To describe use of three types of longer-acting contraception—intrauterine devices, subdermal contraceptives, and depot medroxyprogesterone—among transmasculine and cisgender women patients.
A repeated cross-sectional study using electronic medical records of patients, age 18 to 45, receiving care within Kaiser Permanente Northern California between 2009 and 2019. Variations in demographics, clinical characteristics and contraception method uptake were assessed using t tests for continuous variables and chi-square tests for categorical variables for patients enrolled in 2019. A linear trend test for each group was used to assess the age-adjusted uptake of contraception methods by study year.
The transmasculine group was younger, with a mean age of 27.3 years (±7.2) vs 32.5 years (±7.8) years, respectively p < 0.001. The transmasculine group used more tobacco, alcohol, and illicit drugs. The uptake of these contraception methods increased from 2009 to 2019 for both groups (transmasculine: 0.7% to 4.1%; cisgender: 5.6% to 6.7%) with a positive linear trend for both groups (p = 0.003 and p < 0.001, respectively). The change in uptake of any intrauterine device from 2009 to 2019 was greater for the transmasculine group (0.3% to 2.3% vs 3.3% to 3.5%). Etonogestrel implant uptake had a positive linear trend from 2009 to 2019 for both groups (transmasculine: 0% to 0.5%, p = 0.02, and cisgender 0.1% to 1.2%, p < 0.001).
Annual uptake of these contraception methods increased significantly for both transmasculine and cisgender groups, and this increase was greater for the transmasculine patients. Uptake of these contraception methods was higher in the cisgender population.
These findings suggest an improvement in use of long-term contraception and menstrual suppression medications for the transmasculine population. Further research is needed to understand these differences and identify a possible unmet need for intrauterine and subdermal contraceptives and depot medroxyprogesterone use among this often-marginalized population.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Contraception
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Growing recognition of transgender health.Bull World Health Organ. 2016; 94 (Doi:): 790-791https://doi.org/10.2471/blt.16.021116
- Age of Individuals who Identify as Transgender in the United States.The Williams Institute, 2017 (Available at:)accessed 14 October 2021)
- Contraception across the transmasculine spectrum.Am J Obstet Gynecol. 2020; 222 (Doi:): 134-143https://doi.org/10.1016/j.ajog.2019.07.043
- Contraception knowledge in transgender individuals: are we doing enough? [9F].Obstet Gynecol. 2018; 131 (Doi:): 65Shttps://doi.org/10.1097/01.AOG.0000533319.47797.7e
- The right to (trans) parent: a reproductive justice approach to reproductive rights, fertility, and family-building issues facing transgender people.Wm Mary J Women L. 2013; 20 (Available at:) (accessed 16 October 2021): 73
- Do Transgender and Gender Diverse Individuals Receive Adequate Gynecologic Care?.An Analysis of a Rural Academic Center. Transgender Health. 2020; 5 (Doi:): 50-58https://doi.org/10.1089/trgh.2019.0037
- Approaches to vaginal bleeding and contraceptive counseling in transgender and gender nonbinary patients.Obstet Gynecol. 2019; 134 (Doi:): 81-90https://doi.org/10.1097/aog.0000000000003308
- Committee on Practice Bulletins Gynecology L-ARCWG. Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.Obstet Gynecol. 2017; 130 (Doi:): e251https://doi.org/10.1097/aog.0000000000002400
- Contraceptive challenges and the transgender individual.Womens Midlife Health. 2018; 4 (Doi:): 12https://doi.org/10.1186/s40695-018-0042-1
- Family planning and contraception use in transgender men.Contraception. 2018; 98 (Doi:): 266-269https://doi.org/10.1016/j.contraception.2018.06.006
- Contraceptive use and pregnancy intentions among transgender men presenting to a clinic for sex workers and their families in San Francisco.Contraception. 2017; 95 (Doi:): 186-189https://doi.org/10.1016/j.contraception.2016.09.005
- Effect of long-term testosterone administration on the endometrium of female-to-male (FtM) transsexuals.J Sex Med. 2009; 6 (Doi:): 3193-3200https://doi.org/10.1111/j.1743-6109.2009.01380.x
- The report of the 2015 U.S. transgender survey.National Center for Transgender Equality, Washington, DC2016 (Available at:)accessed 16 October, 2021)
- Care of the transgender patient.Ann Intern Med. 2019; 171 (Doi:): ITC1-ITC16https://doi.org/10.7326/aitc201907020
- HIV testing by transgender status at Centers for Disease Control and prevention–funded sites in the United States, Puerto Rico, and US Virgin Islands, 2009–2011.Am J Public Health. 2015; 105 (Doi:): 1917-1925https://doi.org/10.2105/ajph.2015.302659
- Worldwide burden of HIV in transgender women: a systematic review and meta-analysis.Lancet Infect Dis. 2013; 13 (Doi:): 214-222https://doi.org/10.1016/s1473-3099(12)70315-8
- Cross-Sex Hormones and Metabolic Parameters in Adolescents with Gender Dysphoria.Pediatrics. 2017; 139 (Doi:)e20163173https://doi.org/10.1542/peds.2016-3173
Published online: November 27, 2021
Accepted: November 11, 2021
Received in revised form: November 10, 2021
Received: May 3, 2021
Conflict of Interest: There are no conflicts of interest to declare. This study was made possible by funding from Kaiser Permanente Northern California Graduate Medical Education Department. All authors were involved in the formulation of the research question, choice of study design, data collection, analysis and decision to publish.
© 2021 Elsevier Inc. All rights reserved.