A visit to the OB/GYN can leave you feeling vulnerable. Everyone should have a doctor who puts them at ease. But if you’re a transgender man or nonbinary person who’s pregnant or trying to be, it’s key that your doctor know and respect your medical needs.
“Pregnancy should be an exciting time,” says Amanda Kallen, MD, a Yale Medicine gynecologist and reproductive specialist. “Maybe not necessarily fun all the time, but it should feel like you have a voice and you’re able to participate in your own care.”
Here’s how to find a gender-affirming OB/GYN for adults.
There are a growing number of helpful health websites geared toward the LGBTQ+ community. These resources provide the names of lots of different types of providers. When it comes to transgender pregnancy care, you can search for specifics like an OB/GYN, fertility clinic, or birth support.
To learn more:
Do a quick internet search. Simply type in terms like “trans-friendly OB/GYN near me” or “transgender-friendly pregnancy care” and see what you find.
Use LGBTQ+ provider directories. These aren’t typically made by doctors or hospitals. But nonprofit groups like Family Equality only list providers who’ve taken special courses in how to provide inclusive medical care for people in the LGBTQ+ community.
Try searching for an affirming OB/GYN through:
Check with your insurance provider. Your health plan’s website may not have an LGBTQ+ search tool. But someone in customer service may be able to give you a list of OB/GYNs who work with transgender or nonbinary folks.
Look at doctor or hospital websites. Many clinics make it clear they’re an inclusive space. “If there’s material on the website about LGBTQ or transgender family-building, that would be very positive,” says Mindy Christianson, MD, medical director at the Johns Hopkins Fertility Center and an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine.
The internet can be a big help. But there’s a low-tech approach that can be invaluable: word-of-mouth. Ask your friends, family, or colleagues if they go to or know of an affirming OB/GYN.
You can also:
Consult people in your local LGBTQ+ community. Talk to other transgender parents about their pregnancy experience. Or tap into your local network through Facebook groups or in-person meetups.
Check with other doctors. Your regular doctor may know of an OB/GYN who might be a good fit. That’s because it’s common for transgender-friendly medical providers to know about each other. “I get a lot of referrals,” Kallen says.
There’s still a long way to go when it comes to health equity for people who are transgender, nonbinary, or gender-expansive. But you may find that medical care is more welcoming than it used to be. And there are ways to gauge whether you’re in the right place.
A good first test, Kallen says, is to introduce yourself and use your pronouns. Everyone in the office should respect how you’re asking to be addressed. That includes the OB/GYN, nurses, and sign-in staff.
You’ll also want to look for intake forms with:
- Gender-neutral language
- A place for your preferred name and pronouns
- A spot for your gender identity
When it comes to exams and tests, an OB/GYN experienced in transgender health care will think ahead. For instance, Christianson opted to give a transgender man an abdominal ultrasound instead of the transvaginal kind. And that patient didn’t have to ask for it first.
“Afterwards, he was very grateful,” Christianson says, “[He told us], ‘Thank you for making me feel comfortable.’ ”
Your OB/GYN should also help you plan for any health effects that may come along. For example, if you’re on testosterone, you’ll need to halt that during pregnancy. (Testosterone may harm a growing baby.) Many people do just fine with that temporary adjustment, but for some, not taking testosterone to get pregnant and have a baby may cause or worsen gender dysphoria. “If that’s something you’ve struggled with in the past, then it’s a good idea to line up mental health support ahead of time,” Kallen says.
Most OB/GYNs can treat transgender people throughout pregnancy. But this can be an emotional and stressful time. It’s key that you feel safe with your whole medical team. While all clinics should offer supportive care, “some might be better for transgender men,” Christianson says.
You can ask questions of your OB/GYN to find out if they’re a good fit for you. Here are some questions to get you started:
- How do you make visits more comfortable for transgender or nonbinary people?
- Are you aware of the needs of transgender men on and off hormone therapy?
- How soon can I go back on testosterone after pregnancy or chestfeeding?
- Have you and your staff had special training in transgender health care?
- How many transgender pregnant people have you worked with?
If an OB/GYN hasn’t worked with a lot of transgender people, that’s not always a dealbreaker. “Some people may disagree with me,” Kallen says, “but I think the most important thing is a willingness to be respectful, to learn, and to be accommodating.”
There are general issues your doctor will go over, including prenatal vitamins, genetic screenings, and the medication you take. “Everyone should have a pre-conception visit,” Kallen says.
When it comes to transgender pregnancy care, it’s a good sign if your doctor also asks questions like:
- How do you want to learn about labor and delivery?
- Do you know where to look for a safe space for prenatal care and birth?
- Do you plan to feed your baby with milk from your chest?
- If you aren’t chestfeeding, do you want to know about formula?
- Do you plan to use sperm from a partner, or do you need donor sperm?
- Are you on gender-affirming hormones or plan to take them in the future?
- Do you have a partner or other support system?
- How do you plan to prevent unwanted pregnancies after you deliver?
They may also discuss how you plan to prevent pregnancy after you deliver. “Testosterone is not birth control,” Kallen says. “That’s not always communicated clearly.”
Go over your family-building goals early on, especially if you take gender-affirming hormones. Testosterone therapy doesn’t appear to hurt egg quality or lower your chances of getting pregnant later on. But it can stop your period and mask signs of fertility problems.
Tell your OB/GYN if you’re having trouble getting pregnant or have questions about hormone therapy. They may refer you to a reproductive endocrinologist. Those are doctors with special training in how to help people get pregnant.
“And we’re very comfortable understanding the different relationship between hormones and how testosterone plays a role,” Christianson says.
