This article is part of a series on the impacts of hormone replacement therapy (HRT), designed to help our clients (and others!) prepare for possible changes they may experience as they begin their hormone journeys.
When preparing for transition, many people are eager to start taking hormones. However, it is important to consider how testosterone may impact your reproductive system, including your ability to become a biological parent in the future.
What are the reproductive system changes caused by testosterone?
At first, your periods will likely become lighter, arrive later, or be shorter in duration, though some may notice heavier or longer-lasting periods for a few cycles.
Within six months of starting full-dose testosterone, your cycle will likely stop altogether. Not having a menstrual cycle is called amenorrhea. In cisgender women, it’s usually cause for concern. But it’s an expect effect of testosterone.
If you’re on a low dose of testosterone, your cycle may or may not stop. You can work with your doctor to adjust your dose if you would like to take enough for your cycle to stop, or if you wish for it to continue.
Even if you do not have a period, you may still be ovulating, which is the process that produces an egg for a possible pregnancy each month. Typically, testosterone prevents ovulation, which reduces your ability to become pregnant. But unless you are certain you are not ovulating, you could still become pregnant. So if you are having the type of intercourse that could result in pregnancy, you should always use a secondary method of birth control.
People on testosterone can use any form of contraception, including birth control pills (even those containing estrogen), intrauterine devices (IUDs), rings, condoms, and more.
People on testosterone may also use emergency contraception, also known as the “morning-after pill”. Ask your medical provider for more information on the contraceptive and family planning options available to you.
If you suspect you may have become pregnant while taking testosterone, speak with a medical provider as soon as possible, as testosterone can endanger the fetus.
If you do want to have a pregnancy, you’ll have to stop testosterone treatment and wait until your provider tells you that it’s okay to begin trying to conceive. Many transgender people have successfully stopped testosterone and achieved pregnancies, giving birth to healthy babies even after years of being on hormones. However, stopping hormones can be emotionally challenging, as can pregnancy as a transgender person.
If you do not anticipate wanting a pregnancy in the future, but might want biological children, you can utilize fertility preservation. That’s a process where a doctor prescribes medication that encourages the body to produce many eggs in one cycle, then the eggs are collected and cryopreserved (frozen) for as many years as needed. Frozen eggs can be used later to create embryos, which can then be carried by a future partner or surrogate— allowing you to have biological children even as a transgender person who has transitioned.
