Medical uncertainty and reproduction of the “normal”: Decision-making around testosterone therapy in transgender pregnancy

In this work, we draw upon in-depth interview and focus group data from a three-year international study of 70 trans people (residing across Australia, Canada, the European Union, United Kingdom, and the United States) about their intentions and experiences around pregnancy, as well as 22 health care providers (practicing across Australia, Canada, the European Union, the United Kingdom, and the United States) with self-identified experience working with trans patients and pregnancy along a diverse cross-section of specialty areas (e.g., psychotherapists, general practitioners, endocrinologists, midwives, lactation consultants, OBGYNs, fertility specialists). The central motivating questions guiding the present work are: 1) For trans people who are taking testosterone, what is the medical advice and guidance around stopping or pausing testosterone therapy to become pregnant, throughout pregnancy, and during the postpartum period (particularly in the context of chestfeeding/breastfeeding2); 2) What is the evidence base in the medical empirical literature for this guidance; and 3) How do trans people respond to this guidance? The answers to these questions are likely to be quite impactful for trans people as testosterone therapy among these populations generally serves to reduce gender dysphoria, protect mental health, and provide a greater likelihood of being recognized by social peers in accordance with one’s gender (Lagos, 2019). These answers may also be potentially consequential for the offspring of those receiving and following various advice; our understandings of biological and social reproduction and what constitutes “men’s” versus “women’s” hormones; ongoing legacies of eugenics; and how individuals and their health care providers make determinations around their own and others’ “social fitness,” health, and wellbeing.