What evidence documents pregnancies in transgender men and how common are they?
Executive summary
Medical case reports, clinical reviews and several surveys document that people who identify as transgender men (assigned female at birth who retain a uterus and ovaries) can and do become pregnant; literature includes case reports, clinic cohorts and national surveys rather than comprehensive population registries [1] [2] [3]. Estimates of how often this happens vary by study design and are limited by poor routine data capture—there is no definitive national count of births to people who identify as transgender men in the U.S. because most health systems record sex assigned at birth or female status for birthing patients [4] [5].
1. What kinds of evidence document pregnancies in transgender men — clinical reports to cohort studies
The scientific record ranges from single case reports and narrative reviews to clinic-based cohorts and national self‑report surveys: case reports and literature reviews confirm pregnancy after testosterone therapy and document management issues such as stopping exogenous testosterone during conception [1] [6]; mixed-method clinic surveys captured dozens of pregnant transgender men and described pregnancy experiences and outcomes [7]; and larger national quantitative surveys have reported pregnancy intentions and outcomes across samples of transgender, nonbinary and gender-expansive people assigned female or intersex at birth [3] [5].
2. Concrete numbers from the published studies — what the data show and their limits
Published cohort and survey reports provide counts from samples, not population rates: some clinic- or survey-based studies described dozens of pregnancies—for example, one study reported 32 transgender men with 60 pregnancies (48% resulting in delivery) and other surveys reported similar mixes of deliveries, miscarriages and abortions [8] [3]. A claims-data study analyzed deliveries labeled as trans in large U.S. insurance databases from 2014–2018, demonstrating that deliveries do occur among patients coded as transgender but not yielding a national incidence because charting practices vary [5]. Multiple reviews emphasize that no routine national dataset reliably counts births to transgender men, limiting any claim about how “common” such pregnancies are in the general population [4] [2].
3. How common are pregnancies among transgender men relative to the population — best available approximations
Estimation depends on approach: clinic and survey samples suggest pregnancies are not vanishingly rare—some surveys note substantial proportions of respondents reporting prior pregnancy or unintended pregnancy (one Rutgers-associated estimate cited unintended pregnancy rates up to ~30% in study samples), but these figures derive from convenience or clinic samples and cannot be generalized to the whole transgender population without caution [9] [10]. Population-level prevalence is unknown because most public health systems do not systematically capture gender identity linked to birthing events [4].
4. Pregnancy outcomes and clinical considerations documented in studies
Available studies report that vaginal birth is possible and that common obstetric complications (hypertension, preterm labor, cesarean delivery) have been observed among transgender men in surveys and cohorts, though high-quality comparative incidence data are lacking and some observed differences (e.g., higher C‑section proportion after prior testosterone) were not always statistically significant [7] [2] [1]. Clinical guidance in reviews emphasizes stopping testosterone during attempts to conceive because exogenous testosterone can affect fetal development and maternal physiology, though long-term fertility effects of prior testosterone remain incompletely characterized [1] [6].
5. Why uncertainty persists — data gaps, measurement bias and political framing
Key limitations are methodological: small samples, self‑selection into surveys, clinic-based recruitment, inconsistent coding in administrative databases and lack of routine gender-identity capture in birth records all bias estimates and preclude a clear population rate [2] [5] [4]. Media coverage sometimes sensationalizes individual cases (e.g., “pregnant man” headlines) while political actors frame the issue for policy debates; researchers and advocates warn that stigma and underreporting further obscure true frequencies and that some outlets amplify estimates (Rutgers’ 30% unintended-pregnancy figure) without clarifying sample limits [9] [10].
6. Bottom line and what credible next steps the literature recommends
The credible, evidence-based bottom line is this: pregnancies among transgender men are documented across case reports, clinic cohorts and national surveys, and they can result in live births, miscarriages or abortions; however, how common such pregnancies are in the broader population remains unknown because routine surveillance does not capture gender identity consistently and existing studies rely on nonrepresentative samples [1] [3] [4]. Researchers recommend improved, gender‑inclusive data collection in health records and larger prospective studies to measure incidence, pregnancy outcomes and the long‑term effects of prior hormone therapy [2] [6].