As our world continues to grow and we begin to recognize the diversity of people in our communities, part of this has been understanding that gender is not just the male and female that we may have been taught when we were younger.

What is gender identity?

Gender identity is a person’s internal feelings of being a woman, man, both, neither or something else. Many people have a gender identity and/or gender expression (how a person shows their gender through their appearance or behavior) that matches their sex assigned at birth. However, many people have a gender identity or gender expression that is different from their sex assigned at birth; these people might use the term “transgender” or “gender nonconforming” to describe their gender identity.

What is gender dysphoria?

Gender dysphoria is when someone experiences great distress or general unhappiness associated with the mismatch between their body and their gender identity. Not all people who identify as trans experience gender dysphoria. Gender dysphoria may include emotions such as sadness or anger, but can also include feelings such as a desire to change the way their face, chest, or genitals appear, for example.

Why are gender identity and sex different?

While sex is something you were assigned when you were born, gender is something you can choose or identify with. When people are first born, they are too young to express their gender identity independently, so people often presume their gender identity as the same as their sex. However, as a child grows, they are able to make their own choices about how to express themselves. Some parents are raising their children with a non-binary gender identity. When these children grow up, they may choose a their gender when they are older.

What are different genders?

There are many different gender identities in our world today, even more than we have listed below! Gender is self-defined and impacted by a person’s culture and values. New genders are being discussed every day! Below are a few of the most common.

Below is a growing list of gender terms:

• Girl/Woman
• Boy/Man
• Genderqueer
• Agender
• Bigender
• Gender-fluid
• Transgender

How do people express their gender identity?

Gender can be expressed in many ways: through our clothes, speech, activities, hobbies, and our behaviors. It’s ok for any of these things to change at different times, or in different situations, depending on what feels comfortable. Not all people who share a gender identity express it in the same way. For example, someone can identify as male and wear dresses. Someone can identify as nonbinary and wear dresses. It’s always important to ask someone their pronouns. Some examples of pronouns may be, “He/him/his, or she/her/hers or they/them/theirs.”

What’s the difference between gender identity and sexual orientation?

Many people confuse the two, but here is a simple way to understand the difference: gender identity is more about “who you are” (boy, girl, both, neither, or something else) and sexual orientation is about “who you have a crush on.”

What does transgender mean?

Transgender people have a gender identity that is different than the sex they were assigned at birth (female or male or intersex). For example, a transgender person who is assigned female at birth may feel like a boy, or a transgender person who is assigned male at birth may feel like a girl. Transgender people may seek medical therapies such as hormones or surgical procedures to help change their body to better match their gender. However, some people express their gender through their appearance and/or behavior, without changing their body.

Transgender is also an umbrella term used to describe the whole community of people who identify as a gender different then their sex assigned at birth. So, for example a genderqueer person (someone who identifies as a gender that is not 100% male or female) may identify as part of the transgender community. To try and make sure that everyone feels included, the community generally tries to broaden terms used to include the “transgender and gender diverse” community or “transgender and gender nonconforming” community.”

Is it okay to be transgender?

Absolutely! As with LGBQ people, some people with traditional beliefs may feel uncomfortable with people who express these feelings, but professional medical, psychological, and psychiatric organizations agree that it is better to express who you are, even if it makes other people a little uncomfortable.

Can I be both transgender and LGBQ? What about transgender and straight?

Yes and yes. Being transgender is about gender identity, not sexual orientation. Everyone has a sexual orientation, regardless of what their gender identity is. Transgender people may be attracted to people of the same gender based on their own gender identity, attracted to people of a different gender based on their own gender identity, or they may be attracted to more than one gender.

We used to think that the gender people were given at birth was the one they would have their whole life. But many people grow up and identify as a different gender than what their doctors or parents guessed when they were young. That’s okay!

What is gender identity?

Gender identity is a person’s internal feelings of being a woman, man, both, neither, or someone else. Many people have a gender identity and/or gender expression (how a person shows their gender through their appearance or behavior) that matches their sex assigned at birth. However, many people have a gender identity or gender expression that is different from their sex assigned at birth; these people might use the term “transgender” or “nonbinary” to describe their gender identity.

Some people might think that gender identity is similar to sexual orientation, but these are two different parts of a person. Gender identity is how a person identifies their gender, and sexual orientation is who a person is attracted to, the terms they use to identify their attractions (for example: lesbian, gay, bisexual), and with whom they have sex.

For some people, their gender identity might change over time. They might identify with one gender when they are younger and with another gender when they are older.

What does transgender mean? 

Transgender (or trans) is a term used by people who identify with a gender that is different than their sex assigned at birth. They may identify as a transgender woman or man. Or they may identify with any of the other terms below that is not cisgender. For example, Uri identifies as a woman, and was assigned male at birth. Uri chooses to identify as a transgender woman. Other people like Uri might just identify as a woman without identifying as transgender.

Transgender can also be an umbrella term used to describe the community of people who don’t identify as cisgender.

What does cisgender mean? 

Cisgender is a term used to describe people whose gender identity matches their sex assigned at birth. For example, Alex’s sex assigned at birth was female and she identifies as a woman, so she is cisgender.

What does nonbinary mean?

Nonbinary is a term used to describe either gender identity OR gender expression that is not fully woman or man, or masculine or feminine.

Some people who use this term may feel like both a boy and a girl, neither gender nor another gender. For example, Eli was designated male at birth, but doesn’t identify as a girl or boy and prefers the term nonbinary. Some people like Eli might identify with a term other than nonbinary, such as one of the terms below.

Some people may also attach this term to other gender identities such as a nonbinary transgender man, to express that they identify as a man and their gender expression is not fully masculine.

Additional terms which a person may use when describing their sex or gender identity:

Gender is cultural. That means people from different cultures may use different terms to describe gender. People may use a term to describe their gender that is not listed here. That’s okay! It’s always important, regardless of the term to respect a person’s gender identity.

• Agender: Someone who does not identify with gender.
• Bigender: Someone who identifies as two genders, usually as both a man and a woman.
• Gender fluid: A person whose gender identity isn’t permanent. They may sometimes identify or express themselves as one gender and at other times identify or express themselves as another gender, or they may feel a mix of genders at one time.
• Gender nonconforming: People who identify with this term may express their gender (how they show their gender through appearance and behavior) in a way that doesn’t match typical male and female cultural norms. Some people may identify their gender as simply gender nonconforming, other people may use this term with another gender identity, such as “gender nonconforming man” because they identify as a man but do not express their gender in typical male ways.
• Genderqueer: Genderqueer is a term used by people who identify with a gender that is not fully woman or man. They may feel like both a boy and a girl, neither gender, or another gender.
• Intersex: Intersex is an umbrella term for all the unique variations that can happen in reproductive or genital parts of the body. Variation can occur in several different areas such as a person’s DNA, genitals or internal organs (testes or ovaries), or the hormones they produce. Intersex people sometimes face discrimination because of their variations, but intersex people have always existed. There are over thirty different kinds of medical terms for different intersex variations. Sometimes intersex is called disorders of sex development (DSD).
• Nonbinary: Someone who does not identify as a woman or man. Some nonbinary people identify as transgender and others do not.
• Two-spirit: This term is used by some native and first nation communities to encompass a number of gender identities and sexual orientations amongst native communities.

What is transitioning?

Transitioning is the way in which a person might choose to express their gender identity when it is different from their designated sex at birth. This can include changing the way they dress, their name, pronouns that they use (see below for more on what pronouns are), using medical (such as using hormones to change their body to align with their sense of gender), or surgical (such as changing their chest or breast tissue) therapies.

Not everyone transitions in the same way. Everyone is different. Just as you and your friends might all express and identify with your gender in different ways (some of you might wear dresses or baseball caps, others might have long hair or not wear makeup), not all transgender people may feel the need to transition in the same way. Some people might want to use hormones, others might not. Some people might want to have surgery, others might not. Some may have surgery and later start hormones. Some may use hormones first. Regardless of what a person does in their transition, they should still be treated with respect, as only they can know what they need to affirm their gender. Some people may not know what they want when they’re younger, and that’s okay. There’s no one right way to transition. Because most medical therapies and surgeries require a parent to agree if the person is still a child or teenager, some people may want certain therapies and surgeries but not be able to get them. We know this can be hard if this is your experience, or the experience of a friend of yours. Having a safe and trusted health care provider with whom you can talk to about these things is important.

What are pronouns?

On most days, you probably don’t notice that when you’re talking about your friend or a family member, instead of using their name you might say “he”, “she”, or “they”, which are what the English language calls pronouns. English language pronouns are she/her/hers, he/him/his, or they/them/theirs. The pronouns ze/hir are popular gender neutral pronouns used in different languages around the world. If you don’t know someone’s pronouns, just ask!  If you don’t feel comfortable asking, you can use gender neutral pronouns such as “they/them” to start. Not everyone with the same gender identity uses the same pronouns, and you can’t tell what pronouns someone uses by the way they look. The only way to know someone’s pronouns is to ask them.

Why are pronouns important?

Growing up, you probably used pronouns based on a person’s gender expression. Most of the time you probably got it right, but sometimes you might be corrected and told “no, she’s actually a girl” when you used “he” to describe her. While it’s okay for this to happen every once in a while, it can be hard for the person who doesn’t associate with the pronouns typically associated with their gender expression. Sometimes, people express transphobia by choosing to use the wrong pronouns to refer to a person to make them feel uncomfortable or hurt. For example, imagine your name is Jennifer, but every time you see your cousin, they call you Sarah. Even when you correct them, they keep calling you Sarah every time. This would likely feel annoying, but more importantly, you might also feel like your cousin isn’t really seeing you for you who are.  This is why it’s important to ask people their pronouns and use the correct ones when referring to them. Just remember, not only transgender people have pronouns, we all have them!

A great way to show off your pronouns is by adding them to your email signature or putting them on your social media profile! You may also notice some people wear a button with their pronouns on it to make others aware when they are in public.

People who are transgender may have two different names. A legal name is a name that a person has on legal documentation, such as their driver’s license, school transcript, or medical record. It’s important to remember that a person’s legal name might not match the name they use. A great way to ask might be to say, “Is this the name you go by?” or “Is this the name you use?” The other name that someone might have is a chosen name, which is a name that a person uses in their day to day life. Transgender people are not the only people with chosen names. Some people might not like their given name and decide to use another name (for example, people who go by their middle name instead of their first name). When referring (to anyone) you should always use their chosen name.

What is a dead name?

A transgender person might use a chosen name that’s different from their legal name. Some transgender people refer to their legal name as a “dead” name. Their dead name no longer represents who they are, and they don’t want to be called by that name. If your dead name is still on official documentation, please let your doctors or your teachers know the name you want to be called. This should discourage them from calling you by your dead name. If someone else has told you they use a different name than what you see on their ID or other documentation, it’s important to always use their chosen name.

What is transphobia?

Transphobia is a term used to describe negative feelings and attitudes toward people who identify with any terms other than cisgender, including people who are transgender and/or non-binary. Negative feelings and attitudes about transgender people can be shown in different ways.

Examples of obvious and intentional transphobic behaviors: 

• Direct insults
• Threats
• Bullying
• Physical harm or violence
• Discrimination

Examples of non-obvious forms of transphobic behaviors:

• Using slurs or words in an unintentional way
• Excluding transgender people from group activities or events
• Avoid discussions regarding transgender issues

It’s important to remember all types of transphobic attitudes and behaviors can be hurtful and sometimes dangerous to transgender people.

Why does transphobia exist?

There is no easy answer to this question. The best way to understand transphobia it is to realize that people often feel uncomfortable with differences, such as differences between people in the most common group (the dominant group: cisgender people) and people in other groups (minority groups: transgender and/or nonbinary people) who experience disadvantages in life more than the dominant group. Other minorities, such as racial/ethnic groups, are also discriminated against. Some transgender people may be discriminated against because they are transgender and because they are another type of minority; for example, someone who is transgender and Black or someone who is nonbinary, Asian, and gay. The good news is that through advocacy and social change, people are becoming more welcoming and inclusive of diverse people. Hopefully, transphobic behaviors will become less common in the future. Even if you do not identify as transgender, you can help support your friends who are by ensuring they feel welcome.

How can I be supportive of someone’s gender?

There are many ways you can be supportive of someone’s gender!

• Always use their chosen name and pronouns. If you use the wrong name or pronouns, apologize. If you hear others using the wrong name or pronouns, correct them.
• If you hear or see someone being transphobic, offer support to the person being bullied and tell a trusted adult who can help you.
• Talk to your friends, classmates, and family about gender diversity. Helping others to learn about the transgender community will help create a warm and welcoming environment for everyone. Sometimes this means finding a trusted adult who can help you have these conversations, including holding workshops or lectures about gender diversity and the transgender community.
• Talk to your school, place of work, or places where you volunteer or hang out about making the spaces welcoming, safe and inclusive for people who don’t identify as cisgender. This can include:
  • making sure there are bathrooms and locker rooms available for people who don’t identify as boys or girls (such as gender neutral bathrooms),
  • making sure that name tags allow people to write in their chosen name and pronouns (or letting people wear pronoun buttons)
  • making sure dress codes are not linked to a person’s sex assigned at birth (such as only girls being able to wear makeup or skirts)

What is sexual orientation?

Sexual orientation refers to the type of sexual and romantic feelings for other people. These people can be of the same gender, a different gender, or more than one gender. People who identify their sexual orientation as “straight” or “heterosexual” typically feel attracted to people of a different gender than themselves. People who identify as “lesbian” or “gay” typically feel attracted to people of the same gender as themselves. People who identify as “bisexual” typically feel attracted to more than one gender, such as being attracted to both women and men. “Pansexual” is a term used by people who feel attracted all genders, regardless of those persons’ anatomy. People who use the term “queer” may use it to mean lesbian, gay, bisexual, or pansexual, or they may use it because other terms don’t quite describe their experiences.

Some people might identify their sexual orientation one way, but experience attractions that don’t match the label they are using. For example, a person might identify as “straight,” but feel attracted to people of the same gender or more than one gender and sometimes act on those attractions. Sexual orientation can also change over time for some people. For example, a person might be attracted only to people of the same gender as themselves, and then later be attracted to more than one gender. This is normal! It just means that sexual orientation is complicated for some people. Sexual orientation is based on gender, not sex or anatomy. This means that a person who identifies as lesbian can be attracted to all women, including cisgender and transgender women.

How do I know my sexual orientation?

People usually know their sexual orientation based on how they feel romantically or sexually toward other people over time. For example, people who have repeated crushes and/or pleasurable body experiences with people of the same gender as themselves but have no crushes or pleasurable experiences with people of a different gender than themselves may identify themselves as “gay” or “lesbian.”. People who have repeated crushes and/or pleasurable body experiences with people of a different gender then themselves but have no crushes or pleasurable experiences with people of a similar gender than themselves may identify themselves as “straight.” However, having one or even a few romantic or sexual experiences with someone of the same gender does not automatically make you lesbian, gay, or bisexual, just as having one or even a few romantic or sexual experiences with someone of a different gender does not automatically make you straight. Sometimes it takes a long time to understand our sexual and romantic feelings and how our bodies react to other people. Someone’s sexual orientation can also change over time. How you identify now may be different from how you identify later. Regardless, only you can identify your sexual orientation.

When will I know my sexual orientation?

There is no official time when people know their sexual orientation. For some people, adolescence is the time when they figure out their sexual orientation, but for other people it may not happen until young adulthood or even later in life. During adolescence, our brains start to release certain hormones that help our bodies go through puberty and change. This happens over many years. At the same time, we may start developing crushes towards other people, which may lead to having pleasurable sexual experiences. For some people, this gives them a clue about who they might have sexual and romantic feelings towards, and what their sexual orientation might be. Sexual orientation can change over time. It’s okay to identify with different orientations as you get older.

Is it okay to be lesbian, gay, bisexual, or queer?

Yes! Although some religions and cultures may have traditional beliefs that these types of feelings shouldn’t be expressed as behaviors, current medical, psychological, and psychiatric organizations believe that being lesbian, gay, bisexual, or queer (LGBQ) is normal. Many religions and cultures are inclusive and welcoming of LGBQ people. Regardless, many LGBQ people are able to keep their religious values and cultural identity and feel comfortable expressing their sexuality.

What’s the difference between gender identity and sexual orientation?

Many people confuse the two, but here is a simple way to understand the difference: gender identity is more about “who you are” (boy, girl, both, or neither) and sexual orientation is about “who you have a crush on.”

Can I be both transgender and LGBQ? What about transgender and straight?

Yes and yes. Being transgender is about gender identity, not sexual orientation. Everyone has a sexual orientation, regardless of what their gender identity is. Transgender people, just as cisgender people, may be attracted to people of the same gender based on their own gender identity, attracted to people of a different gender based on their own gender identity, or they may be attracted to more than one gender.

What are homophobia and biphobia?

Homophobia is a term that describes negative feelings and attitudes toward people who are attracted to people of the same gender (e.g., lesbian or gay), and biphobia is a term that describes negative feelings and attitudes toward people who are attracted to more than one gender (e.g. bisexual or pansexual).

What are some examples of homophobia and biphobia?

Negative feelings and attitudes about lesbian, gay, bisexual, and queer (LGBQ) people can be shown in different ways. Some ways are obvious and intentional; for example, direct insults, threats, bullying, physical harm or violence, and discrimination. Some ways are less obvious. Examples of these hidden forms of homophobia, biphobia, or transphobia include people who aren’t comfortable around LGBQ people; not including LGBQ persons in your activities, groups, or events; the use of slurs/words in an unintentional way; and avoiding discussions about LGBQ issues due to feeling uncomfortable. All types of homophobic and biphobic attitudes and behaviors can be hurtful and sometimes dangerous to LGBQ people.

Why do homophobia and biphobia exist?

There is no easy answer to this question! The best way to understand it is to realize that mainstream culture often feels uncomfortable with differences, and minority groups can be labeled as “different.” Minority is a term used to describe any group of people who experience a relative disadvantage in living their day to day lives as compared to the mainstream or dominant group. Other minorities such as racial/ethnic groups are also discriminated against. Even though being LGBTQ is common, these groups are still minorities, as minorities are not necessarily small in numbers. The good news is that through advocacy and social change mainstream people are becoming more welcoming and inclusive of diverse people, and hopefully homophobic and biphobic behaviors will become less common in the future. Even if you do not identify as LGBTQ, you can help support your friends who are by ensuring they feel welcome.

Helpful Resources

•  The Trevor project: https://www.thetrevorproject.org/
• GSA network: https://gsanetwork.org/
• GLSEN https://www.glsen.org/

Adolescence can be an exciting but also a challenging time, since it is a period when bodies change, schoolwork is more difficult, and friends and families might not understand your feelings and thoughts. Sometimes adolescents feel more anxious, depressed, or even suicidal. Other times, adolescents can turn to risky behaviors such as drugs, alcohol or sex. Lesbian, gay, bisexual, and queer youth, and youth who identify as transgender or gender nonconforming experience the same mental health issues as other adolescents. However, they may also feel alone and might not share their feelings about sexual orientation or gender identity because they fear people will reject them. Having this extra burden can cause these adolescents to have a higher risk for these serious mental health issues.

What do I do if I feel suicidal?

Stay safe and do not make an impulsive dangerous decision! The most important thing to do is to find someone supportive who you know. You don’t have to share all the details about what you are feeling right away, although it might help. If you can’t think of anyone supportive, try calling a hotline (see resources below) or even 911 so you can talk to a mental health professional, or go to the closest emergency room.

Who should I tell about my sexual orientation and/or gender identity?

Not everyone will be accepting of lesbian, gay, bisexual, queer, and/or transgender or gender nonconforming identities. Deciding who to tell can be a difficult decision. You may choose to share your sexual orientation or gender identity with everyone you know or just a few close personal friends or family members. It’s important to find at least one supportive person you trust to tell so you don’t have to carry the heavy burden of a secret alone. If you can’t think of a supportive person in your life, you should contact a mental health professional or one of the professional online resources listed below so you won’t feel alone with these feelings. Don’t pick random unknown websites for support; they may not be helpful or knowledgeable about sexual orientation and gender identity.

Will my therapist force me to tell my parents, family, and/or friends about these feelings?

No. Therapists and other mental health professionals are trained to maintain strict confidentiality about your sexual feelings and behaviors as well as gender identity questions. However, at your first appointment make sure to discuss confidentiality with your mental health provider and how and if information is shared with parents or others.

Will my therapist tell my parents about my sexual orientation and/or gender identity?

In general, no. Therapists are always concerned about your health and safety so they will break your confidentiality in the event that your actions/thoughts might lead to an unsafe situation for you or others (for example, if you were feeling suicidal). However, they would only discuss the details needed to get you the services you need. An ongoing conversation with your therapist about confidentiality is important.

Where can I get support?

This is an individual decision for every person. The most important thing is to find someone who you think will be accepting of you regardless of your sexual orientation and/or gender identity.

This may include:

• An accepting friend
• An accepting parent or other family member
• Someone who you know who is lesbian, gay, bisexual, queer and/or transgender or gender nonconforming
• An accepting guidance counselor
• A Gay-Straight Alliance at your school (this group may have a different name at your school, such as the Queer-Straight Alliance or the Pride Club)
• An accepting school teacher
• Health care or mental health provider
• Lesbian, gay, bisexual, transgender, queer (LGBTQ) support organization

If you can’t think of anyone who will be supportive of your thoughts and feelings, you don’t have to be alone. Usually, a mental health professional can help you figure out who might be a good support person.

“I can’t think of a single person who will be supportive of my feelings.” What are some trusted online resources I can turn to?

There are plenty of online professional resources and hotlines for the many adolescents who have similar thoughts and feelings about their sexual orientation and/or gender identity. See below for a list of resources.

“I have a friend who just told me about their feelings related to their sexual orientation and/or gender identity. How can I help them?”

Even if you are uncomfortable with your own feelings about sexual orientation and gender identity, let your friend know that you will support them and be there for them no matter what. Anyone who is willing to share private feelings and thoughts with you probably trusts you as a close friend and support person. Advise them to talk with their health care provider or start seeing a therapist so they don’t have to feel alone. You can also share with them some of the online resources listed below.

“I have a lesbian, gay, bisexual, queer, and/or transgender or gender nonconforming friend who just told me about having suicidal thoughts. How can I help them?”

Again, let that friend know that they are not alone. Find out if they are with someone who can support them. Let them know that you won’t break their secret about their sexual orientation and/or gender identity, but that you still have to let someone know about their unsafe feelings. Then, stay with your friend and right away let a supportive adult know, call a hotline, or even 911 to make sure your friend stays safe!

Additional Resources

Contraception, or birth control, is important for anyone that does not wish to become pregnant. Especially those who are sexually active, are thinking about becoming sexually active, or just aren’t sure yet. It’s always a good idea to plan ahead for those “what if” moments. Teens of all genders who were sex assigned female at birth can benefit from contraception!

For the purposes of this guide we will use anatomic terms (e.g., vagina), but we know people use a spectrum of terms to describe their body (e.g., genital opening, front opening). You should discuss with your clinician if there are alternative terms you prefer to use to describe your body or the way it works.

What types of contraception are there?

You have a lot to choose from when it comes to contraception. The type of contraception you choose may depend on a number of factors including your anatomy, side affects you do/do not desire, and the partners you plan to have sex with. It’s important to know the different types of contraception methods available for individuals, especially if you are sexually active. It is a good idea to discuss with your clinician which contraceptive methods are best for you and your partner’s health and safety.

Here are some things to consider when choosing contraception:

• How much do they cost?
• How effective are they at preventing pregnancy?
• How easy are they to use?
• Will they protect me against sexually transmitted infections (STIs)?

It’s recommended that you use two types of contraceptive methods to help boost your protection against pregnancy and protects against STIs. For example, you can use the birth control pill in addition to condoms. It’s important to remember that while only those born with a uterus (most of whom were assigned female at birth) can get pregnant, anyone can get an STI. If you have unprotected penile-vaginal sexual intercourse and come in contact with semen you are always at risk for pregnancy and sexual intercourse with a partner of any anatomy, put you at risk for STIs. If you practice safer sex, limiting your number of partners, making sure you get tested for STIs to know each other’s status and making informed decisions about contraception, you can greatly lower your risk.

Examples of contraceptive methods:

IUDs

An Intra-Uterine Device (IUD) is a small, T-shaped device that is inserted through the vagina and cervix into the uterus by your healthcare provider, to prevent pregnancy.

There are more than one kind of IUD. Some IUDs (Mirena®, Skyla®, Kyleena®, and Liletta™), contain the hormone levonorgestrel (a type of progesterone). IUDs that contain hormones (levonorgestrel), do a great job of making uterine bleeding much lighter, or in some cases cause it to go away entirely.  IUDs are over 99% effective in preventing pregnancy. This means that’s if 100 people use an IUD, less than 1 person will become pregnant in year.

Here are 4 great reasons to choose an IUD:

1. Less stress – You don’t have to remember to take a pill every day.
2. Great option for everyone – Hormonal IUDs can be used with other medications used to affirm gender such as testosterone.
3. Heavy flow? No problem, Hormonal IUDs are a great option for reducing bleeding
4. Safety – IUDs are safe and proven to be 99% effective against pregnancy.
5. Privacy –The IUD is not visible to others, you can choose if and when you tell others about your IUD.

Your healthcare provider will need to perform a pelvic exam while placing the IUD. This may make you feel uncomfortable, nervous, or dysphoric especially if you are Trans or non-binary. If you’re feeling uncomfortable or anxious, talk to your provider before your appointment, as there may be an option for sedation or medications with your procedure. If you’re worried, it’s always helpful to bring someone you trust along to your appointment to help you feel safe.

Depo-Provera® Hormonal Injection

Depo-Provera ® is a hormonal (progesterone) method of birth control. That is given as an injection by your health care provider, every three months. When given at the same time, every 3 months, Depo- Provera ® is 99% effective at preventing pregnancy and its private (no pills to carry around!). It’s also good at controlling or stopping bleeding, however some irregular bleeding is expected to occur with the first injection. Another great reason Depo-Provera® is so great is, you don’t need a pelvic exam to use Depo-Provera. Depo-Provera ® has one downside – if you don’t like how the injection works or how it makes you feel, it can take time to wear off, especially if you’ve been receiving them for a while.

Nexplanon® Hormonal Implant

Hormonal implants (Nexplanon ®) is a type of birth control in the shape of a tiny piece of plastic that goes under the skin in your arm by your healthcare provider. They are about the size of a toothpick and made of a flexible plastic which contains a type of progestin hormone called etonogestrel. Nexplanon ® is 99% effective in the prevention of pregnancy for 3 years. The implant is convenient because it’s private (no pills to worry about) and it can be placed and removed in your health care providers office.  As with any birth control methods, there are downsides, with Nexplanon ® one of the most common side effects is irregular bleeding. Unfortunately, there is no way to know how your body will react until you try it, but if you don’t like it, your provider can easily take it out. Depending on the person, someone may prioritize pregnancy prevention over stopping bleeding; it all depends on your goals. .

The Mini Pill

The mini pill is the progesterone only pill. The pill is about 91% effective, and you need to take it every day at the same exact time for it to be effective. The mini pill is safe and easy for you to control since it’s a pill. While some people don’t bleed at all with the mini pill, it is normal to have some irregular bleeding, too.

The Pill, Patch or Ring

The pill, patch and ring are all methods that contain both estrogen and progesterone. The pill is taken every day, the patch is worn on your skin (anywhere except your chest) and is changed weekly, and the ring is used in the vagina. All of these methods can be used to stop or reduce uterine bleeding and are between 91-99% effective at preventing pregnancy.

Condoms

Condoms and barrier methods (such as dental dams and latex condoms) should always be used for sex, whether you’re on another form of contraception. Although other methods of contraception are great, contraception alone won’t help protect you or your partner against sexually transmitted infections (STIs).  External condoms are worn on a penis and work best when put on correctly. Internal condoms can be used in the vagina to prevent pregnancy and can be used for anal intercourse as well. Condoms are most effective when you use them with another form of contraception (like an IUD, for example). Ask your health care provider (HCP) if they have any free condoms to offer you!

Hysterectomy

Hysterectomy is the surgery where the uterus, tubes, and sometimes the ovaries are removed.  Hysterectomy is 100% effective in preventing pregnancy and stopping uterine bleeding. Hysterectomy is permanent, so you must be absolutely certain that you do not want to carry a pregnancy in the future. Hysterectomy is not typically considered until after a person reaches adulthood and has completed childbearing.

What do I do in an emergency?

Emergency contraception is for those who have had sex that could lead to pregnancy without a reliable method of routine contraception. This is for those situations where a condom breaks, sex occurred without a condom, or you do not have another form of birth control. It’s important to remember emergency contraception (EC) does not work if the women is already pregnant, as it will not cause an abortion. There are three types of Emergency Contraception.

Copper Intrauterine Device: Copper T IUD (ParaGard®)

This IUD is a small copper device that when placed in your uterus (through your vagina), not only prevents current pregnancy but future pregnancies for up to 10 years as long as it remains in place. Although the Copper IUD is one of the most effective methods of emergency and ongoing birth control, it can cause more pain with periods and heavier bleeding. For some people, this can contribute to dysphoria. It can also be uncomfortable to have placed.

Levonorgestrel (1.5mg pills) Plan B One-Step®, Next Choice One Dose®, MyWay®, AfterPill™

Plan B is a pill you can take to help delay ovulation and prevent pregnancy for up to 3 days (72 hours) after unprotected intercourse. There is some pregnancy prevention up to 5 days, but the sooner the better. The pill is available over the counter (OTC), meaning you can go to your local pharmacy, walk in, and pick-up the medication without a prescription! The cost will depend on where you pick it up, so it’s always a good idea to call the pharmacy and ask about coupons ahead of time. It’s important to keep in mind that you may or may not experience some bleeding after taking Plan B. If you have any questions or concerns, call your health care provider (HCP) right away.

Ulipristal acetate (30mg) includes Ella™

This is one pill (one dose) that can be taken up to 5 days or 120 hours after unprotected intercourse. A prescription is often needed for this pill, but in some states a pharmacist can dispense Ella™ without a prescription. In many cases, a pregnancy test is also needed. Your health care provider can write you an “advanced prescription” for Ella™ it will be available for you if you have unprotected sex in the future. Talk to your health care provider about this option.

Are emergency contraceptives (EC) perfect?

No method of emergency contraception (EC) is perfect, so it’s important to take a pregnancy test in 3-4 weeks after using (EC). If you develop abnormal bleeding, pain, or pregnancy symptoms (nausea, chest tenderness, etc.), call your health care provider (HCP) right away.

Frequently Asked Questions (FAQ)

Do my parents need to know I’m getting contraception? I don’t want them to know I’m sexually active.

No, contraception should be a confidential service. This means that your healthcare provider (HCP) should not tell your parent or legal guardian that you’re receiving contraception. If you’re nervous, tell your HCP that you are seeking care that is confidential and you do not want your parents or legal guardian to know. Remember that it can be helpful to talk to you parent or guardian or a trusted adult about your sexual health.

Can I take contraception while on testosterone?

Some trans-masculine teens may worry about these methods working against the effects of gender-affirming hormones (such as testosterone). In most cases you can safely take these contraceptive agents, even hormonal ones alongside testosterone. It’s important to speak with your own healthcare provider so they can help you pick the right method for you and discuss if there is any reason one might be better for you while on testosterone.

My friend was telling me that being on T (testosterone) works as contraception. Is that true?

This is a common misconception! No, testosterone may stop bleeding, but it will not protect you against pregnancy!

What are some things I should consider when choosing a form of contraception?

Everyone’s goals regarding contraception may be different. The below chart are some things individuals might consider when choosing a method. See if any of these are ones that matter to you!