Men and pregnancy can and do exist. Trans men — that is, people with female reproductive systems but a male gender identity — are capable of becoming pregnant and carrying a pregnancy to term. The topic has also drawn cultural and political attention. On May 17, 2021, L’Espresso sparked a sensation with a cover depicting a pregnant trans man, illustrated by cartoonist Josephine Yole Signorelli.

But from a medical standpoint, much remains uncertain. That gap is highlighted in a review published online on July 8, 2026, in Acta Obstetricia et Gynecologica Scandinavica, an international women’s health journal. The review, led by Catherine Meads, Susan Bewley, and colleagues at Anglia Ruskin University in Cambridge and King’s College London in London, England, underscores how limited the evidence still is.

Data Are Lacking

The authors included a total of 44 studies in the review, the majority of which were from the US (28 out of 44). The quality of the data is poor. Many samples were too small to yield statistically significant results, and in some studies, it was not even possible to distinguish with certainty between trans men and trans women. In fact, most of the studies included pregnancy data only as part of other investigations. The heterogeneity of populations, contexts, and outcomes was therefore such that a meta-analysis was impossible. In any case, given the overall scarcity of data, no study was excluded due to low quality.

The proportion of trans men who have had at least one pregnancy ranges from 5.6% to 8.5%; the proportion of those who have given birth ranges from 4.3% to 8.5%. These estimates come from studies with biases in opposite directions, though those biases are difficult to quantify: Studies involving people already interested in reproductive health tend to overestimate due to selection bias, while studies examining the surgical aspects of transition likely underestimate it. It is, however, a significant percentage.

There are no reliable data on obstetric and neonatal complications in these pregnancies. Two findings, however, warrant attention. The first concerns spontaneous abortion: In four of five studies, the rate ranged from 31.6% to 40%, well above the 11%-22% estimated in the general population. However, none of these studies were comparative, and the sample sizes were very small, so the finding should be treated as a hypothesis that still needs to be verified. The second concerns mental health: Postpartum depression, measured in only two studies, ranged from 15% to 58%, with reports of psychotic symptoms and suicidal ideation. Finally, a significant percentage — ranging from about 20% to 70% depending on the study — attempted breastfeeding at least once.

Testosterone and Pregnancy

The use of testosterone prior to pregnancy is another unknown factor. Current guidelines recommend discontinuing it before conception because it is considered teratogenic. Consistent with its effects on fertility, the review found that testosterone use appears to be associated with fewer conceptions, even when therapy had been discontinued months earlier, suggesting a long-lasting effect. However, testosterone is certainly not a reliable contraceptive: Several studies report significant rates of conception occurring during hormone therapy.

The review confirms that many transmasculine people wish to have children. Their journey involves additional challenges and obstacles compared with that of cis women. Trans people often report difficulties with gynecologists and healthcare services, as well as mistrust, which are largely unprepared to handle these situations. A 2024 study found that in Italy, more than 40% of trans and nonbinary people assigned female at birth reported feeling discriminated against when trying to access care. The study also showed that coverage for cervical and breast cancer screening is significantly lower in this group than in the general population.

From Knowledge Gaps to Poor Care

This is not only a problem for trans people who wish to have children but also for the children themselves. The study highlights the near-total lack of reliable data on the course of trans pregnancies and fetal health. The authors of the review conclude: “Evidence-based guidelines need to be developed for use by multidisciplinary teams. Healthcare providers should be transparent about the current knowledge gaps and take the initiative to fill them through higher-quality research. More needs to be learned about trans men, their pregnancies, childbirth, birth outcomes, and obstetric complications. Future research should focus on answering these questions, along with developing high-quality models of care. Reliable comparative data are urgently needed.”

The shortage of data and knowledge has translated into a lack of clear guidelines, limited awareness among medical staff, and, ultimately, less effective care. In Italy, even the basic numbers remain uncertain: There are no reliable statistics on the size of the transgender population — estimates range from 400,000-500,000 — much less on how many transgender parents there are or what their circumstances may be.

A better understanding of transgender pregnancy is not merely an academic or political issue. It is essential to protecting the health of both parents and children.

This story was translated from Univadis Italy, part of the Medscape Professional Network.