I've got a question after seeing the post about being on T and having an IUD. Is someone who's on oestrogen and still has a penis and sperm able to get someone else with a vagina & ovaries pregnant? Or is it like T in that fertility is reduced but not eliminated entirely? Thanks 😊
Lee says:
Yes, it’s the same thing! Hormones decrease fertility but don’t 100% guarantee that fertility is eliminated fully.
If someone has a uterus and ovaries, they can become pregnant if they have sex with someone with a penis and sperm.
This is true whether or not the person with the uterus and ovaries is on testosterone, or the person with a penis and sperm is on estrogen; reduced fertility is not the same thing as total sterility.
The only exceptions are if either person has had surgical sterilization, like a vasectomy or tubal ligation, or if the person with a uterus and ovaries is using contraceptives to prevent pregnancy like if they have an IUD placed, or if a barrier method is used like an external (“male”) condom worn on the penis, or an internal (”female”) condom placed in the vagina.
Please talk to your partner about this! If you haven’t been sterilized or aren’t using birth control/contraceptives yourself, don’t assume they they are using contraception or assume they’re infertile. Regardless of your gender or your parts, you need to be responsible and confirm that y’all are having safe sex. Also remember that STIs can be transmitted regardless of whether someone is getting pregnant!
Options to prevent pregnancy if you’re on T include:
- Progestin-Only Hormonal Methods (progestin-only contraceptives are usually ok to use even if you’re on T, but talk to your doctor!)
- More on Progestin-Only Oral Contraceptives
- An IUD (more info on those here)
- Internal/female condoms
- Diaphragms
- Tubal ligation + endometrial ablation
- Essure (a warning about that)
- The implant/Nexplanon
- Hysterectomy and Oophorectomy
- (Testosterone isn’t a contraceptive, so if you’re on T, you’ll still need to do one of the above or you could get pregnant even if you don’t have a period anymore)
What are the WPATH criteria for getting a hysto/oopho?
- Two referral letters from professionals (often therapist and endocrinologist)
- Persistent and well documented gender dysphoria and diagnosis
- Capacity to make a fully informed decision and consent for treatment
- Age of majority in a given country (18 or older, not a minor)
- If significant medical or mental health concerns are present, they must be well controlled
- One year of continuous HRT as appropriate to the patient’s gender goals unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones. The aim of HRT before surgery is to have a period of reversible estrogen suppression before doing an irreversible surgical procedure
Options to prevent causing pregnancy if you’re on E include:
- A vasectomy (tw gendered language in the link)
- An orchiectomy (link and link and link, it’s the removal of the gonads/testicles)
- Using an external (”male”) condom on the penis
- (Estrogen isn’t a contraceptive, so if you’re on E, you’ll still need to do one of the above or you could get someone pregnant even if you have clear-looking ejaculate/less sperm)
What are the WPATH criteria for getting an orchiectomy?
- You need two referrals from professionals
- Persistent, well documented gender dysphoria;
- Capacity to make a fully informed decision and to consent for treatment;
- Age of majority in a given country;
- If significant medical or mental health concerns are present, they must be well controlled.
- Twelve continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones). The aim of hormone therapy prior to gonadectomy is primarily to introduce a period of reversible testosterone suppression before the patient undergoes irreversible surgical intervention.
If you want more info on contraceptives or options to prevent pregnancy, I’d recommend that you talk to you doctor or go to Planned Parenthood to discuss what your options are!
If you don’t want a kid, use contraception because otherwise accidents happen! But if you do want to become pregnant/get your partner pregnant while you’re on hormones, you... still need to use contraception.
That’s because if you plan on getting pregnant you have to stop HRT first because taking HRT while pregnant might cause birth defects in your unborn baby.
Similarly, the effects of estrogen on sperm aren’t fully known, so it’s recommended you stop HRT before you start trying.
So in general, whether or not you want to have a child, you need to make sure you’re planning with a doctor to find a safe and healthy way for you to conceive, which might mean both of you temporarily stopping HRT.
Some helpful links:
- 20 Things Transgender People Might Want To Know About Fertility
- All the Things I Worry About As My NB Partner Prepares to Give Birth
- Fertility Options for Transgender Men and Women
- Trans Persons and Fertility
- Fertility options for transgender persons
- Transgender Reproductive Choice and Fertility Preservation
- Transgender Fertility Preservation & Treatment
- Transgender people and fertility preservation
- Celebrating Pride: A Conversation About Transgender Fertility
- I’m trans. Do I need birth control?
Testosterone decreases your biological fertility and it stops menstruation. But even if your period has stopped, there’s still a chance that you can get pregnant, even if the chance is much lower than it would be otherwise.
There’s a study that says that being on T for one year doesn’t decrease fertility after you stop taking it, but there’s no research about whether being on T for years will affect fertility when you stop taking it.
You may want to look into freezing your eggs if you’re interested in having biological children. If oocyte preservation is desired, that should be pursued before you start T.
Similarly, people on estrogen should consider saving sperm if they want to ensure they can have a child. Estrogen causes decreased sperm production and less ejaculate, and some people do find that they are permanently infertile after hormones.
Because you can’t predict what will happen to you, if you really don’t want to take that risk you have to act preemptively if having a biological child is important to you.
If you do want to have a kid, we have some other resources on pregnancy/being a trans parent that you may find helpful, but that’s another post!