We know that the transgender and nonbinary communities face systemic barriers and discrimination within the healthcare system. At Twentyeight Health, we believe everyone deserves safe, affirming, and supportive access to reproductive care.
Gender-Affirming Hormone Therapy (GAHT) is a form of medical treatment that utilizes hormones (like testosterone or estrogen) to help align an individual’s physical characteristics with their true gender identity.
For Transmasculine & Nonbinary Individuals: Taking testosterone helps develop traits like a deeper voice and facial hair, while typically suppressing the monthly menstrual cycle.
For Transfeminine & Nonbinary Individuals: Taking estrogen (often paired with an androgen blocker) supports traits like softer skin and changes in body fat distribution.
A common misconception is that gender-affirming hormone therapy (GAHT) doubles as contraception. It does not. Transgender men and nonbinary individuals who have a uterus and ovaries can still become pregnant.
The Crucial Distinction: While GAHT is a powerful tool for shifting physical traits and reducing gender dysphoria, it is not birth control. Even if testosterone has stopped your regular monthly period, ovulation can still occur unpredictably, so a reliable contraceptive is necessary.
For many transgender men, nonbinary individuals, and gender-diverse people assigned female at birth (AFAB), experiencing a monthly menstrual cycle is more than an inconvenience—it can be a profound source of distress and gender dysphoria. While gender-affirming hormone therapy (GAHT) like testosterone often reduces or entirely stops bleeding over time, it can take several months or even a year to do so completely. In some cases, light bleeding or unpredictable spotting can persist indefinitely.
This is where contraceptives serve a dual purpose. Beyond preventing unintended pregnancy, certain birth control methods can be intentionally used to manage, lighten, or entirely suppress your period.
This process, known clinically as continuous dosing, involves skipping the placebo or "sugar pill" week in a standard birth control pill pack and moving immediately to the next active pack. The same continuous approach can be used with the contraceptive patch or the vaginal ring. By maintaining steady hormone levels instead of letting them drop for a withdrawal bleed, you can safely minimize or eliminate your period entirely.
Read the full guide to learn more about skipping your period →
Because everyone's body is unique, it's always best to connect with a licensed healthcare provider to help you tailor a cycle-suppression plan safely and effectively.
According to the American College of Obstetricians and Gynecologists (ACOG), transgender and nonbinary individuals have the medical right to choose from the exact same spectrum of birth control methods available to cisgender women, provided it is clinically safe for their specific biology.
Choosing a birth control method involves balancing your personal health history, your transition goals, and how you prefer to take medication. Here is a closer look at how different options fit into a gender-affirming care plan.
According to the American College of Obstetricians and Gynecologists (ACOG), transgender and nonbinary individuals have the medical right to choose from the exact same spectrum of birth control methods available to cisgender women, provided it is clinically safe for their specific biology.
Choosing a birth control method involves balancing your personal health history, your transition goals, and how you prefer to take medication. Here is a closer look at how different options fit into a gender-affirming care plan.
For individuals who experience heightened dysphoria at the thought of taking estrogen, or who face medical contraindications to estrogen (such as a history of blood clots or high blood pressure), there are highly effective, estrogen-free alternatives.
Seeking reproductive healthcare can often trigger medical anxiety, particularly for members of the LGBTQ+ community who have previously experienced misgendering, invasive questioning, or a lack of understanding from traditional clinical settings.
At Twentyeight Health, we have designed our asynchronous telehealth platform to minimize these friction points and prioritize your emotional and physical comfort.
To ensure your care is seamless, our platform accommodates both:
While Twentyeight Health does not prescribe gender-affirming hormone therapy, our licensed providers are fully equipped to navigate your contraceptive options and prescribe the method that fits your body best.
Our providers approach your medical assessment with specialized clinical context. We focus solely on the biological data points necessary to prescribe your medication safely—such as your current prescription list, blood pressure, and upcoming surgeries—ensuring a clinical evaluation completely free of judgment or unnecessary barriers.
With Complete Care, your provider is always just a message away. Whether you have questions about side effects or changes in your cycle, we’re here to support you every step of the way.
No. The minimal amount of hormones present in birth control pills will not reverse the deep tissue changes brought on by testosterone therapy. If you prefer to avoid estrogen entirely for peace of mind, progestin-only pills or non-hormonal copper IUDs are highly effective alternatives..
Yes! Your health shouldn't have to wait in a waiting room. Twentyeight Health works with over 100 insurance plans, including Medicaid in many states. If your insurance is in-network, your Complete Care Membership may be $0* (pay no more than your copay, often $0).
Complete Care gives you total flexibility with unlimited video visits and asynchronous messaging—giving you dedicated provider support exactly when and how you want it.
We are committed to protecting and advancing transgender and nonbinary reproductive rights. If you have ideas on how we can improve our platform's language, accessibility, or care models, please reach out to our team at contact@twentyeighthealth.com.
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