Transgender AFAB Teens Use a Variety of Contraceptives to Suppress Menses, Provide Protection
Published July 2019 | International Journal of Transgenderism
What are the contraceptive practices of transgender youth whose sexual identity is assigned female at birth (AFAB) but who embrace a transmasculine identity?
Researchers in the Division of Adolescent Gynecology reviewed charts of 231 transgender AFAB patients to identify patterns and reasons for contraceptive use among those aged 10 to 25 years old who had begun menstruating but were not pursuing puberty suppression. Half were taking testosterone as part of their transition to a more masculine identity.
Patients were seen at least twice between 2013-2017 at the Transgender Health Clinic. AFAB refers to the practice of assigning gender at birth based on visual identification of female-typical genitalia whereas AMAB is the acronym for assigned-male-at-birth.
Led by attending physician Rula Kanj, MD, this study found that 59% of the teens were using a hormonal contraceptive method, and of those, 67% relied on it for the indication of menstrual suppression. The most commonly used contraceptive (49 patients) was depot medroxyprogesterone (DMPA), followed by combined oral contraceptives and norethindrone (progestin-only pills; 34 patients each). Another 13 patients relied on a 52 mg levonorgestrel intrauterine device (IUD). Among the 36% of patients (82) who were sexually active, 43% reported sexual inter-course with AMAB partners and/or reported having penile-vaginal intercourse, activities that potentially put them at risk for pregnancy.
Notably, among the 35 patients who were at risk for pregnancy, only 21 were using hormonal contraception. More than half of sexually active patients taking testosterone discontinued the use of hormonal contraceptives once they stopped menstruating. Kanj encourages counseling for these at-risk patients on continued use of barrier methods and hormonal contraception. Kanj says the findings may spur research into favorable side effect profiles of hormonal contraceptives to encourage their long-term use among transmasculine teens.
