Pregnant Trans Men May Face High Miscarriage Rates, New Review Finds

For transgender men and other transmasculine people who become pregnant, the experience often unfolds with little medical guidance inside a healthcare system that is largely unprepared to help them. A new review of 44 studies, the first to pull together numerical estimates of how often these pregnancies happen and how they turn out, found miscarriage rates that look elevated in several small studies, worrying signals around depression after birth, and a near-total absence of the research needed to understand what is happening or how to fix it.

Research has consistently shown that many transmasculine people, a term that covers trans men, non-binary people, and others who were registered female at birth, have an interest in pregnancy and parenthood. Far less understood is how often these pregnancies occur, what complications arise, and how medical care should respond. This review, published in the journal Acta Obstetricia et Gynecologica Scandinavica, is the first to gather the available numerical data on pregnancy rates and obstetric outcomes for this group and try to make sense of it.

Across those 44 studies, researchers estimated that roughly 6% to 9% of transmasculine people have been pregnant at some point, with roughly 4% to 9% having had a child. Those numbers may sound modest, but behind them sit real people making major reproductive decisions with almost no evidence to guide their care.

A Worrying Miscarriage Signal in Transmasculine Pregnancy

Miscarriage was the finding that stood out most. Across multiple studies, miscarriage rates among transmasculine people who became pregnant ranged from roughly 31% to 40%, and four out of five studies that reported this outcome landed in that elevated range. For comparison, background miscarriage rates in the general female population run closer to 11% to 22%.

None of those studies included a direct comparison group, so researchers cannot say for certain that the rate is higher because of being transmasculine or because of factors like a history of testosterone use. Even so, the authors write that the miscarriage findings “warrant further investigation.” Limited evidence also suggested pregnancy loss may have been more common among people with prior testosterone exposure, though the available studies were too small to show whether that link is real.

Testosterone, a hormone many transmasculine people take as part of their medical transition, already stops menstruation and is considered potentially harmful to a developing baby. Current precautionary guidance recommends stopping it before attempting pregnancy because of concerns about fetal development. The review also found that people who had previously taken testosterone reported fewer conceptions than those who had never used it, even after stopping treatment for several months, although the reason remains unclear.

Testosterone Is Not Reliable Birth Control

One finding carries immediate real-world weight: testosterone should not be treated as reliable contraception. Despite that, the review found evidence that some transmasculine people, and even some of their healthcare providers, have assumed it works that way. In one study, 16% of participants had used testosterone as a contraceptive method, and a smaller share reported that providers had advised this. Conception rates during testosterone use were low, the authors report, but not low enough to depend on for preventing pregnancy.

This matters because unintended pregnancy is already a documented concern in this group. Prior research cited by the review pointed to poor contraceptive knowledge, higher rates of sexual violence, and barriers to reproductive healthcare as contributing factors.

Postpartum Depression Signals From Small Studies

Beyond miscarriage, the review turned up troubling numbers on postpartum depression, the emotional downturn that can follow childbirth. Two small studies that examined it reported rates ranging from 15% to 58%, and one of those also found that 25% of participants reported thinking about suicide after giving birth. Both samples were tiny and cannot be applied broadly, yet the authors treat them as an early warning that deserves proper follow-up research.

Carrying a pregnancy can also intensify gender dysphoria, the distress that comes from a mismatch between a person’s gender identity and their body. Several participants described feeling it acutely during pregnancy and while chestfeeding. Some who had previously undergone chest surgery still chose to chestfeed, and two were caught off guard by complications their providers were equally unprepared to handle.

A Healthcare System Unready for Transmasculine Pregnancy

Much of what gives these findings their weight is the state of care surrounding transmasculine pregnancy. Prior research cited in the review found that 80% of OB-GYN doctors in one earlier survey reported no training on the topic, and fewer than a third felt comfortable caring for transmasculine patients. People in this group have long reported denial or difficulty when trying to access reproductive healthcare.

Most of the 44 studies came from the United States, with additional work from countries including Australia, Canada, Sweden, Belgium, and Brazil. Many were small, lacked comparison groups, and were not designed to study pregnancy at all, meaning pregnancy data often showed up as a side note rather than the main focus. That left the research team unable to do the kind of rigorous statistical work that yields firmer answers. Data on access to fertility treatments, stillbirths, and a range of other outcomes were sparse or missing entirely.

Researchers are calling for action on several fronts: better data collection by maternity services, routine recording of patients’ gender identity, studies built specifically to examine this population, and training for healthcare providers. They also stress that counseling during gender transition should routinely cover fertility, contraception, and how transition-related treatments might affect future pregnancies.

What emerges is a group moving through one of life’s most demanding physical and emotional experiences with almost no medical guidance. Miscarriage rates look elevated across several studies, the postpartum mental health signals are hard to ignore, and there is little data on much else that can go right or wrong in pregnancy. On that point the researchers are blunt: transmasculine people are getting pregnant now, and medicine needs to catch up.

Disclaimer: This article summarizes a systematic review of existing studies, most of which were small and lacked comparison groups. The findings point to possible patterns rather than proven cause and effect, and they should not be read as medical advice. Anyone weighing pregnancy, contraception, or gender-affirming care should consult a qualified healthcare provider about their individual situation.

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