When Danny Wakefield gave birth to their first child in 2020, it brought to light a string of issues faced by transgender parents in the health care system.
“I had a really hard pregnancy,” Wakefield, 36, who is transgender but also uses they/them pronouns, tells Yahoo Life. During emergency room visits, Wakefield says they were met with “snickers” from nurses, as well as “doubt, disbelief and a lack of knowledge” from physicians ill-equipped to handle their needs.
“In one instance, it took an hour and a half to get them to treat me because they didn't believe I was pregnant,” Wakefield says. “The doctors and nurses would talk quietly among themselves, asking each other questions about me, instead of asking me directly — the patient who's sitting right in front of them.”
Stories like Wakefield’s are not uncommon, says Dr. Juno Obedin-Maliver, assistant professor in the Department of Obstetrics and Gynecology at Stanford University School of Medicine. That’s mainly because the medical establishment — and society at large — has little knowledge about pregnancy in the trans male population.
“We grow up in a world with books, from preschool on up, that until very recently have not imagined or really represented the diversity of communities as they are,” Obedin-Maliver tells Yahoo Life. “None of our systems have been designed to delineate the difference between somebody's gender and somebody's pregnancy capacity.”
That’s slowly changing, Obedin-Maliver points out, due to a growing demand from transgender patients — and because more and more are sharing their stories, as with a recently trending New York Times Op-Doc about a trans man giving birth in a small town in Mexico.
But, Obedin-Maliver argues, until society acknowledges the basic truth that “anyone born with a uterus, ovaries and tubes” has the capacity to become pregnant, there will always be a lack of accurate research and data, leaving trans parents at a disadvantage.
Trans men can — and do — give birth.
Transgender men — people born with female anatomy who live and identify as men, sometimes undergoing gender-affirming care through surgeries and/or testosterone and sometimes not — can get pregnant in the same way anyone with reproductive organs can, explains Obedin-Maliver. That includes penetrative sex with someone with sperm as well as through assistive reproductive technology (ART), such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
Due to the fact that trans male pregnancies are vastly under-researched — not to mention their lack of visibility — the process is clouded with misconceptions. One of the biggest, Obedin-Maliver says, is the notion that trans men on testosterone are unable to conceive. Though more studies need to be done on how testosterone influences ovulation in general, taking the hormone does not negate one’s capacity to get pregnant.
“There is a difference between having a period, or not, and ovulating, or not,” she explains. “Those are actually related but distinct processes in the body.” So it’s possible that somebody on testosterone might have stopped menstruating but is still ovulating or producing eggs. “That's true for anyone [with female reproductive organs],” she adds, “and that sometimes makes it difficult for folks to know if they are pregnant, because they're having sex with sperm involved and we don't know how much testosterone diminishes ovulation.”
That message often doesn’t translate to the population that needs it most.
Kayden Coleman, a gay transgender man — meaning his gender is trans male and his sexual orientation, something separate and different, is gay — is father to two daughters, 9 and 2, and has been on testosterone for 14 years. He went off during both pregnancies at the advice of his doctor but was still taking doses of the hormone when he discovered he was pregnant — both times unplanned.
"There are a lot of doctors prescribing testosterone to transgender men and selling them this dream that they'll somehow be infertile or not be able to get pregnant,” Coleman tells Yahoo Life. "As long as you're having relations with anyone who produces semen, you can get pregnant."
Wakefield had a similar experience. When they first started taking testosterone 10 years ago, they were told they "would not be able to conceive or carry a child because it would act as a natural birth control." Wakefield wound up having an unplanned pregnancy.
Sonny Witt, a trans father in Australia who gave birth in 2022, planned his pregnancy through IVF. At the advice of his doctors, he went off testosterone during the egg-retrieval process (as well as during the pregnancy itself). He started up again "about three months" after giving birth.
In some cases, trans men may choose to pause their hormone treatments in an effort to get pregnant, but this step is sometimes unnecessary — and those considering it should consult with their doctor beforehand. And again, not all transgender men use testosterone, just as not all keep their uteruses.
As for Witt, 30, he says he had no idea pregnancy was an option until he started seeing other trans dads sharing their journeys online. That's when he decided to make his dream of fatherhood a reality by reaching out to a "rainbow clinic,” specializing in LGBTQ family planning.
"I had no idea that this was available to a trans person," he tells Yahoo Life, "which is why I have publicly shared my own journey. I want more people to be aware that this is a possibility."
Shon McCloud, a Virginia-based U.S. Army vet who identifies as trans, is currently pregnant with his first child, conceived naturally with his male partner. His doctors considered the pregnancy "high risk" because he was on testosterone during conception, which is partly why he has paused taking the hormone until after giving birth.
"So many of us feel judged, or that we don't have the support we need," McCloud tells Yahoo Life. "So, I'm excited to provide that for [my son]."
Obedin-Maliver, who co-authored a 2019 study about the effects of testosterone during pregnancy, recommends that trans men pause their hormones while pregnant as a precaution — simply because there’s still more research to be done.
“It is not precisely clear for how long before pregnancy or for how long after the pregnancy to restart if, for example, they are chest or breastfeeding," she explains. (The abilities of a trans man to produce milk after having top surgery, which is a removal of the breasts, varies by individual.) "So that is a conversation that each individual should have with their health care provider.”
The truth is, no matter what gender a birth parent identifies as, their basic pregnancy needs are all the same. And no pregnancy is a one-size-fits-all, which is why Obedin-Maliver says ob-gyns ought to approach trans pregnancies in much the same way as they would any other.
"I often get asked, 'What's the experience of a trans man giving birth?' And I say, 'Well, what's the experience of a cis woman giving birth?'" she says. "For example, as a queer woman, I had a terrible time in my pregnancy. That was really different than friends of mine who loved being pregnant and had a wonderful time."
The information gap
According to the Human Rights Campaign’s 2021 survey, more than 1% (close to 2 million) of Americans identify as transgender. While there is no comprehensive data on how many give birth, Obedin-Maliver says the numbers are likely higher than most would expect. Similarly, data is lacking on the number of trans men who want to conceive children through IVF — though a 2019 Family Equality Council report showed that 63% of LGBTQ people planning families are looking into foster care, adoption and some form of ART.
So why is there such a lack of data? One of the reasons, Obedin-Maliver notes, is that most medical systems have a protocol of tracking the birth parent’s gender as “female” when that’s not always accurate, making it difficult to have a full picture.
Such was the case for Wakefield, Coleman and Witt, all of whom were misgendered on their babies' birth certificate and now worry about the real-life implications it might have.
"I had to be labeled as the mother," says Witt, who is concerned that "it's going to cause further complications when enrolling him into school."
Wakefield was also labeled as the "mother" on his son's birth certificate (and sole parent), which contradicts Wakefield's own personal ID documents that label him as "male." Already, he says, it's brought an array of issues, such as difficulties around getting his son a U.S. passport.
As noted by Lambda Legal, accurate documents for trans parents are vital in a variety of life events, such as "enrolling a child in school, authorizing medical care, establishing eligibility for government benefits or child support, and to authorize a parent to pick up a child from day care or school."
Another reason for the lack of data is that there simply aren’t enough people who care to make trans health a priority, adds Obedin-Maliver, who has led many studies — including PrideStudy.org, the first large-scale long-term national health study of LGBTQ people — in efforts to find solutions for queer communities that are disproportionately impacted by a lack of research. Still, that is slowly changing.
The Society for Maternal Fetal Medicine, for example, issued a statement last year about the importance of gender inclusively. Additionally, the American College of Obstetrics and Gynecology, the premier organization for ob-gyns in the U.S., started including the experiences of trans and nonbinary folks in its published work. In 2020, the Yale Journal of Biology and Medicine published a narrative review on trans male pregnancies while giving an overview of the literature’s contributions.
"Not all people who need pregnancy-related care are women," Dr. Devon Ojeda, senior national organizer for National Center for Transgender Equality, tells Yahoo Life. "The research is out there. To uplift this work means that the health care system has to completely change the way they see preventative care beyond the gender binary.”
'I've fallen in love with myself'
For many trans dads, sharing their stories online — including with the hashtag #seahorsedad (which has upwards of 344 million posts on TikTok) — is a radical act that can not only change the way people feel about trans health care but also be a beacon for other trans men who want to start a family.
"I need it to be normalized that transgender people exist, that we give birth," says Coleman, adding that telling stories of Black transgender men is especially important because it challenges both transphobia and racism. "They think we all are transitioning to date women," he adds of the many misconceptions, "and they think that our transition means doing away with all things feminine and all things that have to do with women in the societal sense," including pregnancy and giving birth.
Starting a family, McCloud adds, is a personal choice that shouldn't be dissuaded because of a lack of understanding.
"Birth is part of life," he says. "People are ignorant and cruel when it comes to 'new' information or realities. If it's not seen, we all question it regardless of the truth that male identifying people can and do give birth. Birthing a child doesn't change my identity."
Wakefield, who has been sharing their parenting journey on the blog Danny the Trans Dad for the past two years, adds, "To be public about my pregnancy and my journey to parenthood, because visibility is so important, I wanted other trans and nonbinary people to know that we can, and do, create really beautiful and amazing families — and there are many different avenues to doing that."
The larger message many visible trans dads hope people receive isn't necessarily about the trans experience — but, rather, the joys of being a parent.
"I've fallen in love with myself," Wakefield says of fatherhood. "I never imagined that I would heal so much, just from being a parent. I want to heal my own trauma so that I don't continue the cycles. Especially as a trans person, I've had this struggle, this internal struggle for so much of my life. To be able to see those struggles starting to turn into self-love is really beautiful. I owe all of that to my child."
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