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

[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.)