Pregnant transgender men at risk for depression and lack of care, study finds

Transgender men who become pregnant are at increased risk for depression and difficulty getting medical care due to a lack of knowledge among health care providers, a Rutgers study reports.

The study, published in the journal Maturitas, examined health care research on transgender men who become pregnant at or after age 35 to determine their medical and mental health needs.

"Despite the increased visibility of transgender people—there are about 1.4 million who have transitioned in the United States—medical providers are largely unprepared to care for them and most have had limited educational opportunities," said lead author Justin Brandt, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School.

Transgender men who have transitioned hormonally and are taking testosterone but retain their female reproductive organs have the potential to become pregnant. Since the U.S. medical system has been tracking these patients as female, no data exists on how many transgender men give birth each year, but Brandt said the number is likely higher than people realize. While some plan to become pregnant, the research suggests that occur in up to 30 percent of transgender men.

According to the U.S. Transgender Survey, nearly 40 percent of its 28,000 respondents reported attempting suicide—nearly nine times the national average. That risk can be increased in transgender men with the unwanted physical changes resulting from pregnancy, according to Brandt. "The process of transitioning is long and arduous, and pregnancy, which is regarded as a feminine condition, forces these men to almost fully transition back to their sex assigned at birth, which can worsen gender dysphoria," he said.

Surveys used to screen pregnant and postpartum females for depression are not designed to assess the impact of pregnancy on in transgender men.

The study also found that nearly 25 percent of transgender people reported negative health care experiences in the last year. This correlates with the finding that about 44 percent of pregnant transgender men seek outside of traditional care with an obstetrician. Rather, they may seek out non-physician providers, such as nurse midwives, with 17 percent delivering outside of hospitals—a higher rate than with women.

Although data is limited on how transgender men give birth, the review found that 64 percent had vaginal births and 25 percent requested cesarean delivery.

The report also noted that transgender men who requested cesarean deliveries reported feeling uncomfortable with their genitalia being exposed for long periods of time while those who went through labor reported that the process of giving birth vaginally overcame any negative feelings that they had with the female gender that they had been assigned at birth.

"Although Rutgers physicians have not yet had a pregnant transgender male patient, our healthcare professionals are trained and ready," Brandt said.

The researchers also found that about 51 percent of men breast or chest fed their infants even if they had breast surgery.

Brandt recommended that planning to conceive should visit their doctor before becoming pregnant to address routine issues, such as folic acid supplementation and screening for genetic disorders, and to be counseled on the risks of advanced-age pregnancy, such as infertility, miscarriage, gestational diabetes and pre-term delivery. Transgender men also likely will need to update health screenings that could have lapsed during transition, such as pap smears and, when indicated for those who have not had chest surgery, mammograms.

After delivery, Brandt said doctors should address long-acting and reversible methods of contraception if the individual is at risk for unplanned pregnancy. "Transgender men who intend to restart testosterone after delivery may decide to defer contraception since they perceive that their male hormone therapy induces a state of infertility, which is not always the case," he said.


Explore further

Breaking the barriers to health care for transgender individuals

More information: Justin S. Brandt et al, Transgender men, pregnancy, and the "new" advanced paternal age: A review of the literature, Maturitas (2019). DOI: 10.1016/j.maturitas.2019.07.004
Journal information: Maturitas

Provided by Rutgers University
Citation: Pregnant transgender men at risk for depression and lack of care, study finds (2019, August 15) retrieved 18 September 2019 from https://medicalxpress.com/news/2019-08-pregnant-transgender-men-depression-lack.html
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
5 shares

Feedback to editors

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more