Assessment of Sexual Activity and Contraceptive Counseling Among Transgender Individuals Initiating Testosterone.

Context: Testosterone, which some transgender and non-binary (TGNB) individuals born with a uterus will use for gender affirmation, is not a form of contraception. Gaps remain in understanding how well clinicians address contraceptive needs with individuals initiating testosterone.

Methodology: This was an IRB-approved retrospective analysis of TGNB individuals on testosterone for gender affirmation. Charts were evaluated for whether or not sexual activity that could result in pregnancy was assessed, and whether contraceptive counseling was performed for those at risk of pregnancy.

Results: Of the 280 individuals included, almost all (232, 83%) had documentation of whether or not they were engaging in penile-vaginal intercourse. Nineteen percent (45) were currently engaging in penile-vaginal intercourse at the time of testosterone initiation, and 17% (39) had a history of penile-vaginal intercourse. The majority of those currently engaging in penile-vaginal sex had contraceptive counseling when initiating testosterone (39/45, 87%), and the majority were documented as using a form of contraception (40/45, 89%), with condoms being the most frequently documented form (24/40, 53%). Those who previously engaged in penile-vaginal sex were less likely to have documentation of counseling (16/39, 41%) or contraceptive use (19/39, 49%), with condoms being the most frequently documented form (9/19, 23%).

Conclusion: In this cohort of TGNB individuals who initiated testosterone, the majority had an assessment of penile-vaginal sexual activity documented. The majority of those who had engaged in penile-vaginal sexual activity had documentation of both contraceptive counseling and use of a form of contraception, with condoms being the most common.