Background: Transmasculine individuals can experience unintended pregnancy. However, research that examines contraception among transmasculine individuals is extremely limited. Thus, we conducted a qualitative study to elicit comprehensive and detailed information about contraceptive use and its social determinants among transmasculine people.

Methods: Using purposive sampling, we conducted in-depth interviews with transmasculine individuals (N=21) aged 18-29 years with an assigned male at birth sexual partner in the last 5 years. Interviews were transcribed verbatim and analyzed using thematic analysis.

Results: Most participants believed that contraception was necessary to effectively prevent pregnancy among transmasculine individuals, including those using testosterone. Many participants chose a contraceptive method based on how it affected their gender dysphoria, testosterone use, and menstruation and expressed a preference for condoms and contraceptive implants. Participants’ contraceptive beliefs and decisions occurred in the context of a lack of knowledge, accurate information, and support regarding contraception, especially in relation to testosterone use. Gender bias, discrimination, and stigma in clinical settings negatively influenced transmasculine young adults’ contraceptive care experiences.

Conclusion: Transmasculine young adults have specific contraceptive needs and tailored educational resources that provide accurate information about the full range of contraceptive methods in the context of gender dysphoria and testosterone use are needed. Health care providers can deliver high-quality contraceptive care to transmasculine individuals by supporting patients in choosing the contraceptive method that best meets their needs in the context of social and medical gender affirmation, avoiding hetero- and cis-normative assumptions, and creating environments and practices that are inclusive and respectful of transmasculine patients.