Contraceptive Counseling for the Transgender Patient Assigned Female at Birth

Okano, Sérgio Henrique Pires; Pellicciotta, Giovanna Giulia Milan; Braga, Giordana Campos

doi:10.1055/s-0042-1751063

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev Bras Ginecol Obstet 44 (9) • 2022 • https://doi.org/10.1055/s-0042-1751063 copy

Contraceptive Counseling for the Transgender Patient Assigned Female at Birth

Aconselhamento contraceptivo para a pessoa transgênera designada mulher ao nascimento

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Although almost 0.7% of the Brazilian population identifies as transgender, there is currently no training for healthcare professionals to provide comprehensive care to these patients, including the discussion of reproductive planning. The use of testosterone promotes amenorrhea in the first months of use; however, this effect does not guarantee contraceptive efficacy, and, consequently, increases the risks of unplanned pregnancy. The present article is an integrative review with the objective of evaluating and organizing the approach of contraceptive counseling for the transgender population who were assigned female at birth. We used the PubMed and Embase databases for our search, as well as international guidelines on care for the transgender population. Of 88 articles, 7 were used to develop the contraceptive counseling model. The model follows the following steps: 1. Addressing the information related to the need for contraception; 2. Evaluation of contraindications to the use of contraceptive methods (hormonal and nonhormonal); and 3. Side effects and possible discomfort associated with the use of contraception. The contraceptive counseling model is composed of 18 questions that address the indications and contraindications to the use of these methods, and a flowchart to assist patients in choosing a method that suits their needs.

Keywords
transgender; contraception; testosterone

Authors	Year of publication	Study Design	Country	Main Results
Krempasky et al.⁹9 Krempasky C, Harris M, Abern L, Grimstad F. Contraception across the transmasculine spectrum. Am J Obstet Gynecol. 2020;222 (02):134–143. Doi: 10.1016/j.ajog.2019.07.043 https://doi.org/10.1016/j.ajog.2019.07.0...	2020	Review	United States	Transgender male patients deserve the same comprehensive access to care as their cisgender female peers. The most appropriate contraceptive is ultimately the one chosen by the patient. After providing introductory information, subsequent detailed contraceptive counseling should be tailored to the options of their interest. Those who desire contraception should be offered a family-planning consultation in which skilled clinicians may provide the service.
Montoya et al.³¹31 Montoya MN, Peipert BJ, Whicker D, Gray B. Reproductive considerations for the LGBTQ+ Community. Prim Care. 2021;48(02): 283–297. Doi: 10.1016/j.pop.2021.02.010 https://doi.org/10.1016/j.pop.2021.02.01...	2021	Review	United States	Understanding contraception, family building, and gender-affirming care are important reproductive health concerns for LGBTQI individuals. Appropriate gender-affirming counseling allows providers to engage in supportive, shared decision-making about contraception with their transmasculine patients. Testosterone therapy is not a substitute for contraception, even when amenorrhea is achieved.
Nisly et al.³²32 Nisly NL, Imborek KL, Miller ML, Kaliszewski SD, Williams RM, Krasowski MD. Unique primary care needs of transgender and gender non-binary people. Clin Obstet Gynecol. 2018;61(04): 674–686. Doi: 10.1097/GRF.0000000000000404 https://doi.org/10.1097/GRF.000000000000...	2018	Review	United States	Nonhormonal intrauterine devices are frequently used; therefore one should avoid not only the hormone effect from hormonal birth control forms but also the perception of the hormone effect, which can be frightening to a transgender man who would not like to have estrogen or progestogen effect. TM fear the effects associated with estrogen or progesterone-containing contraception methods, including reduction of clitoral size or breast enlargement or masculinization reversal.
Gorton et al.³³33 Gorton RN, Erickson-Schroth L. Hormonal and surgical treatment options for transgender men (Female-to-male). Psychiatr Clin North Am. 2017;40(01):79–97. Doi: 10.1016/j.psc.2016.10.005 https://doi.org/10.1016/j.psc.2016.10.00...	2017	Review	United States	Hormone therapy provides significant benefits, allowing many patients to live as male in society by 2 years of treatment. No increased risks of malignancy or cardiovascular end points with hormonal therapy are demonstrated in the literature, although minor increases might not be detectable at the current level of evidence.
Obedin-Maliver et al.³⁴34 Obedin-Maliver J, de Haan G. Gynecologic care for transgender adults. Curr Obstet Gynecol Rep. 2017;6(02):140–148. Doi: 10.1007/s13669-017-0204-4 https://doi.org/10.1007/s13669-017-0204-...	2017	Review	United States	If there are no contraindications to combined oral contraception, a continuous low-dose regimen can be prescribed. Levonorgestrel-releasing intrauterine systems are also an option, especially for patients who have a contraindication to, or conceptual aversion to, estrogen-containing compounds. Injectable medroxyprogesterone acetate or daily oral progestin can also be considered for persistent menses.
Mehringer et al.³⁵35 Mehringer J, Dowshen NL. Sexual and reproductive health considerations among transgender and gender-expansive youth. Curr Probl Pediatr Adolesc Health Care. 2019;49(09):100684. Doi: 10.1016/j.cppeds.2019.100684 https://doi.org/10.1016/j.cppeds.2019.10...	2019	Review	United States	Combined oral contraception can be used for both contraception and menstrual suppression. Combined oral contraceptives are less effective than long-acting contraceptive methods. Estrogen may be perceived to be a “feminine” hormone. Ring may be a less desirable option for some transmasculine individuals who may not identify with the anatomical location of insertion. Depot medryprogesterone acetate is often a popular option for menstrual regulation among transmasculine youth because the progestin has a more androgenic effect compared with other progestins. Intrauterine devices contain no hormones, and, as a result do not provide menstrual suppression. Bleeding patterns with the hormonal intrauterine devices are variable. Bleeding patterns of etonogestrel implants are very unpredictable, and may include irregular prolonged bleeding or spotting, amenorrhea, or increased frequency of bleeding.
Wilczynski et al.³⁶36 Wilczynski C, Emanuele MA. Treating a transgender patient: overview of the guidelines. Postgrad Med. 2014;126(07): 121–128. Doi: 10.3810/pgm.2014.11.2840 https://doi.org/10.3810/pgm.2014.11.2840...	2014	Review	United States	Oral progestins (medroxyprogesterone) to decrease androgen secretion. Oral contraceptives can be used to stop menses.

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Sérgio Henrique Pires Okano Av. Costábile Romano, 2201, 14096-900, Ribeirão Preto, SP Brazil (e-mail: sergio.okano@usp.br).