The mission of the American Society for Emergency Contraception (ASEC) is to expand access to and information about emergency contraception in the United States. ASEC is coordinated by Executive Director Kelly Cleland and is fiscally sponsored by Cambridge Reproductive Health Consultants. Our work is guided by a Steering Committee comprised of leading reproductive health leaders from high-impact organizations.
Emergency Contraception for Transgender and Nonbinary patients
Background
Emergency contraception (EC) can reduce the risk for pregnancy after penis-in-vagina sex when contraception failed or was not used, and/or in cases of sexual assault or reproductive coercion. Healthcare providers who offer care for patients of reproductive age should be ready to answer questions about EC for transgender and nonbinary patients. Pregnancy is possible for any individual with a uterus and ovary(ies) who has receptive penis-in-vagina sex with partners who produce sperm, regardless of gender identity. Patients who are amenorrheic due to testosterone use may be surprised that they are at risk for pregnancy. This fact sheet addresses medical and social-emotional aspects of EC for transgender and nonbinary patients.
Considerations for Transgender and Nonbinary Patients
Medical considerations
Transgender and nonbinary individuals may use a variety of gender-affirming medical and surgical interventions. Testosterone is not a substitute for contraception for people capable of becoming pregnant, regardless of its effect on other characteristics (absent menses, voice changes, clitoral growth, etc.) In contrast, people who have undergone hysterectomy (removal of uterus and cervix), salpingectomy (removal of fallopian tubes), bilateral oophorectomy (removal of both ovaries), or any of the combination of these procedures have no risk of pregnancy. The risk of pregnancy is extremely low (<1%) for those who have undergone permanent blockade of the fallopian tubes (tubal ligation, quinacrine, coils).
While some transgender and nonbinary individuals may desire pregnancy and childbirth, preventing pregnancy may be a high priority for others. Healthcare professionals should be aware that individuals may experience gender dysphoria and/or trauma if they become pregnant. In addition, exposure to testosterone in pregnancy can affect the fetus as it is forming, particularly an XX-chromosome fetus prior to 14 weeks. This can include urogenital changes, which may require surgery later in life.12 It is unclear if there are other long-term effects of testosterone on pregnancy.
Transgender and nonbinary patients at risk for pregnancy should be offered a full range of contraceptive options, including EC when needed.13 Some resources for patients and providers are listed at the end of this document. There are no specific studies of EC use among transgender and nonbinary individuals. However, expert consensus and experience with other contraceptive methods indicate no reason to expect drug interactions or loss of efficacy for either ECPs or testosterone when used together.
Social-emotional Considerations
Transgender and nonbinary patients may experience a variety of barriers in acquiring EC. Some may experience increased gender dysphoria due to side effects of EC. Providers should familiarize themselves with effective strategies to help minimize anxiety and negative experiences for their patients.