Queering Babies: Testosterone during pregnancy should be allowed, says study

People who genuinely suffer from gender dysphoria undergo very real suffering that no caring person should question. Up until around 20 years ago, medical professionals treated such people with compassion and endeavored to discover what lay beneath their feelings of “being in the wrong body.” Physical interventions as treatment were extremely rare.

Today, a doctor or therapist who tries to discover why a patient wants to change sex risks losing his license. This applies even if a woman claims she “is a man” and simultaneously states that she would like to become pregnant and give birth. Now, a recent study, published in Social Science and Medicine, proposes that a woman who takes testosterone in order to appear masculine and also wants to have a baby should be allowed to continue taking the hormone throughout her pregnancy, as the distress she would feel due to discontinuing the drug outweighs the risk of causing birth defects in the baby.

Medical verdict on testosterone in pregnancy: Risks undeniable, extent unknown

Testosterone is classified as a teratogen (a substance that interferes with fetal development); the FDA labels it as such because it “may cause fetal harm when administered to a pregnant woman based on data from animal studies and its mechanism of action.” 

The specific risks include “abnormal urogenital development in a female fetus” as well as low birth weight for babies of both sexes.

With regard to testosterone treatment for men, conventional medical advice is that a man using a testosterone patch should ensure that his wife should not come into contact with it and that if she inadvertently does, she should immediately wash the area well. Without suggesting a connection, an article in the Daily Mail discussing testosterone treatment for women describes the case of Caleb Bolden (a woman using the hormone) whose female partner had “three miscarriages and two stillbirths” after using donated sperm to conceive.

No one knows the extent of complications that can occur in a child born to a mother who took testosterone during pregnancy. What is known is that a female fetus can undergo “virilization” and then be born with ambiguous reproductive organs. What that may mean for her future life is also a big question mark.

Researchers' verdict: Risks not proven, reasons for concern ‘outdated’

The study, conducted by sociologists (none of whom has a medical degree) from a number of universities, did not seek to clarify the risks entailed in testosterone pregnancies. 70 “trans” people were enrolled, along with 22 healthcare providers (HCPs) who have experience with “trans” issues and pregnancy. They were followed for three years. The physical outcomes for their children are not described. Instead, the research is focused on the mothers and their experiences.

It is noteworthy that even WPATH, the World Professional Association for Transgender Health, which aggressively promotes “gender reassignment surgery,” states that,

Absolute contraindications to testosterone therapy include pregnancy...

The study admits this, but insists that WPATH’s updated advice is limited to only “recommending” avoidance of the hormone during pregnancy. The researchers then set about casting doubt on the risks entailed:

But what happens when medical science doesn’t yet have all the answers about how patient behaviors may relate to health outcomes for both the pregnant person and the fetus... [emphasis added]

Doctors who promote caution belittled

The study repeatedly calls out doctors who warn women contemplating hormone supplementation to beware of the possible irreversible sterilizing effects, claiming that this medical advice is “outdated” and “disproven in both the current empirical medical research literature and the lived experience…” 

The researchers also belittle doctors issuing such warnings, claiming that their advice is based on outdated conceptions of testosterone as a “male hormone”:

This medical guidance for trans people is based largely on understandings that testosterone, as a “male” hormone, is incompatible with conception, pregnancy, and lactation as “female” biological processes, as well as concerns around potential pre-conception ova, prenatal embryonic and fetal, and postpartum infant exposures to “excess androgens”...

A long list of possible side-effects… but implying causation is ‘misguided’

To further their case that taking testosterone during pregnancy should be freely permitted, the researchers compare women taking the hormone with women with Polycystic ovary syndrome (PCOS), who often have higher-than-normal levels of testosterone in their bodies. They admit to all the known negative consequences for children born to mothers with PCOS:

Concerns about fetal exposure to “excess androgens” among offspring born to people with PCOS include, among others, urogenital and intersex conditions (such as an enlarged clitoris or other forms of “ambiguous genitalia”) and later development of “metabolic dysfunction” (including “obesity” and PCOS), non-normative sexual identities, and/or “neuropsychiatric disorders” such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), largely among those categorized female at birth...

And they even note that the same studies that show all these associations,

often do show increased associations between these conditions, experiences, and identities among the offspring of gestational parents with higher-than-average levels of testosterone during the gestational period.

However, they then assert that the associations are not proven and that claiming that there is any cause-and-effect relationship between testosterone and abnormalities in the fetus would be “scientifically misguided”:

[making] causal claims ... between excess androgens and [all the above-mentioned disorders] would be scientifically misguided [due to the] long latency periods between in-utero exposures to excess androgens and offspring’s later development or diagnosis...”

‘They’re on drugs anyway, so what's a bit of testosterone between friends?'

Some of the HCPs involved in the study openly expressed their concerns about testosterone supplementation during pregnancy. Others, however, downplayed the risks.

One doctor described how she tells women considering supplementation that,

We consider it teratogenic based on extremely limited data and conflicting data. I think to some degree we can look at data on PCOS and pregnancy as a population of people that has increased testosterone levels, not as increased as they would be if you were taking a full dose of testosterone, and we see that there's some impact there but we don't change our pregnancy care. We don't try to reduce those testosterone levels. We just take care of the pregnant person…

Another doctor suggested that in comparison to other dangerous things that her “trans” patients do during pregnancy, testosterone supplementation wasn’t so much of a concern:

Honestly, on my list of things that I'm worried about in pregnancy, it is so far down the list that I don't even go there. My patients have a higher-than-average rate of substance use, of sexually transmitted infections, they have a very high rate of chronic stress related to marginalized status. Exogenous hormones are not my first concern. The fact that there's very little data is concerning, but we give people medications all the time that have very little data in pregnancy, so we can talk through what is known and what is unknown, and people make their decisions.

Don't sacrifice for your children — be ‘balanced’

In conclusion, the researchers expressed their approval of what they call a “balanced” approach that considers the “health and well-being of both trans people and their children.”

Such approaches differ meaningfully from gendered and normative expectations that gestational parents must always and automatically self-sacrifice or choose optimal approaches that exclusively prioritize the potential well-being and normative development of offspring.

Is your doctor concerned about your well-being? No, he's just power-hungry

In fact, the researchers have more far-reaching goals than simply persuading doctors that testosterone supplementation during pregnancy should be allowed. Their aim is to eliminate the supposed “power imbalance” between doctor and patient.

... we find that health care providers reinscribe their status and authority, in the context of uncertainty, by prescribing caution as they advise their trans patients to pause testosterone therapy, center normative development of trans offspring, and cast trans patients’ pursuit of testosterone therapy during pregnancy as illicit or selfish. 

Citing earlier research, they claim that doctors who express their concerns about the safety of the fetus are part of a system that promotes “social control over women.”

Some of the women in the study echo this viewpoint, complaining how their doctors refused to work with them unless they stopped taking testosterone:

… a lot of people have had similar experiences where they've been given some arbitrary time frame, like, “I will or I won't work with you unless you've been off T[estosterone] for X number of months,” or “This is when I feel like it's safe to start trying,” or something like that.

The researchers commented that such narratives,

highlighted the power and control that health care providers held as they made determinations about whether they would or would not provide care for trans patients.

‘I wanted to be a pregnant man, not a pregnant woman’

The women involved in the study expressed their reluctance to stop taking testosterone during pregnancy, describing how having a masculine appearance was important for their emotional health. None of the women interviewed discussed the impact having a pregnant appearance had on their emotional health.

Trans people in our study described concerns about pausing testosterone in order to become pregnant, throughout pregnancy, and during the postpartum period. Common fears included potential changes in voice, hair thickness/growth, or fat distribution that may make public recognition as a man more challenging, concerns about increased levels of body dysphoria and depression and higher likelihood of postpartum depression, being feminized and misgendered by providers throughout their pregnancy...

One study participant stressed how being and appearing pregnant was not problematic — it was being a pregnant woman that was the problem:

... I knew I wanted to have a child but I knew I was not able to get pregnant, as a woman. It was not possible … I knew I could not bear … people — the view other people would have of me.

Another woman described how difficult it had been to stop taking testosterone, and also how wonderful it was to be pregnant:

Being pregnant wasn't the hard thing, being off testosterone was the hard thing. I could've just been, like, a pregnant man, in the most straightforward sense of being myself, being on testosterone, and being pregnant. That would've been fine. 'Cause I loved the feeling of growing this thing inside of me, and being … having this incredible kind of responsibility.

Wanting a healthy, normal baby is ‘eugenics’

What is striking about the women involved in the study is how it never seems to occur to them that wanting to be pregnant and to have a baby, and enjoying the entire experience, could in any way seem contradictory to “feeling like a man.” One wonders what they think “feeling like a man” actually is.

This apparent contradiction is similarly not addressed by the researchers themselves, as their agenda is to leave the “binary” concept behind entirely and move toward a non-binary way of seeing people. 

They take issue with basic biological facts, criticizing healthcare providers who insist on giving “outdated” advice “based on ‘men’s’ versus ‘women’s’ hormones.’”

They make parallels between what the researchers call “ongoing legacies of eugenics” and policies that seek to avoid producing children with ambiguous reproductive organs:

How might assessment of health risks ... reflect historical and ongoing social practices for creating “ideal” and normative bodies and people?

Creating a Queer New World

In fact, they seek to entirely normalize what has heretofore been considered abnormal. Whereas the mothers in this study apparently think they are men due only to their way of thinking, taking testosterone during pregnancy could lead to their having children who have genuine physical reasons for gender dysmorphia — and this may be what the researchers actually want to see as the result:

... current medical advice around precautionary testosterone cessation in pregnancy involves potentially troubling assessments of the sorts of risks testosterone exposure in the prenatal and postpartum environments may pose for later child and adult development: namely, potentially heightened likelihoods of autism, obesity, intersex conditions, being lesbian and/or trans. In this way, precautionary practices of protecting the offspring of trans people become, paradoxically, a method of social control through safeguarding against reproduction of some of the very same characteristics held by some trans parents themselves [emphasis added].

In other words, there’s nothing wrong with being “queer” even if that queerness is physical. Therefore, doctors should stop trying to prevent birth defects, because they are not really defects at all.

Social justice activists, scholars, and the field of critical studies have made important strides to highlight how the desire to maximize the “fitness” of offspring, and guard against development of conditions or human characteristics considered “unhealthy” or less than ideal, may reflect troubling eugenicist and biomedical moralist underpinnings in ways that further harm already-socially-marginalized people...

One woman in the study was clearly confused about what all this could mean for her child. On the one hand, she expressed concern about the results of taking testosterone — on the other hand, she wanted to give her child “options,” as if being intersex was somehow beneficial and meant they could be whatever they wanted:

There's a bunch of research around androgen exposure in utero and intersex conditions and even some around stress hormones and cortisol and androgen and intersex babies. I did have a little bit of a complex feeling around working hard to not have an intersex child … As someone who is a gender ‘other,’ to work hard to not create a different body that is a gender ‘other,’ it feels weird. It feels a little hypocritical. But it kind of came down to wanting the child I created to have the most options in their own body, in their own life, which most intersex folks don't have…