Trans man on testosterone needing help deciding on a secondary BC method

[0h60dd4mni7.livejournal.com]

Hey everyone!

I’m a trans man who takes testosterone, but often go without it due to money issues and needle anxiety. I’ve currently been off it for 3-4 months but plan on starting up again very soon.

I’m in a monogamous relationship with a non-trans man, coming up on our one-year anniversary. We have sex pretty often (at least several times a week, sometimes more than once in a day) and it’s always PIV. Sometimes we start out condom-less and put one on once things move past a certain point, and sometimes he puts a condom on right from the start. He knows his body very well and we’ve never had any close calls.


I DO NOT, under ANY circumstances, want to get pregnant. Lately I’ve found myself thinking, hours after sex, when he’s not around “You’re playing Russian Roulette, and if you get shot, it’s your fault.” Which is a terrible thing to think about sex, especially awesome, loving, safe sex with one’s committed partner. So I’m looking for a second BC method to mitigate that anxiety.

Currently I’ve narrowed down to Implanon and Mirena. My main concerns are:
a) Making sure the method doesn’t decrease the effectiveness of the testosterone, once I start it again
b) Cost (I’m a student with little to no income. I have insurance through my mom's work but I think I’m going to have to call and see what they cover, and my phone anxiety makes that an unfun prospect)

So do y’all have any thoughts on my specific situation, whether just advice about Implanon versus Mirena, other methods that might work better, or general advice that came to mind when reading this? I’ve done a lot of research, but I feel like there’s probably things I’ve missed or just haven’t thought about, and so I wanted to ask this community to weigh in. The only methods I’ve ever used are condoms and spermicide, so venturing into dealing with other methods is a little overwhelming.

Thanks in advance!

Comments

[mandaszoo.livejournal.com]

I can't speak to your specific situation, although I do have a Mirena. I LOVE my mirena!! I haven't had a "real" period since I had it put in almost a year ago. I'm not sure how it would interact with testosterone so I'm not much help there.

[0h60dd4mni7.livejournal.com]

From what I've read, since Mirena is progesterone-only, it shouldn't be an issue. I think I also remember reading it's more localized, so it's not going to be throughout my whole system in the way the testosterone is.

And thanks for your input! Not having a "real" period, even if I miss my testosterone shots, would be glorious. If you don't mind me asking, did yours decrease as far as heaviness, length of time, or both? Mine used to be really heavy but have chilled out a little, but they still last 6-7 days.

[sabishii-kirito.livejournal.com]

I'm sure someone else will have better advice, but if hormones are an issue, would a copper IUD be an option? As far as I know, copper IUDs don't have hormones like Mirena does, so if there is a possibility of hormonal interactions you might want to ask about them when you can call.

[0h60dd4mni7.livejournal.com]

I'm just a little hesitant about the copper IUD since I've heard more about it increasing flow, whereas Mirena is more likely to decrease it, if I'm understanding correctly. I've had some issues with really painful, heavy periods and am worried about the copper IUD making things more painful/heavier.

[0h60dd4mni7.livejournal.com]

Eeep! Unappealing, indeed. I'd only heard people saying that if you haven't given birth, they're harder to get in. Not that they might FALL OUT. Oh dear. Thanks for the info!

[elfbert.livejournal.com]

I've got to say, I think your doctor was utterly, completely, wrong.

IUDs can be absolutely ideal for nulliparous people. ( http://www.ncbi.nlm.nih.gov/pubmed/19896396 ) They definitely don't 'slip out'. The insertion can be more painful - you're putting something in via the cervix, which has potentially never been subject to anything going in or out, apart from fluids, before. Whereas obviously if you've given birth, it's potentially a little easier to get a tiny thing through it, given a baby has already gone the other way!

But I'm not sure the expulsion rates. This article: http://www.medscape.com/viewarticle/563222_4 seems to think there isn't a much higher chance of expulsion if you're nulliparous.

I've got an IUD myself (copper, for me) and the benefits definitely outweigh any risks, and if I had expelled, I would definitely have had it re-inserted.

iud_divas is all about pros and cons of IUDs of all sorts, if you're interested, OP.

[0h60dd4mni7.livejournal.com]

Thanks for clearing that up. I'd heard about a medication that makes insertion easier (I believe the phrase used was "softens the cervix" which sortof horrifies me, but hey, if it works), do you know anything about that?

[elfbert.livejournal.com]

No worries - some doctors have really weird issues about giving IUDs to people who haven't given birth. I think it's some sort of old-fashioned myth that's somehow hung on in some people's minds? So there are all sorts of odd reasons they give to 'back up' their beliefs!

That's something called misoprostol. I didn't have it used on me, so all I know is what I've read over on iud_divas. I just took ibuprofen and co-codamol (which I think is Tylenol 3, in the USA?) before my insertion. And it did hurt - but for me, it was totally worth it :)

I wasn't having periods or withdrawal bleeds at the time, as I was taking a PoP which had completely stopped my bleeds. But if you are still having periods/withdrawal bleeds from hbc, then while you're bleeding, the cervix will naturally be softer anyway, and that's when most health professionals prefer to do insertions :)

[knittinggoddess.livejournal.com]

Elfbert is right, misoprostol is used to soften the cervix. I also had my (no babies) cervix numbed, which had a hugely positive effect on my insertion!

[mrar.livejournal.com]

Someone else said it, but I'm also going to add again: your doctor is wrong. IUD are perfectly fine for nulliparous women, and the "issues" a nulliparous women could have with them aren't expulsion ("slipping out") but having a too small uterus (which they check for before putting it in anyway) and a less-open cervix (which is more an issue of the skill of the inserting doctor).

I am nulliparous and had an IUD that certainly never came out on its own, as have many, many other women.

[0h60dd4mni7.livejournal.com]

Thanks for seconding the correction, I'm glad misinformation gets corrected pretty swiftly in here.

[atalanta0jess.livejournal.com]

I actually don't think this is 100% true. The expulsion rate, last time I checked, may be slightly higher for nulliparous people. (A quick google tells me that the expulsion rate may or may not be impacted by whether you are nulliparous.)

I also wanted to note that it might be more helpful to talk about nulliparous "people" (rather than women) since the OP is not a woman, and not only women use IUDs. :)

I am also nulliparous, and have an IUD that is happily situated! OP, expulsion isn't dangerous, however if you were to pay out of pocket, it might be worth asking about your doctors experience and expulsion rates, since it would be money down the drain. (Although I think Mirena might pay for a new IUD if the first one expels? Maybe? Could be something to ask about anyway.) (http://www.medscape.com/viewarticle/563222_4)

[atalanta0jess.livejournal.com]

Bah. Total fail at closing my link. Sorry.

[mrar.livejournal.com]

Oops, sorry for that slip!

[knittinggoddess.livejournal.com]

Finding a very experienced inserter is also important because the big scary risk for iuds--perforation during insertion--is pretty much dependent on the skill of the professional.

[mennamachine.livejournal.com]

I have a paragard. Aside from the first ~4 cyclecs (many people go through an adjustment period), my periods are no heavier/more painful than my pre-HBC periods. Sometimes I think, (and I've come across more than a few OB/GYNs who agree with me) that very often women switch from HBC to copper IUDs and that's why it has the reputation for increased bleeding. People do have different experiences, though. I just think it's a good one to keep in mind because of the lack of hormones. I thought (though I am not any sort of expert) that Mirena was typically not recommended for transmen because of the extra female hormones. You could check out the IUD-Divas community, there's a lot of experiences of people who've used Mirena, copper IUDs, and other types of implantable birth control devices.

[karenoh.livejournal.com]

Very quickly: I have the copper IUD and I love it...but it has made my period much heavier (and I was not on hormonal birth control before this.)

[six-dollar-baby.livejournal.com]

Not wanting to make assumptions about your life plan, so please excuse me if this is a totally ignorant question, but...do you plan on ever wanting to give birth? (i'm assuming you don't, but you know what they say about assuming...!)

If not, you might consider the Essure or Adiana procedures. They're non-hormonal and permanent, and wouldn't interfere with your testosterone at all. They wouldn't have any effect on your cycles in any way, but they have ridiculously high effectiveness rates. Essure is 99.8% effective as birth control.

[0h60dd4mni7.livejournal.com]

A permanent procedure would be perfect, because you're right in assuming that I don't ever want to give birth. Some trans men do, but not me. The only reason I haven't really looked into permanent stuff is that I'm only 21, and I've heard a lot of female-assigned folks who haven't had children have trouble getting doctors to believe them when they say they don't ever want kids. I'm also wondering if that sort of thing would be significantly more expensive than something like Implanon.

But if it were doable cost-wise, and I could find a doctor willing to do a permanent procedure on a 21-year-old, I'd be all for it.

[six-dollar-baby.livejournal.com]

It depends on your insurance, if any. I have BCBS and paid only the $25 copay for the three visits it required. (Consultation with exam and ultrasound, insertion, and follow-up HSG test.) So $75 for a lifetime of freedom is a pretty good deal. I don't know what it would cost without insurance.

i'm also assuming you're under a doctor's care in regard to your hormone treatments. Perhaps your doctor can recommend/refer you to a trans-friendly doctor who performs sterilizations? It's definitely worth asking. I found my Essure doctor by calling a vasectomy clinic and asking for a referral. I'm thinking/hoping you may have an easier time getting a permanent procedure simply because you're in the trans process?

[0h60dd4mni7.livejournal.com]

I have BCBS as well. Thanks so much for the info, I think this is something I'll look into a bit more seriously now.

[six-dollar-baby.livejournal.com]

Good luck!

[somniumdraconae.livejournal.com]

You may find the childfree comm, and its sister communities, helpful for experiences of sterilization at a young age. Many of the members have successfully done it in their early to mid twenties. You just have to be patient and persistent about finding the right doctor.

[0h60dd4mni7.livejournal.com]

Thanks for the advice!

[knittinggoddess.livejournal.com]

Also cf_resources and sterilizationinfo.

[knittinggoddess.livejournal.com]

Whoops, sterilizationqa.

As a sidenote, is it possible to get your ovaries removed at this stage? That would fix the fertility problem and the estrogen release problem.

[0h60dd4mni7.livejournal.com]

Only problem with that is cost, finding a doctor to do it, and the fact that if I'm no longer producing estrogen via my ovaries, I'd need to know for sure that I'd have a steady supply of testosterone, which is not the case at the moment. But it's definitely something I want eventually.

[sxdx.livejournal.com]

I'd go for Mirena personally. If you want something less invasive the mini-pill progesterone only and most people I know (I haven't researched for official numbers) including myself don't get a period on it.

[0h60dd4mni7.livejournal.com]

Could I ask why you wouldn't go for Implanon? Is it the invasiveness of having to get it implanted, or something else?

[sxdx.livejournal.com]

I think that has something to do with it but also that I've just heard A LOT of feedback about Mirena and not so much about Inplanon. I also like that Mirena is a quicker/less painful removal. The insertion/removal process sends my anxiety sky high. And you have to have it replaced every 3 years, I believe Mirena lasts way longer. Now, I've never use either but I do have a lot of friends who are post baby and need birth control (it comes up a lot in my parenting communities) and the general consensus is for Mirena.

I, personally, am not a fan of birth control and successfully used the pull out method for nearly 10 years but even a tiny risk is too big now plus I don't always like sperm on me. ANYWAY, all of that led me to the mini-pill. Mostly because I am still nursing my toddler but also because it was the least invasive and I don't have periods on it at all. I had minor breakthrough bleeding the first month and after that nothing (it's been 6 months). I even stopped it for a few days (Mardi Gras, ran out, nothing open) and still no bleeding. I hate my period so this was the best outcome. I DO have a pack of pregnancy tests that I will use every month or two for peace of mind.

I hope you work things out, birth control is so confusing and overwhelming. Honestly, I think if you find the right doctor and have your t-note in hand you may be able to get a permanent procedure. I have found that the tumblr blog fuckyeahftm is really great for getting information on these types of things. The age range is like 13-24 (give or take) and the guys there are all in various stages of transition world-wide and usually someone has first hand advice. I find it to be a really active, supportive, and informative community. I hope things work out in the best way possible!

[0h60dd4mni7.livejournal.com]

I actually posted on fuckyeahftms first, and was given some pretty good advice. I then went to the ftm lj community and looked through the tags, and saw a suggestion to come here. There wasn't a lot of consensus on how progesterone interacts with testosterone though, so I figured I'd come here as well.

[sxdx.livejournal.com]

Oh cool! You're way ahead of me! I really enjoy that group. I'm not trans but I do consider myself moderately gender fluid (and have been since I could remember) and I enjoy the posts.

I hope you figure out what you're looking for.

No pressure but if you want a tumblr follower, I'm farside0fnowhere!

[stateofwonder.livejournal.com]

I would also highly recommend the Mirena. I had mine inserted when I was 22. Never had children. It hurt a bit on insertion, but otherwise it was my best friend for 5 years. Didn't have to worry about birth control, and my period disappeared completely after a couple of months. So awesome.

Actually my current partner is a trans boi and is considering getting a Mirena as well simply to reduce his menstruation (although it works differently for different people).

[0h60dd4mni7.livejournal.com]

Do you have any info on whether Mirena and T don't go well together? The general consensus seems to be that it's fine (specifically that estrogen would be a problem while progesterone really isn't, and Mirena is also more localized) but some people seem to be unsure.

[knittinggoddess.livejournal.com]

There are some trans men (as well as trans* people) on iud_divas, and I know one person is just starting on T. If you don't get a whole lot of responses here, you should totally ask there.

My suspicion is that medical science knows basically diddly, but there might be extensive community knowledge among medical professionals who work with transition (as well as the trans* people themselves, obviously!)

Also, activist and writer Julia Serano (http://www.juliaserano.com/) is a biologist by trade: her degree is in molecular biology and biochemistry, and she teaches evo and devo bio. If you can't get good solid medical answers from the internet and your docs, I bet she'd help you out!

[fallconsmate.livejournal.com]

I don't have any suggestions on the birth control, but I will commiserate on the testosterone injections. TheEngineer takes them every 2 weeks, also.

He's a cis-male, but he and his sister were both born with birth defects, we're thinking because their mother was raised downwind (and close) to the nuclear bomb testing site in New Mexico. She had to have a hysterectomy at age 15, and he was born with only a small portion of one testicle, which was removed when he was 5. So he's been on hormone therapy most of his life.

As I use insulin, I'm understanding of his (and your) hatred of the needle, I really am. And I know the testosterone is worse because it's a more viscous liquid. I hate taking my shots too. :(

[0h60dd4mni7.livejournal.com]

Thanks for the sympathy. :)

[kaberett.livejournal.com]

I'm trans and react really badly to progesterone. The Mirena contributed significantly to my depression, but I appear to be hyper-sensitive to the damn stuff. I also found that when I *did* have periods they were about eleven billionty times more unpleasant (like, not-able-to-call-for-help levels of pain), but I have endometriosis so that's probably less relevant to you!

Without knowing more about how you react to progestins, I'd be wary, honestly. If you know from past experience that they're not a problem for you, then GO FOR IT.

(I will also say that when I had my Mirena out early, it took about 3 days for me to get back to normal mood-wise. That's much better than typical for Implanon!)

[0h60dd4mni7.livejournal.com]

Hmmm. Oh man. This is definitely food for thought. I'm just so worried about getting something with progesterone and then finding out I react badly to it. Because if it were pills, I could just stop taking them and not buy anymore. But I don't think they let you return IUDs for a full refund, lol. Maybe a copper one, then.

[kaberett.livejournal.com]

A though I am not well/awake enough to articulate helpfully: you might be able to find pills that contain hormones equivalent to those in the Mirena and Implanon. You could then trial using the hormones orally, and if you get on with them move to a lower systemic dose.

[knittinggoddess.livejournal.com]

The Mirena contains levonorgestrol (spelling!), and PoPs in the USA don't. But maybe your doc can be open to ordering from Canada or somewhere else that has LNG POPs?

[somniumdraconae.livejournal.com]

It looks like USA PoPs are all made with norethindrone / norethisterone. It is actually quite similar chemically to levonorgestrel. So, if you wanted to have a go with norethindrone, it would be a good indicator to see how you'd do on levonorgestrel. Not perfect though, you can do good on one and terrible on the other. So if your doc is willing to help you get the UK brand Norgeston or the Aus. brand Microlut that would be better.

[somniumdraconae.livejournal.com]

You could always do a month of PoPs as an experiment. Every progesterone is a little different, so it wouldn't be a guarantee that you'd do well on a Mirena, but it'd be a good indicator.

[viva-hater.livejournal.com]

Have you asked about Paraguard? It's the non-hormonal IUD.