An American study points to the lack of psychological care provided to transgender men who would carry a child.
When they begin their gender transition, some women who have been assigned births make the choice to preserve their ovaries and uterus. It is then possible for them to become pregnant and carry a pregnancy to term after their gender reassignment.
Still little known to the general public and still taboo, these "trans pregnancies" are not always easy to live by the first concerned. This is shown in a new study by Rutgers University researchers published in the journal Maturitas. According to its authors, trans men waiting for one or more children are at increased risk of depression compared to pregnant cisgender women. They are also more likely to miss medical and psychological care during pregnancy
"Despite the increased visibility of transgender people - there are approximately 1.4 million people transitioning to the United States - medical providers are largely unprepared to care for them and most have had little training opportunities, "says Justin Brandt, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Rutgers Robert Wood Johnson Medical School.
A risk of gender dysphoria
Currently, there is no data in the United States or France on the number of transgender men who give birth each year. This does not preclude, according to Professor Brandt, that their number is probably higher than people think. These pregnancies are not always desired: research suggests that this is the case for 30% of trans pregned men.
However, the study also shows that transgendered men need more psychological support during and after pregnancy. According to the U.S. Transgender Survey, nearly 40% of the 28,000 people surveyed reported having made a suicide attempt, nearly nine times the national average. This risk may be increased in transgender men who experience undesirable physical changes as a result of pregnancy.
"The transitional process is long and difficult, and pregnancy, which is considered a female condition, forces these men to almost completely make the transition back to their assigned sex at birth, which can worsen gender dysphoria," he says. Professor Brandt.
The fear of prejudices
Another problem raised by trans men during their pregnancy: the sometimes discriminating look of the medical profession. 25% of respondents reported negative health care experiences in the last year.
This negative view of their transidentity leads many trans- ferred men (44%) to consult an obstetrician outside their usual care path. They are also more likely to turn to other health professionals than doctors - such as midwives - and deliver outside of maternity hospitals (17%).
Other data collected during the study: the mode of delivery. 64% of trans men interviewed gave birth vaginally, 25% asked for a caesarean section. It is a choice for them not to feel uncomfortable with the fact that their genitals are exposed for several hours. Those who chose a vaginal delivery reported that this allowed them to overcome the negative feelings they had towards the female sex.
The researchers also found that about 51% of transgender men fed their infants in the breast or chest, even if they had breast surgery.
Better manage trans pregnancies
For Brandt, it is important for transgender men planning to conceive to consult their doctors before they become pregnant. They will be able to ask questions that concern them and receive advice on the risks of pregnancy in old age. He is however optimistic. "Although Rutgers' doctors have not yet had pregnant transgender patients, our health professionals are trained and ready," says the researcher.
He also advises doctors to consider post-delivery methods of contraception that they can offer to their patients. "Transgender men who intend to take testosterone after giving birth may decide to delay their return to contraception because they think that their male hormone therapy induces a state of infertility, and this is not always the case" .