Pregnancy care for a transgender person quitting hormonal therapy and getting unintentionally pregnant

Introduction: There is an increasing number of cases and experiences of pregnancy in transgender men and nonbinary people. However, according to a review of the literature, cases of regret are extremely rare (ranging from 0.3% to 3.8%), as are data on pregnancies in these patients.

Methods: This case report describes the experience of an unintended pregnancy in a transgender man during detransition and discusses pregnancy-related needs.

Results: The patient whose sex assigned at birth is female was referred to the transgender center Innsbruck (TGCI) at the age of 17. After appropriate diagnostic confirmation and having informed consent from the patient and the mother, therapy with gonadotropin-releasing hormone agonists was started and seven months later gender-affirming testosterone therapy was added. Over the next year, mastectomy, ongoing psychological support and routine follow-up were carried out. The patient then failed to attend agreed appointments for two years until contact was made because of discontinuing the therapy for 8 months. During this time, unprotected sexual intercourse had taken place, and a scan confirmed a pregnancy at 21 weeks of gestation. The diagnosis caused an acute stress reaction in the patient, so that psychological support and a social worker were called in. Under an anonymous identity, the pregnancy was followed in the TGCI with continuous psychological support. Antidepressants, which are well tolerated during pregnancy, have been started for depression. Regular ultrasound scans, performed in such a way that the patient could neither see nor hear the fetal heartbeat, showed normal findings. In interdisciplinary consultation with pediatricians, an anonymous caesarean section was planned for the 36th week of pregnancy. The baby was given to adoptive parents after birth. Post-operative follow-up was carried out at the TGCI. Furthermore, a contraceptive implant was inserted to provide an effective method of contraception. The first desired intervention will be an augmentation mammoplasty as a part of the process of detransition.

Summary: This case illustrates the importance of good collaboration in the care of transgender patients, particularly in contraceptive counseling and perinatal care, as there is a paucity of literature on the incidence of pregnancy complications in transgender patients.

 

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Publication History

Article published online:
02 September 2024