Survey finds interest in progestin-only pills among transgender populations

The availability of over-the-counter progestin-only pills can improve contraception access among transgender, nonbinary, and gender-expansive individuals, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

The first nonprescription oral contraceptive, progestin-only pill received FDA approval in 2023. Health equity for over-the-counter access is reliant on giving focus to marginalized populations, and data about interest in over-the-counter progestin-only pills among transgender, non-binary, and gender-expansive individuals is currently lacking.

These populations face multiple barriers toward reproductive health care, including provider biases, discomfort, and lack of knowledge about treatment for transgender, non-binary, and gender-expansive individuals. Therefore, over-the-counter access to contraceptives may improve autonomy and reduce barriers to care.

In an interview with Contemporary OB/GYN, Lauren Abern, MD, FACOG, assistant professor of gynecology and obstetrics at Emory University, noted that there are multiple reasons transgender individuals may need contraception, including menstrual suppression or management.² This makes it important for clinicians to be able to personalize care.

To determine likely rates of over-the-counter progestin-only pill use among transgender, non-binary, and gender-expansive individuals, investigators conducted a self-administered, online, cross-sectional survey.¹

Participants included US individuals assigned female or intersex at birth identifying as a gender other than cisgender woman aged 18 to 49 years able to complete the survey in English. These patients were enrolled through an anonymous online survey and The Population Research in Identity and Disparities for Equality (PRIDE) Study.¹

Survey questions were created by a community advisory team and The PRIDE Study’s Research and Participant Advisory Committees. Interest in over-the-counter progestin-only pill use was the primary outcome, determined by the question, “Would you use a birth control pill that only had progestin that you could buy over the counter (without a prescription)?”

Interest was determined by responding “Yes” to this question rather than “No” or “Don’t know.” Sociodemographic variable data was also obtained, including gender identity, sexual orientation, age, race and ethnicity, education, region, relationship status, employment and student status, insurance status, and food stamp assistance.

Reproductive health variables included prior pregnancy and self-perceived risk of unintended pregnancy. Participants were also asked if they had legally changed their gender on their health insurance.

There were 1415 respondents aged a median 26 years included in the final analysis. Of participants, 55% were non-binary, 41.8% genderqueer, and 35.5% transgender men. Health insurance was reported in 91.9%, being a race and ethnicity other than exclusively White in 19.9%, and considering themselves as at risk of unintended pregnancy in 12.4%.¹

For pregnancy risk factors, penis-in-vagina sex was reported in 33.7% of participants, any contraception use in 72.9%, and current contraception use in 50.1%. Progestin-only pill use at any time was reported in 14.6%, general oral contraceptive use in 51.7%, and current oral contraceptive use in 9.3%. Two percent of participants were sterilized.

Interest in over-the-counter progestin-only pill use was reported by 45% of overall participants, and 45.5% when excluding those who were sterilized. The odds of being interested were increased among patients aged 18 to 24 years, with an odds ratio of 1.67.¹

Participants with a high school degree or less, uninsured, currently using oral contraceptives, and who had ever used progestin-only pills were also more likely to express interest in over-the-counter access, with adjusted odds ratios of 3.02, 1.91, 1.69, and 2.32, respectively.

Interest was also increased among patients reporting contraceptive coverage challenges because of their legal gender on their health insurance. These difficulties were reported among 6.7% of patients.

These results indicated interest in over-the-counter progestin-only pill use among transgender, non-binary, and gender-expansive individuals. Investigators concluded its availability may improve contraceptive access for this population.¹

Reference

1. Grindlay K, Obedin-Maliver J, Ragosta S, et al. Interest in over-the-counter progestin-only pills among transgender, nonbinary, and gender-expansive individuals in the United States. Am J Obstet Gynecol. 2024;230:657.e1-17. doi:10.1016/j.ajog.2024.02.006
2. Karas A. Meeting the contraceptive needs of transgender and gender nonbinary individuals. Contemporary OB/GYN. May 19, 2024. June 25, 2024. https://www.contemporaryobgyn.net/view/meeting-contraceptive-needs-transgender-gender-nonbinary-individuals