SCIENTIFIC EVIDENCE ON EXPERIENCES OF PREGNANT TRANSSEXUAL MEN

a descriptive, integrative literature review study without a defined time cut, carried out in January 2021 in the following Databases: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO and BDENF, in Portuguese, English and Spanish; using the DECs and MeSH descriptors: “Transgender People”, “Pregnancy”, “Reproduction”, “Fertilization”, “Insemination”, “Prenatal Care”, “Postpartum Period”, “Lactation”, “Mispontaneous Abortion” , “Habitual abortion”, “Reproductive health” and “Health Care” and their respective synonyms. The elaboration of the guiding question was conducted by the PICo Strategy: (Population): transgender men; I (Interest): experiences during the puerperal pregnancy cycle; Co (Context): reproductive health and health services. The final sample was submitted to the Thematic Analysis Technique.

Results:

a total of 1,011 studies were identified, 10 of which composed this review after the selection process and peer review. The analysis resulted in two thematic categories: “Pregnancy-puerperal cycle: challenges and experiences” and “Pregnant bodies: perceptions and social relationships”.

Conclusion:

the experiences of pregnant transsexual men are marked by concerns related to pregnancy, childbirth, birth and the puerperium, causing unexpected psychological and/or emotional impacts, evidencing cisheteronormativity and transphobia as structuring aspects which add an additional part to fear of childbirth and violations of rights.

DESCRIPTORS:
Transgender people; Pregnancy; Reproduction; Fertilization; Insemination; Prenatal care; Nursing

Search	Strategy	Results
PUBMED
P	"Transgender Persons" OR transgenders OR transgender OR transsexualism	10,892
I	Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous"	1,649,924
Co	"Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare"	961,378
PICo	P AND I AND Co	279
Web of Science
P	ALL=("Transgender Persons" OR transgenders OR transgender OR transsexualism)	14,078
I	ALL=(Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous")	1,100,992
Co	ALL=("Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare")	448,847
PICo	P AND I AND Co	124
EMBASE
P	transgender persons' OR transgenders OR transgender OR transsexualism	13,906
I	pregnancy OR gestation OR pregnancies OR reproduction OR fertilization OR insemination OR 'prenatal care' OR 'antenatal care' OR 'care, antenatal' OR 'care, prenatal' OR 'postpartum period' OR puerperium OR lactation OR paternity OR 'abortion, habitual' OR 'abortion, spontaneous'	1,532,975
Co	reproductive health' OR 'health, reproductive' OR 'delivery of health care' OR 'health care' OR 'delivery of healthcare'	1,839,571
PICo	P AND I AND Co	247
SCOPUS
P	ALL ("Transgender Persons" OR transgenders OR transgender OR transsexualism )	46,525
I	ALL (Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous")	3,326,898
Co	ALL ("Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare")	2,839,679
PICo	TITLE-ABS ("Transgender Persons" OR transgenders OR transgender OR transsexualism ) AND TITLE-ABS (Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous") AND TITLE-ABS ("Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare")	69
CINAHL
P	"Transgender Persons" OR transgenders OR transgender OR transsexualism	6,849
I	Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous"	294,673
Co	"Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare"	541,874
PICo	P AND I AND Co	68
Psycinfo
P	Any Field: "Transgender Persons" OR Any Field: transgenders OR Any Field: transgender OR Any Field: transsexualism	47,586
I	Any Field: Pregnancy OR Any Field: Gestation OR Any Field: Pregnancies OR Any Field: Reproduction OR Any Field: Fertilization OR Any Field: Insemination OR Any Field: "Prenatal Care" OR Any Field: "Antenatal Care" OR Any Field: "Care, Antenatal" OR Any Field: "Care, Prenatal" OR Any Field: "Postpartum Period" OR Any Field: Puerperium OR Any Field: Lactation OR Any Field: Paternity OR Any Field: "Abortion, Habitual" OR Any Field: "Abortion, Spontaneous"	181,618
Co	Any Field: "Reproductive Health" OR Any Field: "Health, Reproductive" OR Any Field: "Delivery of Health Care" OR Any Field: "Health Care" OR Any Field: "Delivery of Healthcare"	258,073
PICo	P AND I AND Co	217
LILACS
P	("Transgender Persons" OR transgenders OR transgender OR transsexualism)	10,820
I	(Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous")	1,260,545
Co	("Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare")	1,270,318
PICo	P AND I AND Co	6
BDENF - Enfermagem
P	("Transgender Persons" OR transgenders OR transgender OR transsexualism)	10,820
I	(Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous")	1,260,545
Co	("Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare")	1,270,318
PICo	P AND I AND Co	1
CUIDEN
P	("Transgender Persons" OR transgenders OR transgender OR transsexualism)	27
I	(Pregnancy OR Gestation OR Pregnancies OR Reproduction OR Fertilization OR Insemination OR "Prenatal Care" OR "Antenatal Care" OR "Care, Antenatal" OR "Care, Prenatal" OR "Postpartum Period" OR Puerperium OR Lactation OR Paternity OR "Abortion, Habitual" OR "Abortion, Spontaneous")	2,733
Co	("Reproductive Health" OR "Health, Reproductive" OR "Delivery of Health Care" OR "Health Care" OR "Delivery of Healthcare")	5,465
PICo	P AND I AND Co	0

	Authorship	Year of publication	Research design	Level of evidence
E1	Malmquist A. et al.1616. Malmquist A, Jonsson L, Wikström J, Nieminen K. Minority stress adds an additional layer to fear of childbirth in lesbian and bisexual women, and transgender people. Midwifery [Internet]. 2019 [cited 2021 Jan 17];79:102551.Available from:https://doi.org/10.1016/j.midw.2019.102551 https://doi.org/10.1016/j.midw.2019.1025...	2019	Qualitative	VI
E2	Charter R. et al.1717. Charter R, Ussheret JM, Perz J, Robinson K. The transgender parent: experiences and constructions of pregnancy and parenthood for transgendermen in australia. Int J Transgend [Internet]. 2018 [cited 2021 Jan 21];19(1):64-77.Available from:https://doi.org/10.1080/15532739.2017.1399496 https://doi.org/10.1080/15532739.2017.13...	2018	Qualitative	VI
E3	Light A. D. et al.1818. Light AD, Obedin-Maliver, J, Sevelius JM, Kerns, JL. Transgender men who experienced pregnancy after female-to-male gender transitioning. Obstet Gynecol [Internet]. 2014 [cited 2021 Jan 18];124(6):1120-7.Available from:https://doi.org/10.1097/aog.0000000000000540 https://doi.org/10.1097/aog.000000000000...	2014	Mixed	VI
E4	Hoffkling A. et al.1919. Hoffkling A, Obedin-Maliver J, Sevelius JM. From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers. BMC Pregnancy Childbirth [Internet]. 2017 [cited 2021 Jan 25];17(Suppl 2):332. Available from:Available from:Available from: https://doi.org/10.1186/s12884-017-1491-5 https://doi.org/10.1186/s12884-017-1491-...	2017	Qualitative	VI
E5	MacDonald T. et al.2020. Macdonald T, Noel-Weiss J, West D, Walks M, Biener M, Kibbe A, et al. Transmasculine individuals’ experiences with lactation, chestfeeding, and gender identity: a qualitative study. BMC Pregnancy Childbirth [Internet]. 2016 [cited 2021 Jan 25];16:106.Available from:https://doi.org/10.1186/s12884-016-0907-y https://doi.org/10.1186/s12884-016-0907-...	2016	Qualitative	VI
E6	Moseson H. et al.2121. Moseson H, Fix L, Hastings J, Stoeffler A, Lunn MR, Flentje A, et al. Pregnancy intentions and outcomes among transgender, nonbinary, and gender-expansive people assigned female or intersex at birth in the United States: results from a national, quantitative survey. Int J Transgend Health [Internet]. 2020 [cited 2021 Jan 25];22(1-2):30-41.Available from:https://doi.org/10.1080/26895269.2020.1841058 https://doi.org/10.1080/26895269.2020.18...	2020	Qualitative	VI
E7	Ellis S. A. et al.2222. Ellis SA, Wojnar DM, Pettinato M. Conception, pregnancy, and birth experiences of male an gender variant gestational parents: it's how we could have a family. J Midwifery Womens Health [Internet]. 2014 [cited 2021 Jan 29];60(1):62-9.Available from:https://doi.org/10.1111/jmwh.12213 https://doi.org/10.1111/jmwh.12213...	2014	Qualitative	VI
E8	Angonese M. et al.2323. Angonese M, Lago MCS. Reproductive health and rights for the population of transvestites and transsexuals: abjection and symbolic sterility. Saude Soc [Internet]. 2017 [cited 2021 Jan 25];26(1):256-70.Available from:https://doi.org/10.1590/s0104-12902017157712 https://doi.org/10.1590/s0104-1290201715...	2017	Qualitative	VI
E9	MacDonald K. T. et al.2424. Macdonald TK, Walks M, Biener M, Kibbe A. Disrupting the norms: reproduction, gender identity, gender dysphoria, and intersectionality. Int J Transgender Health [Internet]. 2020 [cited 2021 Jan 29];22(1-2):18-29.Available from:https://doi.org/10.1080/26895269.2020.1848692 https://doi.org/10.1080/26895269.2020.18...	2020	Qualitative	VI
E10	Light A. et al.2525. Light A, Wang L-F, Zeymo A, Gomez-Lobo V. Family planning and contraception use in transgendermen. Contraception [Internet]. 2018 [cited 2021 Jan 26];98(4):266-9.Available from:https://doi.org/10.1016/j.contraception.2018.06.006 https://doi.org/10.1016/j.contraception....	2018	Mixed	VI

	Thematic categorization	Synthesis of the experiences of pregnant transsexual men
C1	Pregnancy-puerperal cycle: challenges and experiences (E3, E5, E6, E9, E10)	It is noticed that interruption of using testosterone often contributes to the appearance of anguish, loss of muscles, lack of energy, intense mood changes, weight gain, breast growth and sensitivity, nausea, stress, anxiety and even depression as a result of changes in the body resulting from the pregnancy process, bringing with it significant psychological and emotional impacts.^17-18,25 It was also revealed that heterocisnormativity and LGBTphobic violence in the context of health services contribute to the increase in fear of childbirth among transgender men.^16,18,24 Breastfeeding during the puerperal period for those who have a breast becomes deeply distressing and, combined with a feeling of postpartum isolation, many participants specifically mentioned having postpartum depression.^17-18 However, there is also the conviction that breastfeeding is a political and positive act for the father-baby binomial.²⁰ In addition, pregnancy fulfills the dream of becoming a father.¹⁸
C2	Pregnant bodies: perceptions, representations and social relationships (E1, E2, E4, E7, E8)	It is noticed that the recognition of male gender identity becomes fundamental for promoting emotional security, well-being and quality of life during pregnancy, making transgender men able to even publicly affirm their condition of being pregnant.^{16, 19} However, some reports bring the use of pregnancy concealment strategies to the public as a protection strategy in the face of a context of transphobic violence, causing them to grow beards, be careful to limit weight gain, use large jackets and sweaters.^17,19

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Danilo Martins Roque Pereira danilo.martins@ufpe.br