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After I discuss our analysis workforce’s work on being pregnant in transgender folks, folks usually recall Thomas Beatie, a pregnant man who appeared on “Oprah” and in Folks journal in 2008. The media deal with Beatie and his being pregnant provoked public fascination that tended to overshadow the on a regular basis lived realities of being pregnant as a trans particular person.
Transgender folks, versus cisgender folks, have a gender id that’s totally different from the gender they had been assigned at beginning. Some might go on hormone remedy to assist align their physique with their gender id. Like most trans males, Beatie went off testosterone throughout his being pregnant as a result of it was medically suggested as commonplace observe. However testosterone remedy is commonly important to the psychological and bodily well being of many trans males in addition to some nonbinary folks whose genders don’t match throughout the classes of man or girl. What’s the expertise of pausing therapy like for them? Why do medical tips suggest going off testosterone?
As a sociologist who research intercourse, gender and sexuality, and trans experiences of household, well being and well-being, these questions piqued my curiosity. I work with a global workforce of researchers on a undertaking about trans males and nonbinary folks’s experiences of being pregnant. We interviewed 70 trans and nonbinary individuals who had been both presently or meaning to change into pregnant, in addition to 22 well being care suppliers specializing in working with these communities, throughout seven international locations.
Whereas testosterone is broadly thought of a “male hormone,” all folks produce testosterone. Physicians think about a variety of testosterone ranges to be “regular.”
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Many transgender and nonbinary folks take testosterone as a part of their psychological and bodily well being care. Testosterone remedy usually leads to a extra masculine look by facial hair and muscle development, fats redistribution and lowered vocal pitch.
Along with bodily modifications, a lot of our research contributors spoke of constructive psychological well being enhancements whereas on testosterone remedy, together with feeling calmer, balanced and extra totally themselves – generally for the primary instances of their lives. This can be a frequent discovering throughout analysis on hormone remedy and trans and nonbinary folks.
Whereas there’s no common dosing protocol for trans or nonbinary folks present process testosterone remedy, the Endocrine Society’s therapy tips suggest supplementing testosterone till blood ranges fall inside these for cisgender males. By basing scientific requirements on cisgender males, these tips can reproduce intercourse and gender binaries that won’t match with precise wishes of many trans and nonbinary folks. Some resist this prescriptive medical mannequin by microdosing testosterone, with or with out well being care supplier assist.
Testosterone and being pregnant
When my workforce and I analyzed our analysis interviews, we realized that the well being care suppliers in our research sometimes informed their trans sufferers to cease testosterone remedy both six months earlier than attempting to get pregnant or instantly upon turning into conscious of being pregnant. Additionally they suggested persevering with to withhold testosterone remedy till both after beginning or stopping chestfeeding (nursing their infants). This might imply a pause in testosterone remedy for as much as two years.
Why do docs inform trans and nonbinary sufferers to cease testosterone remedy throughout being pregnant?
The well being care suppliers we interviewed expressed issues about sufferers persevering with testosterone whereas pregnant or chestfeeding. Once we requested them what dangers they had been most involved about, they usually famous that there’s both not sufficient or inconclusive analysis on utilizing supplemental testosterone throughout being pregnant. Regardless of this, practically all the suppliers we interviewed routinely suggested sufferers to pause testosterone remedy with out reservation.
Some suppliers in contrast persevering with testosterone remedy throughout being pregnant to illicit drug use throughout being pregnant, perceiving it as a future threat to the kid. Others recommended that testosterone use throughout being pregnant is egocentric as a result of it prioritizes the dad or mum’s personal well being and well-being within the current over the potential well being and well-being of their baby sooner or later. Some suppliers even recommended that trans and nonbinary sufferers shouldn’t have kids if they’re unwilling or unable to pause testosterone remedy throughout being pregnant.
In distinction, the trans males and nonbinary folks we interviewed described grappling with tough and weighty choices round pausing testosterone throughout being pregnant. These choices usually concerned selecting between their very own psychological well being and well-being in opposition to the potential well being and well-being of their baby. As one participant described their expertise going off testosterone throughout being pregnant:
“My lows had been depressing, depressed, to the purpose of suicidal. … I knew that going again on testosterone would assist. I didn’t actually know whether or not [my doctor] could be glad to re-prescribe me testosterone … and there was a concern there that it could be withheld from me … that they had been going to say, ‘Properly, sorry, you got here off it, you’re not getting it again.’”
PCOS and producing ‘regular’ kids
Regardless of it being pretty commonplace medical recommendation, there stays comparatively scant empirical proof guiding the observe of pausing testosterone remedy for trans males and nonbinary folks throughout being pregnant and chestfeeding. There’s additionally presently no revealed work on microdosing testosterone throughout being pregnant.
As an alternative, a lot of the medical literature on the potential developmental results of “extra androgen” publicity within the womb focuses on pregnant folks with polycystic ovary syndrome who’ve testosterone ranges that usually fall between these for cisgender men and women. These research middle on the probability of the infant later creating intersex situations, or having organic traits that don’t match binary definitions of male or feminine traits; later self-identification as lesbian or trans; metabolic and cardiovascular dysfunction, corresponding to weight problems; and neuropsychiatric problems, corresponding to autism and attention-deficit dysfunction. Most of those issues have concerned kids categorized as feminine at beginning.
Folks with polycystic ovary syndrome, nevertheless, aren’t routinely positioned on testosterone blockers throughout being pregnant or discouraged from feeding their infants milk they produce.
In my overview of our interviews and the medical literature, I grew to become more and more involved that this deal with producing “regular” kids fails to take care of each pure human variety in cognitive processing, our bodies and identities, and the psychological well being of trans and nonbinary mother and father. It could additionally echo eugenicist insurance policies that try to remove human traits and communities that society deems inferior or dangerous. However folks from these communities have executed quite a lot of work over the previous a number of many years to make sure they’re granted equal rights and protections.
Paradoxically, the need to guard offspring from testosterone publicity throughout being pregnant and chestfeeding might change into a way to stop the copy of among the exact same traits held by trans and nonbinary mother and father themselves. As one participant famous:
“There’s a bunch of analysis round androgen publicity in utero and intersex situations. … I did have advanced emotions round working exhausting to not have an intersex baby. … As somebody who’s a gender ‘different,’ to work exhausting to not create a special physique that could be a gender ‘different’ feels bizarre. It feels hypocritical.”
Shifting past one-size-fits-all
Whereas issues about “androgen extra” throughout being pregnant for trans males and nonbinary folks parallel these for folks with polycystic ovary syndrome, docs deal with these instances in a different way. This discrepancy in scientific method signifies that there could also be different pathways ahead that don’t require stopping testosterone remedy utterly.
I consider that cautious consideration to the bodily and psychological well being and well-being of trans and nonbinary folks earlier than, throughout and after being pregnant is lengthy overdue in medication. As an alternative of approaching testosterone remedy throughout being pregnant as a binary sure/no query or a one-size-fits-all commonplace, investigating how numerous dosages of testosterone might have an effect on all phases of being pregnant and chestfeeding may result in higher outcomes for each trans mother and father and their kids.
Carla A. Pfeffer acquired funding from the Financial and Social Analysis Council for her work on the Transgender Being pregnant Undertaking.
The Trans Being pregnant Undertaking workforce contains: Sally Hines (PI), Ruth Pearce, Carla A. Pfeffer, Damien W. Riggs, Elisabetta Ruspini, and Francis Ray White.