Transgender men, pregnancy, and the “new” advanced paternal age: A review of the literature

  • Justin S. Brandt
    Correspondence
    Corresponding author at: Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, United States.
    Affiliations
    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States

    Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
    Search for articles by this author
  • Amy J. Patel
    Affiliations
    Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States

    Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
    Search for articles by this author
  • Ian Marshall
    Affiliations
    Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States

    Division of Pediatric Endocrinology, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
    Search for articles by this author
  • Gloria A. Bachmann
    Affiliations
    Gender Center of New Jersey, Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, United States

    Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
    Search for articles by this author

      Highlights

      • Some transgender men undergo hormonal treatment and/or surgery that preclude pregnancy, but many retain their capacity to become pregnant.
      • The reproductive desires of transgender men appear to be similar to those of cisgender individuals.
      • Many aspects of obstetrical care for transgender men is routine.
      • The provision of gender-affirming services and close monitoring for depression and worsening gender dysphoria are needed.
      • Research is needed to clarify the prevalence of pregnancy among transgender men of advanced paternal age as well as the risks and long-term impacts.

      Abstract

      Transgender men are assigned female at birth, but self-identify as male. Although some transgender men undergo gender-affirming hormonal treatment and/or surgery that preclude pregnancy, many (if not most) retain their female reproductive organs and, as a result, their capacity to become pregnant. Although the visibility of the transgender community has increased, the exposure of healthcare providers to transgender individuals, especially transgender men during pregnancy, as well as research that addresses evidence-based practice remain limited. In this review, we discuss obstetrical issues for transgender men who are ≥35 years old, termed the “new” advanced paternal age. We review preconception care and focus on fertility issues, the impact of stopping gender-affirming hormonal treatment, and age-appropriate health maintenance. We review antepartum and postpartum care, including labor and delivery, monitoring for perinatal depression, contraception, and chest feeding. Finally, we conclude with suggestions for areas for further research and study.

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Trebay G.
        He’s Pregnant. You’re Speechless.
        New York Times, 2008
        • Beatie T.
        Labor of Love: Is Society Ready for This Pregnant Husband?.
        The Advocate, 2008
        • Slotnick D.
        Bruce Jenner Says He’s Transitioning to a Woman.
        New York Times, 2015
        • Hoffkling A.
        • Obedin-Maliver J.
        • Sevelius J.
        From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers.
        BMC Preg Child. 2017; 17: 332
        • James S.
        • Herman J.
        • Rankin S.
        • et al.
        The Report of the 2015 US Transgender Survey.
        National Center for Transgender Equality, Washington DC2016
        • Grant J.
        • Mottet L.
        • Tanis J.
        • et al.
        Injustice at Every Turn; A Report of the National Transgender Discrimination Survey.
        National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington DC2011
        • Vance Jr, S.R.
        • Halpern-Felsher B.L.
        • Rosenthal S.M.
        Health care providers’ comfort with and barriers to care of transgender youth.
        J. Adolesc. Health. 2015; 56: 251-253
      1. Committee Opinion, No. 512. Health care for transgender individuals.
        Obstet. Gynecol. 2011; 118: 1454-1458
        • Berger A.
        • Potter E.
        • Shuttes C.
        • et al.
        Pregnant transmen and barriers to high quality healthcare.
        Proc. Obstet. Gynecol. 2015; 5: 1-10
        • Grinberg E.
        • Kantor A.
        • Walker C.
        To Be Herself, She Needs to Change Her Body. But First, Comes the Battle With Insurers.
        (Available from:)2018
      2. Committee Opinion, No. 685: care for transgender adolescents.
        Obstet Gynecol. 2017; 129: e11-e16
        • Makadon H.
        • Mayer K.
        • Potter J.
        • et al.
        Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health.
        2nd ed. The Fenway Institute, Philadelphia2015
        • Kuper L.E.
        • Nussbaum R.
        • Mustanski B.
        Exploring the diversity of gender and sexual orientation identities in an online sample of transgender individuals.
        J. Sex Res. 2012; 49: 244-254
      3. Gender Dsyphoria. Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
        4th ed. American Pyschiatric Association, Washington DC2013
        • Coleman E.
        • Bockting W.
        • Botzer M.
        • et al.
        World Professional Association for Transgender Health standards of care for the health of transsexual, transgender, and gender-nonconforming people. 7th Ed.
        Transgenderism. 2012; 13: 165-232
        • T’Sjoen G.
        • Arcelus J.
        • Gooren L.
        • Klink D.T.
        • Tangpricha V.
        Endocrinology of transgender medicine.
        Endocr. Rev. 2019; 40: 97-117
        • Hembree W.C.
        • Cohen-Kettenis P.T.
        • Gooren L.
        • et al.
        Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline.
        Endocr. Pract. 2017; 23: 1437
        • Flores A.
        How Many Adults Identify as Transgender in the United State.
        Williams Institute, California2016
        • Obedin-Maliver J.
        • Makadon H.J.
        Transgender men and pregnancy.
        Obstet. Med. 2016; 9: 4-8
        • Ellis S.A.
        • Wojnar D.M.
        • Pettinato M.
        Conception, pregnancy, and birth experiences of male and gender variant gestational parents: it’s how we could have a family.
        J Midwife Wom Health. 2015; 60: 62-69
        • Light A.D.
        • Obedin-Maliver J.
        • Sevelius J.M.
        • et al.
        Transgender men who experienced pregnancy after female-to-male gender transitioning.
        Obstet Gyencol. 2014; 124: 1120-1127
        • Maxwell S.
        • Noyes N.
        • Keefe D.
        • Berkeley A.S.
        • Goldman K.N.
        Pregnancy outcomes after fertility preservation in transgender men.
        Obstet Gynencol. 2017; 129: 1031-1034
        • Chen D.
        • Simons L.
        • Johnson E.K.
        • Lockart B.A.
        • Finlayson C.
        Fertility preservation for transgender adolescents.
        J. Adolesc. Health. 2017; 61: 120-123
        • Armuand G.
        • Dhejne C.
        • Olofsson J.I.
        • Rodriguez-Wallberg K.A.
        Transgender men’s experiences of fertility preservation: a qualitative study.
        Hum. Reprod. 2017; 32: 383-390
      4. American College of Obstetricians and Gynecologists. Good Health Before Pregnancy: Prepregnancy Care.
        2018 ([Available from: https://www.acog.org/Patients/FAQs/Good-Health-Before-Pregnancy-Prepregnancy-Care])
      5. Centers for Disease Control and Prevention. Planning for Pregnancy.
        2018 ([Available from: https://www.cdc.gov/preconception/planning.html])
        • Carolan M.C.
        • Davey M.A.
        • Biro M.
        • et al.
        Very advanced maternal age and morbidity in Victoria, Australia: a population based study.
        BMC Preg Childbirth. 2013; 13: 80
        • Dildy G.A.
        • Jackson G.M.
        • Fowers G.K.
        • et al.
        Very advanced maternal age: pregnancy after age 45.
        Am. J. Obstet. Gynecol. 1996; 175: 668-674
        • Brandt J.S.
        • Cruz Ithier M.A.
        • Rosen T.
        • et al.
        Advanced paternal age, infertility, and reproductive risks: a review of the literature.
        J. Prenat. Diagn. Ther. 2019; 39: 81-87
        • Phillips N.
        • Taylor L.
        • Bachmann G.
        Maternal, infant and childhood risks associated with advanced paternal age: the need for comprehensive counseling for men.
        Maturitas. 2019; 125: 81-84
        • Murad M.H.
        • Elamin M.B.
        • Garcia M.Z.
        • et al.
        Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes.
        Clin. Endocr. 2010; 72: 214-231
        • Hunter M.H.
        • Sterrett J.J.
        Polycystic ovary syndrome: it’s not just infertility.
        Am. Fam. Physician. 2000; 62 (90): 1079-1088
        • Chisolm-Straker M.
        • Jardine L.
        • Bennouna C.
        • et al.
        Transgender and gender nonconforming in emergency departments: a qualitative report of patient experiences.
        Transgend. Health. 2017; 2: 8-16
        • Stroumsa D.
        • Roberts E.F.S.
        • Kinnear H.
        • Harris L.H.
        The power and limits of classification – a 32-year-old man with abdominal pain.
        New England J. Med. Surg. Collat. Branches Sci. 2019; 380: 1885-1888
      6. Committee Opinion, No. 757. Screening for perinatal depression.
        Obstet. Gynecol. 2018; 132: e208-e212
        • Wolfe-Roubatis E.
        • Spatz D.L.
        Transgender men and lactation: what nurses need to know.
        Am. J. Mat. Child Nurs. 2015; 40: 32-38
      7. Testosterone. LactMed.
        2019 (Accessed 13 June 2019). [Available from:
        • Light A.
        • Wang L.F.
        • Zeymo A.
        • Gomez-Lobo V.
        Family planning and contraception use in transgender men.
        Contraception. 2018; 98: 266-269
      8. Testosterone. ReproTox.
        2019 (Accessed 13 June 2019). [Available from: