LGBTQ+

What LGBTQ+ People Need To Know About Birth Control

Traditionally, LGBTQ+ people have been excluded from conversations about birth control and contraception. Our guide aims to change that, with expert advice on all the options available

Written by Michele Theil

Historically, hormonal birth control, like the pill, has been advertised as a way to protect yourself from getting pregnant, so it’s been targeted at cisgender, heterosexual women. But excluding LGBTQ+ people from conversations around birth control is not only wrong, it also makes finding the right method of contraception even harder. 

We know that there are many reasons why someone who’s LGBTQ+ might want to take birth control, from easing period symptoms to avoiding unplanned pregnancy and controlling their cycle. 

“Sadly, we still live in such a cisgender and heteronormative world, where young LGBTQ+ people aren’t educated enough around their sexual health and well-being,” queer sexual health practioner Amy Smith, from Rethinking Sex, tells Flo. 

Studies have highlighted that narrow, heteronomative perceptions of birth control start in the classroom, and they have very real consequences. A recent study by LGBTQ+ education activists GLSEN found that only 19 percent of U.S. secondary schools provide sex-ed that is LGBTQ+ inclusive. And in the U.K., two in five  — that’s 40 percent — of LGBTQ+ students are never taught anything about LGBTQ+ issues at school, according to Stonewall’s 2017 School Report

This perpetuates the myth that certain conversations surrounding birth control simply don’t apply to the LGBTQ+ community. Research says otherwise, highlighting that young people who are of a sexual minority are at increased risk of teen pregnancy.

Finding the right birth control method for you can take time. The first option that’s presented to you may not always be the best. From hormonal methods (such as pills, IUDs, and implants) to barrier methods like condoms, it’s always worth discussing the side effects, benefits, and effectiveness with your doctor or a healthcare professional. 

Whichever option you choose, Smith reiterates that practicing safe sex is “incredibly important to our well-being and our relationships.” We agree, which is why we asked her to share everything people who are LGBTQ+ need to know about birth control.

Why do LGBTQ+ people need birth control?

Conversations around birth control often ignore the LGBTQ+ community because they assume that pregnancy is not a risk for people who have sex with members of the same sex. But sex and gender are two different things, and unplanned pregnancy is a risk for anyone with a uterus who has sex with partners who produce sperm. 

Experts have reported that one of the persisting myths that trans men are told is that they can’t conceive because testosterone therapy (T) has damaged their reproductive organs, meaning they’re infertile. However, a small study conducted by Boston IVF found that trans men who froze their eggs for fertility preservation while transitioning via T had similar egg yields to those of cisgender female patients.

Similarly, a recent U.S. study found that 61 percent of pregnant trans men and non-binary people surveyed had used T before becoming pregnant, and of these pregnancies, a quarter were unplanned. 

Also, remember that while taking T may stop ovulation, the egg reserves that trans men and non-binary people may have do not disappear, and their menstrual cycle will return if they stop taking T, which makes them able to conceive and carry a baby.

Preventing unplanned pregnancy isn’t the only reason why people use contraception. They might want to control their cycles, stop their periods altogether, or control hormonal imbalances and acne. 

How to find the right birth control for you

“Working out the right form of birth control for you can take some time,” Smith says. “It can be a journey for some. The most important thing is to look up the methods that interest you online and have an open and honest conversation with your GP or health professional about what could work for you.”

In the U.K., she adds, “local sexual health clinics are the best place to ask questions and access contraception. Plus, they keep all your information confidential, so you can have a safe and comfortable chat with them about all sexual health and relationship-related questions.” Where possible, you can also request a chat with a practitioner of a specific gender or someone who understands LGBTQ+ issues.

There are so many types of birth control out there that it can seem a bit overwhelming at first. However, your doctor or health care professional should be able to answer any of your questions. 

Types of birth control: The implant and IUD/IUS

“Fit and forget” birth control, as Smith calls it, is one popular option. These forms of long-acting contraception (or LARCs) are inserted into your body by a medical professional. Once they’re in, they provide birth control for an extended period, allowing you to “forget” about them until they need to be replaced. 

The contraceptive implant is one type of LARC that can be used by anyone with a uterus, whether they’re trans, non-binary, or cis. It’s a small, plastic rod that’s inserted into your upper arm just under the skin by your doctor. Once it’s in, it slowly releases progestogen into your bloodstream, which can prevent pregnancy. 

The progesterone typically stops ovulation, thickens cervical mucus, and thins the lining of the uterus. One of the benefits of the implant is that it lasts for three years and is more than 99 percent effective. It also doesn’t contain estrogen, can be removed at any time, and shouldn’t cause too much interruption to your cycle once removed. 

Another option is the hormonal intrauterine device (IUD) (also known as an intrauterine system (IUS), or coil, in the U.K.). This is a T-shaped piece of plastic that needs to be fitted by your doctor. Once in place, it releases progesterone, which works much like the implant to prevent pregnancy. It’s 99 percent effective and can last between three and seven years. A bit of discomfort is common after an IUD has been fitted.

There is also a non-hormonal (IUD) (or copper coil), which uses copper instead of progesterone. It’s inserted into the uterus in the same way as the hormonal IUD. The copper in the IUD changes your cervical mucus and makes it more difficult for sperm to reach your eggs during ovulation. One of the key benefits to IUDs is that they’re over 99 percent effective and can last between five and 10 years. However, some people have noted that their periods become longer, heavier, and more painful when using the copper IUD. 

Types of birth control: Contraceptive pills

The most common form of non-permanent contraception used in the U.S. and U.K. is the pill. However, there are many different types of pill, and it can take a bit of trial and error to figure out exactly which one works best for you. 

One type of pill you may consider taking if you’re a cis woman, trans man, or non-binary person with a uterus is combined oral contraceptives (COCs), also known as the combined pill. This type of birth control contains a combination of both artificial estrogen and progesterone. It works by preventing ovulation, thickening the cervical mucus, and thinning the lining of the uterus. Some versions of the pill have a built-in seven-day break in each packet. This break causes withdrawal bleeding that’s similar to a period. 

If you can’t use contraception that contains estrogen, then your doctor may recommend the progesterone-only pill, also called the minipill. Unlike the combined pill, you take the progesterone-only pill every day without breaks. It prevents pregnancy in the same way that the combined pill does. The minipill has a small window of time it needs to be taken in to be effective. If you use the minipill, be sure to carefully read the instructions to make sure you take it on time. If you do, then it can be more than 99 percent effective at preventing unplanned pregnancy. 

Side effects of the pill can include depression, anxiety, a long period, and low sex drive, but these can vary depending on your body and the type of pill you take. Some people don’t experience any side effects at all. 

If you notice a change in mood or physical well-being after you’re prescribed the pill, then speak to your doctor or health care professional. They should review your options with you and help you find an alternative you’re happy with.

“If you are on any puberty blockers or HRT, then be sure that your GP or sexual health practitioner is aware,” Smith explains. “Don’t worry though, there are certainly options out there so you can be yourself and have an enjoyable sex life.”

Types of birth control: Non-hormonal birth control options

There are plenty of non-hormonal birth control options available too, including condoms and dental dams.

“Condoms are the most commonly known forms of contraception, as they are the easiest to access; however, you can also get femidoms, which is an internal condom, and dental dams, which is a piece of latex to prevent STIs when giving oral sex,” Smith says. “These are called barrier methods and are effective at preventing pregnancy and STIs when used properly.”

Barrier methods can be used during penetrative sex (whether that’s manual, vaginal, or anal) and during oral sex. 

Though some people who are LGBTQ+ aren’t at risk of pregnancy, STIs do not discriminate, so it’s key to take steps to prevent yourself. “You should definitely use external contraception to prevent pregnancy and STIs ‘just in case,’ especially at a young age,” Smith says. “It’s very important if you have an active sex life that you stay protected.”

Using barrier methods is the best way to do this: “Condoms can be used on both penises and sex toys to prevent the spread of STIs, and dental dams can be used for vulvas when giving oral sex.” You can also use condoms and barrier methods of protection when participating in anal play. 

Regular sexual health screening is important, too, even if you are having sex with one long-term partner. In the U.S., in addition to your provider or OB-GYN, testing services are offered by Planned Parenthood, Lets Get Checked, Get Tested, and many other local health clinics. In the U.K. you can be tested for STIs at your GP or local sexual health clinic. In some areas, there’s also the option to get an at-home STI test that can be mailed back for results in just under a week. 

Where to go for birth control advice and support

If you want to learn more about where you can access safe, accurate LGBTQ+-inclusive sexual health and birth control advice, here’s a list of organizations that can help: 

Please note these resources are just for reference and are in no way associated with Flo

U.S.

American Sexual Health Association
Planned Parenthood
CDC
Besider
O.School

U.K.

Brook
Fumble
Get It
Eve
The Lowdown
The Rainbow Project
LGBT Youth Scotland

Australia

Center Clinic
Headspace
Family Planning Victoria

Canada

Action Canada
Alberta Sex Positive Education and Community Center
Sex & U

If you’ve been affected by anything in this piece or are struggling with your mental health and would like to speak to someone, Flo has gathered links to support services that might be helpful. Please visit this page for helplines in different countries.