Preconception Care for Gender-Diverse Individuals

Guidance for Health Care Providers

Key Messages for Providers

  • Gender-diverse individuals, including transgender, non-binary, and gender-expansive people, may have reproductive goals and pregnancy intentions that should be supported through inclusive, patient-centred preconception care.
  • Barriers to care, including stigma, discrimination, and limited provider knowledge, can affect access to reproductive health services for gender-diverse patients.
  • Providing gender-affirming, respectful care can improve trust, engagement with health services, and access to preconception counselling and preventive care.
  • Preconception discussions should focus on reproductive goals, health optimization, and informed decision-making, while respecting patients’ gender identity and preferences.

Why Inclusive Preconception Care Matters

Gender-diverse individuals may experience barriers to accessing reproductive health care, including:

  • Discrimination within health systems
  • Lack of provider knowledge about gender-affirming care
  • Assumptions about fertility or pregnancy desires
  • Limited access to gender-affirming services

These barriers can delay or prevent access to preconception counselling and preventive care.

Preconception care provides an opportunity to:

  • Support reproductive autonomy
  • Review fertility and pregnancy considerations
  • Optimize physical and mental health prior to pregnancy
  • Coordinate care across providers

Inclusive care helps ensure that gender-diverse patients receive equitable access to reproductive health services.

Clinical Pearl: Do Not Assume Reproductive Goals Based on Gender Identity. Gender-diverse individuals may desire pregnancy, may wish to avoid pregnancy, or may be uncertain about their future reproductive plans. Asking open-ended questions supports patient-centred care.

Gender-Affirming Care Clinical Reminder

Providing gender-affirming care helps ensure that gender-diverse individuals receive equitable access to reproductive health services.

Clinicians can support gender-affirming preconception care by:

  • Asking patients about their name and pronouns and using them consistently
  • Avoiding assumptions about fertility, pregnancy goals, or sexual orientation
  • Recognizing that gender-affirming hormone therapy may affect fertility and pregnancy planning
  • Basing preventive care on anatomy and individual health needs
  • Supporting reproductive autonomy and shared decision-making
  • Referring patients to gender-affirming services when appropriate

Respectful, gender-affirming care improves engagement with health services and supports better health outcomes.

Core Clinical Principles

Preconception care for gender-diverse individuals should emphasize:

  • Gender-affirming and inclusive care
  • Respect for patient identity and pronouns
  • Avoidance of assumptions about fertility or reproductive intentions
  • Shared decision-making and reproductive autonomy
  • Coordination between reproductive health and gender-affirming care

Using inclusive language and respectful communication can improve patient comfort and engagement with care.

Routine Screening and Assessment

Preconception visits should include assessment of both clinical health risks and reproductive goals.

Screening should be:

  • Routine
  • Inclusive and non-judgmental
  • Repeated over time
  • Independent of assumptions about gender identity

Areas to assess include:

  • Reproductive goals and pregnancy intentions
  • Use of gender-affirming hormones
  • Chronic medical conditions
  • Mental health and psychosocial stress
  • Substance use
  • Social support and access to care

Understanding the patient’s individual goals and circumstances helps guide appropriate counselling.

Core Clinical Priorities

Reproductive Goals and Fertility

Gender-diverse individuals may have a wide range of reproductive goals.

Key Preconception Actions

  • Ask about pregnancy intentions without assumptions
  • Discuss fertility preservation when appropriate
  • Review potential effects of gender-affirming treatments on fertility
  • Provide counselling about pregnancy planning or contraception

Not all gender-affirming treatments cause permanent infertility, but discussions about fertility options may be helpful.

Gender-Affirming Hormone Therapy

Some gender-affirming hormones may influence fertility and pregnancy.

Key Preconception Actions

  • Review current hormone therapy
  • Discuss potential effects on fertility and pregnancy
  • Plan discontinuation of testosterone before pregnancy when appropriate
  • Coordinate care with clinicians experienced in gender-affirming care

Patients should receive clear information about treatment options and reproductive implications.

Mental Health and Psychosocial Well-Being

Gender-diverse individuals may experience higher rates of mental health concerns due to stigma and discrimination.

Key Preconception Actions

  • Screen for depression, anxiety, and psychosocial stress
  • Provide trauma-informed care
  • Offer referrals to affirming mental health services when needed

Supporting mental health is an important component of preconception care.

Chronic Disease and Preventive Care

Gender-diverse patients should receive the same preventive care and chronic disease management as other patients planning pregnancy.

Key Preconception Actions

  • Screen for chronic health conditions
  • Optimize disease management before pregnancy
  • Review medications for pregnancy safety
  • Provide routine preventive care

Preventive care should be based on anatomy and individual health needs rather than gender identity alone.

Communication and Inclusive Care

Inclusive communication can improve patient comfort and engagement.

Helpful practices include:

  • Asking patients about their name and pronouns
  • Using gender-neutral language when discussing reproductive health
  • Asking patients about their preferred terminology for body parts
  • Avoiding assumptions about partners or family structures

Providers should create a respectful environment where patients feel safe discussing reproductive goals.

Referral Pathways and Support Services

Collaborative care may help address complex health or social needs.

Consider referral to:

  • Gender-affirming health services
  • Reproductive endocrinology or fertility services
  • Mental health providers experienced in gender-affirming care
  • Social work or community support services

Connecting patients with affirming services can improve continuity of care.

Practical Clinical Actions

Preconception care for gender-diverse individuals can be incorporated into routine visits.

At routine visits, consider:

  • Asking about reproductive goals
  • Reviewing hormone therapy and medications
  • Screening for chronic disease and mental health conditions
  • Providing contraception or pregnancy planning counselling
  • Using inclusive language and communication
  • Connecting patients with gender-affirming resources
  • Arranging follow-up care

Supporting reproductive autonomy and inclusive care can help ensure equitable access to preconception health services.

Resources for Health Care Providers

To support clinical practice, the following resources provide evidence-based guidance, continuing education, and practical tools related to preconception care.

SOGC HUB

Trauma and Violence-Informed Care
An SOGC resource hub that provides information, tools, and learning resources to support trauma and violence-informed practice in health care.

Online Courses

Transgender & Gender Diverse Health 101
An SOGC online course that builds knowledge and practical skills to support inclusive, culturally competent care for transgender, non-binary, and gender-diverse patients.

Gender Affirming Hormone Therapy
An SOGC online course that builds knowledge and practical skills in gender-affirming hormone therapy for transgender, non-binary, and gender-diverse patients.

Surgical Transition and Advanced Care
An SOGC online course that builds knowledge and practical skills related to surgical transition and advanced care for transgender, non-binary, and gender-diverse patients.

Trauma and Violence-Informed Care
An SOGC online course that builds knowledge and practical skills in trauma- and violence-informed care to support safer, more effective patient care.

SOGC Resource

Inclusive Language Quick Guide for Clinicians – Supporting Gender-Inclusive Preconception Care
A brief guide to respectful, gender-inclusive communication in preconception care.

Educational Video

Care for the Gender Diverse Community: An Educational Video
An educational video that supports inclusive, affirming care for gender-diverse people by highlighting key considerations for health care providers and patients.

Websites

Centre for Addiction and Mental Health
A Canadian mental health resource hub that provides information, clinical services, education, and tools to support mental health and substance use care.

World Professional Association for Transgender HealthAn international professional association that provides standards of care, policy statements, educational resources, and provider tools to support transgender health.

Rainbow Health Ontario
A resource hub that provides education, clinical tools, and evidence-based resources to support affirming and equitable 2SLGBTQ+ health care.

Trans Care BC
A Canadian resource hub that provides information, clinical guidance, and care navigation support for transgender, non-binary, and gender-diverse people and the providers who care for them.

The Society of Obstetricians and Gynaecologists of Canada (SOGC)