In 2016, the Council on Social Work Education published Guidelines for Transgender and Gender Nonconforming (TGNC) Affirming Education. These guidelines offered points of entrée for social workers learning about/engaging with TGNC clients. While important, these guidelines merely scratch the surface of key issues central to TGNC people’s lives. The present work moves beyond TGNC Inclusion 101 to consider specific sites of action and support social workers might undertake as they work with TGNC people in the context of pregnancy. The central motivating questions for this work are: 1) What is the medical empirical literature evidence base for current guidance on testosterone administration cessation among TGNC people in the context of pregnancy; 2) How do TGNC people respond to this guidance; and 3) How might social workers best support TGNC clients and their families in the context of pregnancy?
This work draws from content analysis of existing medical literatures on testosterone in the context of pregnancy, along with in-depth interview and focus group data from a three-year international study of 70 purposively-sampled TGNC people (residing across the U.S., Canada, U.K., Australia, Germany, and Bulgaria) about their intentions and experiences around pregnancy, as well as 22 healthcare providers (practicing across the U.S., U.K., Australia, and Italy) who focus on TGNC health/working with TGNC patients along a diverse cross-section of specialty areas (e.g., social workers, psychotherapists, general practitioners, endocrinologists, midwives, lactation consultants, OBGYNs, fertility specialists). Drawing upon this content analysis, grounded theory analysis, and axial coding of 120 pages of interview transcript excerpts, culled from a thematic node focusing on testosterone, the present study offers insights into the three aforementioned central motivating questions.
Medical advice counsels TGNC people to discontinue testosterone administration in the context of pregnancy. These recommendations are often made in the absence of compelling medical bases and fail to consider that many cisgender women with high testosterone (e.g., polycystic ovarian syndrome/PCOS) conceive, give birth, and breastfeed without use of testosterone blockers. Further, abrupt cessation of testosterone administration among TGNC people may result in increased gender dysphoria, depression, anxiety, and gender misrecognition. As such, some TGNC people wish to continue testosterone supplementation to varying degrees in the context of pregnancy. Some social workers and health professionals warn patients to discontinue hormones based on binary assumptions around gender, hormones, and pregnancy. Other social workers and health professionals strive to meet TGNC clients where they are; consider potential harms in unilateral hormone cessation advice; and work to support/advocate for TGNC clients in making informed choices.
Testosterone supplementation among a considerable cross-section of TGNC people reduces gender dysphoria, protects mental health, and provides greater likelihood of accurate gender recognition. Social and healthcare worker patient advocacy and support are vital to positive health outcomes for TGNC clients. Attention to the details of TGNC clients’ lives, and sources for potential social work advocacy and support where these are concerned, exemplify 2022 CSWE Educational Policy and Accreditation Standards (EPAS) competencies for anti-racism, diversity, equity, and inclusion (ADEI) commitments in practice and education.