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For transgender men, pregnancy is often an isolating, rather than joyful, experience. (Maria Manco/Offset)
In 2008, Thomas Beatie drew international attention as the world’s “first” pregnant man — a position many criticized, though his decision to conceive was made out of medical necessity. His wife, Nancy, had previously undergone a hysterectomy, due to severe endometriosis, so when the couple decided they were ready to become parents, Beatie — a transgender who’d made the female-to-male transition in 2003 — stopped taking his testosterone injections. After suffering an ectopic pregnancy with triplets, Beatie conceived again. This time, the pregnancy was viable: The couple’s first child was born on June 29, 2008. He’s since given birth to two more children.
To Beatie, the experience was nothing short of transformative. “How does it feel to be a pregnant man? Incredible,” he wrote in a 2008 essay in The Advocate, a magazine geared toward the gay community. “Despite the fact that my belly is growing with a new life inside me, I am stable and confident being the man that I am.”
However, pregnancy wasn’t an entirely positive experience for Beatie, primarily because of the reactions of health-care providers to his nontraditional route to fatherhood. One doctor told Beatie that he had to shave his facial hair, and after consulting with his hospital’s ethics board, decided he wouldn’t treat Beatie, period — after the couple had shelled out thousands of dollars for checkups.
Although Beatie has been touted as the “first” pregnant man, he’s actually one of many transgender men who have given birth. “He did a lot for visibility around the topic, but he’s not the first or the only,” said Dr. Juno Obedin-Maliver, a founding member of the Stanford Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group. However, “we have no idea how many transgender men are getting pregnant,” she said. “We don’t know if what we’re seeing is just people coming forward and talking about it more, or if there’s actually been a change in incidence.”
"There’s very little for transgender men who are pregnant, where they can get that support and recognition," researchers say. (Photo by WIN-Images/Corbis)
Last week, Obedin-Maliver and other researchers from the University of California, San Francisco, released a landmark study examining pregnancy in 41 transgender men, all of whom conceived after they’d transitioned. The scientists analyzed the effects of testosterone treatments on self-reported pregnancy outcomes — as it turned out, there were none (although this topic requires more research) — but they also aimed to explore the psychological experience of pregnancy as a transgender male.
Not surprisingly, a common theme among the men was feelings of isolation, often for reasons that echoed Beatie’s struggles: a lack of acceptance in their communities and from health care providers. In a much smaller Seattle University study, published earlier this fall in the Journal of Midwifery & Women’s Health, a group of eight transgender men similarly recalled feeling lonely through every stage of pregnancy, from pre-conception to parenthood — but also felt that they had no other way of becoming a father, since the likelihood of being chosen as an adoptive parent seemed slim.
The issue of transgender health care is of particular concern to the researchers. “We know that transgender individuals face a lot of issues with health care access. A lot of providers aren’t trained to take care of them,” Obedin-Maliver told Yahoo Health. “If you think about maternity clothes or clothes for chest feeding — which is what the trans community tends to call breastfeeding — and the pamphlets that women receive during their pregnancy, they’re all geared toward women, not men. There’s very little for transgender men who are pregnant, where they can get that support and recognition.”
As a result, pregnant transgender men may not feel comfortable seeking care, and if they do, they may find the services lacking or that they’re received poorly. “[Some] were turned away from care,” said Obedin-Maliver. One 21-year-old transgender man even reported that his medical provider called Child Protective Services to alert them that a “tranny” had a baby. Another transgender man in the Seattle University study recalled his doctor awkwardly referring to his boxers as “panties”—what the father-to-be saw as an adamant denial of his male identity. Even the waiting room of the obstetrician’s office can seem like a threat to pregnant transgender men, since patients are expected to be female.
On the flipside, some transgender men reported that pregnancy made them feel more connected to their bodies. (Photo by Annie Engel/Cultura/Corbis)
It’s not just in the doctor’s office that many transgender fathers-to-be feel uncomfortable. For some, being at ease even in their own skin can be a challenge: In the Seattle University study, a number of the men found it difficult to adjust to their pregnant bodies — as they gained weight in new places, their face shape changed, and their physical strength diminished, they struggled with a sense of loss. Others grappled with the perceived paradox of being male, yet walking around with a baby bump, leading some to grow beards, limit their pregnancy weight gain, or wear oversized clothing — all attempts to avoid what they saw as inevitable judgment.
Yet the University of California researchers also observed an interesting flipside to these men’s negative experiences. Some of the study participants reported a decrease in gender dysphoria: Through the pregnancy experience, they felt increasingly connected to their own bodies, possibly because the anatomy they were born with finally seemed to make sense, said Obedin-Maliver. “This whole process has made me more…at peace with my own body,” one man in the Seattle University study said. “The whole pregnancy and birth has made me more whole and more comfortable in my own skin, more comfortable with myself and my past.”
For many of the transgender fathers, pregnancy didn’t threaten their masculine identity at all. For some, that required viewing pregnancy through a strictly pragmatic lens, as a way of using their body as a “workshop” to achieve an end result (this is also a common way of viewing breastfeeding among transgender men). “At its core, pregnancy is a practical, physiologic process,” Obedin-Maliever said. “Not everybody is connected to it as a bigger process [beyond] the simply practical one.” Like Beatie, two transgender men in the Seattle University study viewed themselves strictly as their child’s surrogate.
But for others, pregnancy didn’t require any sort of mental reframing because it wasn’t a “female” experience to them — they felt fully male through the entire nine months. As one 29-year-old transgender man recalled, “Pregnancy and childbirth were very male experiences for me. When I birthed my children, I was born into fatherhood.” “For some people, there’s no dissonance there — if that’s your experience as a man, then it can be a male thing,” explained Obedin-Maliver. “Is pregnancy a necessarily female experience — or more of a human experience?”
The researchers hope their work will spark more than a passing tabloid interest in the topic — they see this as the first step toward ensuring proper care for pregnant transgender men. “Many health care providers may feel confused about how to best care for transgender men — for many, this is new information,” study author Dr. Jennifer Kerns told Yahoo Health. “What this study emphasizes is that we can all start with the simple step of asking our patients about who they are and how they view this pregnancy. That’s just good care, regardless of who the patient is.”
More specifically, Obedin-Maliver hopes doctors will make a conscious effort to use transgender patients’ preferred names and pronouns — and begin to view their health care needs as more than, “How do you plan to transition?” “They need routine consideration of both contraception and fertility planning — like anyone else,” she said. “This study will hopefully spur more people to be interested and think about creating evidence-based guidelines [for transgender health care].”
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