If you were to ask 100 pregnant women what it’s like to be pregnant, then you would get 100 different answers. Some of them would feel the same about some things — maybe they couldn’t get enough of their babies’ kicks or shared an unusual craving — while others’ experiences have nothing in common, even though they seem, on the surface, quite similar.
Of course, the same is true of pregnant trans people (in this article I’m using “trans” in the broadest sense, to include non-binary people and those questioning, or exploring, their gender identity).
It’s thought that trans people make up around one percent of the U.K. population. It’s a small number, and yet, if you think about it being made up of individuals, it’s also pretty huge. After all, one percent of 60 million is 600,000. That’s over half a million. Unfortunately, we currently have no way of knowing how many of these people are parents, let alone how many have been — or plan to become — pregnant, but it’s likely to be in the thousands.
Even amongst my group of birthing trans friends dotted around the U.K., there’s a huge variety of experience. There’s all the usual variation that’s common to pregnant people, regardless of gender identity — and then there’s stuff that feels specific to being trans. Some of my friends, for instance, found that pregnancy itself caused a shift in how they identify. Maybe they felt more aligned with a non-binary identity after giving birth, or the opposite: Giving birth actually intensified their male or masculine identity.
In this way, my experience was different again. I felt like my identity stayed fixed throughout conception, pregnancy, and birth despite all the hormonal and physical changes. However, I did struggle with the profound shift from being my old carefree-self to my new dad-self during the newborn phase. Again, I think this is a fairly common parental experience, whether a person is trans or cis (not trans), or whether someone is a birthing or non-birthing parent.
Another thing that tends to be specific to trans people is whether pregnancy triggers gender dysphoria (the sense of unease a person might feel because of a mismatch between their gender identity and biological sex). It might be a familiar dysphoria — for example, linked to a specific area, like the hips or chest — or a totally new and disconcerting kind.
If you’re not trans, gender dysphoria can be virtually impossible to imagine or empathise with, so don’t worry if you just can’t get your head around it. The best description I ever heard is that it’s a “cosmic toothache” — a feeling of malaise and/or physical discomfort that reverberates in the background of your consciousness, or sometimes barges front and centre, making it hard to focus on, or think about, anything else.
It can be general — an all-over feeling that happens wherever you are — or site-specific, meaning it’s related to a specific part of your body or even particular social or private locations, for example, at swimming pools or the shower.
Equally, some birthing trans people feel totally “at home” in their bodies during pregnancy. They might feel like the whole process empowers them and allows them to feel more themselves, in a way that’s often quite separate from gender identity (that is, it doesn’t feel like an especially “female” or “male” experience, despite what society tells us).
During my first pregnancy, I really struggled with dysphoria. I felt that by pausing my testosterone hormone therapy (T), I was walking away from the gender euphoria medical transition had allowed me to experience.
Trans people on T need to stop taking it if they want to conceive, carry, and give birth. Testosterone can be harmful to the fetus, but the good news is there’s no risk of this once it clears your system. It’s important to note that this will take different amounts of time for different people and can be monitored with simple blood tests. There is no evidence that T affects trans adults’ fertility. In fact, there is emerging empirical evidence (not to mention thousands of birth parents the world over) that it does not.
Of course, stopping T is voluntary, and the desire to become a parent is a strong, positive motivation. However, the reality of coming off, and being off, T may still be psychologically rough. It’s vital that prospective parents are able to express negative feelings without judgement and that they have access to mental health support.
Now that I’m pregnant for a second time, the dysphoria is back but feels easier to manage. I think this is partly the confidence of being a bit older and, to a greater extent, feeling less isolated nowadays as a birthing trans man. (Just think, there’s no way I’d have been asked to write this article five years ago!) Also, I know now how amazing it feels to get back on T after giving birth, so I have that to look forward to.
Of course, not all trans people take hormones or medically transition at all. As that isn’t my experience, I don’t want to try to explain or translate it. It simply bears repeating that all people who experience pregnancy do so differently, whether they are trans or cis, and it’s always best not to make assumptions. That said, if you have a close enough relationship with someone, you can always ask if they’re open to talking about their experience.
There might be just one experience that all pregnant and birthing trans people share: That of being excluded from, or erased by, pregnancy care — whether by doctors, midwives, doulas, or in other perinatal spaces, such as hypnobirthing and pregnancy yoga. Even though more trans parents are finding each other and building communities of our own, mainstream pregnancy care (usually referred to by the gendered term “maternity”) can still feel hostile at worst and tolerable at best.
In one sense, this is understandable. Historically, trans people have been invisible (though, importantly, we’ve always existed), so it’s unsurprising that pregnancy care has become so heavily and universally gendered. All we are asking, now that awareness of diversity in birth is growing, is for inclusion. It’s not about never saying “mother” or “woman.” No one would want that. It’s about saying “mothers and …” or “women and ….” This is increasingly known in the birth world as the “additive” approach.
Lastly, and perhaps most importantly, this isn’t simply about respect and not causing offence. Yes, everyone wants to feel safe and respected when accessing health care. Trans people are no different to other people in that regard. However, the most important thing is to actually be safe, and for trans people, exclusion and erasure can mean the opposite.
If a trans man, especially if he is young or a person of colour, does not see himself spoken about and included in the realm of pregnancy care, he is much more likely to self-exclude from that care. This may look like enduring a miscarriage completely alone or, later on, not seeking help when he stops feeling his baby’s movement.
Even if he does feel able to attend a hospital when he’s in pain or bleeding, due to lack of guidance from his own GP or gender clinic, he may not know he is pregnant. By the same token, due to lack of up-to-date training, doctors at the hospital may see this person, with a deep voice and facial hair, and not consider the possibility that he is pregnant.