Testosterone & pregnancy
Testosterone may be taken by transgender, Two-Spirit, and non-binary (TTNB) people to reduce estrogen-related features, induce development of testosterone-related features, and relieve gender-related distress.
Testosterone may cause amenorrhea, but it is not an effective contraceptive. People who have a uterus can become pregnant while taking testosterone [1,2].
This information is provided for general clinical guidance. For questions related to specific clinical situations, clinicians may use eCase or call the RACE Line at 604-696-2131 or toll free at 1-877-696-2131 and request the “Transgender Health'' option to consult an experienced provider.
There is limited research on testosterone and pregnancy, however, it is considered teratogenic and may cause virilization of the external genitalia of the female fetus [1,3,4].
Discontinuing testosterone for pregnancy
While the ideal time frame for discontinuing testosterone before a planned pregnancy is unknown, the current standard is to discontinue testosterone before trying to conceive or undergoing fertility preservation [1,5]. A small number of cases studies have shown oocyte retrieval can be successful when people continue to take testosterone [5,6].
Stopping testosterone may cause gender dysphoria for clients as estrogen-related features may return, including mood swings, return of monthly bleeding, chest tenderness and growth, and increased fat to the chest, abdomen, and hips [7–9].
Unplanned pregnancy while on testosterone
Unplanned pregnancies can occur in people who are taking testosterone and have a uterus [10,11]. In the case of an unplanned pregnancy, clients should be counseled on their reproductive options. If planning to continue with the pregnancy, they should be encouraged to discontinue testosterone immediately. If pregnancy is already advanced, consider referral to an obstetrician experienced in provision of gender-affirming care with TTNB clients to determine potential testing and monitoring needs related to testosterone use during pregnancy.
Coleman E, Radix AE, Bouman WP, Brown GR, De Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health. 2022;23: S1–S259. doi:10.1080/26895269.2022.2100644
Yoshida A, Kaji T, Imaizumi J, Shirakawa A, Suga K, Nakagawa R, et al. Transgender man receiving testosterone treatment became pregnant and delivered a girl: A case report. Journal of Obstetrics and Gynaecology Research. 2022;48: 866–868. doi:10.1111/jog.15145
Testosterone Cypionate. Depo-testosterone (Testosterone cypionate). 2018. Available: https://pdf.hres.ca/dpd_pm/00046306.PDF
Testosterone Enanthate. Testosterone enanthate. 2023. Available: https://pdf.hres.ca/dpd_pm/00071616.PDF
Stark BA, Mok-Lin E. Fertility preservation in transgender men without discontinuation of testosterone. F&S Reports. 2022;3: 153–156. doi:10.1016/j.xfre.2022.02.002
Greenwald P, Dubois B, Lekovich J, Pang JH, Safer J. Successful In Vitro Fertilization in a Cisgender Female Carrier Using Oocytes Retrieved From a Transgender Man Maintained on Testosterone. AACE clin case rep. 2022;8: 19–21. doi:10.1016/j.aace.2021.06.007
Charter R, Ussher JM, Perz J, Robinson K. The transgender parent: Experiences and constructions of pregnancy and parenthood for transgender men in Australia. International Journal of Transgenderism. 2018;19: 64–77. doi:10.1080/15532739.2017.1399496
Ellis SA, Wojnar DM, Pettinato M. Conception, pregnancy, and birth experiences of male and gender variant gestational parents: It’s how we could have a family. Journal of Midwifery & Women’s Health. 2015;60: 62–69. doi:10.1111/jmwh.12213
MacDonald T, Noel-Weiss J, West D, Walks M, Biener M, Kibbe A, et al. Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: A qualitative study. BMC Pregnancy & Childbirth. 2016;16: 1–17. doi:10.1186/s12884-016-0907-y
Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstetrics & Gynecology. 2014;124: 1120–1127. doi:10.1097/AOG.0000000000000540
MacDonald T, Walks M, Biener M, Kibbe A. Disrupting the norms: Reproduction, gender identity, gender dysphoria, and intersectionality. International Journal of Transgender Health. 2021;22: 18–29. doi:10.1080/26895269.2020.1848692
| Current version | January 14, 2025 | |
| Authors | Caitlin Botkin | Nurse Educator, Trans Care BC; Registered Midwife (non-practicing) |
| Rowan McNiven Gladman | Registered Midwife, IBCLC | |