What to Know About Birth Control If You Aren’t Cisgender

People who aren’t cisgender are often left out of the conversation when pregnancy prevention is discussed. This can include people who are transgender, non-binary, gender nonconforming, and more. 

But reproductive health is an important topic that affects people across the gender spectrum. And having access to reliable information about fertility and birth control is essential for your reproductive health.

There are many factors to consider when navigating your birth control options. For example, you might be wondering which ones are compatible with your gender-affirming care. The right choice for you depends on your specific situation and goals.

In this article, we’ll discuss some options to consider. 

Why is birth control important for people who aren’t cisgender?

There are many different treatments you may decide to pursue as part of your gender-affirming care. This may involve hormone therapy and/or surgical procedures — or you may choose to do nothing at all.

Birth control may still be necessary if you don’t want to become pregnant. That’s because you might be able to become pregnant if you were assigned female at birth and you’re having receptive vaginal sex. And people assigned male at birth can get their partner pregnant from vaginal sex, too. But this can depend on the type of gender-affirming care you choose.

Gender-affirming surgical procedures

Some people choose to have their uterus and/or gonads — ovaries or testes, depending on one’s anatomy — removed as part of their gender-affirming care. These procedures have a more permanent effect on your ability to get pregnant, ability to get your partner pregnant, and your need for birth control.

But some type of birth control may be necessary if your uterus and/or gonads are still intact. For example, an ovary could continue to release an egg. In this case, you could become pregnant if you’re having receptive vaginal sex. And sperm may continue to be made by the testes. In this case, your partner could become pregnant if you’re having vaginal sex.

Gender-affirming hormone therapy (GAHT)

It’s also important to know that pregnancy can still occur even if you’re taking gender-affirming hormone therapy (GAHT). This includes testosterone-based GAHT and estrogen-based GAHT.

For example, some people stop menstruating while taking testosterone-based GAHT. But it’s still possible to get pregnant if this happens. And it’s still possible to make sperm if you’re taking estrogen-based GAHT. 

In other words, you may still need birth control if you’re taking GAHT. This is also important because the hormones used for GAHT can be harmful to an unborn baby. So, knowing about reliable birth control options is necessary for your reproductive health.

Birth control options to consider

Choosing a birth control option is an individualized decision. And it can also be a balance with the use of GAHT and whether you’re looking for something temporary or permanent. 

Keep in mind: Birth control should be used in combination with safe sex practices, like using condoms or other barriers. This can not only help prevent pregnancy, but sexually transmitted infections (STIs) as well. 

Assigned female at birth

There are many different types of birth control available for people with female-assigned reproductive systems. These include pills, intrauterine devices (IUDs), implants, and more. Some contain hormones while others are hormone-free. We’ll cover a few options to consider below.

Progestin-only options

You may be interested in birth control options that are more likely to stop your menstrual cycle. And you may prefer an estrogen-free option, too. 

In both cases, you might be interested in certain progestin-only options. For example, some people experience lighter or no bleeding at all with hormonal IUDs. These are T-shaped devices that are inserted inside the uterus by a healthcare provider. They work by releasing progestin over time.

Hormonal IUDs can prevent pregnancy for 3 to 7 years, depending on the brand. And they’re rapidly reversible, meaning you can become pregnant very soon after it’s removed. Examples include Skyla, Liletta, and Mirena. 

There are a few other progestin-only options, including the progestin-only implant, shot, and pills. Some people have lighter or no bleeding with these options. But this can be more unpredictable. There’s also a hormone-free copper IUD, but it can cause heavier and longer bleeding.

Combination birth control pills

Combination birth control pills contain progestin and estrogen. You might be concerned that estrogen could affect testosterone-based GAHT. But it’s unclear if this is actually the case. Based on your potential benefits and risks, you and your healthcare provider may decide to give combination pills a try. 

Many combination pills have a hormone-free period that results in bleeding every month. But there are several continuous or extended-cycle options if you’re looking to stop or minimize this.

Amethyst is the only FDA-approved birth control pill for continuous use for a full year. This means that you’ll only take active pills every day. This prevents your menstrual cycle from happening at all. 

Jolessa and Seasonique are examples of extended-cycle pills. Each pack contains 12 weeks of active pills and 1 week of sugar pills. This results in four menstrual cycles per year. LoSeasonique is a lower-estrogen alternative to Seasonique.

Permanent birth control

As discussed earlier, certain gender-affirming surgeries can permanently affect your ability to get pregnant. Another more permanent option is a tubal ligation. This procedure involves closing, tying, or cutting the fallopian tubes, which prevents eggs from reaching the uterus.

Other options

Perhaps you’re wanting something more simple. If so, internal and external condoms are another option for you or your partner. They can help prevent pregnancy and protect against STIs.

Assigned male at birth

Birth control for people with male-assigned reproductive systems isn’t quite as complex. If you’re looking for something less permanent, condoms can be used to prevent pregnancy with vaginal sex.

Permanent options could be considered, too. These procedures include a vasectomy or orchiectomy. A vasectomy is a procedure that blocks the tubes that carry sperm from the testicles. An orchiectomy is a procedure that removes the testicles.

How to find an LGBTQ-friendly healthcare provider for birth control

With all of these birth control options, how do you choose? It can be helpful to find an LGBTQ-friendly healthcare provider who’s open to working with your individual needs. 

If you don't already have one, there are a couple places to start:

• The World Professional Association for Transgender Health (WPATH) provider directory lists local providers that specialize in gender-affirming care. 

• GLMA is a network of health care providers that advance healthcare equality. GLMA also has a provider directory on their website. 

• Planned Parenthood offers both affordable care and LGBTQ+ services.

• CenterLink is an organization that lists LGBTQ+ community centers around the world. Search their member directory to find a community center near you.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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