Ask the Expert: How do trans men navigate reproductive health?

April 28, 2022 - Liz Schondelmayer, Karessa Weir

Dr. Carla A. Pfeffer is an associate professor within the MSU School of Social Work, the director of the Consortium for Sexual and Gender Minority (SGM) Health, and affiliate faculty in the Department of Sociology and Center for Gender in Global Context. Dr. Pfeffer's research centers on the health and wellness of marginalized people - including members of the LGBTQIA+ community.

A major topic within Dr. Pfeffer's research is the experiences of transgender men and transmasculine non-binary people navigating reproductive care. Below, Dr. Pfeffer (pictured left) shares more about the central themes of her research, as well as explains the biases and discrimination that some gender-diverse people face when seeking medical care. 

Whaare the major themes that drive your research?

I tend to look at health and well-being across marginalized populations, including those who are LGBTQIA+ as well as people of various body sizes. I'm always looking at the people at the margins to get a sense of what's happening at the center. I like to think about how people at the center enact power to control the margins in particular ways. I examine social stigma, bias and discrimination as well as individual and collective resistance among those who are marginalized.

What questions surrounding reproductive health for trans people are you answering through your research?

In general, this research is looking at individuals categorized female at birth who later come to live their lives as men, trans men, or non-binary, and getting a sense of their thoughts about reproduction. What are their hopes or aspirations around reproduction? What conversations are they having with their healthcare providers, community members and/or partners? What are their experiences around things such as conception, pregnancy, chestfeeding, abortion, postpartum care and fertility preservation? This research is meant to be a full-spectrum, holistic analysis of what reproduction is like for trans and non-binary people who have ovaries and/or a uterus.

What kind of challenges do trans men and non-binary people face when seeking reproductive care?

Some challenges are administrative in nature. For example, in some places in the United States, if you are the natal parent (meaning the parent giving birth to the child), you are automatically considered the mother on a birth certificate. Though we've seen changes in how people are able to change their name as well as their sex and gender markers on official documents, these things are state-dependent - we still don't have a national policy in place - which creates a legal patchwork of confusion across the country. Additionally, in some insurance coding and classification systems, there are no built-in options for male birth, meaning that insurance coverage can be denied due to bureaucratic claims processing within electronic medical records systems. This often means that trans men and their families have to jump through a lot of hoops just to make sure that their pregnancy and childbirth are covered expenditures under their insurance plan.

Other challenges can start before you even end up in the doctor's office. For example, if you're a transmasculine person using public transportation, you're nine months pregnant, and your back is killing you, people may not realize you're pregnant and give up their seat for you as they may have for a pregnant cisgender woman. Additionally, if someone is more gender-ambiguous, they may be putting up with a lot of stares in public, which may make them feel more stigmatized.

In the doctor's office, reproductive spaces are often heavily coded toward cisgender womanhood, with terms such as "women's care" and "maternity ward," which often exclude trans men through their naming practices. The walls are often painted in pastels and covered with pictures of feminine people in hyper-feminine maternity clothes - which, by the way, are depictions that also do not resonate for many cisgender women. Patients may be expected to wear pink medical gowns and/or experience doctors using gendered language and incorrect terms for their body parts that make them feel extremely uncomfortable. Furthermore, if you are a trans man attending an appointment alone, sometimes people will not recognize you as the patient and will either misgender you or call you by the wrong name, which can create a lot of discomfort. If you are with a feminine-presenting partner, doctors and staff may assume that your partner is pregnant rather than you.

What efforts are being made by medical professionals and physicians to become better educated and more inclusive in regards to some of the challenges you've outlined?

There has not only been pressure from the community for change, but also from groups of health care providers who have recognized that they are ill-informed to serve their trans patients in a way that upholds their imperatives toward patient-centeredness, ethical practice and "first, do no harm." There is a big push for research to provide empirical evidence of best practices for patient-centered positive health care practice and outcomes. There are certainly progressive groups of doctors, nurses, midwives, social workers, therapists and other health professionals advocating for trans-affirmative care, which shows that change is happening - slowly, but it's still happening, which is encouraging to see.

What other research are you doing to better understand the experiences of trans people and their partners?

One of my publications studied cisgender women partners of transgender men with a focus on normative resistance and inventive pragmatism. In the article, I explore the ways that cisgender women in these relationships resist heteronormativity when people assume that they and their partners are a typical heterosexual couple and try to reaffirm their queer identities. But, in other situations, they also strategically embrace and engage in an inventive pragmatism. When it fits their and their partner's needs, they can draw upon the misrecognition of their identity to get needed social resources, ranging from reproductive technologies to parental acceptance. I've been happy about being able to take this theory that I developed for one research project and apply it to my research on trans pregnancy in another article exploring conception.

Finally, what other research pertaining to these questions are you hoping to conduct?

In many cases, doctors have advised pregnant transmasculine people to stop administering testosterone during their pregnancy and immediately postpartum and I'd like to understand why. Is it based on medical literature and the biology of pregnancy or something else? I see why a pause in testosterone can contribute to the greatest likelihood of becoming pregnant, but I'm not convinced that stopping testosterone administration altogether during pregnancy should be the rule.

The empirical justifications that many doctors and physicians are using when they make that judgment, from the data I'm collecting, seem to center around concerns that increased exposure to androgens (like testosterone) in the fetal environment is associated with an increased likelihood of the child being lesbian, transgender, autistic or having a higher body weight. If these are really many of the primary concerns that doctors are trying to prevent, I'm concerned that this reflects eugenicist-type thinking and aims to erase many of the very same groups of people I focus on in my research.  

Learn more about Dr. Pfeffer and her research here.