Pathways to parenthood among transgender men and gender diverse people assigned female or intersex at birth in the United States: analysis of a Cross-Sectional 2019 SurveyAJOG Global Reports at a Glance

Shalmali Sunil Bane, PhD; Juno Obedin-Maliver, MD, MPH, MAS; Sachiko Ragosta, BA; Jen Hastings, MD; Mitchell R. Lunn, MD, MAS; Annesa Flentje, PhD; Matthew R. Capriotti, PhD; Micah E. Lubensky, PhD; Diana M. Tordoff, PhD, MPH; Heidi Moseson, PhD, MPH

AJOG Global Reports (Aug 2024)

Pathways to parenthood among transgender men and gender diverse people assigned female or intersex at birth in the United States: analysis of a Cross-Sectional 2019 SurveyAJOG Global Reports at a Glance

Shalmali Sunil Bane, PhD,
Juno Obedin-Maliver, MD, MPH, MAS,
Sachiko Ragosta, BA,
Jen Hastings, MD,
Mitchell R. Lunn, MD, MAS,
Annesa Flentje, PhD,
Matthew R. Capriotti, PhD,
Micah E. Lubensky, PhD,
Diana M. Tordoff, PhD, MPH,
Heidi Moseson, PhD, MPH

Affiliations

Shalmali Sunil Bane, PhD: Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA (Shalmali Bane); Corresponding author: Shalmali Sunil Bane, PhD.
Juno Obedin-Maliver, MD, MPH, MAS: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA (Juno Obedin-Maliver); Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA (Juno Obedin-Maliver and Mitchell R. Lunn); The PRIDE Study, Stanford University, Stanford, California, USA (Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Matthew R. Capriotti, Micah E. Lubensky and Diana M. Tordoff)
Sachiko Ragosta, BA: Ibis Reproductive Health, Oakland, California, USA (Sachiko Ragosta and Heidi Moseson)
Jen Hastings, MD: Department of Family and Community Medicine, University of California San Francisco, San Francisco, California, USA (Jen Hastings)
Mitchell R. Lunn, MD, MAS: Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA (Shalmali Bane); The PRIDE Study, Stanford University, Stanford, California, USA (Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Matthew R. Capriotti, Micah E. Lubensky and Diana M. Tordoff); Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA (Mitchell R. Lunn and Diana M. Tordoff)
Annesa Flentje, PhD: The PRIDE Study, Stanford University, Stanford, California, USA (Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Matthew R. Capriotti, Micah E. Lubensky and Diana M. Tordoff); Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA (Annesa Flentje and Micah E. Lubensky); Alliance Health Project, Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA (Annesa Flentje)
Matthew R. Capriotti, PhD: The PRIDE Study, Stanford University, Stanford, California, USA (Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Matthew R. Capriotti, Micah E. Lubensky and Diana M. Tordoff); Department of Psychology, San Jose State University, San Jose, California, USA (Matthew R. Capriotti)
Micah E. Lubensky, PhD: The PRIDE Study, Stanford University, Stanford, California, USA (Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Matthew R. Capriotti, Micah E. Lubensky and Diana M. Tordoff); Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA (Annesa Flentje and Micah E. Lubensky)
Diana M. Tordoff, PhD, MPH: The PRIDE Study, Stanford University, Stanford, California, USA (Juno Obedin-Maliver, Mitchell R. Lunn, Annesa Flentje, Matthew R. Capriotti, Micah E. Lubensky and Diana M. Tordoff); Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, USA (Mitchell R. Lunn and Diana M. Tordoff)
Heidi Moseson, PhD, MPH: Ibis Reproductive Health, Oakland, California, USA (Sachiko Ragosta and Heidi Moseson)

Journal volume & issue: Vol. 4, no. 3
p. 100381

Abstract

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Objective: To assess pathways to parenthood, pregnancy outcomes, future pregnancy desire, and fertility counseling experiences among a cross-sectional sample of transgender men and gender diverse individuals assigned female or intersex at birth in the United States Methods: Participants were recruited from The Population Research in Identity and Disparities for Equality (PRIDE) Study and the general public. Eligible participants for this analysis were able to read and understand English, assigned female or intersex at birth, US residents, 18+ years old, and identified as transgender, nonbinary, or gender diverse. We analyzed responses to close-ended survey questions, overall and stratified by gender identity, race/ethnicity, and testosterone use. We also qualitatively assessed open-text responses on fertility counseling. Results: Among the 1694 participants, median age was 27 years (range: 18–72), 12% had ever been pregnant, and 12% were parents. Carrying a pregnancy where the individual was the egg source (36%) was the most common pathway to parenthood. Individuals with an exclusively binary gender identity (ie, transgender man or man) more often reported becoming parents through adoption than individuals with gender diverse identities (19% vs 12%). A third of individuals did not receive fertility counseling prior to initiating testosterone; individuals who exclusively reported nonbinary identities were recommended to investigate fertility preservation options less often (36%) compared to transgender men (50%). Conclusion: Transgender men and gender diverse individuals who were assigned female or intersex at birth build their families through a variety of pathways, including pregnancy, stepparenting, and adoption. Clinicians should avoid making assumptions about reproductive desires in these populations based on gender identities or testosterone use and should provide consistent fertility counseling prior to and after hormone initiation.

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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