Reproductive
Pregnancy and contraception service utilization among transmasculine and nonbinary patients attending a sexual health clinic Ruby Lucas* Ruby Lucas Lucas Lucas Lucas Lucas Lucas Lucas Lucas Lucas Lucas Department of Epidemiology, University of Washington School of Public Health
Introduction: While historically sexual health clinics have focused on HIV/STI services for transgender populations, transmasculine and nonbinary individuals assigned-female-at-birth (AFAB) have pregnancy and contraceptive needs.
Methods: We used electronic health record and computer-assisted self-interview data from transgender/nonbinary patients AFAB attending a municipal sexual health clinic in Seattle from January 2019 to December 2024. We compared differences in pregnancy and contraception service utilization by gender identity and testosterone use. Among patients capable of pregnancy, we assessed correlates of contraception use and desire for a pregnancy test at the visit-level using Poisson regression with robust standard errors clustered by patient ID. Adjusted models included age, gender identity, sexual orientation, race, ethnicity, insurance status, and gender of sexual partners.
Results: Of 369 unique trans/nonbinary patients, 36% (n=106/302) reported testosterone use at their last visit. Half of the 550 patient-visits reported birth control use (54%), with most being long-acting reversible contraceptive methods (42%), followed by non-long-acting (7%), and barrier only (5%). Overall, 20% desired a pregnancy test, 2% thought they may be pregnant, and <1% were actively attempting conception. In unadjusted models, testosterone use was associated with contraception use (prevalence ratio [PR]=1.25, 95% CI: 1.08-1.40). In adjusted models, testosterone use was positively associated with desire for pregnancy test (aPR=2.38, 95% CI: 1.38-4.13), while male (aPR=0.29, 95% CI: 0.09-0.93) and transgender man (aPR=0.31, 95% CI: 0.15, 0.62) gender identities were inversely associated. Male gender identity was inversely associated with contraceptive use (aPR=0.39, 95% CI: 0.22-0.71).
Conclusion: Our findings suggest that public sexual health clinics can play an important role in providing trans-inclusive pregnancy planning and preventative care.