Testosterone & pregnancy

Testosterone may be taken by transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) , and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. (TTNB) people to reduce estrogen-related features, induce development of testosterone-related features, and relieve gender-related distress.  

Testosterone may cause amenorrhea, but it is not an effective contraceptive. People who have a uterus can become pregnant while taking testosterone [1,2].  

 This information is provided for general clinical guidance. For questions related to specific clinical situations, clinicians may use eCase or call the RACE Line A phone consultation line for primary care providers, staffed by physicians who are experts in trans health care. at 604-696-2131 or toll free at 1-877-696-2131 and request the “Transgender Health'' option to consult an experienced provider.  

There is limited research on testosterone and pregnancy, however, it is considered teratogenic and may cause virilization of the external genitalia of the female fetus [1,3,4]. 

Discontinuing testosterone for pregnancy

Unplanned pregnancy while on testosterone

Unplanned pregnancies can occur in people who are taking testosterone and have a uterus [10,11]. In the case of an unplanned pregnancy, clients should be counseled on their reproductive options. If planning to continue with the pregnancy, they should be encouraged to discontinue testosterone immediately. If pregnancy is already advanced, consider referral to an obstetrician experienced in provision of gender-affirming care Processes through which a health care system cares for and supports an individual while recognizing and acknowledging their gender and expression. with TTNB clients to determine potential testing and monitoring needs related to testosterone use during pregnancy. 

Coleman E, Radix AE, Bouman WP, Brown GR, De Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse Refers to gender roles and/or gender expression that do not match social and cultural expectations. people, Version 8. International Journal of Transgender Health. 2022;23: S1–S259. doi:10.1080/26895269.2022.2100644

Yoshida A, Kaji T, Imaizumi J, Shirakawa A, Suga K, Nakagawa R, et al. Transgender man receiving testosterone treatment became pregnant and delivered a girl: A case report. Journal of Obstetrics and Gynaecology Research. 2022;48: 866–868. doi:10.1111/jog.15145

Testosterone Cypionate. Depo-testosterone (Testosterone cypionate). 2018. Available: https://pdf.hres.ca/dpd_pm/00046306.PDF

Testosterone Enanthate. Testosterone enanthate. 2023. Available: https://pdf.hres.ca/dpd_pm/00071616.PDF

Stark BA, Mok-Lin E. Fertility preservation in transgender men without discontinuation of testosterone. F&S Reports. 2022;3: 153–156. doi:10.1016/j.xfre.2022.02.002

Greenwald P, Dubois B, Lekovich J, Pang JH, Safer J. Successful In Vitro Fertilization in a Cisgender Refers to people who are non-trans, i.e. whose gender matches their assigned sex at birth. Female Carrier Using Oocytes Retrieved From a Transgender Man Maintained on Testosterone. AACE clin case rep. 2022;8: 19–21. doi:10.1016/j.aace.2021.06.007

Charter R, Ussher JM, Perz J, Robinson K. The transgender parent: Experiences and constructions of pregnancy and parenthood for transgender men in Australia. International Journal of Transgenderism. 2018;19: 64–77. doi:10.1080/15532739.2017.1399496

 Ellis SA, Wojnar DM, Pettinato M. Conception, pregnancy, and birth experiences of male and gender variant gestational parents: It’s how we could have a family. Journal of Midwifery & Women’s Health. 2015;60: 62–69. doi:10.1111/jmwh.12213

MacDonald T, Noel-Weiss J, West D, Walks M, Biener M, Kibbe A, et al. Transmasculine Refers to trans people who were assigned female at birth and whose gender expression leans towards the masculine. individuals’ experiences with lactation, chestfeeding, and gender identity A person's deeply held, internal sense of themself as male, female, a blend of both or neither. (Source: GenderSpectrum.org) : A qualitative study. BMC Pregnancy & Childbirth. 2016;16: 1–17. doi:10.1186/s12884-016-0907-y

Light AD, Obedin-Maliver J, Sevelius JM, Kerns JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstetrics & Gynecology. 2014;124: 1120–1127. doi:10.1097/AOG.0000000000000540

MacDonald T, Walks M, Biener M, Kibbe A. Disrupting the norms: Reproduction, gender identity, gender dysphoria Distress resulting from a difference between a person’s gender and their sex assigned at birth, associated gender role, and/or primary and secondary sex characteristics. (Source: WPATH) , and intersectionality. International Journal of Transgender Health. 2021;22: 18–29. doi:10.1080/26895269.2020.1848692