may be at increased risk of postpartum mood disorders. They may also choose to chest feed and require extra support and accommodations to be successful in this endeavor. Summary TNGE patients should be provided the same standard pregnancy-related care as their cisgender counterparts. Special consideration should be given to fertility preservation, contraception, postpartum mood disorders, and lactation/chest feeding as TNGE patients have unique needs within these areas. Much of the available research in this population is retrospective and qualitative with small sample sizes. Future research should focus on larger-scale quantitative studies to help develop evidenced-based, community-informed guidelines for care.