Some men can become pregnant, and the healthcare system's refusal to say so clearly causes genuine clinical harm: missed screenings, hostile consultations, and people who simply stop seeking care rather than be misgendered every appointment. A review published via Endocrinology Advisor, co-authored by Dr Justin Brandt of NYU Langone and Dr Daphna Stroumsa of the University of Michigan, makes the case plainly and I am glad it exists.
Let me start with the people, because the clinical detail is only half the story. A decade ago, a pregnant trans man trying to access maternity care was often trying to navigate a system that had no framework for him at all. The forms said "mother". The midwives said "mum". The waiting rooms were decorated with images of women in floaty dresses, and the consultations assumed that the person on the couch matched all of that. Many trans men described those experiences to me as alienating at best and traumatic at worst. Some stopped going altogether. And when a pregnant person stops attending antenatal appointments, that is not a bureaucratic inconvenience: that is a clinical risk, for the parent and for the baby.
Dr Stroumsa names it precisely: providers who are not competent, not knowledgeable, and sometimes discriminatory themselves create "poor experiences in obtaining care, which may elevate chronic stress, avoidance of care, and low-quality care — all potentially leading to poor obstetric outcomes for both the parent and the neonate." That is a researcher saying, in careful academic language, that discrimination kills, and it is worth reading it in those terms.
The good news is that things have changed. Dr Brandt notes that where a decade ago many pregnant trans men struggled to find clinicians with basic familiarity, today there are more clinicians with genuine expertise, more inclusive clinical guidelines, and broader recognition that trans people want and deserve fertility care, pregnancy, and parenthood. That is real progress, and I do not want to rush past it. The field has moved, and the people who drove that movement, trans parents, advocates, researchers, and yes, some very good doctors, deserve credit for it.
But the review is also honest about what has not changed, and in some respects has got worse. The current political climate in the United States, and the UK is not far behind, has made the environment for trans and gender-diverse people increasingly unwelcoming. Anti-trans sentiment in legislation and public discourse has had, as Dr Brandt puts it, "real implications for access to affirming health care services." That means pregnant trans men in some parts of the US are now finding it harder, not easier, to access good care than they were a few years ago. That should concern every clinician who takes their duty of care seriously, regardless of their politics.
There are also practical clinical points in this review that deserve wider attention. Testosterone, for instance, is not a contraceptive. It generally suppresses ovulation, but it does not reliably prevent it, and pregnancy while on testosterone does happen. Trans men and gender-diverse people with a uterus who are sexually active in a way that involves sperm need clear information about this, and they need it without judgment. Testosterone should also be discontinued once pregnancy is confirmed: the data on fetal exposure are limited, but there are theoretical concerns about virilisation and some suggestion of effects on placental implantation and fetal growth. Clinicians need to know this, and they need to be able to have that conversation in a way that does not begin with the assumption that the person in front of them is a woman.
What strikes me about this review is how small many of the asks actually are. Use the patient's chosen name and pronouns. Create an environment that is respectful and affirming. Monitor for worsening gender dysphoria during pregnancy, because pregnancy can intensify it for some people even as it is a source of profound meaning for others. Ensure a smooth transition back to affirming primary care in the postpartum period. Include partners and support people. These are not radical demands. They are basic competent care, and the fact that we need a formal clinical review to make the case for them tells you something about how far we still have to go.
Dr Brandt also raises something that matters beyond obstetrics: trans and gender-diverse people have historically been excluded from reproductive research. Gender identity is frequently not assessed in studies, which makes these populations invisible in the data. And in the current climate, trans people may be reluctant to participate in research at all, or may conceal their gender identity to protect themselves. The result is a knowledge gap that feeds the clinical uncertainty that feeds the poor care. Breaking that cycle requires researchers, institutions, and funders to actively commit to inclusion, not just to stop excluding people passively.
Some men can become pregnant. Some non-binary people can become pregnant. Obstetric care that cannot hold that truth is not good obstetric care. The clinicians writing this review know that, and they are doing the work to change things. I hope their colleagues are listening.