Even if you are taking gender-affirming hormones, it is still possible to become pregnant if you have a uterus and ovaries and you have penis-in-vagina sex with a partner who produces sperm. Testosterone, oestrogen, or hormone blockers are not reliable forms of contraception. Using contraception can help you prevent pregnancy and give you more control over your sexual and reproductive health.
Gender-affirming hormones and fertility:
- Testosterone may reduce fertility, but ovulation can still occur unpredictably.
- Oestrogen and anti-androgens do not guarantee infertility.
- If you've had a hysterectomy (uterus removed) or orchiectomy (testicles removed), your pregnancy risk will change. Ask your provider what that means for you.
- Some contraceptive methods may cause gender dysphoria. It's okay to discuss this openly with your healthcare provider and choose a method that feels right.
Contraceptive options
All standard birth control methods are available to trans and gender diverse patients. The best choice depends on your body, medical history, and preferences.
Long-acting reversible contraception (LARC)
IUDs (intrauterine devices) – hormonal or non-hormonal copper; last 3–12 years.
Implant – a small rod placed under the skin of your arm; lasts up to 3 years.
Pros: Highly effective, low maintenance.
Considerations: Insertion procedures may be triggering for some.
Hormonal methods
Pills, patch, or vaginal ring – contain oestrogen and/or progestin.
Progestin-only pill (mini-pill) – may be better if you are on oestrogen.
Pros: Can regulate bleeding, flexible use.
Considerations: Some contain oestrogen, which may interact with hormone therapy.
Barrier methods
Condoms (external and internal), dental dams.
Pros: Protect against sexually transmitted infections (STIs).
Cons: Must be used every time; slightly less effective than LARC or hormonal methods.
Injectable contraception
Progesterone injection – given every 3 months.
Pros: Very effective, private.
Considerations: May cause irregular bleeding or mood changes.
Permanent contraception
Tubal ligation or vasectomy (depending on anatomy).
Pros: Permanent, highly effective.
Considerations: Irreversible; only for those certain they do not want future pregnancy.
Points to remember
Testosterone is not birth control. Even if you stop having periods, pregnancy can still happen.
If you are on oestrogen and spironolactone, you may still be fertile.
Discuss interactions: Some birth control methods may affect hormone therapy or vice versa.
Mental health and dysphoria: Some methods (e.g., vaginal ring, procedures requiring pelvic exams) may cause discomfort. Look into alternatives.
Reproductive goals: If you think you may want children in the future, ask about fertility preservation before starting or changing hormones. You can read more about this here.