A group of transgender sociologists without medical degrees has released a study in which they promote the use of testosterone for pregnant biological women identifying as men — despite the known health risks to their preborn children.
In the study’s findings, the authors claim that doctors who advise caution regarding testosterone use in their pregnant male-identifying patients are being influenced by discriminatory beliefs rather than scientific research. These doctors are labeled by the study’s authors as “cisnormative and judgmental,” focused on “center normative development of trans offspring” and are accused of characterizing the “trans patients’ pursuit of testosterone therapy during pregnancy as illicit or selfish.” The authors also state that such patients “grapple with what it means to protect their offspring from becoming anything other than ‘normal'” due to the known effects of testosterone on the developing child.
Known effects of testosterone during pregnancy
It’s important to note that the use of testosterone in the female body makes it difficult to become pregnant in the first place and women who identify as men but wish to become pregnant may be advised to pause testosterone use in order to become pregnant.
Planned Parenthood, which sells cross-sex hormones to patients, states on its website, “[S]ome trans men’s [biological women’s] ability to get pregnant might decrease after taking testosterone for a while…” Therefore, the study appears to advocate for the resumed use of testosterone once pregnancy is achieved.
This is problematic because testosterone is a teratogen — a substance known to interfere with embryonic and fetal development and to cause congenital disabilities. Teratogens also increase the risk of miscarriage, preterm labor, and stillbirth. Alcohol and drugs are other examples of teratogenic substances.
According to research, exposure to excess testosterone in the womb is also known to cause the development of male physical characteristics in female children including body hair, a deep voice, larger muscles, and irregular genitals.
“It is well-established that prenatal exposure to androgens, such as testosterone, can cause genital defects in females,” explained Jennifer Lahl, MA, BSN, RN and Kallie Fell, MS, BSN, RN. They continued:
Androgens act as masculinizing hormones, guiding the formation of male genitalia and inhibiting the development of a vaginal opening in males. Consequently, medical practitioners are not displaying ‘cisnormativity and judgment’ in their handling of ‘trans’ patients regarding testosterone ‘therapy’; they are fulfilling their ethical duties of beneficence and non-maleficence. Given the known effects of testosterone on a developing fetus, a conservative, precautionary approach is duly warranted.
Yet, the study undermines these documented health effects as “theoretical or hypothetical” and states, “In the context of medical uncertainty around testosterone therapy during pregnancy, providers offered rationales for following a precautionary approach that centers normative fetal development and advises pausing testosterone therapy.”
After childbirth, the use of testosterone also interferes with a biological woman’s ability to produce breast milk. The La Leche League states that “testosterone interferes with the hormone necessary for lactation (prolactin) and can cause a significant decrease in milk supply.”
In addition, little to no information is known about the effects of testosterone on a pregnant woman’s own health.
Creating a child who is different
There is an attempt by the study to justify taking testosterone during pregnancy despite the health concerns for the baby because trying to avoid having a child who is ‘different’ could be viewed as discriminatory. Therefore, knowingly causing that child to be different in order for the mother to continue taking testosterone to pass as a man is touted as acceptable, justifiable, and maybe even a valid approach to parenting.
One biological woman who participated in the research stated her concerns about taking testosterone during pregnancy, saying “There’s a bunch of research around androgen exposure in utero and intersex conditions.” But, she added, “I did have a little bit of a complex feeling around working hard to not have an intersex child… As someone who is gender ‘other,’ to work hard to not create a different body that is gender ‘other,’ it feels weird. It feels a little hypocritical. But it kind of came down to wanting the child I created to have the most options in their own body in their own life which most intersex folks don’t have fertility open to them.”
However, being intersex and identifying as transgender are different, noted Lahl and Fell. Being intersex involves serious health concerns with chromosomes, genitals, hormones, and the reproductive system. It is a non-normative biological condition.
Protecting the most vulnerable
Doctors have a duty to do no harm, which means both to do good and to not do bad, said Lahl and Fell. They also must hold respect for a patient’s autonomy and treat all people/patients equally and equitably.
“In the context of pregnancy, the physician must uphold these principles towards both the mother and her unborn child(ren),” they explained.
The study’s authors claim, however, that doctors tend to take the stance of “offspring-focused” care during pregnancy. There are numerous medications, foods, and substances that women must refrain from while pregnant in order to help protect their extremely vulnerable preborn children from the negative effects of those otherwise safe items. Most women will seek to protect their children first and do whatever is necessary to ensure their children’s safety and good health. This isn’t the result of a doctor’s “offspring-focused” care but of motherly instincts and love for her baby.
While, of course, the mother’s health must be protected as well, unnecessary medications, foods, and activities that could cause harm to the child are widely accepted as something that pregnant women would willingly avoid.
Pregnancy care isn’t gendered
Lahl and Fell explain that the authors of the study cite a “lack of training on trans pregnancy care” and the “highly-gendered space of pregnancy care” for the doctors’ advice to avoid testosterone during pregnancy. But, they argue, there is no data to back up the study’s claims.
Fell and Lahl continue, “[W]e must point out the obvious flaw in the article: pregnancy care isn’t ‘gendered,’ it’s sexed. Only the biologically fertile human females of our species possess the physical attributes necessary for pregnancy and childbirth. This is a simple biological reality.”
Most participants in the research had concerns about ceasing the use of testosterone during pregnancy because they were afraid doing so would affect their ability to be perceived as men in public. They feared it might increase their body dysphoria.
“We have to stop here, rub our eyes, and shake our heads,” wrote Lahl and Fell. “Why would someone wanting to pass as a male desire to take on the very female task of pregnancy? Not only that, but none of the stated concerns or fears of stopping testosterone during pregnancy, postpartum, or while breastfeeding are life-threatening or permanent conditions. There are ways to safely manage depression and body dysphoria that don’t involve potentially harmful compounds.”
So while the authors of the study consider whether or not it is acceptable for a pregnant biological woman to take testosterone during pregnancy for the sole purpose of making her appear and feel more masculine, the fact remains that testosterone is dangerous for a developing human being in the womb.
