A hand-drawn illustration of a woman, a man, and a small child. The woman has long dark hair and is wearing a pink top and purple skirt. The man is holding a large white object, possibly a pillow or cushion. The small child is standing next to the woman, partially hidden behind her legs.

As the southern United States has the highest concentration of trans people in the country while also having the strictest abortion bans and restrictions in place, some trans people would be required to travel hundreds of miles for abortion services. Because trans people, especially racialized trans people, are more likely to live in poverty than the general population, it can be even more difficult to schedule and access abortion services within those six short weeks or to travel out of state to access abortion services.

In states with “fetal heartbeat bills” on the books, some trans masculine people can be at additional risk of harm. For trans people who experience menstrual cessation as a result of HRT, there would be no abnormal lack of menstrual cycle to indicate pregnancy. This means that in states with six-week abortion bans, they are even more likely to miss the cut-off to access legal abortion services before knowing they are pregnant.

Pregnancy & Parenting:
Trans Experiences

Threats to abortion care and gender-affirming care are interconnected, strategic, intentional, and have intensified since the overturning of Roe v. Wade. States with abortion bans often have restrictions on gender-affirming care and vice versa, compounding the criminalization of trans pregnant people accessing care.

Transgender and nonbinary people face unique barriers to abortion and reproductive care related to transphobia, including being refused medical care, being misgendered by medical providers and staff and an overall lack of knowledge among healthcare providers about transgender bodies and health. Many trans and nonbinary people avoid accessing routine reproductive health care for this reason.

Health care professionals often assume that trans pregnancies don’t happen—or if they do happen, that they are so rare that it doesn’t affect their practice. Trans pregnant people do not get the care they need to end a pregnancy or support a healthy pregnancy, and therefore do not often get to make the same choices that cis pregnant people do. Some trans pregnant people with wanted pregnancies report being offered an abortion many times without prompting throughout the course of their pregnancies.

Amid discourse surrounding women’s rights and bodily autonomy in the time since the Dobbs decision, transgender and nonbinary advocates say their communities are often excluded from conversations about abortion care and other forms of reproductive healthcare. Some trans pregnant people have reported being denied access to certain pregnancy-related services and support groups due to the misconception that these spaces are exclusively for cisgender women.

With the absence of studies on the matter, the same negative outcomes attributed to the lack of abortion access for cisgender women can be assumed to be the reality for trans people as well, according to Our Bodies Ourselves. However, trans masculine people on HRT face additional consequences in the face of abortion restrictions that are not experienced by cisgender women.

Testosterone is teratogenic, which means that taking testosterone while pregnant can lead to birth defects in the fetus and, potentially, miscarriage. For trans people on HRT who are pregnant, doctors recommend stopping testosterone for the safety of the pregnant person and the fetus.

Trans pregnant people are faced with the illusion of choice: carry the fetus to term and stop HRT for their own safety and the safety of the fetus or attempt abortion without clinical supervision. Studies show that trans and gender-expansive individuals are more likely to choose self-managed abortions (SMA). While cisgender women tend to seek medication abortions due to fears surrounding a clinical procedure trans men tend to seek medication abortions because it allows them to avoid interactions with medical providers and medical facilities. SMA can carry more risk for those individuals who may already not feel safe or supported accessing reproductive health care, and is being criminalized in increasingly insidious ways. If individuals are not able to or do not want to have an abortion, they are effectively forced to de-transition until the fetus has been born.