First things first (this is the big one)

Testosterone is NOT contraception

• Testosterone can reduce fertility
• But it does NOT reliably stop ovulation
• Pregnancy is still possible

Geek insight:
Ovulation suppression on T is inconsistent — meaning you can’t predict when you’re protected.

If you’re having sex with someone who produces sperm → you need contraception

The Main Players: What are your options?

Long-acting (set and forget)

The Implant (Implanon NXT)

What it is:
A tiny rod under the skin of your arm

Why people like it:

• >99.9% effective
• No internal exam
• Lasts 3 years
• Very discreet

What can be annoying:

• Irregular spotting (~30%)
• Acne, mood, weight changes

Geek tip:
Bleeding issues are often less if you’re already on testosterone.

Hormonal IUD (Mirena / Kyleena)

What it is:
A small device inside the uterus

Why people like it:

• >99.9% effective
• Lasts 5–8 years
• Great at stopping bleeding on T
• Mostly local hormone effect

Barriers to consider:

• Requires internal exam (can trigger dysphoria)
• Can be painful (but pain control options exist)

Geek insight:
Very little hormone enters the bloodstream compared to pills or injections.

Daily or regular options

The Pill (Slinda– progesterone-only)

Why people like it:

• No procedure needed
• Flexible (just take daily)
• Often stops periods

Downsides:

• Must remember daily
• Irregular bleeding possible
• Mild anti-androgen effect (usually small in practice)

Geek insight:
Still compatible with testosterone for most people.

The Shot (Depo Provera)

What: Injection every 12 weeks

Why people like it:

• Reliable
• Private
• Can align with T injections

Consider carefully:

• Bone density loss with long-term use
• Delay in fertility return (6–12 months)
• Regular appointments needed

Options that may not suit everyone

Combined hormonal methods (contain oestrogen)

Includes:

• Combined pill
• Vaginal ring

Potential issues for trans guys:

• May worsen dysphoria (chest changes)
• May counteract testosterone effects
• Slight clotting risk

Geek takeaway:
These are effective — but often not preferred in gender-affirming care.

Hormone-free options

Condoms (external + internal)

The only option that does BOTH:

• Prevents pregnancy
• Protects against STIs

Limitations:

• Less effective than long-acting methods
• Must use every time

Best used WITH another method

Copper IUD

Why people like it:

• >99.9% effective
• No hormones
• Long-lasting (5–10 years)

Downside:

• Can increase bleeding/cramps
• Same insertion barriers as hormonal IUD

Pull-out method

Reality check:

• Not reliable
• Pre-ejaculate can contain sperm

Not recommended

By GHA G.P. Dr Mitch Krosch

Read the full article here: https://www.mitchkrosch.com/articles/contraception-options-for-trans-guys

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