Becoming pregnant while on testosterone therapy is a complex topic with varied individual experiences. While testosterone often leads to a reduction in fertility, it does not consistently eliminate the possibility of pregnancy. Understanding the physiological changes and available reproductive options is important for individuals considering this path.
How Testosterone Affects Fertility
Exogenous testosterone significantly influences the female reproductive system. Testosterone acts as a dose-dependent ovulation suppressant, meaning higher doses are more likely to stop ovulation. It works by affecting the hormonal signals from the brain to the ovaries, which regulate the menstrual cycle and egg release. This suppression can lead to irregular or absent menstrual periods, a common effect of testosterone therapy.
Despite these effects, testosterone is not a reliable form of birth control, and fertility is not always completely eliminated. The degree to which fertility is impacted varies, and some individuals may still ovulate while taking testosterone. Research indicates that prior testosterone use does not necessarily harm egg quality or ovarian reserve, and ovulation can return once therapy is stopped.
Achieving Pregnancy While on Testosterone
For individuals on testosterone who wish to conceive, pausing therapy is a common recommendation to allow the reproductive system to resume its natural function. Most individuals regain menstruation within about three months of stopping testosterone. Once regular menstrual cycles return, natural conception may be attempted.
If natural conception proves difficult, assisted reproductive technologies (ART) can be considered. Options such as intrauterine insemination (IUI) or in vitro fertilization (IVF) may be used. IUI involves placing sperm directly into the uterus, while IVF involves fertilizing eggs outside the body and then transferring embryos into the uterus. Consulting with healthcare providers specializing in reproductive health and gender-affirming care is important to develop a personalized and safe plan.
Pregnancy Considerations
If pregnancy occurs while on testosterone or after recent use, immediate discontinuation is important. Testosterone is considered teratogenic, meaning it can harm a developing fetus. Continued exposure during pregnancy may lead to androgenic effects on fetal genitalia, reproductive, or endocrine systems. Elevated maternal testosterone levels have been linked to low birth weight in human and animal studies.
Beyond discontinuing testosterone, general health considerations during pregnancy include close monitoring. Integrated care between obstetric and gender-affirming care providers is beneficial to address any specific health concerns.
Resuming Testosterone After Pregnancy
Resuming testosterone therapy after childbirth involves several considerations. The timing for restarting testosterone depends on individual recovery, personal goals, and whether the individual plans to breastfeed or chestfeed. While limited data exist, some studies suggest testosterone can be transferred to breast milk, though the relative infant dose may be low.
High doses of testosterone may suppress milk supply. Discussing these factors with healthcare providers is necessary to determine the appropriate timing and protocol for restarting testosterone, balancing individual needs with infant feeding choices. Some individuals may choose to wait until they have completed breastfeeding or chestfeeding, while others might explore options for resuming testosterone earlier under medical guidance.