Elsevier

Contraception

Volume 98, Issue 1, July 2018, Pages 74-75
Contraception

Case report
Use of Copper Intrauterine Device in Transgender Male Adolescents

https://doi.org/10.1016/j.contraception.2018.02.010Get rights and content

Abstract

Transgender men need contraception if engaging in intercourse with a cis-gender male partner. The copper IUD is an effective, non-hormonal contraceptive well suited for trans-males even while utilizing gender affirming hormone therapy. A gender-neutral medical facility with well-trained and sensitive staff is the ideal setting to provide such contraceptive care.

Introduction

Transgender individuals comprise, at a conservative estimate, less than 1 % of our nation's population [1]. Young transgender people have increased psychosocial stressors such as family rejection, homelessness, and unemployment [2] leaving them vulnerable to sexual coercion and high risk sexual behaviors [2].

Current primary care guidelines recommend contraception counseling for patients who participate in penile-vaginal intercourse [2] regardless of affirmed gender. While testosterone supplementation may reduce ovulation, it does not provide reliable contraception [3]. The majority of reliable contraceptive options available contain synthetic progesterone with or without an estrogen. Discomfort with taking “female” hormones may be a deterrent for use to trans-men resulting in high rates of condom use or method non-use, despite a desire to avoid pregnancy [4]. The copper intrauterine device (IUD) is a highly effective, hormone-free method of contraception. Guidelines published by the organizations representing pediatricians and obstetrician-gynecologists consider long-acting reversible contraception (LARC) methods-IUDs and subdermal implants, first line contraception for all adolescents [5], [6]. Therefore, the copper IUD may be an excellent option for trans-men seeking reliable, effective contraception. This study received IRB approval and patient consent was waived.

Section snippets

Cases

Patients presented to an urban, adolescent health clinic that focuses on providing comprehensive, multidisciplinary care to youth 12–24 years old. This clinic has a transgender health program that has served approximately 500 youth since July 2012. All clinical and support staff receive annual trainings and clinical updates to care for transgender youth.

During the initial evaluation, all transgender patients are counseled on gynecologic health and the importance of contraception use during

Case 1

An 18-year-old transgender man, nulligravid, on Testosterone 100 mg intramuscularly every 2 weeks with cessation of menses, presented for IUD placement. Gonorrhea and Chlamydia testing were negative prior to device insertion. He is sexually active with cisgender-men and cisgender-women. The IUD was placed by an Adolescent Medicine specialist. He returned for follow-up string check 3 weeks after placement. As of his most recent visit, he has used the IUD for 24 months without spontaneous or elective

Case 2

An 18-year-old transgender man, nulligravid, on Testosterone 100 mg intramuscularly every 2 weeks with cessation of menses, presented for IUD placement. Gonorrhea and Chlamydia testing were negative prior to device insertion. He was contemplating coitarche with a cis-gender male. The IUD was placed by a Family Planning gynecologist. He returned for a follow-up string check 1 month after placement with concerns of heavy menses which resolved at subsequent visits and amenorrhea resumed. His IUD has

Case 3

A 17-year-old transgender man, nulligravid, on Testosterone 120 mg intramuscularly every 2 weeks with cessation of menses, presented for IUD placement. Gonorrhea and Chlamydia testing were negative prior to device insertion. His last sexual partner was a cis-gender male. The IUD was placed by an Adolescent Medicine specialist. He experienced expulsion of the IUD one month following insertion with subsequent reinsertion one month later, also by an Adolescent Medicine specialist. He was diagnosed

Discussion

Medical indications and contraindications for an IUD are the same for transgender individuals as they are for cis-gender individuals. However, significant psychological issues, such as lack of experience with a gynecologic exam, may make placement challenging. Performing the exam and procedure with sensitivity while paying close attention to the use of correct pronouns can help the patient feel safe and respected [7]. Due to body dysphoria, the provider may avoid using gender loaded terms that

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References (7)

There are more references available in the full text version of this article.

Cited by (13)

  • Pediatric Research and Health Care for Transgender and Gender Diverse Adolescents and Young Adults: Improving (Biopsychosocial) Health Outcomes

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  • Sexual and reproductive health considerations among transgender and gender-expansive youth

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    For some individuals however, the lack of hormones may be appealing. A case series on use of the copper IUD in 3 transmasculine individuals who were amenorrheic on testosterone therapy reported that all had eventual return to amenorrhea following copper IUD insertion, though with variable duration of bleeding in the time immediately after insertion.27 The etonogestrel implant (trade name Nexplanon) is a 4 cm × 2 mm progestin-containing rod inserted subdermally in the upper arm and may be used for 3–5 years.28

  • Primary Care in Transgender Persons

    2019, Endocrinology and Metabolism Clinics of North America
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    Long-acting contraception methods that contain progesterone, such as the implant or intrauterine device, can serve a dual purpose of contraception and reduction of menstruation, especially in transmasculine patients who have recently started or are not using testosterone therapy.42 Copper intrauterine devices are also a popular hormone-free contraceptive option, but patients should be aware that if they continue to menstruate, they can experience heavier cycles, which can exacerbate dysphoria.43 For more on fertility considerations for transgender persons, see Michael F. Neblett II and Heather S. Hipp’s article, “Fertility Considerations in Transgender Persons,” in this issue.

  • FSRH Guideline (March 2023) Intrauterine contraception

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