HRT & Birth Control: Giving Every Body the Control They Want

First thing’s first: hormone replacement therapy (HRT) is not a substitute for birth control. Not testosterone, not estrogen, nada.

Choosing  birth control for you and your partner on HRT

If having the type of sex in which sperm could enter the uterus of a person with ovaries who is ovulating, then pregnancy is still a real possibility. And second: there are uses for certain birth control other than pregnancy prevention! So here are a few things to consider if combining HRT and birth control.

Most folx taking testosterone who go on hormonal birth control decide on a progesterone-only birth control method because they don’t want to put estrogen in their bodies. Taking birth control with estrogen (combined pill, patch or ring) may cause some unwanted side effects at the beginning like chest tenderness, but it should not alter or decrease testosterone's effect on your body. If someone doesn’t want to put estrogen in their body, there are many options with just progesterone, and many with no hormones at all! If taking birth control for reasons other than preventing pregnancy, like controlling bleeding/cramps, after being on testosterone a while it may be worth reassessing the need, since testosterone alone may help with those. But if using birth control to prevent pregnancy, determining which depends on the person, their bodies, and their preferences!

For folx taking estrogen (with or without anti-androgens), while estrogen HRT may lower sperm count, there is still the ability to get someone pregnant!

Some forms of birth control are hormonal, some are not, some are more immediate, and some are long-term. Each person should choose the type of birth control that feels best for them.

Immediate methods of birth control are only needed at the time of sex, primarily to prevent pregnancy

  • External condom worn on the penis (also can prevent STIs!)
  • Internal condom inserted in the vagina (also can prevent STIs!)
  • Diaphragm (with the use of spermicide) or cervical cap inserted in the vagina/front hole
  • Spermicide alone inserted in the vagina/front hole
  • Withdrawal method (pulling the penis out of vagina before ejaculation)
  • Plan B/Ella emergency contraception taken up to five days after 

Short-acting methods that require a daily habit but can support needs beyond preventing pregnancy

  • The Pill (contains estrogen), can also improve bleeding/cramps and acne for some
  • Progestin-only pills, can also improve bleeding/cramps and acne for some

Medium-acting methods that require weekly or monthly attention

  • A shot every 3 months (ex. Depo-provera)
  • The Patch (contains estrogen), applied three weeks in a row, followed by one week off, can also improve bleeding/cramps and acne for some (ex. Xulane)
  • The Ring (contains estrogen), inserted in the vagina and changed monthly (ex. Nuvaring, Annovera)

Long-acting methods that require a healthcare provider to place or remove

  • Copper IUD (contains no hormones) placed in the uterus and may be left in place up to 12 years, (ex. ParaGard)
  • Progestin IUD placed in the uterus and may be left for 3-7 years (ex. Liletta, Mirena, Kyleena, Skyla) 
  • Implant placed under the skin of the arm by a healthcare provider (ex. Nexplanon) can be left in for 4 years

Birth control is fully up to the person living in their body, and having the sex they want to have, and the FOLX clinicians are available for any further questions to find the right combination of birth control and HRT for each person.

For those interested in longer-term family planning, there’s more to read about in the articles Testosterone & Fertility and Estrogen & Fertility.

For FOLX members with questions about the right form of birth control for their bodies, consider scheduling an appointment with a provider. For anyone who isn't a FOLX member, drop us a line at support@folxhealth.com and we'll do our best to offer some helpful info.