Contraception options for trans people

Reviewed by our clinical team

For the trans community, contraception can be a tricky subject matter. Often, the language used by healthcare providers to describe contraception is gendered in a way that might make you feel as though it’s not relevant or appropriate for your situation. As an example, hormonal contraception is usually talked about as an option for women, even though it can also be used by trans men and non-binary people.

Regardless of your personal circumstances, and whether you’re cis, trans or non-binary, contraception is really important if you’re going to be having sex that could lead to an unwanted pregnancy. To find out about your options, read on. 

Contraception for trans men

Trans men are men assigned female at birth – normally this means you were born with a uterus, ovaries and vagina but you identify and present as male.

Some trans men might choose to have their uterus removed (a hysterectomy) or their ovaries removed (a bilateral oophorectomy) – both of these procedures will prevent unwanted pregnancy. 

However, if you still have your uterus and ovaries, and you’re having sex that could lead to pregnancy (i.e. vaginal/frontal), you’ll need contraception if you don’t want to get pregnant. 

Good options for trans men include the following: 

• Male and female condoms 
• The IUD (coil) 
• Progestogen-only methods

Male and female condoms

Condoms are a great option for contraception as they’re hormone-free, easy to get hold of, easy to use, and – best of all – protect against STIs as well as pregnancy. 

In general, “male” or “external” condoms (i.e. those designed to cover the penis) are considered more effective, so you might ask your partner to use these. Otherwise, you can try using “female” or “internal” condoms (i.e. those designed to be inserted into the vagina/front hole or anus). 

The IUD (coil)

The IUD (coil) is another hormone-free option that’s suited to trans men. This is a small, T-shaped device made from plastic and copper that’s inserted directly into the uterus. Over time it releases small amounts of copper into the surrounding tissue – this acts as a contraceptive, preventing pregnancy.

The coil has to be fitted by a healthcare professional, and the process can be painful for some people. However, once fitted, it can be left in for five to 10 years and doesn’t require any maintenance. 

Progestogen-only methods

You might think that hormonal contraception is unsafe for trans men, but in fact this isn’t true. Methods that use only progestogen (a synthetic form of progesterone) and not oestrogen aren’t thought to interfere with hormone therapy.

There are four types of progestogen-only contraception:

• The progestogen-only or mini pill – a pill taken every day at around the same time 
• The injection – an injection in your buttock, thigh or upper arm given every eight to 13 weeks
• The implant – a small plastic rod inserted under the skin of your arm that releases progestogen over a period of three years
• The IUS – a device similar to the coil that’s inserted directly into the uterus and releases progestogen over a period of three to five years

Does testosterone therapy work as contraception?

Many trans men use testosterone therapy and might be under the misconception that this prevents pregnancy. The truth is that testosterone will decrease your fertility and – taken for a long time – may end up leading to infertility. However, it can’t be relied upon to prevent pregnancy. 

The same goes for gonadotrophin releasing hormone (GnRH) analogues – if you're taking this treatment, you can’t rely on it for contraception. 

Can trans men take the pill? 

Trans men who are using hormone therapy can take the progestogen-only pill safely. However, the combined contraceptive pill and other types of combined contraception (e.g. the patch and ring) aren’t recommended. This is because they contain oestrogen, which can disrupt the effects of hormone therapy.                         

Can trans men use emergency contraception? 

All three types of emergency contraception are safe for trans men to use: 

• Morning after pills containing levonorgestrel (e.g. Levonelle) 
• The morning after pill ellaOne  
• The IUD (copper coil)

The most effective of these is the coil, however it has to be fitted by a healthcare professional. 

Contraception for trans women

Trans women are women assigned male at birth. This usually means you were born with a penis and testicles, but you identify and present as female.

You might have had a vasectomy or had your testicles removed (an orchidectomy) – if so, this will prevent you from getting your partner pregnant. If you haven’t had these procedures done, you might need to think about contraception to stop your partner from getting pregnant. 

Even if you’re on hormone therapy, vaginal/frontal sex with your partner might still get them pregnant, so if you don’t want your partner to get pregnant, it’s a good idea to use “male” or “external” condoms i.e. one that covers the penis. The added benefit of condoms is that they protect against STIs. 

You should also consider speaking to your partner about their contraception options.

Contraception for non-binary people

Non-binary people are those assigned male or female at birth who feel that their gender identity isn’t strictly male or female. Some non-binary people might want to use hormone therapy or have surgeries, while others may have no treatments at all. 

The type of contraception you’ll need as a non-binary person will depend on lots of factors, including the sex you were assigned at birth, whether you’re having any hormone therapy, and whether your sexual partners can get you pregnant or get pregnant themselves. 

Tips for safe sex

If you want to stay safe in the bedroom, remember these simple rules when you’re having sex with a new or casual partner:

• Use condoms for anal and vaginal/frontal sex 
• Use plenty of water-based or silicon-based lube with condoms to prevent breakage 
• Avoid sharing sex toys  
• Consider using condoms and dental dams for oral sex and rimming

If you’ve had unprotected sex and you’re worried about unwanted pregnancy or STIs, there are some emergency steps you can take, including taking emergency contraception and using post-exposure prophylaxis (PEP) to prevent HIV.

For more advice, check out the guidance for trans and non-binary people on the Terrence Higgins Trust website.

References

https://www.fsrh.org/documents/fsrh-ceu-statement-contraceptive-choices-and-sexual-health-for/
https://www.nhs.uk/conditions/contraception/male-condoms/
https://www.nhs.uk/conditions/contraception/female-condoms/
https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-masculine/safer-sex
https://www.nhs.uk/conditions/contraception/iud-coil/
https://www.nhs.uk/conditions/contraception/contraceptive-injection/
https://www.nhs.uk/conditions/contraception/contraceptive-implant/
https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/
https://www.tht.org.uk/hiv-and-sexual-health/sexual-health/trans-people/trans-feminine/safer-sex