A person who was born male and is living as a man cannot get pregnant. However, some transgender men and nonbinary people can.
In most cases, including cis-men who have sex with men, male pregnancy is not possible. New research in uterine transplants may mean that male pregnancy could be a possibility in the future, though.
In this article, we will discuss the difference between sex and gender before explaining more about transgender and male pregnancy.
Anyone who has a uterus and ovaries could become pregnant and give birth.
People who are born male and living as men cannot get pregnant. A transgender man or nonbinary person may be able to, however.
It is only possible for a person to be pregnant if they have a uterus. The uterus is the womb, which is where the fetus develops. Male reproductive organs include testicles and a penis but no uterus.
The terms “man” and “woman” refer to a person’s gender, which encompasses the socially constructed characteristics that differentiate the traditional binary sexes — male and female.
Unlike a person’s biological sex, which an individual’s reproductive organs and secondary sex characteristics define, genetics alone do not determine a person’s gender.
A person’s gender may include specific social roles, norms, and expectations that differentiate men and women.
These characteristics are subjective, and they differ among societies, social classes, and cultures. The gender by which a person identifies depends on the individual.
Gender is much more fluid than biological sex.
Typically, people are assigned male or female at birth. Those who identify with the gender that society associates with their biological sex are “cisgender” men and women.
Cisgender men who have sex with cisgender men cannot get pregnant.
However, not everyone identifies with the gender role that is associated with their designated sex. For instance, a person who was assigned female at birth (AFAB) but identifies as a man may refer to themselves as a “transgender” man or a gender nonconforming individual.
Many AFAB people who identify as men or gender nonconforming people retain their ovaries and uterus, which allows them to get pregnant and give birth.
People who have a uterus and ovaries can become pregnant and give birth.
However, some AFAB people may take testosterone. Testosterone therapy helps suppress the effects of estrogen while stimulating the development of masculine secondary sex characteristics, including:
- muscle growth
- redistribution of body fat
- increased hair growth on the body and face
- deeper voice
Research suggests that menstruation usually ends within 12 months after starting testosterone therapy and often within 6 months, which can make conceiving more difficult but not impossible.
In a 2014 study, researchers surveyed 41 transgender men and gender nonconforming AFAB individuals who became pregnant and gave birth.
Of the individuals who reported using testosterone before pregnancy, 20% became pregnant before their menstrual cycle returned.
The authors of this study concluded that prior testosterone use did not lead to significant differences in pregnancy, delivery, or birth outcomes.
The authors also noted that a higher percentage of transgender men who reported previous testosterone use had a cesarean delivery compared with those who had no history of testosterone use.
These findings do not suggest that testosterone therapy makes people incapable of vaginal delivery, as 25% of the transgender men who had a cesarean delivery chose to do so based on their comfort levels and preferences.
However, there is limited research regarding transgender pregnancy, so it is unclear how testosterone may affect a person’s fertility or pregnancy.
In a 2019 case study, researchers documented the experience of one 20-year-old transgender man who became pregnant 2 months after he discontinued testosterone therapy.
After 40 weeks, he gave birth to a healthy baby after an uncomplicated labor.
The authors stated that he chestfed for 12 weeks before restarting testosterone therapy.
People who have had a bilateral mastectomy or other chest surgeries may not be able to chestfeed.
For AMAB people, uterine transplantation may, in theory, be a possibility.
A uterine transplant is a relatively new surgical procedure that involves transplanting a healthy uterus into a person’s body.
However, this surgery is still experimental, even for AFAB people with uterine factor infertility. There is not enough research to confirm whether AMAB people can conceive and carry a baby to full term.
Before a person can consider having a uterine transplant, doctors will need to take their social, physical, and mental health into consideration.
If a person wants to become pregnant, they may need to take a variety of hormones. Often, this will involve hormone replacement therapy (HRT), which typically provides estrogen and progestogen. Once the wall of the uterus becomes more than 7 millimeters in thickness, they must take a progesterone supplement.
They must also wait 6 months after the surgery to allow for healing. It is only at this point that a doctor can transplant an embryo.
After the surgery, there may be a chance that the body rejects the new uterus. A person will have to take immunosuppressants to reduce the likelihood of this occurring.
A person must take the immunosuppressive agents throughout the pregnancy to ensure that the body does not reject the transplant, which may expose the fetus to dangerous chemicals. An obstetrician with special training in high risk deliveries will provide support for the duration of the pregnancy.
Transgender men and AFAB individuals who do not identify as female may elect to undergo a range of medical treatments and surgical procedures during the transition process.
Examples of gender-affirming surgical procedures for transgender men include:
- Male chest reduction or “top surgery”: This procedure involves the removal of both breasts and any underlying breast tissue.
- Hysterectomy: A hysterectomy refers to the removal of the internal female reproductive organs, including the ovaries and uterus.
- Phalloplasty: During this procedure, a surgeon constructs a neopenis from skin grafts.
- Metoidioplasty: This treatment uses a combination of surgery and hormone therapy to enlarge the clitoris and make it function as a penis.
If a person has undergone a partial hysterectomy — which involves the removal of the womb but not the ovaries, cervix, and fallopian tubes — it is possible for the fertilized egg to latch onto the fallopian tubes or the abdomen, resulting in an ectopic pregnancy.
However, this is exceedingly rare, and according to a 2015 review, there are only 71 cases on record since 1895.
Gender does not determine who can become pregnant.
People who identify as men can, and do, become pregnant and give birth.
Innovations in medical technology may even make pregnancy possible for people who do not have a uterus.