Review flags possible miscarriage risk gap for trans men and calls for better pregnancy research

A new review has called for more research into pregnancy outcomes for transmasculine people after finding that reported miscarriage rates among trans men may be higher than those seen in the general population.

The review, published in the Acta Obstetricia et Gynecologica Scandinavica journal, examined data from 44 existing studies. It found reported miscarriage rates between 31% and 40% among trans men, compared with an estimated 11% to 22% in the wider population.

But the authors cautioned that the evidence base remains very thin. None of the studies included direct comparison groups, which means the review cannot establish whether the apparent gap is connected to testosterone use before pregnancy, other medical factors or unrelated variables.

The paper also says pregnancy among transmasculine people is still significantly understudied. Researchers estimate that 6% to 9% of transmasculine people experience pregnancy during their lifetime.

The authors said testosterone should not be treated as contraception and argued that reproductive healthcare conversations need to cover contraception, fertility planning and the limits of current medical knowledge.

“Service providers should be transparent about the current lack of knowledge and take the initiative to improve this through better quality research,” the authors wrote.

They added that more needs to be known about transmasculine people, their pregnancies, delivery, birth outcomes and obstetric complications, and said future research should examine those questions alongside high-quality care models.

“Reliable comparative data is urgently required,” the authors wrote.

The central conclusion of the review is that better evidence is needed. The authors warned that the current shortage of research leaves both patients and healthcare providers without enough information to make fully informed decisions.

They concluded that “better data collection and research are urgently required” to improve care for transmasculine people who wish to become pregnant.

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