Hormonal contraceptive choices in a clinic-based series of transgender adolescents and young adults

Abstract

Aims: To describe the use of hormonal contraceptives for menstrual management and/or pregnancy prevention in a clinic-based series of transgender adolescents and young adults who were assigned female at birth (transmasculine identity).

Methods: We performed a chart review of post-menarchal transgender assigned-female-at-birth (AFAB) patients, age 10–25 years, seen at CCHMC Transgender Health Clinic for at least 2 visits between July 1, 2013 and September 17, 2016, and who were not on a puberty suppression method. We collected data including choice of hormonal contraceptive and indication (menstrual suppression, pregnancy prevention, or both), duration of use, initiation of sexual activity, reported sexual partners, and use of gender-affirming hormone therapy (i.e., testosterone). We present simple descriptive statistics.

Results: A total of 231 patients met inclusion criteria, with ages from 11 to 25 years. Of those, 135 (59%) were using a hormonal contraceptive method. Most patients (67%) used hormonal contraception for the indication of menstrual suppression. Most commonly used method was depot medroxyprogesterone (DMPA) (49 patients), followed by combined oral contraceptives (COC) and norethindrone (progestin-only pill, POP) (34 patients each). Thirteen patients used 52 mg levonorgestrel IUD (LNG-IUD). Of the total sample (n = 231), 82 (36%) reported sexual activity, 35 of whom (43% of sexually active patients) reported sexual intercourse with assigned-male-at-birth (AMAB) partners and/or penile–vaginal intercourse. Among 35 patients at risk for pregnancy, only 21 (60%) were using hormonal contraception. Over half (54%) of sexually active patients taking testosterone discontinued their hormonal contraceptive method once they stopped having menses.

Discussion: Within a sample of transgender AFAB adolescents, half of whom were taking testosterone, a variety of contraceptives were used, including depot medroxyprogesterone, combined oral contraceptives, and levonorgestrel IUD. Among those taking testosterone, many patients discontinued contraception once they stopped having menses.

Keywords:

• Transgender
• contraception
• menstrual suppression
• transmasculine
• adolescent
• testosterone

Acknowledgments

Our appreciation goes to Leslie Villanueva and Swathi Prasad for their significant efforts in the review of patient records and collection of data.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

The Academic and Research Committee at the study institution provided award funding for statistical analyses. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.