Transgender Youth's Perspectives on the Relationships Between Pregnancy, Contraceptives, and Dysphoria

Purpose: To explore how trans youth with pregnancy capacity think through and understand the associations between pregnancy, contraception methods, and dysphoria. Methods: We conducted 8 asynchronous online focus groups (n = 152) between 2020 and 2021 with trans youth assigned female at birth, and thus presumed capable of pregnancy, aged 14–18, who were living in the United States. Data were analyzed using a qualitative thematic approach informed by interpretive description. Results: Some youth participants were unequivocal in their belief that both pregnancy and contraception would give rise to gender-related distress, which affected how they framed the acceptability of pregnancy and various methods for its prevention. Others had more dynamic understandings of dysphoria, recognizing that it is not inevitable or uniformly experienced. Still others posited that dysphoria that does occur can be managed considering the individual's priority goal or desire – whether to become a gestational parent or to prevent pregnancy. Participants discussed the importance of accessing sexual and reproductive healthcare, even if doing so requires them to navigate terrains of potential dysphoria, including dysphoria that is provoked by having to access gendered spaces and services and due to the use of gendered language. Discussion: Youth participants had varied, nuanced understandings of dysphoria and its potential impact on their conception, pregnancy, and contraception experiences. Many did not hold prescriptive views that dysphoria is a defining aspect of their lives as trans people. Findings suggest strategies for the delivery of gender-affirming, youth-friendly sexual and reproductive healthcare that attends to dysphoria-as-distress when it occurs.