A new article in a mainstream medical journal says that many transgender men who want to bear children often face barriers because of healthcare professionals’ lack of training—and it offers some guidance to correct that.
“Transgender Men and Pregnancy” appears in the latest issue of the peer-reviewed journal Obstetric Medicine. Authors Juno Obedin- Maliver (University of California San Francisco and the San Francisco Veterans Affairs Medical Center) and Harvey Makadon (The Fenway Institute and Harvard Medical School) write that while health care programs for transgender people have grown in recent years, there is still a “gaping chasm” between transgender people’s needs and what is taught in medical schools and training programs. The result is that many health care professionals are “unprepared to provide quality care, with many needing to ‘catch up’ or refer (possibly delaying care) to someone else, when a transgender person presents for care.”
One area in need of improvement is that of pregnancy and childbirth. Obedin- Maliver and Makadon remind us that many, if not most transgender men retain the capacity to have children. The authors hope “to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy.”
Although trans man Thomas Beatie made headlines when he became pregnant a few years ago, they observe, “the struggles of men and other gender nonconforming individuals going through pregnancy and birth may be much more common than Mr. Beatie’s press coverage might suggest.”
Not surprisingly, they have found, “a positive psychological outcome will depend on the experience someone has from the moment they first present for care and depends on the total experience from beginning to end being inclusive and affirmative.”
The authors explore both physical and psychological concerns. On the physical side, they cover questions trans men and their practitioners may encounter, such as: Should one delay top surgery in order to breast feed? Is chest feeding possible after top surgery? What is the impact of testosterone on fertility? They never assume surgery and/or hormones are a given, however, and put as much emphasis on the emotional questions. “While having a family is something that many transgender individuals want,” they say, “pregnancy can lead men to acknowledge that they still have female reproductive organs which for many can be difficult, however rewarding the pregnancy may ultimately be.” When breast or chest feeding, too, what are the emotions that may arise “as they take on (and challenge) this traditionally feminine role”?
Crucially, they advise providers not to assume a trans man will never want to bear children, and to keep this in mind while providing other care. For example, they advise, “It is always important to discuss family planning—and in particular desires for genetically related children and or carrying a pregnancy prior to the initiation of cross-sex hormones.”
Providers should treat the pregnancies of transgender men as what they are—personal experiences—and not media sensations. “Many of the news reports on pregnancies of transgender men having children sensationalize what for trans men, as for all parents having children, should be a personal and intimate experience. ”
The bottom line is simple. Healthcare providers have a responsibility to their trans patients’ who wish to become genetic parents:
Though little is known about the desires of transgender individuals for creating families and having genetically related children, likely desire for parenting and having genetically related children is present for many and it is incumbent on providers to help preserve and or support that desire.
The authors also make the important observation that a trans-inclusive practice means not making assumptions about the gender identity of any patient who walks in the door:
Principles of care will depend on efforts to ensure that the experience of care is designed around the needs of patients, which may vary. This will mean asking all patients at the outset about their gender identity and assigned sex at birth in addition to questions about preferred name and pronouns.
Fully addressing the needs of transgender people, however, means training everyone in the healthcare system:
All staff from the front line receptionists to clinicians will need training to understand why gender affirming polices and behaviors are important…. Every health care system needs to introspectively examine how they can comprehensively meet the needs of the gender diversity we have amongst our patients and community…. We need to support training and inquiry that enhances medical and social understanding of the situation as well as advancing an individual’s care but is not simply for the purpose of idle curiosity, gossip, or entertainment.
This is an important paper that supplements and deepens LGBTQ-inclusive medical resources such as the The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, whose 2nd edition I reviewed in May. It packs a lot into just over three pages (plus notes) and should be disseminated to anyone working in the OB/GYN field, as well as to family and general practitioners who may be the first point of contact for a transgender person considering pregnancy (or who might consider it someday). Both parents and their children will be better off for it.