Transmasculine and Pregnant

This article offers a answer that some of our patients have about pregnancy:

•  Can someone still get pregnant if they are taking gender affirming testosterone hormone replacement therapy (HRT)?
• Can pregnancy reverse the effects of top surgery, causing a growth in mammary tissue?
• If I want to chest/breastfeed, should I wait until after having a child to get top surgery?

Can trans people get pregnant?

Pregnancy can be a possibility for many people who have not undergone a hysterectomy (removal of the uterus), oophorectomy (removal of one or more ovaries) or vaginectomy (removal of the vagina). Generally speaking, most people who take testosterone HRT experience a stopping of their menstrual cycle. Trans people taking testosterone HRT who would like to get pregnant are recommended to stop their gender affirming hormone treatment.

The consensus in the medical literature is that people on gender affirming testosterone HRT can usually resume their menstrual cycle 3-6 months after stopping therapy [1]. That said, a study published in 2023 found that in a cohort of 18 trans men, it took a median of 7.7 weeks off testosterone for ovarian stimulation to restart so that they could begin fertility preservation or in vitro fertilization (IVF) [2].

Do you need fertility treatments to become pregnant?

Everyone’s ability to conceive varies based on your own genetic makeup. However, there’s no evidence at this time that says being on testosterone at any point in your lifetime causes complications in conceiving. You can read more about fertility preservation and fertility treatments here.

Can pregnancy reverse the effects of top surgery, causing a growth in mammary tissue?

Overall, there is no scientific consensus on whether or not former top surgery patients will experience growth in their mammary tissue during pregnancy. There is little data to demonstrate whether or not certain surgical techniques are associated with lesser likelihood of chest regrowth during pregnancy. One study found that even across patients who underwent double incision top surgeries with nipple grafts, there were no consistent results; some experienced no tissue regrowth while others experienced a minimal regrowth of mammary tissue during pregnancy. The two participants that reported significant chest growth, bringing them back to pre-top surgery size, underwent the keyhole surgery with liposuction and the other underwent a double incision without a nipple graft [3].

Can trans people chest-feed (breastfeed) after top surgery?

Though there is sparse medical research on the subject, many people who have been on testosterone hormone replacement therapy (HRT) and/or have had top surgery can still carry a pregnancy to term. There is evidence to suggest that some top surgery patients may experience mammary tissue growth during pregnancy. For more information about chestfeeding, HRT, top surgery and pregnancy, click here. For more specific questions, we recommend speaking with a trans or gender-competent medical provider. In the video below, Dr. Jacobs (he/him) addresses the unlikelihood that patients will be able to chest-feed after top surgery. Still, he mentions, there is a chance that the infant can bond with their parent’s chest even if they are incapable of milk production.

Sources:

[1]: https://www.fertilityiq.com/trans-masculine-fertility/assigned-female-at-birth

[2]: https://www.fertstertreports.org/action/showPdf?pii=S2666-3341%2823%2900004-1)