Endocrinology AdvisorMen Can Get Pregnant, Too: Providing Obstetric Care for Transgender and Gender-Diverse Patients

🎓 Expert Commentary / Peer Perspective

As more transgender and gender-diverse individuals pursue pregnancy and parenthood, clinicians are encountering a growing need for reproductive and obstetric care that is both clinically competent and gender affirming. Available evidence remains limited, particularly regarding pregnancy outcomes and long-term maternal and neonatal health.

Clinical Considerations

• Transgender men and nonbinary individuals assigned female sex at birth may conceive and carry healthy pregnancies.
• Current evidence regarding pregnancy outcomes, hypertensive disorders, preterm birth, and peripartum mental health remains limited.
• Testosterone suppresses ovulation but is not considered reliable contraception, and pregnancy may occur while therapy continues.
• Testosterone discontinuation is generally recommended during pregnancy because of theoretical fetal and placental concerns.
• Gender dysphoria may worsen during pregnancy, making affirming communication and individualized care important considerations.
• Research participation and outcome reporting remain limited, creating substantial evidence gaps across reproductive medicine.

Practice Applications

• Avoid assumptions regarding gender identity, reproductive goals, or sexual practices.
• Use patients’ chosen names, pronouns, and preferred terminology.
• Discuss fertility planning, contraception, and pregnancy intentions before testosterone initiation when appropriate.
• Recognize that testosterone does not eliminate pregnancy risk.
• Support coordinated postpartum transitions back to affirming primary care and gynecologic services.
• Include partners, family members, and support persons according to patient preferences.