(916) Perinatal outcomes of transgender individuals with prior testosterone use: An Epic Cosmos cohort analysis

Objective:
To evaluate perinatal outcomes among transgender and gender diverse (TGD) birthing persons with testosterone use prior to pregnancy.

Study Design:
We conducted a retrospective cohort study of TGD individuals with a prior pregnancy stratified by testosterone exposure. Demographic, clinical, and perinatal outcomes were compared using descriptive statistics.

Results:
Of 755 transgender men, 49.8% reported prior testosterone use. Compared to those with prior testosterone use, individuals without testosterone use were more likely to be younger and of white race. There were no significant differences between groups in initial body mass index, rates of hypertensive disorders, or diabetes. Of 843 pregnancies, 49.7% occurred in individuals with prior testosterone use. Among those without prior testosterone use, pregnancy loss or termination before 20 weeks’ gestation was significantly more common (32% vs 23%, p< 0.005). Postpartum depression (PPD) was less common among those without prior testosterone use (6% vs 9%, p< 0.05). No other differences in perinatal outcomes were observed, including method of delivery, preterm delivery, pregnancy induced hypertension or gestational diabetes.

Conclusion:
Prior testosterone use among TGD individuals is not associated with adverse perinatal outcomes. However, pregnancy loss or termination before 20 weeks was more frequent among individuals without prior testosterone use. This finding may reflect differences in pregnancy planning, as individuals using testosterone are recommended to discontinue it prior to conception. Further, prior testosterone use was associated with a higher prevalence of PPD. The underlying cause for this association remains unclear but may reflect needs that are unique to this population. These findings underscore the importance of mental health screening and support for TGD individuals, particularly those with prior testosterone use. Further research is needed to explore the psychosocial and structural factors that influence pregnancy outcomes and postpartum care in TGD populations.