In his essay for Seahorses, an anthology of trans, non-binary and gender expansive pregnancy stories which he also curated and edited, Simon Knaphus describes pregnancy as the “most stereotypically masculine experience I’ve had.” The writer and disability attorney recalls being “impressively gassy” and horny, and feeling strong and protective over his ever-changing body during his pregnancy back in 2005. “My gender identity stayed the same,” he writes, “but my experience of maleness broadened. I was shocked at how much I felt like Homer Simpson. I did not expect that from pregnancy.”

Stories like these, of trans pregnancy in all its messy splendour, have been shared throughout the years in community centres and closed WhatsApp groups, but to read them in a published book is a new phenomenon. For the last few years, we’ve seen rising awareness and more sensitive media coverage of pregnant men and “seahorse parents,” an affectionate term for transmasculine people who carry pregnancies, given because male seahorses are one of only three known male animal species to experience pregnancy—the others being pipefish, and the seahorse’s close cousins, sea dragons. We have documentaries, like Jeanie Finlay and Freddy McConnell’s Seahorse, to lift the lid on these experiences—but so many of us still have questions, and healthcare professionals are often ill-equipped to answer them.
 

“Trans people are, by nature, do-it-yourselfers,” Knaphus tells Script. “We create our own genders, our own bodies, so of course we want to get in there and shape what our pregnancy and birth experiences are going to look like.” This DIY attitude can be a necessity. In the U.S., trans healthcare is under sustained attack, so treatment can require individual research and advocacy.
 

A lack of competent care also shapes people’s reproductive journeys: Knaphus recalls that two decades ago, he made the painful decision to wait until after having babies to start testosterone and have top surgery, for fear that medical transition would harm his chances of getting pregnant. Now, we know that’s not true. Had he been able to access this knowledge, his path may have looked different.
 

There is no singular experience of trans pregnancy, but there’s a growing library of online advice on platforms like Reddit, on the social media accounts of individual creators with lived experience and on online support groups. Weeding through those platforms can be a daunting experience—and sometimes it’s hard to tell what’s accurate and what isn’t. Here, Script has put together evidence-based answers to some of the most commonly asked online questions, in hopes that this knowledge will enable us to continue the long—and usually, undocumented—tradition of building trans families.
 

Will testosterone make me infertile?

No, and it’s an often-overlooked fact that trans people who take testosterone can still get pregnant. When taken continuously, testosterone can cause amenorrhea, or a lack of periods, but this doesn’t mean you can’t get pregnant; one 2024 study of 52 trans people found that 17 of them, or 33 percent, were still ovulating. The chance of pregnancy is lower, but it’s still there.

Research is limited, but there’s also proof that fertility can be regained after stopping testosterone. In 2020, fertility service provider Boston IVF released the findings of landmark eight-year research, which showed that trans men who had stopped taking testosterone for an average of four months had similar egg yields to cis women, dispelling the long-held myth that testosterone led to permanent infertility. Another study, a large-scale analysis of medical literature released in 2024, identified “about 99 reports in the medical literature of pregnancies carried by someone previously on testosterone.” 
 

What if my partner is a trans woman who takes HRT? Will her medical transition affect how likely we are to conceive? 

According to Dr. Mireia Galian, medical director of U.K.-based fertility clinic IVI London, “estrogen and anti-androgens can suppress testicular testosterone production, as well as sperm count and motility, which may reduce the chances of conceiving successfully.” Clinicians should always discuss this before prescribing hormones, as it’s possible to freeze sperm beforehand.
 

Galian says that recovering fertility after stopping hormones is “possible, but it remains unpredictable.” If you do decide to freeze sperm after pausing hormones, this “typically involves stopping estrogen and anti-androgens, and could take up to three to six months,” she says, “or longer in some cases.” For others still, fertility potential may not fully return or improve. 
 

How long will I need to come off testosterone before trying for a baby?

Testosterone is teratogenic, meaning it can cause birth defects if taken during pregnancy, but there’s still no established consensus on how long someone should be off testosterone before attempting to conceive, whether that’s by having sex with a partner, by IVF or by freezing their eggs.
 

Dr. Bradford Kolb, a board-certified reproductive endocrinologist at HRC Fertility, explains: “Traditionally, fertility clinics have recommended stopping testosterone for at least two months before egg retrieval. However, this practice was largely precautionary and not strongly evidence based, and emerging research is beginning to challenge it.” He cites a 2024 study, in which he says researchers found “no relationship between the length of time off testosterone and the number of mature eggs retrieved,” and that “outcomes were also similar between patients who had used testosterone and those who had not.”

Long-term safety data is still limited, so a few months is the cautious answer. Generally, you’ll need to be off testosterone until your periods restart, a length of time which differs for everyone. You can, it’s worth noting, still get pregnant if your period hasn’t restarted—but it’s recommended that you wait until it’s returned so that it is easier to track. As always, working with a medical professional is the best and safest option.
 

Will pregnancy make me more dysphoric?

Here, things get more anecdotal. “For me, I think it helped that I had always wanted to be pregnant,” says Knaphus. “That was part of my pathway from being a young child; I always just knew that I wanted to have kids and my assumption was that that meant that I would carry them and that didn’t cause me dysphoria.”
 

In Seahorses, there’s a round table discussion on the topic between contributors. Zillah Rose describes being “excited to be pregnant … I felt like I got to wear a drag pregnant belly and be this otherworldly magical being who got chosen to carry another life.” g k somers concurs: “I felt probably the most at home I ever have in my gender when I was pregnant.” This isn’t true for everyone. In a 2021 research paper, in which scholars analyzed various studies on transmasculine pregnancy, dysphoria came up so frequently that it warranted its own subheading. Participants in various studies reported “physical dysphoria”—the sense of deep unease in your own body—and “social dysphoria”—the disconnect between your gender and the way you’re perceived by others.

Pausing testosterone causes hormonal swings, which can have knock-on mental health impacts, such as fatigue and low mood, and pregnancy comes with its own mental health risks, like antenatal or postnatal depression—so making a support plan is always advisable.
 

Will I be able to opt for a C-section if it lowers my risk of dysphoria during birth?

Your healthcare choices will always vary based on where you are and what insurance you have, as well as the potential risks of an elective C-section. But Kolb says it’s “widely regarded as an acceptable option for many patients.” He reiterates that these decisions should “follow a thorough discussion with a healthcare provider about potential benefits and risks,” and that you can seek alternative care if you feel an initial healthcare worker isn’t listening to your concerns.

Knaphus opted for a home birth with his first baby and had no choice but to be induced for his second, but in his experience, the U.S. healthcare system “pushes C-sections so much that I think it would be very easy.” Subreddits like r/ElectiveCsection are fountains of knowledge, too, with stories shared from around the world.
 

What fertility costs can I expect?

This depends entirely on where in the world you are. In Canada, insurance coverage varies across the country; for egg-freezing specifically, Rainbow Health Ontario has produced a brilliant, in-depth guide on what to expect throughout the process, and how it varies based on location.
 

In the U.S., giving birth can still be expensive even with insurance, once premiums and deductibles are factored in. An in-depth breakdown published on Forbes cites US $19,000 as the average cost, dropping to around US $3,000 with insurance.

There might also be fertility treatments to consider. At the time of writing, 25 states and Washington, D.C. require private insurance coverage for fertility treatments, and even then, this coverage depends on your provider, whether the treatments are deemed medically necessary, and in some cases, identity markers like age or marital status. There has been at least one high-profile case of trans parents being denied insurance coverage, but these seem few and far between. Still, historically, queer couples have run into what’s been described as a “queer tax,” with insurance providers adding expensive hurdles, like proof of self-funded failed fertility tests, in the way of payouts.
 

Will I have to advocate for myself to healthcare professionals?

Unfortunately there’s still a risk of discrimination if you’re a pregnant trans person—a big one being misgendering in fertility appointments. But there are trans pregnancy support groups available, and a growing number of queer doulas to help navigate these difficulties, as well as—in worst-case scenarios—advocacy non-profits like the Transgender Law Center. 
 

Remember that for every negative story, there are dozens more positive ones. Knaphus, for example, grew frustrated with one doctor while he was in hospital delivering his second baby. “For several days in a row, she was trying to get me induced before I was ready,” he recalls. “I finally just said: ‘I don’t want her to come back in the room.’ She was being very pushy. The midwives put a sign on the door saying she couldn’t come back in!”
 

Can I use a binder if I’m pregnant?

If you do bind while pregnant, more caution than usual is recommended. Buy a larger size, keep the binding to shorter periods (around three to four hours max) and stop in the second trimester—sports bras still offer some compression, and are much safer. Trans Care BC has a super useful, in-depth breakdown of binding while pregnant, including why it can be more dangerous, and what risks to look out for. 
 

Should I expect chest growth?

It could depend on whether or not you’ve had top surgery. According to Knaphus—who hadn’t had top surgery at the time of his pregnancies—chest growth was one of the worst parts of pregnancy. “My chest grew a lot, and that was really uncomfortable,” he says. “I continued binding until it became way too uncomfortable. I just thought, ‘Fuck it, being comfortable is way more important to me than how somebody else sees me.’”  

For those who have had surgery, experiences vary. In a 2016 study of transmasculine chest-feeding, for example, six participants who had undergone top surgery “found that their chest tissue was growing back some amount or even to pre-surgery size,” although others experienced little to no change. 

It’s also worth noting that there are some anecdotal claims online to suggest that the drugs injected to stimulate egg production before egg harvesting can similarly lead to chest growth.
 

Where can I find more masculine pregnancy clothes?

“I thought I would just be able to wear larger clothing,” says Knaphus of his pregnancy wardrobe, but this proved tricky. “My body was so big and round in the middle, and then kind of medium-sized everywhere else, so it was really helpful to use clothing made specifically for pregnant people.” Knaphus settled on a uniform of oversized pregnancy T-shirts and overalls, which he says were easy to find in large chain stores, as well as two pairs of corduroy pregnancy pants. “They have that elasticated waistband situation with the buttons, like they’re made for kids,” he laughs.
 

In Seahorses, a candid roundtable also advises buying sliders in a size up (your feet will almost definitely swell), and one person recommends Hanes boxer briefs for their extra absorbency. Flannels and button-downs are other recommendations to escape the hyper-femininity of most maternity wear, and there are comprehensive guides to masc pregnancy dressing online like this article, published on Backseat Driver. 
 

Will I get unwarranted touches from strangers?

It could happen. 

“People didn’t really know what to do with me when I was pregnant,” Knaphus says. “I looked pretty dykey, because I hadn’t taken testosterone but I had a fairly masculine haircut and clothing. I never had anybody on the street come up and touch me, which is pretty amazing, as I know it’s a huge problem for a lot of people.” 
 

Will I be able to chestfeed after I give birth?

This depends on whether you’ve had top surgery, and if so, whether the mammary glands were kept intact. According to Kolb, “those who choose to chestfeed are generally advised to wait until chestfeeding is complete before starting testosterone.” “There’s limited evidence that testosterone can pass into the milk itself,” he adds, but “caution is typically recommended.”
 

What about if I’ve already had top surgery?

A few different factors impact whether or not you’ll be able to chestfeed. The first is chest growth. In the aforementioned study on chestfeeding, it was possible in some cases. “Chestfeeding, if desired, may be possible if there is enough tissue for a comfortable latch,” the researchers summarized. “Some transmasculine individuals do produce milk after [top surgery], although at-chest supplementation and donor milk or formula is likely to be required.”

In terms of dysphoria, most participants said the hardest part was strangers misgendering them as their chests grew, rather than the lactation itself being a source of discomfort. 
 

How long should I wait to go back on testosterone after giving birth?

Here, caution is advised. The postpartum period is hormonal chaos, so it’s best to work with a medical provider to decide on a timeline; likely, the advice will be to wait at least six weeks, and that’s based on anecdotal online evidence. According to the National Library of Medicine, a tiny handful of case studies show that trans men who resume testosterone at low doses can chestfeed their children with no adverse effects, but in these examples, the men waited at least a year before resuming testosterone. 
 

Where can I find more info? 

You’ll find countless guidance threads in subreddits like r/Seahorse_Dads, glimpses into everyday life as a trans parent through the social media accounts of parents like Logan Brown and online support groups, like TransFamilies’ monthly virtual meeting, “A Dad’s Place.” Guides like these are always bound to be incomplete; both transness and pregnancy are enormously nuanced experiences which vary for everyone, but there’s a growing online community and more information than ever for those seeking it out.

For Aakash Kishore, who wrote about the pain of losing a baby in the Seahorses anthology, this community support would have been vital. “There is the potential for so many different forms of loss and grief,” they told Script. “You both need and deserve support connections to lean on, to help you navigate these challenges, to buffer against harmful systems and also to deeply celebrate you.”