Why would a trans person get pregnant?
I get asked a lot why I, as a trans man, would want to be pregnant. Now, given that the question is often asked in the comments section on my social media I have to answer pretty concisely so I usually say something along the lines of “I only have eggs and it was cheaper to use my own uterus”. This is all true but as we often find on social media, there’s nuance that’s lost when we reduce our experience down to a few words so I’m going to use this space to look a little deeper. Yes, it was a pragmatic decision, but it was also about my body, my gender and how I have come to understand what it means to be trans.
When I first transitioned back in 2008 the assumption from both medical staff and society was that trans people would want to make their bodies as close to cis (not trans) as possible. This meant having every surgery possible, taking hormones for the rest of your life and being sterilised – because of course one thing you can’t change is the sex cells you use to make a baby and back then that assumption was that you should want nothing to do with your sex assigned at birth.
But that way of looking at it doesn’t actually understand what being trans is like and what is actually best for us. Being trans just means that your gender doesn’t match with your sex at birth, which doesn’t actually suppose anything about what your body should or shouldn’t be or what it should or shouldn’t do. When we change ourselves (our bodies, our presentation, the words we use for ourselves etc) we do it to feel good within ourselves. Either to stop gender dysphoria or to move towards gender euphoria.
"Being trans just means that your gender doesn't match with your sex at birth, which doesn't actually suppose anything about what your body should or shouldn't be or what it should or shouldn't do. "
For example, I had dysphoria about my chest and so I had chest surgery. I knew I wanted a beard so I took testosterone and now my hairy face brings me joy. Thankfully, both of these things were on the medical pathway that the gender clinic assumed I would take I was able to access them
But then my gender clinic assumed the next stage would be a hysterectomy and I had a strong emotional reaction to that. This is where the reality of my trans identity clashed with the assumptions of what being trans should look like. Not only is a hysterectomy a deeply invasive surgery with lifelong side effects but it would leave me entirely sterile and at a time where gamete storage for my eggs was not available on the NHS and was wildly outside of what I could afford.
My gender clinic was strongly encouraging me to have a hysto. Telling me that I had an increased cancer risk if I didn’t (which I have yet to find evidence for) and that testosterone had already made me infertile (a lie). I believed them when they told me I was infertile but still I knew I didn’t want to have a hysterectomy so I stood my ground. It is sobering to realise that my children wouldn’t be here today if I hadn’t.
When my husband and I considered having children we quickly realised that pregnancy was our only financially viable option. As well as all the ways that pregnancy is already hard, for me it also meant facing gender dysphoria, accessing services not made for me and my trans body changing in unpredictable ways – including ways that could impact the changes I had made through medical transition.
And even with all of that, I know that I was lucky compared to many trans people who experience pregnancy. I was at a point in my life and my transition where I didn’t experience gender dysphoria with any regularity. The changes and choices I had made during my transition meant that I was in a good place with my body. I went into pregnancy protected by that in a lot of ways – nobody misgendered me directly throughout my pregnancies (with the exception of a family member who did so on purpose and who I no longer have contact with).
Even though it’s hard, the reality for so many trans people is that pregnancy is the only viable way to have biological children.
When LGBTQ+ people are considering family making we have to think about what ingredients we have and how accessible they are. Some may have eggs or sperm stored by themselves or a partner and others may seek donations from a known or anonymous donor. There’s no one way that trans people’s relationships look, we can have any sexuality and any family make up and just like the cis population, many trans people are single parents by choice. For this reason fertility clinics can play a vital role in many trans people’s fertility and pregnancy journey.
My husband and I are incredibly lucky as a queer couple that we had all the ingredients necessary to make a baby within our relationship. We didn’t need to access external fertility care or the support of a donor.
I needed to stop testosterone to get my periods back, and when that took a long time we had a scan to find out that I wasn’t ovulating. For me, testosterone had stopped ovulation in the same way that taking the pill does. After about a year my periods had returned and were regular and I was able to try to conceive with my hormone levels the same as any cis woman who is trying for a baby.
If you’re wondering about how a trans person might fall pregnant accidentally (or in any way without medical support), it’s ok, I get it!
It goes back to what I said before about what it means to be trans – our genders don’t determine how we use our bodies and that includes how our bodies experience pleasure.
Many trans people have the kind of sex that can result in pregnancy. We are allowed to have sex in ways that feel good for us. If something causes us gender dysphoria and that feels bad, then we won’t do it. But that’s for us to determine, not societies expectations of what it means to be a man, a woman or any other gender.
It’s also possible to fall pregnant naturally without having intercourse (for example, at home insemination is often used by couples using a known donor) so even if you know someone didn’t have fertility support you can’t actually assume anything about their sex life.
And of course, just like in the cis population, many trans people fall pregnant accidentally. This can happen regardless of whether someone it on testosterone as for some people testosterone doesn’t act as a contraceptive and they continue ovulating even if they don’t have periods. This is actually hugely problematic as many trans guys have found themselves far along in pregnancies without having received proper care. [note: If you are taking testosterone and you discover you’re pregnant, it’s really important that if you want to continue the pregnancy that you stop testosterone asap.]
We need so much more research done on the effects of testosterone and fertility in trans people, both while it’s being taken (what’s the risk of pregnancy?) and what fertility levels are like after it’s been stopped. If you happen to have a research budget available this is a wildly underresearched area and it’s only getting more important!
I’m just one person with my single experiences of pregnancy but the thing I can say that I think speaks for the whole of the trans community is that bodily autonomy is incredibly important. The right to change your body in ways that feel good, the right to grow your family – these are both basic human rights and we all deserve them.
People often assume that trans people are obsessed with gender, but I often find it’s the opposite. We’re finding gender where it’s joyful and removing it where it’s not needed. If a woman finds pregnancy to be a feminine and womanly thing then that’s joyful and we should celebrate it. If someone experiences pregnancy and finds it isn’t gendered at all, then there’s no need to add gender there. The same thing goes for all our bodies and our lives, as well as what we do with them.
I chose to be pregnant because being pregnant is an amazing thing that my trans body can do. I feel so lucky to have been able to take part in a mundane miracle, the everyday magic of making a new human. How I made my babies was a pragmatic decision, but just as my trans-ness is a natural part of me (just like the hand I write with and the tastes I enjoy) pregnancy felt natural too.
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