At a glance
This page includes recommendations for health care providers that address testosterone use and risk for pregnancy, including offering contraceptive counseling and services to those who are at risk for and do not desire pregnancy. This information comes from the 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR).
Testosterone use and risk for pregnancy
- Counsel that testosterone use might not prevent pregnancy among transgender, gender diverse, and nonbinary persons with a uterus who are using testosterone. Offer contraceptive counseling and services to those who are at risk for and do not desire pregnancy.
Comments and Evidence Summary
Transgender, gender diverse, and nonbinary persons assigned female sex at birth often have a uterus, ovaries, and fallopian tubes.[60] In a national survey of transgender, gender diverse, and nonbinary persons assigned female or intersex at birth, 54% of pregnancies were reported to be unintended, 61% of respondents did not want to be pregnant in the future, and 11% of respondents considered themselves to be at risk for pregnancy when they did not want to be pregnant.[61] Some transgender, gender diverse, and nonbinary persons use testosterone for gender-affirming hormone therapy. Although certain regimens of testosterone might suppress fertility, testosterone therapy has not been studied as contraception. Testosterone is teratogenic and might have androgenic effects on fetal genitalia, reproductive systems, or endocrine systems.[62] Evidence on the safety and effectiveness of hormonal contraceptive use among transgender, gender diverse, and nonbinary persons with a uterus who are using testosterone is limited.[63] Professional organizations provide information on contraceptive and reproductive health care for transgender, gender diverse, and nonbinary persons.[63–67]
A systematic review identified one study that assessed risk for pregnancy among transgender, gender diverse, and nonbinary persons assigned female sex at birth using testosterone (Supplementary Appendix, https://stacks.cdc.gov/view/cdc/156517).[68] This noncomparative study followed 16 continuing testosterone users and six new testosterone users (who started testosterone at the beginning of the study) for 12 weeks and assessed the occurrence of ovulation as a proxy measure of risk for pregnancy through daily urine samples; ovulation was defined as urinary pregnanediol-3-glucuronide (PdG) >5 µg/mL for 3 days. One (5%) participant ovulated, who was a new testosterone user. When using a lower threshold of PdG >3 µg/mL for 2 days, 36% of participants ovulated (100% of new users and 13% of continuing users) (Certainty of evidence: very low).