In recent years, media coverage of transgender individuals and their experiences with parenthood has increased noticeably. Among the stories that have drawn significant public attention are those involving transgender men — individuals who were assigned female at birth but identify and live as male — who become pregnant. These stories can seem sensationalized at first glance, but the reality behind them is grounded in biology, medical science, and deeply personal decisions. Learning about the biological mechanisms, medical processes, and social contexts involved can help dispel misconceptions, reduce stigma, and promote a more informed understanding of gender identity and reproductive health.

A transgender man is someone whose gender identity is male despite having been assigned female at birth. Gender identity refers to a person’s internal understanding of themselves as male, female, or somewhere along the spectrum, and this may or may not align with the physical sex assigned at birth.

Many transgender men pursue gender-affirming care to align their physical characteristics with their identity. These interventions can include:

Hormone therapy: Usually testosterone, which induces male secondary sex characteristics.

Usually testosterone, which induces male secondary sex characteristics. Chest surgery (top surgery): Removal of breast tissue to achieve a male-appearing chest.

Removal of breast tissue to achieve a male-appearing chest. Social transition: Changes in name, pronouns, clothing, and other aspects of public presentation.

It is crucial to note that not all transgender men undergo these medical or surgical procedures. Consequently, reproductive organs such as the uterus and ovaries may remain intact, making pregnancy biologically possible in some cases.

Pregnancy in transgender men is possible if the uterus and ovaries are functional. Despite identifying as male, these individuals retain the biological capacity for conception if reproductive organs developed during female puberty remain operational. Several factors influence pregnancy in transgender men:

A uterus capable of supporting fetal growth is essential. Similarly, functional ovaries are necessary to produce eggs that can be fertilized naturally by a partner or through donor sperm.

Testosterone therapy, commonly used to masculinize the body, suppresses ovulation. Transgender men who wish to conceive usually pause testosterone under medical supervision to allow fertility to return safely. Medical oversight ensures that hormone levels are carefully monitored to prevent complications.

While natural conception is possible if ovulation resumes, some individuals may opt for assisted reproductive technologies such as:

Intrauterine insemination (IUI): Sperm is inserted directly into the uterus to increase chances of fertilization.

Sperm is inserted directly into the uterus to increase chances of fertilization. In vitro fertilization (IVF): Eggs are retrieved and fertilized in a laboratory before being implanted in the uterus.

These methods may be especially helpful if conception is challenging or if the individual previously experienced long-term hormonal therapy.