Transgender individuals who undergo gender-affirming medical or surgical therapies are at risk for infertility. Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential. Testosterone therapy in transgender men can suppress ovulation and alter ovarian histology, while estrogen therapy in transgender women can lead to impaired spermatogenesis and testicular atrophy. The effect of hormone therapy on fertility is potentially reversible, but the extent is unclear. Gender-affirming surgery (GAS) that includes hysterectomy and oophorectomy in transmen or orchiectomy in transwomen results in permanent sterility. It is recommended that clinicians counsel transgender patients on fertility preservation (FP) options prior to initiation of gender-affirming therapy. Transmen can choose to undergo cryopreservation of oocytes or embryos, which requires hormonal stimulation for egg retrieval. Uterus preservation allows transmen to gestate if desired. For transwomen, the option for FP is cryopreservation of sperm either through masturbation or testicular sperm extraction. Experimental and future options may include cryopreservation and <i>in vitro</i> maturation of ovarian or testicular tissue, which could provide prepubertal transgender youth an option for FP since they lack mature gametes. Successful uterus transplantation with subsequent live birth is a new medical breakthrough for cisgender women with uterus factor infertility. Although it has not yet been performed in transgender women, uterus transplantation is a potential solution for those who wish to get pregnant. The transgender population faces many barriers to care, such as provider discrimination, lack of information, legal barriers, scarcity of fertility centers, financial burden, and emotional cost. Further research is necessary to investigate the feasibility of experimental FP options, provide better evidence-based information to clinicians and transgender patients alike, and to improve access to and quality of reproductive services for the transgender population.

BACKGROUND: Little is documented about the experiences of pregnancy for transgender and gender-diverse individuals. There is scant clinical guidance for providing prepregnancy, prenatal, intrapartum, and postpartum care to transgender and gender-diverse people who desire pregnancy. CASE: Our team provided perinatal care to a 20-year-old transgender man, which prompted collaborative advocacy for health care systems change to create gender-affirming patient experiences in the perinatal health care setting. CONCLUSION: Systems-level and interpersonal-level interventions were adopted to create gender-affirming and inclusive care in and around pregnancy. Basic practices to mitigate stigma and promote gender-affirming care include staff trainings and query and use of appropriate name and pronouns in patient interactions and medical documentation. Various factors are important to consider regarding testosterone therapy for transgender individuals desiring pregnancy.

Transgender men are assigned female at birth, but self-identify as male. Although some transgender men undergo gender-affirming hormonal treatment and/or surgery that preclude pregnancy, many (if not most) retain their female reproductive organs and, as a result, their capacity to become pregnant. Although the visibility of the transgender community has increased, the exposure of healthcare providers to transgender individuals, especially transgender men during pregnancy, as well as research that addresses evidence-based practice remain limited. In this review, we discuss obstetrical issues for transgender men who are ≥35 years old, termed the "new" advanced paternal age. We review preconception care and focus on fertility issues, the impact of stopping gender-affirming hormonal treatment, and age-appropriate health maintenance. We review antepartum and postpartum care, including labor and delivery, monitoring for perinatal depression, contraception, and chest feeding. Finally, we conclude with suggestions for areas for further research and study.

<b><i>Background:</i></b> Many trans and non-binary people wish to be parents. However, few countries record figures for trans and non-binary people becoming pregnant/impregnating their partners. Pregnant non-binary people and trans men may be growing populations, with heightened vulnerabilities to traumatic birth and perinatal mental health difficulties (i.e. pregnancy-one year postpartum). <b><i>Aim:</i></b> To conduct a scoping review on traumatic birth and perinatal mental health in trans and non-binary people to identify research evidence, summarize findings, and identify gaps. <b><i>Methods:</i></b> Electronic databases were searched to identify published English-language evidence. Eligibility was not restricted by type of study, country, or date. <b><i>Findings:</i></b> All studies were from the Global North and most participants were white. The literature focuses on structural and psychological barriers faced by non-binary people and trans men and on the lack of reliable medical information available. There is a lack of empirical research and, to date, no research into trans and non-binary parents' experiences has focused on traumatic birth or perinatal mental health. However, common themes of dysphoria, visibility, isolation, and the importance of individualized respectful care indicate potential vulnerability factors. Trans women's and non-binary people's experiences are particularly under-researched. <b><i>Discussion:</i></b> The themes of dysphoria, visibility, and isolation present a series of challenges to pregnant non-binary people and trans men. These coalesce with external events and internal choices, creating the potential to make the individual feel not man enough, not trans enough, not pregnant enough, and not safe enough during pregnancy, birth, and the postpartum. Further research involving trans people is needed to inform future services.

Introduction Pregnancy in transgender men is an area of increasing study due to data showing that pregnancy can occur in this population despite the reduction in fertility that generally accompanies treatment with gender-affirming hormone therapies. Case In this case, we describe a healthy 21-year-old transgender man who was able to achieve pregnancy without reproductive assistance after stopping his testosterone therapy for 2 months. Discussion. Our case is important as it highlights how little is known in regards to gender-affirming hormone therapy on fertility. While testosterone is known to reduce fertility by inducing anovulation and altering ovarian histology, its long-term effects on conception rates and pregnancy are largely unknown. Some studies demonstrate that transgender men, treated with gender-affirming hormone therapy (GAHT), including testosterone, have similar oocyte quantity and quality, as well as similar ovarian reserve, when compared to cisgender women, suggesting that resumption of fertility may be possible after cessation of GAHT. Long-term outcomes for the pregnancy and the offspring of those who have been treated with GAHT are unknown. Conclusion Recent studies have shown that pregnancy is possible for transgender men who desire biological children and have received gender-affirming hormonal therapy without fertility-preserving measures. Further research is needed to help determine rates of fertility, the likelihood of recovery of fertility, conception rates, and long-term pregnancy outcomes. Such information would help guide physicians in providing education and counseling to their transgender patients regarding reproductive options.

Many transgender men receive testosterone therapy to achieve virilization. The therapy is often mistaken for having a contraceptive effect because it causes amenorrhea. However, some treated patients become pregnant, which is not well known. A 25‐year‐old transgender man who had received testosterone for 3 years had an unplanned pregnancy during discontinuation of treatment. He was unaware of his pregnancy, resumed testosterone, and continued treatment until pregnancy was confirmed. His female child was exposed to androgens during the fetal period; thus, careful, long‐term observation was required. He developed insomnia and depression during the postpartum, and giving birth made it difficult for him to change his family register to male. Transgender men can become pregnant through sexual intercourse with biological men, even during hormone replacement therapy, so correct contraception is necessary to avoid unwanted pregnancies. Transgender sex education is important to increase awareness of this issue among individuals and medical professionals.

Many transgender men receive testosterone therapy to achieve virilization. The therapy is often mistaken for having a contraceptive effect because it causes amenorrhea. However, some treated patients become pregnant, which is not well known. A 25-year-old transgender man who had received testosterone for 3 years had an unplanned pregnancy during discontinuation of treatment. He was unaware of his pregnancy, resumed testosterone, and continued treatment until pregnancy was confirmed. His female child was exposed to androgens during the fetal period; thus, careful, long-term observation was required. He developed insomnia and depression during the postpartum, and giving birth made it difficult for him to change his family register to male. Transgender men can become pregnant through sexual intercourse with biological men, even during hormone replacement therapy, so correct contraception is necessary to avoid unwanted pregnancies. Transgender sex education is important to increase awareness of this issue among individuals and medical professionals.

<h4>Introduction</h4>Transmasculine people experience incongruence between their gender identity and sex (registered female at birth, AFAB). Little is known about transmasculine pregnancy. This project systematically reviews all published quantitative evidence on transmasculine pregnancy occurrence, associations, and outcomes, using midwifery, obstetric, and transgender health expertise.<h4>Material and methods</h4>Prospero protocol CRD 42020159034. Searches combined concepts of "transmasculine," registered/assigned female at birth (AFAB), and "pregnancy," using broad, inclusive sets of MeSH terms and keywords. Database searches: Embase, Maternity and Infant Care and Medline (OVID platform), and CINAHL (EBSCO platform) were searched from 2000 to August 2024, with no language restrictions. Included study references and relevant systematic reviews were also searched.<h4>Results</h4>From 2166 citations, 44 studies were included, many of which were small and uncontrolled.<h4>Primary outcome</h4>The mean proportion of transmasculine people ever having been pregnant (gravidity) was 5.6%-8.5% (47/835-321/3777, range 0%-16.3%), and the mean proportion having had births (parity) was 4.3%-8.5% (35/806-24/284, range 0%-19.1%).<h4>Secondary outcomes</h4>The conception rates during testosterone use were low, but insufficient to rely upon as contraception; miscarriage rates appeared high (4/5 studies had rates between 31.6 and 40%-16/40 per person, 156/493 per pregnancy). Similarly, postnatal depression rates (two studies) range 15-58% (3/20-7/12). The limited data available suggested that testosterone use before pregnancy seemed to be associated with fewer conceptions compared to never having taken it, even where transmasculine people had stopped for several months before attempting conception. Pregnancy loss seemed to be higher in those exposed to testosterone antenatally. There was no or inadequate data on most other important outcomes, including access to care, assisted reproduction, stillbirths, and obstetric and neonatal complications.<h4>Conclusions</h4>A significant minority of transmasculine people become pregnant, including after transition. The miscarriage findings warrant further investigation. Reproductive and maternity services should adapt, although minimal information risks negative consequences for users and providers, potentially adding to the lack of trust. Better data collection and research are urgently required in order to provide effective services.

Abstract Purpose To assess the prevalence of cervical cancer precursor lesions in transgender men who have undergone screening by Pap smear, with the intent of contributing with data for the formulation of public policies to widen access to this population. Methods observational studies were selected, with no language or year restrictions, which presented Pap smear results in transgender men. Reviews, case reports and qualitative studies were excluded. The PRISMA guidelines were followed. The risk of bias was assessed using the “NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies”. Results Eleven studies met the inclusion criteria. The prevalence of precursor lesions in transgender men was 0.8%, which is in line with the rates expected by the BETHESDA system for women. However, there was a very high rate of unsatisfactory results in this population (10%), compared to what was expected by the BETHESDA system (1%). Conclusion There is no difference between the prevalence of cervical cancer precursor lesions among transgender men and the expected population prevalence. The number of unsatisfactory tests is high, probably due to the use of testosterone by this population, which makes difficult to collect the material. Studies on transgender men are limited and heterogeneous, and mostly American, limiting the quality of evidence. We suggest that cervical cancer screening policies include, in the exams, information about transgender status and the use of testosterone so that we can reflect on the real health situation of trans men in the context of prevention.

Transgender people can become pregnant.