MENSTRUAL SUPPRESSION AND CONTRACEPTIVE CHOICES IN A TRANSGENDER ADOLESCENT AND YOUNG ADULT POPULATION
February 04, 20171:30 PM-February 04, 20171:43 PM
RulaKanj, MD ;
Lee AnnConard, DO; MPH RPh;
GylynthiaTrotman, MD; MPH
Hormonal contraception is indicated for menstrual management and/or contraception in the transgender female-to-male (FTM) population (transmen). Gender dysphoria increases in some patients after menarche, leading patients to seek options for menstrual lightening or suppression. Additionally, although testosterone therapy often leads to amenorrhea, it is not a contraceptive, and cases of pregnancy have been reported among transmen who have used testosterone. Thus, transmen may be at risk for unintended pregnancy if they are sexually active with people assigned male at birth (AMAB). Currently, there is no literature on the use of hormonal management for contraception and menstrual management among transmen with which to guide providers. Given the unique issues that arise among transgender adolescents, data on acceptance and use of contraception in adolescents without gender dysphoria cannot simply be extrapolated to this population. We sought to describe our institutional experience with the use of hormonal contraception in adolescent and young adult transgender FTM patients.
Materials and Methods:
IRB approval was obtained. We conducted a retrospective chart review of transgender FTM postmenarchal patients with diagnosis of gender dysphoria that presented for medical management between 1/1/2000 and 9/11/2015 and that continued the method for at least 6 months. Patient age, testosterone use, hormonal contraceptive choices, indication for hormonal contraception, sexual activity, and compliance were collected. Simple statistics were used to describe hormonal management choices.
316 transgender patients were identified. Of these, 197 were FTM patients, of which 123 met inclusion criteria and were included in final analysis. Ages ranged from 11 to 24 years, with an average age 17 years. 79 of 123 (64%) patients were on a hormonal method for menstrual management, contraception, or both. 52 of 123 (42%) patients were on testosterone for gender-affirming hormone therapy. Of the patients on testosterone, 36/52 (69%) were also on a hormonal contraceptive method. Table 1 outlines number of patients using each method. 53 patients presented for menstrual management without known need for contraception. Among these patients, the most common methods used were depot medroxyprogesterone (DMPA) 51%, norethindrone 23% and combined oral contraceptive pills, 21%.
41 of 123 (33%) patients reported current or previous sexual activity. 18 of the 41 (44%) were known to be sexually active with AMAB partners. Among sexually active patients, 26/41 (63%) were on hormonal contraception. The methods used included DMPA (17), combined oral contraceptive (COC) (5), levonorgestrel intrauterine device (LNG-IUD) (2), norethindrone (2).
DMPA was the most commonly used method for menstrual management and contraception in transgender FTM patients. Although combined oral contraceptives are considered less optimal due to the effects of estrogen, they were the second most commonly used method in our population. Norethindrone and LNG-IUD are also accepted. Almost half of sexually active patients disclosed encounters with AMAB partners, thus are at risk for pregnancy. As such, healthcare providers should not assume patients’ sexual behaviors, and all transgender patients should be counseled regarding barrier and hormonal methods of contraception.