Transgender Care Providers

After caring for a transgender man during pregnancy, our team wrote this article to share what we had learned in the partnership of providing prenatal care with the pregnant person. We identified best practices and systems change for our multidisciplinary care teams in the perinatal care setting, with the goal of promoting gender-affirming experiences for patients.  Very little existing clinical guidance perinatal care for transgender and gender-expansive individuals motivated us to write this article. With transgender health gaining more visibility in perinatal care, we hope this guidance is helpful.

 

Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individuals: A Collaborative Multidisciplinary Team Approach

Members of the HIVE Clinic team and colleagues recently wrote an article about caring for transgender and gender-diverse patients in and around pregnancy.  This article was published in the Journal of Obstetrics and Gynecology’s November 2019 issue:

Recommended System Changes and Best Practices

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:

Teaching Points About Testosterone Use In and Around Pregnancy*

  • 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

Recommended systems-level and interpersonal-level interventions for trans-inclusive care in and around pregnancy*

Check out these great resources:

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

GenderHealthSF: https://www.sfdph.org/dph/comupg/oprograms/THS/default2.asp 

Transline Transgender Medical Consultation Service: http://project-health.org/transline/ 

The National LGBT Health Education Center, The Fenway Institute: http://www.lgbthealtheducation.org/

World Professional Association for Transgender Health: http://www.wpath.org/

National Center for Transgender Equality: https://transequality.org/know-your-rights/health-care

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