Pregnant trans men should not be pressured to stop taking testosterone, despite the risks it poses to babies, researchers have controversially argued in a government-funded study.
Current maternity care guidelines for trans men — biological women who identify as the opposite sex — recommends discontinuing hormone treatment during pregnancy.
The NHS warns that it ‘may affect the baby’s development’, with some studies linking exposure to the male sex hormone in the womb to genital abnormalities.
Testosterone is listed in the US as a ‘Category X’ substance during pregnancy because of the dangers it poses to a fetus.
But a panel of experts, including three from Britain, said current advice focuses too heavily on preventing birth defects in babies.
Transgender man Caleb Bolden, 27, (left) from Chatteris, Cambridgeshire, stopped taking testosterone and had a baby after his partner found out she couldn’t have children
Objections to the use of testosterone during pregnancy are too focused on producing “normal” babies, they argued.
Instead, the team – which received a £500,000 grant from a subsidiary of UK’s UK Research and Innovation to conduct research into trans men’s experiences – suggested that NHS guidelines should be shifted to better support trans men in adhere to their gender identity.
The three British experts were sociologists from the universities of Sheffield, Westminster and Glasgow.
American bioethicists Jennifer Lahl and Kallie Fell called the findings “insane.”
Write for the website Reality’s last battlethey said, “Adhering to their paper’s guidelines would leave us in a vacuum without medical ethics and a seismic shift away from the importance of scientific research and medical evidence in favor of activist-led health care.”
Testosterone is considered teratogenic, meaning it has been linked to birth defects.
Female fetuses are particularly vulnerable to the effects, scientists believe.
High levels of the hormone in the mother’s body have been linked to problems with genital development, a process called masculinization.
Studies suggest that this can lead to incontinence and infertility, and cause later psychological consequences later in life.
Write in the journal SSM – Qualitative Research in Healththe researchers, made up of experts from the US, Australia and Italy, argued that such concerns should take a back seat to the harm trans men could suffer from not taking their hormones.
“Patients and providers alike tend to pursue progeny-centered treatment approaches out of precaution,” they wrote.
These approaches rewrite binary conceptions of sex resulting in social control in their attempts to protect against non-normative possible future outcomes for offspring.
“These progeny-focused risk avoidance strategies and approaches, in our view, are part of the gendered precautionary work of pregnancy and maternity care itself, and not without potentially harmful consequences for transgender people.”
Healthy baby Isla-Rae Bolden was born in May at West Suffolk Hospital
Caleb (right) started menopause six years ago – at the same time he started trying to have a child via a sperm donor with partner Niamh Bolden, 25 (left)
They based their arguments on a survey of 70 transgender people and on responses from 22 health care providers who worked with transgender people.
Most of the trans men they surveyed feared stopping testosterone treatment during pregnancy, it was claimed.
Concerns included fear of losing facial hair, change in voice, and being mistaken for a woman.
Others feared they would get the wrong gender, which could result in “increased levels of body dysphoria and depression.”
Some volunteers described their resistance to testosterone withdrawal during pregnancy and explicitly stated that they had wanted to be a ‘pregnant man’.
Healthcare providers gave mixed answers in the guidance they provided.
But most offered a “precautionary approach,” warning trans men of the potential risk testosterone poses to their baby.
The authors were critical of this approach, writing that such advice “may not fully account for the extent to which some transgender people’s sense of self and well-being are associated with continued testosterone therapy.”
A UK research and innovation spokesperson told MailOnline that the project was funded by the Economic and Social Research Council.
They added: ‘The Economic and Social Research Council invests in a diverse research and innovation portfolio. Decisions to fund the research projects we support are made through a rigorous process of peer review by relevant independent experts from academia and industry.’
Trans men are biological women who identify as men. They can still get pregnant – provided the necessary organs, such as the uterus, have not yet been removed.
Instead of paying an estimated £70,000 to Niamh for private fertility treatment, Caleb stopped his daily testosterone injections and used a sperm donor. Six months later he became pregnant
Many take an artificial version of testosterone, which can shrink breast tissue, stop their periods and cause facial hair to grow on their faces, to help them live out their new gender identity.
This helps address feelings of gender dysphoria, the distress they experience when they’re in a body that doesn’t match their gender identity.
The medical community is still uncertain about the full extent of the risk testosterone poses to a developing fetus and how factors such as dosage or levels of other natural hormone levels play a role.
This is partly due to the relative rarity of trans men having children, and little is known about the long-term effects of children whose parents took testosterone during pregnancy.
The NHS advises that the use of testosterone during pregnancy is not recommended as it ‘may affect the development of the baby’.
However, it adds that trans men should talk to their doctor before quitting because “you may find that being pregnant triggers feelings of gender dysphoria.”
In the controversial “breastfeeding advice” section, officials also warn that the hormone can pass into breast milk, but don’t go so far as to advise against it.
“It’s unclear what effect this could have on your baby,” it says.
The U.S. Food and Drug Administration classifies testosterone as a “Category X” during pregnancy.
In summary, this means that there is evidence that it poses a risk to a fetus and that ‘the risks of using the drug in pregnant women clearly outweigh any potential benefits’.
Testosterone can also make it harder for trans men to get pregnant in the first place.
This leads many to choose to interrupt their treatments while trying to conceive.
That was the case for Chatteris trans man Caleb Bolden, who decided to get pregnant from a sperm donor after his partner found out she couldn’t have children.
Mr Bolden, 27, began menopause six years ago – at the same time he started trying to have a child via a sperm donor with his partner Niamh Bolden, 25.
But Ms Bolden suffered three miscarriages and a stillbirth of twins at 23 weeks and 27 weeks before being told she would probably never have children.
Although private fertility treatments were an option, the couple were told it could cost £70,000.
Instead, Mr. Bolden stopped his daily testosterone treatments to help the couple achieve their dream of starting a family.
Six months later, he got pregnant from a sperm donor he found on social media, and Isla-Rae Bolden was born in May.
Despite nasty comments from strangers and suffering from gender dysphoria during pregnancy, the store manager said he loves being a dad — and plans to do it again.
“It was a tough road to get rid of testosterone because there were so many hormones going through my body,” he said.
“It was soul-destroying. Switching was something I knew I wanted to do from a young age.
“But I knew for myself and my partner that it was something we had always wanted and I wanted to try.
“If it’s age appropriate, I’ll tell her the things that are relevant. I want other transgender people to know that it’s okay to carry a child.
“We are no different from other people. Just because we were born with a biologically different gender doesn’t mean we should worry or lock ourselves up.”
Trans women, people who are biologically male but identify as female, cannot get pregnant, although some scientists argue it is only a matter of time before this becomes possible.
The topic of trans women using hormones while breastfeeding came into the spotlight recently after Mika Minio-Paluello, a former Labor special adviser, shared a photo of her breastfeeding her child on a bus.