Can I still get pregnant if I’m on testosterone? What should I know about contraceptives and fertility?

Yes—you can still get pregnant while on testosterone. Even if your periods have stopped. Even if it’s been years. Testosterone is not birth control.

Here’s what you should know:

1. Ovulation can still happen—even without a period.
Testosterone often stops menstruation, but that doesn’t mean your body isn’t ovulating. Pregnancy is possible if you have a uterus and ovaries and you’re having sex involving sperm.

2. You need reliable birth control if pregnancy is not part of your plan.
There are safe, effective birth control options for people on testosterone, including:

• IUDs (hormonal or copper)

  • I know what you’re thinking - Does the hormone in a hormonal IUD interact with testosterone?

    Nope. The progestin in a hormonal IUD does not interfere with testosterone therapy.

    The hormone in IUDs acts locally in the uterus, not systemically throughout your whole body like testosterone does. That means it doesn’t cancel out or diminish the effects of T (like voice deepening, facial hair growth, or body fat redistribution), and it doesn’t lower your testosterone levels in the blood.

    So you can safely use a hormonal IUD while on testosterone—and still get the benefits of both.

    Those benefits?

    • Over 99% effective birth control without daily effort

    • Lighter or no bleeding, which can help reduce gender dysphoria

    • Long-term protection (up to 3–8 years depending on the brand)

    • Low maintenance, with no impact on your gender-affirming care

    It’s a great option for transmasc and nonbinary folks who want pregnancy prevention and period control—without compromising their transition goals.

• Implants (like Nexplanon - which releases no estrogen!)

• Progestin-only pills

• Barrier methods (like condoms)
  Note: Estrogen-containing methods (like the traditional pill) may not be a good match for people on T, but a provider can help you find what fits your body and goals.

3. Stopping testosterone doesn’t mean automatic fertility.
If you're planning for pregnancy, it might take time for ovulation to resume after stopping T. Some people conceive without intervention, others may need fertility support.

4. Fertility preservation is an option—but recommended to be done before starting T.
If having biological kids in the future is something you’re considering, you can explore egg freezing or embryo freezing before starting long-term hormone therapy.

5. You deserve affirming, judgment-free care.
Too many providers assume trans and nonbinary people don’t need reproductive health counseling. You deserve providers who respect your body, your identity, and your reproductive goals—whether that’s birth control, pregnancy, or fertility preservation.

If you're on testosterone and don't want to be pregnant, use birth control. If you're thinking about future fertility, talk to an LGBTQ+-affirming provider before making big decisions. Your identity and your family-building choices are valid—whatever they look like.