Danny Wakefield and his wife gave birth to their first child in 2020. This brought to light a number of problems faced by transgender families in the health system.
“I had a really hard pregnancy,” Wakefield, 36, who is transgender but also uses they/them pronouns, tells Yahoo Life. During emergency room visits, Wakefield says they were met with “snickers” from nurses, as well as “doubt, disbelief and a lack of knowledge” from physicians ill-equipped to handle their needs.
“In one instance, it took an hour and a half to get them to treat me because they didn’t believe I was pregnant,” Wakefield says. “The doctors and nurses would talk quietly among themselves, asking each other questions about me, instead of asking me directly — the patient who’s sitting right in front of them.”
Stories like Wakefield’s are not uncommon, says Dr. Juno Obedin-Maliver, assistant professor in the Department of Obstetrics and Gynecology at Stanford University School of Medicine. That’s mainly because the medical establishment — and society at large — has little knowledge about pregnancy in the trans male population.
“We grow up in a world with books, from preschool on up, that until very recently have not imagined or really represented the diversity of communities as they are,” Obedin-Maliver tells Yahoo Life. “None of our systems have been designed to delineate the difference between somebody’s gender and somebody’s pregnancy capacity.”
That’s slowly changing, Obedin-Maliver points out, due to a growing demand from transgender patients — and because more and more are sharing their stories, as with a recently trending New York Times Op-Doc: A trans man gives birth in a small Mexico town.
But, Obedin-Maliver argues, until society acknowledges the basic truth that “anyone born with a uterus, ovaries and tubes” has the capacity to become pregnant, there will always be a lack of accurate research and data, leaving trans parents at a disadvantage.
Trans men can — and do — give birth.
Transgender men — people born with female anatomy who live and identify as men, sometimes undergoing gender-affirming care through surgeries and/or testosterone and sometimes not — can get pregnant in the same way anyone with reproductive organs can, explains Obedin-Maliver. Penetrative sex can be done with someone with sperm or with an assisted reproductive technology (ART), like intrauterine insemination, IUI, and in vitro fertilization.
Due to the fact that trans male pregnancies are vastly under-researched — not to mention their lack of visibility — the process is clouded with misconceptions. Obedin-Maliver states that one of the most common misconceptions is the belief that trans men who take testosterone cannot conceive. Though more studies need to be done on how testosterone influences ovulation in general, taking the hormone does not negate one’s capacity to get pregnant.
“There is a difference between having a period, or not, and ovulating, or not,” she explains. “Those are actually related but distinct processes in the body.” So it’s possible that somebody on testosterone might have stopped menstruating but is still ovulating or producing eggs. “That’s true for anyone [with female reproductive organs],” she adds, “and that sometimes makes it difficult for folks to know if they are pregnant, because they’re having sex with sperm involved and we don’t know how much testosterone diminishes ovulation.”
That message often doesn’t translate to the population that needs it most.
Kayden Coleman, a gay transgender man — meaning his gender is trans male and his sexual orientation, something separate and different, is gay — is father to two daughters, 9 and 2, and has been on testosterone for 14 years. At the suggestion of his doctor, he went off during the pregnancies. He was still on testosterone when he realized he was pregnant. Was pregnant — both times unplanned.
“There are a lot of doctors prescribing testosterone to transgender men and selling them this dream that they’ll somehow be infertile or not be able to get pregnant,” Coleman tells Yahoo Life. “As long you are having relationships with any person who produces semen you can get pregnant.”
Wakefield went through a similar situation. They were told that they would not be able “to conceive or bear a child” if they started using testosterone 10 years ago. Wakefield ended up having an unplanned child.
Sonny Witt, a trans man in Australia, gave birth to his child in 2022. He planned his IVF pregnancy. He stopped taking testosterone after the egg-retrieval procedure and also during his pregnancy, according to his doctors. He began to use testosterone again “about three weeks” after giving birth.
In some cases, trans men may choose to pause their hormone treatments in an effort to get pregnant, but this step is sometimes unnecessary — and those considering it should consult with their doctor beforehand. Transgender men do not all use testosterone and not all women keep their uteruses.
Witt, now 30 years old, says he did not know that pregnancy was possible until he saw other trans dads share their journeys online. That’s when he decided to make his dream of fatherhood a reality by reaching out to a “rainbow clinic,” specializing in LGBTQ family planning.
He told Yahoo Life that he did not know that such a service was available for transgender people. “That is why I shared my journey publicly.” This is something I want to make more people aware of.
Shon McCloud, an Army veteran who identifies transgender, is currently pregnant. He had his first child naturally with his male partner. Because he was taking testosterone during his pregnancy, his doctors considered it a high-risk pregnancy. This is why he stopped taking the hormone after giving birth.
McCloud told Yahoo Life that many people feel judged or don’t get the support they need. “So, that’s why I’m so excited to offer it for.” [my son].”
Obedin-Maliver, who co-authored a 2019 study about the effects of testosterone during pregnancy, recommends that trans men pause their hormones while pregnant as a precaution — simply because there’s still more research to be done.
“It is not precisely clear for how long before pregnancy or for how long after the pregnancy to restart if, for example, they are chest or breastfeeding,” she explains. Trans men can produce milk after top surgery. This is when the breasts are removed. “So that is a conversation that each individual should have with their health care provider.”
No matter the gender of a birth parent, basic pregnancy needs will be met regardless. Obedin Maliver says that no pregnancy is one-size-fits all, and therefore ob-gyns should approach trans pregnancies the same as they approach any other.
“I am often asked, “What is the experience of a trans woman giving birth?” “I am often asked, “What’s the experience of a trans man giving birth?”. I reply, “Well, what’s it like for a cis-woman to give birth?” She responds. “For instance, as a queer women, I had terrible times in my pregnancy. It was a different experience than my friends who were happy to be pregnant and had a great time.
Information gap
According to the Human Rights Campaign’s 2021 survey, more than 1% (close to 2 million) of Americans identify as transgender. Obedin-Maliver believes that the number of people who give birth is likely to be higher than many would think. Similarly, data is lacking on the number of trans men who want to conceive children through IVF — though a 2019 Family Equality Council report showed that 63% of LGBTQ people planning families are looking into foster care, adoption and some form of ART.
Then why is the data so sparse? One of the reasons, Obedin-Maliver notes, is that most medical systems have a protocol of tracking the birth parent’s gender as “female” when that’s not always accurate, making it difficult to have a full picture.
Witt, Coleman, Wakefield and Coleman were also misgenerated on their baby’s birth certificates. They now worry about what real-life consequences it could have.
Witt says, “I had to labeled as the mom,” and is worried that it will cause more complications when he enrolls in school.
Wakefield was also listed as the “mother” (and sole parent) on his son’s birth certificates. This contradicts Wakefield, whose own ID documents label him as “male.” It has caused many problems for Wakefield, such as difficulty getting his son an American passport.
Lambda Legal points out that accurate documentation is vital for trans parents in many life events. These include “enrolling a student in school, authorizing medical treatment, establishing eligibility to government benefits or child support and authorizing a parent to take a child to day care or school.”
Another reason for the lack of data is that there simply aren’t enough people who care to make trans health a priority, adds Obedin-Maliver, who has led many studies — including PrideStudy.org, the first large-scale long-term national health study of LGBTQ people — in efforts to find solutions for queer communities that are disproportionately impacted by a lack of research. But, things are slowly changing.
For example, the Society for Maternal Fetal Medicine issued a statement last spring highlighting the importance of gender inclusivity. The American College of Obstetrics and Gynecology (the premier American organization for ob/gyns) began publishing the experiences of trans and other nonbinary people in its publications. In 2020, the Yale Journal of Biology and Medicine published a narrative review on trans male pregnancies while giving an overview of the literature’s contributions.
Dr. Devon Ojeda is the senior national coordinator for National Center for Transgender Equality. She tells Yahoo Life that not all people who require pregnancy-related treatment are women. The research is available. To uplift this work means that the health care system has to completely change the way they see preventative care beyond the gender binary.”
“I have fallen in love with myself”
For many trans dads, sharing their stories online — including with the hashtag #seahorsedad (which has upwards of 344 million posts on TikTok) — is a radical act that can not only change the way people feel about trans health care but also be a beacon for other trans men who want to start a family.
Coleman states, “It needs to be accepted that transgender persons exist and that we have children.” He also says that sharing stories about Black transgender men is crucial because it challenges transphobia as well as racism. He says that they believe that all transgender men are trying to date women.
McCloud says that starting a family is a personal decision and should not be discouraged because there isn’t enough understanding.
He says, “Births are part of life.” “People are cruel and ignorant when it comes to ‘new information’ or reality. It doesn’t matter if it isn’t seen, We all doubt it, regardless of the fact that men identifying as males can and do have children. “Birthing a child does not change my identity.”
Wakefield has been sharing their parenting journeys on the blog Danny, the Trans Dad for the past two years, adds, “To be public about my pregnancy and my journey to parenthood, because visibility is so important, I wanted other trans and nonbinary people to know that we can, and do, create really beautiful and amazing families — and there are many different avenues to doing that.”
The larger message many visible trans dads hope people receive isn’t necessarily about the trans experience — but, rather, the joys of being a parent.
Wakefield describes fatherhood as “I have fallen in love” with himself. I never thought that I would be able to heal so much just by being a parent. I want my trauma to be healed so I don’t keep going through the same cycle. This struggle, this inner struggle has been a part of my life, especially as transgender. It’s amazing to see those struggles turn into self-love. All of this I owe to my child.
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