Methods of Birth Control
By: Peter Buggert | Last Reviewed: 10/12/19 Last Updated: 10/12/19
FtM people have to worry about pregnancy if they have sex with people able to produce sperm and haven’t had a hysterectomy themselves. While the chance is low a person can still get pregnant on testosterone despite not having periods. Every FtM person is comfortable with different things, has different sexualties, and is at different places in their transition, so birth control is not an issue everyone needs to think about.
Many FtMs wish to avoid hormonal birth control because they increase the amount of progesterone and possible estrogen, both female sex hormones, in a person’s body and can have undesirable side effects. Progesterone on its own does not have any recorded effect on making someone appear more or less feminine, although they are commonly linked to weight gain. The most effective method of birth control is to avoid vaginal sex altogether, the next is to combine methods such as taking the pill and using a condom so if one fails which is already unlikely, the other hopefully will not.
Please note the the percentage of pregnancy risk is an average and can be higher or lower depending on a person’s natural anatomy, the type of sex they have, and if the product is properly and regularly used.
Non-Hormonal Birth Control:
These are methods of birth control which do not use hormones, or have variations with no hormones. Non-hormonal birth control methods tend to be less effective than hormonal variations when used on their own.
- IUD (Intrauterine Device) – Chance of Pregnancy <1%. An IUD is a small T shaped device that is inserted by a professional through the vagina, through the cervix, and into the uterus. Most women say the pain from insertion is minimal. There are two types of IUD, one is hormonal, but the other is made of copper which while being a natural spermicide also damages eggs and lasts up to 10 years. The copper insertion can cause heavier periods among other side effects and cannot be worn if a person has a copper allergy or endometriosis. These do not protect against STDs.
- Diaphragm – Chance of Pregnancy 12%. A diaphragm is a small disk that is filled with a spermicide and then placed in the back of the vagina covering the cervix before sex. Any sperm will have to get around the cap and through the spermicide. They cannot be removed until six hours after sex. There are some one size fits all diaphragms, but many will have to be fitted by a professional. They are available by prescription only. These do not protect against STDs.
- Cervical Cap – Chance of Pregnancy 17%-23%. A cervical cap is a small bowl shaped device that is filled with a spermicide and then placed in the back of the vagina covering the cervix before sex. Any sperm will have to get around the cap and through the spermicide. They cannot be removed until six hours after sex. This is usually much smaller than a diaphragm and always has to be fitted by a professional and is available only by prescription. These do not protect against STDs.
- External Condom – Chance of Pregnancy 18%. External condoms are by far the easiest method of birth control to get ahold of. Legally, people do not need to be 18 to buy condoms. Condoms go over the penis of the person “topping” so that the sperm cannot escape into the vagina. Sometimes the condom may rip or come off during sex. Condoms can prevent STDs, but are not 100% effective.
- Internal Condom – Chance of Pregnancy 21%. Internal condoms are like a much larger version of the external condom. They are inserted into the vaginal canal with the opening staying outside, a person’s partner inserts their penis into the condom during sex and eventually cums inside. There is only one brand approved by the FDA (FC2 Female Condoms). Internal condoms can prevent STDs although the products effectiveness has not been well studied.
- Withdrawal – Chance of Pregnancy Variable 20%. Commonly referred to as the pull out method, this method requires a person’s partner to pull out of the vagina before they ejaculate. It is not recommended to use this method without a secondary form of protection already in place. This has variable results because sometimes it is hard to tell when a person is about to cum. It is also important to note that there can be sperm inside of precum and men don’t experience a strong feeling from precumming like they do when they orgasm. This does not prevent STDs.
- Sponge – Chance of Pregnancy 12%-24%. The sponge contains spermicide so that when it is inserted in the back of the vagina against the cervix before sex any semen should be either blocked from entering the cervix or killed by the spermicide. These do not prevent STDs and have to remain inserted until six hours after sex. There is only one brand available in the US (the Today Sponge). This does not prevent STDs.
- Natural Family Planning and Fertility Awareness – Chance of pregnancy 25%. Fertility awareness is usually used by couples who are attempting to get pregnant, but can also work in the opposite. By tracking a person’s period and other physical symptoms it is possible figure out when they are at their most fertile in order to avoid sex and when they are least fertile and can have sex with less risk. This method does not work well for FtM’s on T because they will have changes in discharge and no longer have periods. This does not prevent STDs, although a person with more reproductive knowledge is less likely to make a mistake leading to STDs.
- Spermicide – Chance of Pregnancy 28%. Spermicide is a chemical agent that kills sperm before it can pass through the cervix. These can be found in the form of a cream, gel, foam, or suppository. All spermicides are different, but they all are put in the vagina before sex and must remain until six hours after. Some people do find spermicides to be irritating to their skin. Spermicide is available as easily as condoms and legally a person does not need to be 18 to buy it, but unlike condoms it does not protect against STDs.
- Abstinence – Chance of Pregnancy 0%. Abstinence is the act of willfully not participating in sex. A person cannot get pregnant from oral sex or any other “pants on” activity, and they are unlikely to get pregnant from anal sex, unless semen somehow gets from the anus to the vagina. True abstinence does protect against STDs but other forms of non-vaginal sex do not.
- Emergency Contraception – Chance of Pregnancy 0.1%. If a person does have unprotected sex and is worried that they may become pregnant, they can have a copper IUD inserted. If done within the first five days then they are extremely unlikely to become pregnant, but it is not effective after five days so they need to see a doctor immediately so they can implant the device. Emergency contraception is not abortion.
Hormonal Birth Control:
These are birth control methods which use hormones, or have variations that use hormones. Some use only progestin or have variations that use only progestin, while others use estrogen or a mix of the two.
- IUD (Intrauterine Device) – Chance of Pregnancy <1%. An IUD is a small T shaped device that is inserted by a professional through the vagina, through the cervix, and into the uterus. Most women say the pain from insertion is minimal. There are two types of IUD, one is copper, but the other is hormonal. Over the implants lifetime (3-5 years) it will release progestin into the uterus causing its lining to get thinner and for it to make thicker mucus and therefore making it more difficult for the sperm to reach the egg. These implants can make periods lighter and more regular and sometimes periods stop altogether. This does not prevent STDs.
- Contraceptive Implant – Chance of Pregnancy <1%. A contraceptive implant is an implant about the size of a match stick that is inserted into the arm and will slowly release progestin over the course of up to three years, after three years it will need to be removed and replaced. This does not prevent STDs.
- Birth Control Shot – Chance of Pregnancy 6%. This is a shot of progestin that must be given every 12 weeks by a healthcare professional, if the shot is not given regularly and on time then the chance of pregnancy goes up. This does not prevent STDs.
- Birth Control Pill – Chance of Pregnancy 5%-9%. This is the most common method of hormone based birth control. There are two types of pills a combined pill contains both progestin and estrogen and most FtM people want to avoid taking estrogen. There is also a mini-pill which contains only progestin. These pills are taken every day and are most effective if they are never forgotten and always taken at the same time. They do not prevent STDs.
- Birth Control Patch – Chance of Pregnancy 6%. Patches work a lot like pills but are only replaced once a week for three weeks and then skipped on the fourth week to allow for a person’s period. Patches contain both progestin and estrogen and can contain more estrogen than combined pills. They do not prevent STDs.
- Vaginal Ring – Chance of Pregnancy 9%. The vaginal ring is a small plastic ring that is placed in the vagina and over the course of three weeks releases both progestin and estrogen. At the end of three weeks it in removed for a week and then replaced with a new ring. This does not prevent STDs.
- Emergency Contraception – Chance of Pregnancy 0.1%. If a person does have unprotected sex and is worried that they may become pregnant, they can take special pills to prevent the pregnancy. If done within the first three days (although a couple pills allow for five) then they are extremely unlikely to become pregnant, but it is not effective after a few days so they need to see a doctor immediately so the pills can be prescribed as soon as possible. Emergency contraception is not abortion.
Any method of birth control that contains estrogen (the combo pill, patch, or ring) is not ideal for FtMs unless a medical professional declares otherwise due to that individual’s health circumstances. Always talk with your healthcare provider about exactly what is in your birth control, how it works, what other medications you may be on (testosterone), and what your transition plans are.
Once again there have been little to no visible physical effects observed from taking progestin other than possible weight gain. Estrogen however is most definitely associated with feminine physical characteristics and is commonly used in MtF transitions. Starting hormonal birth control should be talked about with one’s endocrinologist if they are on or about to start testosterone.
Methods of “Birth Control” that Do Not Work
There are a lot of myths as to what can and cannot prevent pregnancy, some common misconceptions are:
- Douching – this is the act of squirting a solution into the vagina to “rinse out the sperm”. This does not work, odds are that the sperm has already entered the cervix and is out of reach of the rinse. Also, douching is not commonly recommended by health professionals unless instructed otherwise.
- Jumping Up and Down – some people think that if they jump up and down they will shake out the sperm. For obvious reasons this is completely ineffective.
- Not Orgasming – if the person producing sperm doesn’t orgasm that significantly reduces the risk of pregnancy, however, there is a myth that if the person who is at risk of being impregnated does not orgasm they cannot get pregnant and that is completely untrue.
- “Gravity” – the idea to this basically goes it the sperm has to fight gravity to get up into the uterus then it will just fall back out, so if a person has sex in a certain position and stays standing after then they can’t get pregnant. This is completely false. Those little guys can swim hard.
- DIY Condoms – when a condom isn’t available some people use plastic wrap or a bag. There is a high risk of the plastic ripping or falling off, plus this is not sanitary and these objects are not meant to go inside people.
- Showers/Baths/Peeing – no, no, and no, none of these things will have any effect.
- Taking Birth Control Immediately After – birth control methods usually take a good week to start working their magic, the only method that work after someone has already had sex is emergency contraception.
Finding a LGBT Friendly Professional
Going to a doctor about your “down there” parts can be extremely nerve racking and dysphoria inducing. Many doctors are not used to transgender patients and finding one that is can be a challenge. The best way to find someone is to just call around your area and explain your situation, they should be able to inform you if there is someone there that is trans friendly and relatively qualified, or perhaps they will know of someone who is. A few good places to start are:
Planned Parenthood – a chain of reproductive health clinics that is extremely LGBT friendly (some locations even offer testosterone under informed consent).
GLMA – a database of LGBT friendly healthcare providers.
Sources and Resources for More Information:
Office of Population Affairs. (2018, February 13). Birth Control Methods. Retrieved July 24, 2019, from https://www.hhs.gov/opa/pregnancy-prevention/birth-control-methods/
Planned Parenthood. (n.d.). Birth Control Methods & Options: Types of Birth Control. Retrieved July 24, 2019, from https://www.plannedparenthood.org/learn/birth-control
The American College of Obstetricians and Gynecologists. (2018, March). Progestin-Only Hormonal Birth Control: Pill and Injection. Retrieved July 24, 2019, from https://www.acog.org/Patients/FAQs/Progestin-Only-Hormonal-Birth-Control-Pill-and-Injection?IsMobileSet=false