10 essential reproductive health facts every trans person should know

Reproductive health is more than baby-making. It’s about how your body works, how you feel in it, and whether you have access to care that respects who you are

The World Health Organization defines reproductive health as “complete physical, mental and social well-being in all matters relating to the reproductive system.” That includes fertility, contraception, STI prevention, screenings, pregnancy care, abortion access, and the right to make decisions without shame or coercion.

This guide breaks it down through an anatomy-based, trans-informed lens. Your body. Your goals. Your timeline. Take what applies now and bookmark the rest.

1. Reproductive health is bigger than pregnancy

It includes:

• Birth control and pregnancy prevention
• STI screening and safer sex
• Cancer and organ-specific screenings
• Fertility preservation and family-building
• Pain management and menstrual care
• Trauma-informed, gender-affirming providers

Some people want kids. Some never do. Some just want a doctor who uses the right language and doesn’t make assumptions.

All of it counts, and all of it is for us: not just for cis women.

2. Hormone therapy can affect fertility, but not the same way for everyone

Gender-affirming hormone therapy (that is, testosterone, estrogen, anti-androgens) can change egg or sperm production. It can also shift libido and sexual function. That’s totally normal. 

Here’s a super important truth: hormones are not guaranteed birth control, and they are not guaranteed sterilization either.

Some fertility changes may reverse if hormones are stopped. But some may not. Duration, dosage, and your body’s baseline all matter.

If having biological kids might be on your radar one day (even as a “maybe”), talk to a knowledgeable provider before starting long-term hormones. Planning early keeps more options open.

Good overviews: the UCSF TransCare fertility guidelines, Planned Parenthood on sexual health for trans and nonbinary people, and Yale Medicine on reproductive options.

3. Fertility preservation works best when you think ahead

Fertility preservation means saving eggs, sperm, or embryos for later use; ideally, before any surgeries or long-term hormone use that could lower future fertility. The earlier you do it, the better your odds of preserving strong reproductive material. Reproduction journal review. Here’s a quick comparison:

Method	Who it may fit	Timing	Invasiveness	Typical cost (USD)	Notes on success
Sperm banking (cryopreservation)	People producing sperm (AMAB)	Before starting estrogen/anti-androgens	Low (ejaculated sample)	~$250–$1,000 upfront + $150–$400/yr storage	High success for later use via IUI/IVF depending on counts/quality
Egg freezing (oocyte cryo)	People with ovaries (AFAB)	Best before long-term testosterone or age-related decline	Moderate (hormone stimulation + retrieval)	~$8,000–$15,000/cycle + meds; storage extra	Success depends on age and number of eggs banked
Embryo freezing	Partners or those using donor gametes	Same as egg freezing	Moderate	Egg retrieval + IVF lab fees (~$12,000–$20,000/cycle)	Useful if you have a known partner/donor now

For process details and timing considerations, see the UCSF TransCare fertility guidelines.

4. Assisted reproductive technology can help build families

If your fertility is reduced or your anatomy has changed, assisted reproductive technologies (ART) can help. These include some pretty common, clinic-based options such as IVF (which means fertilizing eggs in a lab), ICSI (also known as injecting a single sperm into an egg), and IUI (where they’re placing sperm in the uterus)

Family-building paths vary widely, but here’s some of the most common ART paths: 

• If you’re AFAB: egg retrieval (with or without a pause in testosterone), IVF with partner/donor sperm, embryo transfer to self or a gestational carrier.
• If you’re AMAB: sperm use with IUI/IVF, donor eggs, gestational carrier, or co-parenting plans.
• Donor gametes and reciprocal IVF are options for many queer/trans couples Yale Medicine on reproductive options.
  

Success depends on age, time off hormones, overall health, and sometimes even environmental factors like exposures to certain chemicals. NIEHS on reproductive health and environmental exposures. Clinics publish outcome data, so you can compare before committing. CDC reproductive health statistics.

5. Contraception still matters if pregnancy is possible

Nearly half of U.S. pregnancies are unplanned, and the burden falls hardest on those with the least access to care Rhia Ventures analysis. If you have a uterus/ovaries and have penis-in-vagina sex, testosterone is not birth control. If you produce sperm, estrogen does not reliably prevent pregnancy.

Match methods to your body and sex practices:

Situation/anatomy	Options to consider	Notes
Uterus/ovaries present, PIV sex	IUDs (copper or hormonal), implant, shot, pill/patch/ring, condoms, emergency contraception	Progestin methods can be compatible with testosterone; copper IUD is hormone-free.
Vagina/frontal opening, STI risk	External/internal condoms, dental dams	Also reduces STI risk; add PrEP if HIV risk applies.
Producing sperm	Condoms, partner’s contraception, vasectomy (permanent)	Estrogen isn’t reliable contraception. Test semen if fertility is uncertain.
Avoiding hormones	Copper IUD, condoms, fertility awareness	FAM requires regular cycles; less reliable with cycle changes.

Every $1 invested in contraception access averts nearly $3 in pregnancy-related health costs Guttmacher investment analysis. For a method fit with HRT, see Planned Parenthood on sexual health for trans and nonbinary people.

6. Inclusive pregnancy care saves lives

Pregnancy care should affirm your name, pronouns, anatomy language, and mental health needs.

The stakes are high!  The U.S. maternal mortality rate has more than doubled in recent years, and unfortunately Black women are 3 to 4 times more likely to die from pregnancy-related causes than white women Rhia Ventures analysis. States with stronger reproductive care environments include Massachusetts, New Jersey, and Connecticut.  In comparison,  Mississippi, Arkansas, and West Virginia face higher risks and fewer supports Commonwealth Fund 2024 State Scorecard.

Affirming care isn’t just cosmetic. It’s protective.

Here’s a few practical moves:

• Seek queer- and trans-competent OBs or midwives
• Bring a simple birth preferences sheet, noting language and dysphoria triggers
• Arrange perinatal mental health and lactation/chestfeeding support early
• Tap into your community: doulas, peer groups, and legal name/pronoun protections in your hospital systems International Confederation of Midwives on trans-inclusive SRH.
• For self-advocacy tips, see HER’s guide to speaking up for your sexual health.

7. Abortion care is essential health care

Abortion (that is, ending a pregnancy safely with medication or a procedure) is part of comprehensive basic reproductive care. It is common. It is normal. WHO definition of reproductive health. 

About 24% of people categorized as women in U.S. datasets have an abortion by age 45, which really underlines just how common it is Rhia Ventures analysis. Without insurance, medication abortion typically costs $500–$750, and barriers are higher in some states and for people without documentation or medical paid leave Rhia Ventures analysis.

If you might need abortion care:

• Know your state laws
• Identify funding resources ahead of time
• Ask clinics about trans-affirming intake practices
• Plan post-care support

Reproductive autonomy includes the right to end a pregnancy safely.

8. STI screening should match your anatomy and sex practices

Screen based on:

• The parts you have
• The type of sex you’re having

Not just what your ID says.

That’s how you avoid missed infections and unnecessary stigma or judgment. 

Common tests for STIs include: chlamydia and gonorrhea (urine or swabs of throat/rectum/vagina/front hole/penis as relevant), syphilis (blood), HIV (blood/rapid), and sometimes hepatitis panels. 

Frequency depends on partners and practices. For most people, this is yearly, or every 3 to 6 months if you have multiple partners or higher-risk exposures National Center for Transgender Equality on unmet needs.

Here’s a quick match-up:

• Receptive vaginal/front sex: urine or vaginal/front swab for chlamydia/gonorrhea.
• Receptive anal sex: rectal swab for chlamydia/gonorrhea.
• Receptive oral sex: throat swab for chlamydia/gonorrhea.
• Insertive sex (penis): urine test for chlamydia/gonorrhea.
• All: blood tests for HIV and syphilis as indicated.
  Prevention basics: condoms/dental dams, regular partner testing, and PrEP if HIV risk applies Planned Parenthood on sexual health for trans and nonbinary people. For sex safety tips specific to trans women, see HER’s guide to safer sex for trans women.

Remember, this isn’t about shame. It’s about accuracy and protection, and keeping yourself (and your partners) as healthy as possible.

9. Cancer screening should be organ-based

Preventive screening just means looking for disease before the symptoms show up, when it’s the most treatable. Early screening saves lives, and we’re not just saying that to be dramatic. While your gender identity is totally valid, these screenings should reflect your anatomy.

• Cervix present? Follow Pap/HPV screening guidelines.
• Breast tissue present? Discuss mammography timing.
• Prostate present? Talk about age-appropriate screening.
• Uterus or ovaries present? Monitor symptoms and risk factors.

For more organ-based, trans-affirming guidance, see the ACOG guidance on transgender care and the Johns Hopkins overview of transgender health.

10. Mental health and access shape reproductive outcomes

Things like insurance coverage, legal ID match, clinic bias, transportation, and paid leave can make or break your reproductive outcomes. Misgendering, denial of care, and discrimination unsurprisingly track with worse mental and physical health. However, having supportive networks, gender affirming providers, and clear insurance navigation can improve everything from prenatal experiences to ART follow-through ACOG guidance on transgender care. 

Practical moves:

• Line up mental health care that understands transition and reproductive decision-making (HER’s LGBTQ+ mental health guide).
• Confirm coverage for contraception, fertility preservation, and pregnancy care
• Ask insurers about gender “edits” that block organ-based claims
• Document names/pronouns in portals
• Bring a support to appointments, like a doula or friend
• Know your rights and common barriers via the National Center for Transgender Equality on unmet needs.

Frequently asked questions

How does hormone therapy affect fertility for trans people?

Hormones can reduce or stop sperm or egg production, and effects vary from person to person as well as based on how long you’ve been on HRT. Some changes may reverse after stopping, others may not.

What fertility preservation options should I consider before starting hormones?

Consider sperm banking, egg freezing, or embryo freezing to keep future biological family-building on the table.

Can trans people still get pregnant or cause pregnancy?

Yes! If you have functioning ovaries/uterus or testes and have unprotected sex, pregnancy is possible regardless of gender identity or hormones.

What kinds of cancer screenings do trans people need?

Get screenings based on the organs you have (like cervical, breast/chest, or prostate) , and not just what’s in your records.

How can I find affirming reproductive health care providers?

Look for clinics with LGBTQ+ policies, ask local queer/trans groups, and use directories that flag gender-affirming, inclusive reproductive care.