Contraception for trans or non-binary people

Whatever your gender identity, if you have sex you need to think about contraception. Here are some common questions asked by trans and non-binary people. Talk to your healthcare provider about the best option for you.

Am I at risk of getting pregnant?

If you have a uterus and ovaries and any of your sexual partners have testicles, you are at risk of getting pregnant, unless you or your sexual partner have had surgery that prevents this. 

Surgeries that prevent pregnancy are:

  • a hysterectomy (removal of your womb or uterus)
  • a oophorectomy (removal of both your ovaries)
  • orchidectomy (removal of your testicles).

Do I need contraception if I am taking hormone therapy?

While hormone therapy is known to reduce fertility in people with ovaries or with testicles, it's still possible to get pregnant or get someone pregnant. You still need to use contraceptives if you want to prevent pregnancy.

Examples of hormone therapy include:
  • testosterone 
  • gonadotrophin releasing hormone (GnRH) analogues 
  • estradiol therapy
  • finasteride
  • cyproterone acetate.

It's possible to use hormonal contraceptives without them interfering with your hormone therapy. However, if you would prefer to avoid these, there are other options too, such as the copper IUD and condoms. Talk to your doctor about which option is best for you.

Hormone contraceptives Non-hormone contraceptive methods
  • Progestogen-only pill (the mini pill)
  • Combined oral contraceptive pill (the pill)
  • Injection – Depo Provera
  • Implant – the rods
  • Intra-uterine devices (IUDs) that contain progestogen only, such as Mirena®, or Jaydess®
  • Condoms
  • Copper IUD 
  • Permanent methods - tubal ligation or vasectomy 

Most contraceptives do not protect you from sexually transmitted infections (STIs). You need to use condoms as well to protect you from STIs. Read more about STIs and safer sex.

What if I am feeling distressed about contraception?

Sometimes using contraceptives that are appropriate for the anatomy you were born with can trigger gender dysphoria and feelings of distress. Talk to your healthcare provider or local Family Planning clinic about finding the method that causes you the least discomfort or trauma. 

Here are some things that might help:

Sedation

You may be able to be sedated while getting an IUD inserted.

Stopping periods

If you don’t identify as female but you have periods, some methods can stop you getting periods periods and this may help reduce feelings of gender dysphoria. For example, the hormonal IUD Mirena is a ‘fit and forget’ type of contraceptive that lasts up to 5 years, is 99% effective at preventing pregnancy and can prevent menstruation (periods).

Another option is the combined oral contraceptive pill (the pill), which can prevent periods if you take the 21 hormone pills continuously and skip the non-hormone pills. This is perfectly safe and is the most effective way to take the pill.

Are there any permanent contraceptive options?

If you want a permanent contraceptive option and don't want to get pregnant or get someone else pregnant in the future, the options are:

  • tubal ligation for people with a uterus
  • vasectomy for people with a penis.

(Note: You must use another method of contraception for the first 3 months after a vasectomy.)

What if I have unprotected sex?

If you have a uterus and ovaries and your sexual partner has testicles, you are at risk of pregnancy after unprotected sex or if your usual type of contraception has failed. If this happens, you can use emergency contraception to prevent pregnancy.  

There are 2 types of emergency contraception available in New Zealand:

  • emergency contraceptive pill (ECP)
  • copper intra uterine device (IUD).

The emergency contraceptive pill is approved for use for up to 72 hours (3 days) after unprotected sex, but research shows it may still work when used up to 4 days after sex. However, the sooner you take it the better. 

A copper IUD is the most effective method of emergency contraception and can be inserted up to 5 days after unprotected sex, or within 5 days of your earliest expected date of ovulation. Talk to your healthcare provider as soon as possible if you think you might need emergency contraception.

Read more about emergency contraception.

Learn more

Contraception if you are trans or non-binary Family Planning, NZ

Reference

  1. FSRH CEU statement: contraceptive choices and sexual health for transgender and non-binary people The Faculty of Sexual and Reproductive Healthcare of the Royal College of the Obstetricians and Gynaecologists, UK, 2017

Reviewed by

Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP, Wellington Last reviewed: 17 Apr 2021