I'm a man who wants to take birth control pills — What do I need to know?

Dear Maryan,

Seeking the advice of health care professionals is always recommended when you’re considering a new medication. It sounds like your main goal for taking birth control pills is to feel more feminine, and you have been thinking about taking birth control for some time now with that aim in mind. Kudos to you for consulting a trusted source as you gather more information and explore your options. Prior to seeking medical advice, however, you may also want to consider other ways you can enhance feeling feminine in your day-to-day life and achieve a similar result without the potential side effects of a new medication.

First, if your interest in taking birth control pills is to begin hormone therapy, keep on reading for information about birth control and medical options for feminization that you might discuss with your health care provider:

There are many forms of birth control, but not all kinds work the same way in the body or contain estrogen. Hormonal birth control pills contain varying levels of the synthetic hormones estrogen or progestin (or a combination) to regulate the menstrual cycle. These types of medications are not typically prescribed to induce a feminizing effect on the body. Additionally, the use of birth control pills is not without risks and is best monitored by a health care provider. Serious side effects of birth control pills exist, but be aware that these were found in females — not enough information is available to know what side effects could occur in males.

Some forms of estrogen can be prescribed for hormonal therapy. When people want to increase feminization and reduce testosterone levels many begin a combination of estrogen therapy with a prescription anti-androgen, which blocks the effects of testosterone. Regular physical exams and blood tests are especially critical when on hormone therapy because your health care provider will want to monitor kidney and liver functioning, cholesterol levels, and other aspects of your health that can be impacted by hormone use. Estrogen therapy is also associated with increased risk of high blood pressure, blood clots, liver problems, stroke, and diabetes. Research is lacking in specific side effects of estrogen use by males. That said, it bears repeating that this type of therapy is best when paired with the supervision of a health care provider.

The Center of Excellence for Transgender Health at the University of California, San Francisco has more information on hormone therapy protocol for balancing a person’s physical body with their gender identity. 

If your interest in taking birth control pills is a means of feeling more feminine by adopting a feminine activity, here are some other non-medical options you might consider:

• Physical expression. Clothing (shoes and accessories, too!), hairstyle, makeup, and body language are all ways people outwardly express their identity, whether feminine, masculine, or elsewhere on the spectrum of gender. Often a little experimentation will help narrow down what feels right for your self-expression.
• Community involvement. Talking and spending time with others who also identify similarly may also be a way to embrace and explore gender expression and identity. Clubs, social outings, community classes, online groups, or local organizations with like-minded members can provide a supportive setting to be yourself. Some people find that the more time they spend in the company of people with whom they feel safe to be themselves, the more their self-confidence improves. Many lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) centers will offer events that specify safe space guidelines for gender non-conforming expression.
• Hobbies, pastimes, and personal interests. Some people affirm their identity by investing more time and energy in themselves and their interests. What other habits or hobbies might you adopt to feel more feminine? Reading books or articles that explore femininity, watching movies, listening to music, or beginning a new hobby that allows you to embrace and express your feminine self are just a few ideas.

Speaking with a therapist may be another option to help you affirm and fully articulate your reasons for exploring your feminine self, no matter what route(s) you take. Regular therapy may also be a source of support as you continue your journey. Some health care providers may recommend or even require meeting with a counselor or therapist before beginning hormone therapy. Knowledgeable and sensitive providers can be found through the Gay and Lesbian Medical Association or World Professional Association for Transgender Health. Community based clinics such as Callen-Lorde (in New York City) and San Francisco Community Clinic Consortium (in San Francisco) offer services specifically for individuals exploring their gender; you might do a bit of research to see if there’s a similar clinic near you. In any case, make sure you can be honest with them and comfortable sharing your concerns and experiences when choosing a health care provider or mental health provider.

Gender identity and expression exist on a spectrum, unique to each person. There are lots of ways to continue to explore and understand your feminine side, both on your own and with the support of others. Try to find the ideas and options that resonate most with you. Best of luck as you continue on your journey.