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Myth busting

Real information about gender affirming care

Is gender-affirming hormone therapy birth control?

Gender-affirming hormone therapies (both masculinizing and feminizing) are not considered birth control. 

People who are using testosterone, have uteruses, and are having sex with pregnancy potential (sex where sperm gets near the uterus) should use birth control to prevent pregnancy. People whose periods have stopped with testosterone use have become pregnant while taking testosterone. Testosterone should not be used during pregnancy (due to effects on the fetus). 

Use of birth control by people who could get pregnant is recommended if they are having sex with pregnancy potential with someone who is using feminizing hormone therapy unless pregnancy is desired.

 

What types of birth control can I use while on testosterone? Can I use hormonal birth control while taking testosterone?

Using testosterone is not a contraindication to the use of any form of hormonal birth control. Use of birth control is recommended for all people using testosterone who are having sex with pregnancy potential. While research is limited, we do not think that hormonal birth control (including estrogen-containing methods) have a significant negative impact on the effects of testosterone. Said another way, this means people using testosterone can use birth control pills, patches, and rings to prevent pregnancy.

How does testosterone affect the fertility of people assigned female sex at birth? Can I carry a pregnancy or contribute gametes (eggs) to a pregnancy after using testosterone?

We support people of all genders in achieving their family planning goals. At this time there is limited data on the long-term impact of testosterone on fertility and pregnancy outcomes. However, the available data generally suggests that people can get pregnant and carry a healthy pregnancy after using testosterone. Testosterone should not be used during pregnancy (due to effects on the fetus). There may be some impact of long-term testosterone use on gametes (eggs) or future pregnancies, but existing data is limited. Some people pursue gamete (egg) banking (oocyte cryopreservation) prior to or during testosterone use. This process involves taking hormones to stimulate the ovaries to make eggs and then undergoing a needle guided procedure to harvest the eggs. This is not a service PPMI offers. If this is something you are considering, we are happy to provide resources for exploring these services.

How does feminizing therapy affect the fertility of people assigned male sex at birth? Can I contribute gametes (sperm) to a pregnancy after using feminizing hormones?

We support people of all genders in achieving their family planning goals. At this time there is limited data on the long-term impact of feminizing hormones on fertility. However, the available data suggests that feminizing hormone therapy likely has a long-term negative impact on the quality and quantity of gametes (sperm). It is possible (and likely) that decreased fertility persists even after stopping feminizing hormones. Some people pursue gamete (sperm) banking (semen cryopreservation) prior to or during feminizing hormone use. This process involves banking ejaculated semen with a fertility lab. This is not a service PPMI offers. If this is something you are considering, we are happy to provide resources for exploring these services.

Does gender-affirming hormone therapy increase my risk of uterine or ovarian cancer?

Masculinizing hormone therapies do not appear to increase the risk of either uterine or ovarian cancer. Studies are limited at this time, but researchers and clinicians do not think there is a link between testosterone use and uterine or ovarian cancer.

If I have been on testosterone for years, do I have to have my uterus or ovaries removed?

No. Removal of the uterus and/or ovaries is medically necessary for gender dysphoria for some transmasculine and nonbinary people, but use of testosterone does not mean that someone needs to proceed with any particular surgeries.

If I am on testosterone, do I still need Pap smears (cervical cancer screening)?

If you have a cervix (the bottom portion of the uterus) and are between the ages of 21 and 65 years old, cervical cancer screening is recommended. Use of testosterone does not change cervical cancer screening guidelines.  Depending on your age, type of screening, and your results, Pap tests may be needed every 1 to 5 years. People using testosterone should be aware that testosterone increases the risk that cervical cancer screening samples may be “unsatisfactory”; this result occurs approximately 10% of the time for people using testosterone, and repeat testing is recommended following this result. People may experience spotting (light bleeding) after a Pap test.

Does Pap test (cervical cancer) screening require a pelvic exam with a speculum at PPMI?

Yes. Currently, PPMI does not use self-swab testing technology. Cervical cancer screening at PPMI requires a pelvic exam with a speculum. If you have concerns about pelvic exams, please speak with your clinician about ways in which we may be able to best support you to facilitate an exam when you are ready.

If I am on testosterone and was assigned female sex at birth, do I still need breast/chest cancer screening (mammography)?

You may. In general, breast cancer screening may be recommended for transfeminine and nonbinary people who have been on feminizing hormone therapy for at least 5–10 years and are at least 50 years old. Additionally, we always recommend letting a clinician know if you have a breast or chest concern.

If I am on feminizing hormone therapy and was assigned male sex at birth, do I still need prostate cancer screening?

Yes, people assigned male sex at birth retain their prostate tissue even if they undergo a vaginoplasty procedure (construction of the vagina). PPMI clinicians do not perform prostate exams. People using estradiol should speak with their primary care doctor about prostate cancer screening. In people who have had a vaginoplasty procedure, the prostate sits in front of the vagina and exams of the prostate are typically best performed by placing a finger in the vagina rather than the rectum.

What type of sexually transmitted infection screening should I have if I have had gender-affirming genital surgery?

Some sexually transmitted infection screening, such as hepatitis, syphilis, and HIV, are completed using blood samples. Other testing, like gonorrhea and chlamydia, are done using swabs or urine. The type of testing recommended depends both on the part of the body you have and how you engage in sex. Our health center staff can help recommend screening based on your specific practices. However, in general, for people who have had a vaginoplasty and use their vagina for sex, urine STI screening is recommended rather than vaginal swabs.

I am having pain with sex (orgasm, penetration, or touch). Is that normal?

We encourage you to discuss any concerns you may have related to sexual pleasure or function with a clinician. 

Testosterone can increase libido, genital sensitivity, and can change lubrication; some people with uteruses also experience uterine cramps intermittently or with orgasm for reasons that are not well understood. Depending on one’s symptoms and goals, additional lubrication, dilator use, pelvic floor physical therapy, ibuprofen use for cramping, an exam, and/or resources for sex therapy may be recommended. Some people have a hysterectomy if symptoms of uterine cramping persist and cannot be well controlled and if having the uterus removed aligns with their needs and goals.

Feminizing hormones typically cause spontaneous erections to stop or decrease significantly and may decrease or change libido; erections may be less firm and orgasms may take longer to achieve on feminizing hormones. Of note, orgasms can occur without erections. Some people using feminizing hormones who desire assistance with erections may use medications marketed for erectile dysfunction; PPMI does not prescribe erectile dysfunction medications but encourages folks who are interested to speak with their primary care doctor. Sex therapy may also be helpful; we are happy to provide resources!