Please note: This text post talks about reproductive organs, pregnancy, hormones and menstruation/periods. I will be using anatomically correct language.
This post is meant to inform transmasculine people on IUDs, things to expect from your IUD placement, and how to select an IUD.
Let’s be clear here: Testosterone alone is not 100% effective at preventing pregnancy. It’s not even close. My doctor gave me a rough estimate of about 60-80% effectiveness at 100mgs/week or 200mgs/biweekly. These aren’t great odds, if you ask me. As a transman who has sex with men, I felt that T and condoms weren’t going to give me 100% protection (or, at the very least, peace of mind that I won’t accidentally get pregnant). So I opted to get an IUD.
What is an IUD?
An IUD stands for intrauterine device. It’s a small, flexible, T-shaped implement that sits at the top of the uterus and has two strings that descend through the cervix and nestle at the top of the vagina (for easy removal). There are two major kinds of IUDs: non-hormonal (copper) ones and progesterone-based hormonal ones.
Copper IUDs, also marketed under the name Paraguard, prevent pregnancy by irritating the endometrium enough to make the uterus inhospitable to a pregnancy. They are 99.9% effective at preventing pregnancy. Side effects of Paraguard IUD placement include heavier periods and stronger cramps. It is important to note that some transmen on testosterone (even the 100mg/week or 200mg/biweekly dose) may experience their menstrual cycle suddenly restart after Paraguard is placed, that may or may not stop with time.
Progesterone IUDs, also marketed under the name Mirena, prevent pregnancy by using a very low dose, locally-acting (only affecting the uterus and ovaries) amount of progesterone to inhibit ovulation and the growth of the endometrium. They are 99.9% effective at preventing pregnancy. Side effects of Mirena IUD placement include lightened or the absence of periods, reduced cramps, and a slight increase in overall progesterone levels. The progesterone in Mirena should not effect your T dose or the effectiveness of your T under normal circumstances. It’s important to check with your doctor, endocrinologist and gynecologist to make sure that in your circumstances, Mirena will not affect the outcome of your medical transitioning.
It is extremely important to remember that after the placement of an IUD, you will most likely experience intermittent spotting for a month afterwards. If this triggers you, talk to your doctor about starting a temporary regiment of anti-anxiety medication. You may also experience intermittent cramping as your uterus gets used to the presence of a foreign object.
Before scheduling a consultation and placement of an IUD, check with both your primary care physician and your endocrinologist to make sure you select the right type of IUD for your personal needs.
I strongly encourage all transguys, especially guys with significant bottom dysphoria, to find a gynecologist who has experience working with transmen. The physician I saw has significant experience working with the transgender community and was extremely respectful. She was able to conduct the procedure without triggering my dysphoria at all. If you are a sexual assault survivor, make sure to mention this so they are able to accommodate your needs and make you more comfortable. If you’re very dysphoric, triggered or uncomfortable with the procedure, ask your doctor to prescribe you Valium or Xanax in preparation.
IUD placement takes a few steps. First, the physician uses their fingers to check the position of your uterus. Next, they insert a lighted speculum that helps hold the cervix in place. They swab the cervix with a disinfectant, then dilate the cervix. They insert a tool that measures your uterus so they know how long the strings must be, then the IUD is placed at the top of the uterus. The strings are trimmed and the tools are slowly removed. You’re encouraged to remain laying down for about ten minutes afterwards, then you’re good to go.
I’ll be frank: IUD placement was without a doubt the worst pain I’ve ever experienced in my life. I nearly threw up and fainted. I ended up needing three Vicodin to stop the cramping afterwards.
At six weeks, you’re encouraged to return to the physician who placed your IUD for a follow-up. Check your strings weekly as well — do this by inserting your fingers and checking to make sure the strings haven’t suddenly grown significantly shorter or longer.
As always, call your doctor if you notice extremely heavy bleeding, severe cramping, vomiting, or any signs of infection, such as a fever.
This is good information to have, and it’s good to hear someone’s personal experience. We’ve heard a lot of different figures on how effective testosterone is at preventing pregnancy, and so deciding what to do if you regularly have sex that could get your pregnant is something you should discuss with your doctor given your dose and how long you’ve been on T. You may feel that you’re comfortable enough just using condoms, but for those who are not an IUD may be a good option for non-hormonal birth control.
Things that are significant.