Here are some ways you can help support transgender and gender-diverse patients in having a positive and gender-affirming experience before, during, and beyond pregnancy.

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• Testosterone should not be considered a contraceptive. Testosterone may lead to amenorrhea and cessation of ovulation. However, although testosterone may reduce fertility, fertilization is possible despite prior or active use of testosterone and while amenorrheic from testosterone use.

• Testosterone is not currently recommended during pregnancy owing to possible irreversible fetal androgenic effects. An optimal interval between discontinuing testosterone and conceiving is unknown at this time.

• Although transgender and gender-diverse people previously on testosterone may adjust well to pregnancy, lack of testosterone use during fertilization and pregnancy may lead to or exacerbate gender dysphoria.

• Testosterone may be excreted in small quantities in human milk and may affect milk production. Currently, it is not recommended to use testosterone while chestfeeding, until more information is known about the effects of testosterone use on human milk.

  *Teaching points source: Hahn M; Sheran N; Weber S; Cohan D; Obedin-Maliver, J. Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individual: A Collaborative Multidisciplinary Team Approach. Obstet Gynecol 2019;134:959?63

• UCSF Center of Excellence for Transgender Health: http://transhealth.ucsf.ed

• Fenway Institute: http://www.lgbthealtheducation.org/

• World Professional Association for Transgender Health: https://transequality.org/know-your-rights/health-carehttp://www.wpath.org/

• National Center for Transgender Equality: https://prevention.ucsf.edu/transhealth/education/trans101

• Transgender 101 online course: https://prevention.ucsf.edu/transhealth/education/trans101