Contraception options for gender minorities

If you have a uterus and ovaries, you have penis-in-vagina sex, and you don’t want to get pregnant – you need to think about contraception.

If you get a period, and you don’t want to, there are some forms of contraception that can stop menstruation. These options won’t make you look more masculine, but they might help relieve discomfort caused by bleeding.

If you want to start contraception to stop your period – or for any other reason than to prevent pregnancy – you’ll need to talk to a doctor first. 

Some people think that gender-affirming hormone therapy can prevent pregnancy. This is a myth. You can still get pregnant, or get someone else pregnant, if you’re on gender-affirming GAHT.

If you have a uterus and ovaries, GAHT usually involves taking testosterone (T). Testosterone can stop your period.

Even if your period has stopped on T, you can still get pregnant if you have sex with somebody who has a penis and testicles.

If you have a penis and testicles, GAHT usually involves taking two types of medication – one helps increase the oestrogen in your body, and the other helps you produce less testosterone.  

Even if you’re on medication to reduce your testosterone levels, you can still get your sexual partner pregnant if they have a uterus and ovaries. 

If you have a penis and testicles, you can get condoms and STI testing and treatment from Sexual Wellbeing Aotearoa – and lots of other places. The cheapest way to get condoms is on prescription. 

Some people choose to have a vasectomy. A vasectomy – or “the snip” – is a permanent form of contraception. It’s a small operation that stops sperm being released when you cum. We can’t help with this – you need to see your doctor or a specialist to find out more about getting a vasectomy. 

These options use hormones, including the hormone progestogen, to prevent pregnancy. There’s no evidence that progestogen makes gender-affirming testosterone less effective or causes feminisation. 

• taking a pill every day (the combined oral contraceptive pill, or the progestogen-only contraceptive pill)
• having a hormonal IUD inserted into your uterus by a trained nurse or doctor (these can last up to 8 years). (By the way, there’s also the copper IUD that doesn’t contain hormones)
• getting an implant in your arm (this can last up to 5 years)
• getting a Depo Provera injection every three months 

Condoms are the only form of contraception that also protects you from many STIs. You can get external condoms (which fit over the penis) for free at many places, including Sexual Wellbeing Aotearoa clinics. Another option is to use internal condoms (which fit inside the vagina or anus). These are more expensive and less common than external condoms, but some people prefer them. You can find them on our webshop.

There's also a non-hormonal IUD option – the copper IUD – that you can have inserted into your uterus.

Some people choose more permanent contraception options, like having their tubes tied (tubal ligation) or having a hysterectomy. These are permanent surgical procedures. We don't do these at Sexual Wellbeing Aotearoa.   

Testosterone won’t interfere with any form of contraception. But there are some forms of contraception (like the copper IUD and the implant) that can cause irregular bleeding in people who still get periods. This might make these options less appealing. 

Contraception like Cerazette (a progestogen-only pill you can take every day), Depo Provera, and the hormonal IUD are the best options for stopping bleeding. 

Most contraception uses hormones. The combined contraceptive pill (a pill you can take every day) is the only contraception option that uses oestrogen – the feminising hormone. Others use progestogen. There’s no evidence that progestogen interferes with gender-affirming testosterone, but some trans and non-binary people still feel uncomfortable with it. It’s up to you to decide what feels right. 
 
If you don’t want to use hormonal contraception, there are a few options. You can use condoms or an IUD. The copper IUD doesn’t contain any hormones. The hormonal IUD does use hormones, but these hormones are released only into your uterus.

One of the best options for preventing pregnancy and menstruation is a progestogen-only pill – Cerazette. This pill works by stopping ovulation. To be effective, this pill has to be taken every day. If taking a daily contraceptive pill isn’t an option for you, there are some other options. 

The hormonal IUD is very effective at preventing pregnancy and stopping menstruation. The copper IUD is very effective at preventing pregnancy. IUDs are a type of long-acting reversible contraception (LARC) – they last for years, and after an IUD has been inserted, you don’t have to think about it until it’s time to have it removed. IUDs need to be inserted into your uterus, and removed, by a trained nurse or doctor. These appointments can trigger gender dysphoria for some people – it’s up to you to decide whether this is something you’re comfortable with. 

The emergency contraceptive pill (ECP) can be taken up to four days after unprotected sex – but it’s best to use it within three days after having sex. It’s safe to use if you’re on T, and it doesn’t contain any oestrogen. 

A copper IUD can inserted up to five days after unprotected sex to prevent pregnancy. As well as being emergency contraception, this is a long-acting reversible contraception (LARC). It can last up to five years. 

But if T has stopped your menstrual cycle, and you’ve had unprotected sex more than once, a copper IUD won’t be a good form of emergency contraception for you. That’s because doctors use the date your period is due to work out if a copper IUD is safe for you. If you don’t get a regular period, they can’t be sure.