Navigating iPLEDGE enrollment for transgender and gender-diverse patients: A guide for providing culturally competent care

Abstract

Fig 1. Flow chart for iPLEDGE enrollment categorization.

Letter in reply: Understanding pregnancy risk and contraception options for transmasculine individuals on gender-affirming testosterone therapy

“…Additionally, patients on testosterone should be counseled that starting combined oral contraceptives does not appreciably increase their risk of breakthrough bleeding nor is it likely to counteract the masculinizing effects of testosterone. 4,6 With that in mind, as noted by Gao et al, 1 ''contraceptives without estrogen may be preferable'' for many TM patients. However, for the purposes of iPledge enrollment, a progestin-only oral contraceptive is not an eligible form of contraception, so these patients should be referred to gynecology for consideration of a long-acting reliable contraceptive.…”

“…To the Editor: We read the article by Gao et al 1 regarding registration of transgender and gender nonconforming patients in iPledge with great interest. The authors briefly discuss contraception needs for transmasculine (TM) patients who still have a uterus and ovaries, noting ''It is still possible for anyone with a uterus and ovaries to become pregnant, even with consistent use of testosterone and cessation of menses.''…”

“…As highlighted by Gao et al, 1 any patient with a uterus and ovaries, regardless of gender identity and sexual practices, must be registered in iPledge as a female with reproductive potential. Many patients are curious whether testosterone is considered a form of hormonal contraception as the vast majority of patients receiving weekly testosterone injections experience amenorrhea within 1e6 months of use.…”

“…As highlighted by Gao et al, 1 best practice guidelines are necessary for iPledge registration of TM patients. This letter attempts to help dermatologists understand special considerations when assessing the pregnancy risk and contraceptive needs of TM patients enrolling in iPledge.…”