Roe Is Gone. What Happens for Trans Men?
by Elias Fox Bova Schmidt
December 1, 2022
When the Dobbs v. Jackson Women’s Health Organization decision was leaked on May 2, 2022, I was sitting at my desk, studying for my final exam in my last semester of law school. I had just accepted a fellowship at a reproductive justice organization but I knew that, as a trans man, I was somewhat out of place. I had already felt the hesitancy from many within the reproductive rights landscape to acknowledge that, like cisgender women, trans men require safe and legal access to abortion. As soon as I got the Twitter notification about the leak, I knew that trans men would be among some of the first communities to be further erased in the reactions to the decision.
I was right. Almost immediately, the comments I received both online and in person made it very clear that even for many abortion justice advocates who would otherwise consider themselves to be trans allies, people like me just do not exist. For many, the idea of trans men being treated as partners within the fight for abortion justice is simply too foreign to comprehend.
I do not write this essay to introduce a theoretical question for academics and scholars (and pseudo-scholars) to debate. I write this because trans men need reproductive justice, too.1 I have met men in my community that have been pregnant, that have given birth, that are raising children, that have had abortions, and that plan to become pregnant one day. Trans men requiring abortion justice is not a theoretical concept, but a lived reality for men across the United States, and especially for the most vulnerable of us: Black trans men, Indigenous trans men, trans men of color, migrant trans men, disabled trans men, southern and rural trans men, and trans men living in United States colonial territories, just to name a few.
In the fight for abortion justice, trans men cannot be erased or pushed to the margins. Although it may be uncomfortable to fully include, and sometimes even center, trans men, our involvement is critical to ensure that all gender-marginalized people are protected from the control of a white supremacist cisheteropatriarchy that aims to strip us all of our bodily autonomy.
“If Men Could Get Pregnant, Abortion Would be a Sacrament” – Florynce Kennedy, or Gloria Steinem, or maybe an elderly Irish taxi driver from Boston
Contrary to the famous quote, men do become pregnant. Real men become pregnant. Real men with vaginas and uteruses become pregnant. Pregnancy for trans men is not impossible, nor is it wholly abnormal. Pregnancy for trans men is, however, severely understudied and regularly erased from discussions of pregnancy-related legal and medical needs.
Although some trans men also have intersex traits, most trans men are born with and continue to possess external and internal reproductive organs that are medically and legally defined as “female.” Only 14 percent of trans men surveyed in the 2015 U.S. Transgender Survey reported undergoing a gender-affirming hysterectomy, and only five percent of trans men reported undergoing gender-affirming genital surgery.
It should be noted, however, that there are no studies that specifically measure rates of hysterectomy or gender-affirming genital procedures undergone by trans men of color. This is disheartening, as Black, Latine, and other adults of color are more likely than white adults to identify as transgender, and further demonstrates that even current trans-affirming medical and legal frameworks evolve from a white racial context and ignore the unique needs and experiences of people of color.
There is no population-level data for the number of trans men in the United States who have been pregnant or who can become pregnant. The few studies that do exist on the topic have reported pregnancy rates for trans men and other transmasculine individuals surveyed that range from 12 percent to 17 percent of total study participants. However, notably, there are no studies documenting pregnancy rates for trans men of color or tracing racial impacts. This contributes to further erasure and negative health outcomes for trans men of color who have been essentially made invisible in the fights for abortion justice and bodily autonomy for trans people.
Testosterone, the masculinizing hormone prescribed to trans men undergoing hormone replacement therapy (HRT), is a dose-dependent ovulation suppressant that can impact fertility. If a trans man forgets to take his testosterone or is unable to have his prescription filled for a few weeks, he could begin ovulating, putting him at risk for pregnancy. Studies have also shown that even trans men who have been on testosterone for more than six continuous months can still experience breakthrough ovulation despite taking regular doses.
In one 2014 study surveying trans men who had given birth, around 25 percent of the pregnancies for men who had previously taken testosterone were unplanned. For men who had not previously used testosterone, nearly 50 percent of the pregnancies were unplanned, which is comparable to the national average, a number that one can assume is made up mostly of cisgender women. Anecdotal evidence also confirms the truth that trans men can, and do, become pregnant; just search the #SeahorseDad tag on Instagram. (“Seahorse dad” is used by many trans men to describe their own pregnancy, referring to how male seahorses become pregnant and give birth.)
Trans men are often inadequately educated about their own pregnancy risks and the need to use contraception, even while on HRT, because medical providers are often unaware of the reproductive and sexual health needs of trans men. I can speak from experience in saying that my own doctors have told me that testosterone would render me completely infertile, despite the evidence showing that this is not the case. Because of this misinformation, trans men who have sex that can result in pregnancy run the risk of becoming unintentionally pregnant, which may then require access to abortion services.
Trans Men’s Need for Abortion Access
Trans men need abortion justice just as much as cisgender women do. With the absence of studies on the matter, the same negative outcomes attributed to the lack of abortion access for cisgender women can be assumed to be the reality for trans men as well. However, trans men face additional consequences in the face of abortion restrictions that are not experienced by cisgender women.
Testosterone is teratogenic, which means that taking testosterone while pregnant can lead to birth defects in the fetus and, potentially, miscarriage. For trans men who are pregnant, doctors recommend stopping testosterone for the safety of the father and the fetus.
Trans men are faced with the illusion of choice: carry the fetus to term and stop HRT for their own safety and the safety of the fetus or attempt abortion without clinical supervision. Such methods for self-managed abortion without clinical supervision may include physical trauma, substance use, herbs, or other methods such as continued testosterone use. If trans men are not able to have an abortion, they are effectively forced to de-transition until the fetus has been born.
When trans men do attempt a self-managed abortion, they often face the risk of criminalization, even in states without statutes designed to criminalize self-managed abortion. In these states, prosecutors often apply laws that address mishandling of human remains, concealment of a birth, child abuse, assault, and homicide. For racialized trans men, Indigenous trans men, migrant trans men, and other trans men who are subjected to heightened surveillance, the risk of criminalization is even greater.
In states like Tennessee and Ohio with “fetal heartbeat bills” on the books, trans men can be at additional risk of harm. For trans men who experience menstrual cessation as a result of HRT, there would be no abnormal lack of menstrual cycle to indicate pregnancy. This means that in states with six-week abortion bans, trans men are even more likely to miss the cut-off to access legal abortion services before knowing they are pregnant.
As the southern United States has the highest concentration of trans people in the country while also having the strictest abortion bans and restrictions in place, some trans men would be required to travel hundreds of miles for abortion services. Because trans people, especially racialized trans people, are more likely to live in poverty than the general population, it can be even more difficult to schedule and access abortion services within those six short weeks or to travel out of state to access abortion services.
The Immediate Impact of Medication Abortion Bans
These disparities are felt in laws and regulations blocking access to medication abortion as well. In a post-Dobbs world, medication abortions are the leading type of abortion care for many people. For trans men, an immediate lack of access to medication abortion can have urgent consequences. According to preliminary data from the Guttmacher Institute, the 2022 national average for medication abortion use was 54 percent. There is no current post-Dobbs figure for abortion methods used among trans folks, but the last known figure of medication abortion use among trans people was 34 percent in 2019.
Studies have also indicated that the major motivation behind seeking medication abortion differs between trans men and cisgender women. While cisgender women tend to seek medication abortions due to fears of bleeding, complications, or anesthesia, trans men tend to seek medication abortions because it allows them to avoid interactions with medical providers and medical facilities.
Given the discrimination and violence that trans people often experience in medical systems, this motivation makes sense. The 2015 U.S. Transgender Survey reported that 33 percent of trans respondents had at least one negative experience with a medical provider, including verbal harassment, refusal of treatment, or being required to teach the health care provider about transgender people to receive appropriate care. These negative experiences are significantly worse for trans people of color, especially Native and Indigenous trans people.
Welcoming Trans Men in The Fight for Abortion Justice
A lack of access to abortion services could have devastating consequences for the mental health of many trans men as well. As testosterone is quite literally a life-saving intervention for many trans men, including myself, I cannot help but worry about the psychological impacts of being forced to both cease testosterone and to carry an undesired pregnancy to term. Not only is a necessary medical intervention to alleviate (often debilitating) gender dysphoria immediately unavailable, but a pregnant trans man must now navigate a system designated as “women’s health care” while also potentially losing any ability to pass as a cisgender man for safety purposes. But again, these realities are rarely addressed in discussions of abortion justice.
The man who needs an abortion is not a theoretical question to debate. He is not a “gotcha” used to minimize the harm experienced by cisgender women in a post-Dobbs world. He is not the enemy of feminism, nor does he take up unnecessary space in the reproductive justice movement. He is real, and he needs abortion justice as much as any cisgender woman does. Many reproductive rights and abortion justice circles have taken the welcome first step of using gender neutral language. But for the safety of trans men, it is not nearly enough. Now is the time to wholeheartedly welcome trans men into the fight for abortion justice.
- In this article, I use trans men to refer to men who were designated “female” at birth. Transmasculine, when it is used, specifically describes masculine-identifying people who were designated “female” at birth, including men as well as other genders. I want to stress that trans men should not be read to exclude trans men who do not identify with a binary construction of manhood or masculine identity, as I myself identify as what would most succinctly be described as a non-binary trans man. I additionally want to make it very clear that although this article discusses the needs of trans men, it in no way is meant to invalidate the needs or experiences of transmasculine people who do not identify as men. I focus this article on the needs of trans men because there are very few, if any, legal articles or reproductive justice writings that discuss the specific needs of trans men and transmasculine people who can get pregnant, give birth, or require access to abortions. Not all trans men fall into these categories either, as many individual trans men may be unable to get pregnant. In this article, while I speak of trans men as a marginalized gender that is often erased and ignored in discussions of the need for reproductive justice, its argument also applies to transmasculine people generally.
This article was originally published on CUNY Law Review Blog and has been republished here with permission.