Providing contraception to trans youth: a qualitative study investigating the acceptability of DMPA-SC and prior experiences with contraceptive counseling.

Introduction: The transgender and gender diverse (TGD) population continues to face unmet healthcare needs, especially when pertaining to sexual and reproductive health (SRH). When receiving care, TGD individuals may face discrimination or receive care that does not affirm their gender identity or is rooted in cisgender, heteronormative assumptions. This qualitative study sought to understand the experiences and perspectives of TGD youth surrounding contraceptive use and counseling, and investigate acceptability of self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC).

Methods: We conducted semi-structured focus groups and individual interviews to understand what drove initiation and discontinuation of contraceptives, specifically DMPA-SC. We recruited 35 TGD individuals assigned female at birth, with median (IQR) age of 17.5 (2.75) years. Twenty-one participants completed focus groups and 10 completed individual interviews. Interviews were conducted virtually and analyzed using rapid thematic analysis.

Results: We identified four themes: (1)Dysmenorrhea and dysphoria associated with menses that were alleviated by DMPA; (2)DMPA seen as the best method for menstrual suppression; (3)Negative experiences with previous primary care providers (PCPs); the importance of language and a desire for individualized care regarding SRH.

Discussion: The SRH needs of TGD individuals differ from their cisgender counterparts. Historically, the primary endpoint for contraceptive studies focused on preventing pregnancies. Assuming this as the primary goal for TGD individuals can be harmful to the provider-patient relationship and lead to avoidance of care. When providing contraceptives at the intersection of gender identity and sexual orientation, counseling should be tailored towards an individual's unique SRH needs.