The trans guide to abortion care

A common misconception surrounding abortion care is that it’s synonymous with women’s health care, but this couldn’t be further from the truth. While cisgendered women (women whose gender identity aligns with their sex assigned at birth) certainly have abortions, trans, nonbinary, and genderqueer people also have abortions (and it’s perfectly safe and effective). 

At Hey Jane, our Clinical team provides supportive, inclusive care for all of our patients. It’s important to us that you feel safe and seen, which is why we ask for your current name and pronouns in addition to sharing our own. We’ll work with you to answer any questions or concerns, accurately date your pregnancy if you don’t have regular menses, and be here for emotional support before, during and after treatment.

Continue reading to learn more about what you need to know as a trans, nonbinary, or gender expansive person seeking an abortion. 

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Trans, non-binary, and gender expansive people have abortions

Anybody who can become pregnant (including trans, nonbinary, and gender expansive people) may need to seek an abortion. In 2017, an estimated 462 to 530 trans, nonbinary, and gender expansive people had an abortion in the US. 

Similarly, in a 2020 study of approximately 1,700 trans, nonbinary, and gender expansive participants, 210 (12 percent) had been pregnant. Of the 433 reported pregnancies from participants, 92 (21 percent) ended in abortion. 70 percent of participants in this study reported that they prefer medication abortion over procedural abortion due to increased privacy.

A review of abortion providers in 2017 found that approximately 23 percent of reproductive care clinics provide trans-affirming care. However, with increasing attacks on the rights of trans individuals across the country, finding trans-affirming providers continues to be a challenge for many. In fact, since the Supreme Court’s decision to overturn Roe v. Wade, a national survey of approximately 6.500 trans and gender-nonconforming patients found that 19 percent were denied health care because they were trans, and 28 percent delayed care due to harassment and violence in a health care setting.

Excluding trans, nonbinary, and gender expansive people from the conversation about abortion has real consequences. The misconception that abortion is only for cis women may discourage others from seeking the care that they need. A 2019 study of trans and gender-expansive people who had been pregnant found that 36 percent of participants considered trying to end their pregnancy without clinical supervision, and 19 percent attempted to do so. The bottom line? Abortions are for everybody.

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Can I get pregnant while taking hormones?

It’s important to be aware that you can get pregnant while taking gender-affirming hormones, even if you don’t have a period or your period is irregular. Irregular or nonexistent periods can make it difficult to date a pregnancy, which is required to confirm you are eligible for medication abortion care (prescribed up to 10 weeks with Hey Jane). 

If we are unable to determine the gestational age of the pregnancy based on your last menstrual period (LMP), our Clinical team will work with you to get an accurate gestational age. In some cases, an ultrasound may be required in order to accurately date a pregnancy. If so, our Patient Care Advocates will help coordinate testing at a local clinic near you that is inclusive and supportive of all gender identities. 

A pregnancy can be seen on an abdominal ultrasound after 6 or 7 weeks. Under 7 weeks, providers will usually do an internal or “transvaginal” ultrasound. Just remember, it is your body and if you are not ok with a certain exam or procedure that is ok! An understanding provider will work with you on a plan that you are comfortable with.

If you choose to continue your pregnancy, note that it is important to stop testosterone, as it may impact the development of the fetus, and find prenatal care. You can find affirming OB/GYN providers across the US here.

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Can I have an abortion on hormones?

Yes. You can have an abortion while receiving gender-affirming hormone therapy. Medication abortion is safe and effective for people taking hormones, and can be prescribed up to 10 weeks with Hey Jane. Abortion pills and hormone medications together are not contraindicated, and you can safely take both at the same time. You can also have a procedural, or in-person, abortion at a local clinic if your pregnancy is later than that.

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How to find a trans-affirming abortion provider

If you feel an in-person, procedural abortion is the best option for you, here are some tips to identify trans-affirming providers:

• Inclusive language to discuss services on a provider’s website and social media channels 
• Intake forms/paperwork that request your current name and pronouns (if you are using insurance, the name on your insurance may also be requested or needed)
• Pronouns listed for providers and staff on the website
• Access to all-gender bathrooms 

You can also search for trans-affirming providers in your area on:

• World Professional Association for Transgender Health (WPATH) Provider Directory
• OutCare Provider Directory
• LGBTQ+ Healthcare Directory

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Telemedicine abortion for trans, nonbinary, and gender expansive people

Depending on how far along your pregnancy is, you may be eligible for a medication abortion using telemedicine, which can be completed from the comfort of your own home or a safe place of your choosing. Continue reading to learn more.

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What is telemedicine abortion?

A telemedicine abortion is a medication abortion prescribed and guided by a virtual reproductive care provider, like Hey Jane. Medication abortion consists of two abortion pills–mifepristone (which prevents the pregnancy from growing) and misoprostol (which helps to empty your uterus). Abortion pills are up to 98 percent effective at ending pregnancy and incredibly safe. Complications occur in less than 0.4 percent of people for medication abortion. Complications are less than 1% for in-clinic procedural abortion. At Hey Jane, our serious adverse reaction rate is even lower—0.16 percent. Unless you experience rare complications related to the medication, abortion pills will not impact your ability to get pregnant in the future or your future health. 

Abortion pills can be prescribed by Hey Jane for pregnancies up to 10 weeks and can be shipped to your home, local post office, or another safe space in just a few days. After 10 weeks, you can receive a procedural abortion from an in-person provider. If abortion is illegal in your state, you may have to travel to receive care.

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What are the benefits of telemedicine abortion?

There are many benefits to telemedicine abortion, particularly for trans, nonbinary, and gender expansive people who may have experienced medical trauma and/or discrimination in the past: 

• No need for transportation. Because abortion pills can be delivered discreetly to your own home through providers like Hey Jane, you don’t have to arrange a ride to and from your procedure. However, you should have an emergency plan in place should you need to seek medical attention during your medication abortion.
• Privacy. Telemedicine abortions can be completed from the comfort of your own home,the home of a loved one, or another safe space. You can choose to be surrounded by as many (or as few) members of your support system as you like.
• Comfort: Telemedicine consultations via text or a phone call can help reduce stress and anxiety around physical presentation. Instead of worrying about an in-person clinical team or other patients in the waiting room, you can get care from the comfort of your own home.
• Provider support: Telemedicine allows you to receive expert guidance throughout treatment from a licensed provider without having to visit a health care facility. At Hey Jane, you have the option to connect with us via text, chat, phone, or video call depending on your preference.
• Less invasive. A telemedicine abortion may reduce gender dysphoria experienced as a result of a transvaginal ultrasound and/or procedural abortion in-clinic. 
• On your own schedule. Unlike an in-person procedural abortion, you can plan to take your abortion pills on a schedule that’s convenient for you. This allows you to plan around your work or class schedule, events, and the schedules of any loved ones.

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How to access telemedicine abortion services

You can get abortion pills discreetly delivered to your home, PO box, or post office pick-up locations through online providers like Hey Jane. You can fill out an intake form online at any time, and a provider will reach out in 1 business day to determine if you are eligible for care. While some telemedicine providers require a video appointment for patients seeking a medication abortion, Hey Jane patients also have the option to consult with us via text, messaging through our secure online patient portal, by phone or video call. Note that if you are using insurance, will need to have a  video visit.

You’ll have the opportunity to connect with a provider before they send your prescription to the pharmacy. While each clinic is different, you can typically expect abortion medication to arrive 1-3 business days after the prescription is sent to the pharmacy. Hey Jane offers next-day shipping and discreet, unmarked packaging without the company name to maintain your privacy. 

What to expect during and after the procedure

Medication abortion involves taking two medications, mifepristone and misoprostol, over a couple of days. Here’s what to expect during each step of your medication abortion.

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Step 1: Take mifepristone with water 

Take one 200 mg dose of mifepristone orally with water. If you are very nauseous, consider taking an anti-nausea medication like ondansetron (included in your Hey Jane order). After taking mifepristone, you will likely be able to proceed with your normal day-to-day activities. You may or may not experience some vaginal bleeding and or cramping–neither is cause for concern.

The medication will absorb into your system within 30 minutes. If you happen to vomit within 30 minutes of taking the medication, you should contact your provider for next steps. If you vomit 30 minutes or more después de tomar el medicamento, puede continuar según lo planeado. 

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Paso 2: Elija cómo tomará el misoprostol

Existen varias formas de tomar misoprostol. Puede tomar el medicamento debajo de la lengua (sublingual), entre las mejillas y las encías (bucal) o por vía vaginal. La administración vaginal puede reducir las náuseas. Sin embargo, si la inserción vaginal le causa trauma o disforia de género, elija otro método. Todos los métodos son igual de eficaces. 

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Paso 3: Tome el misoprostol

Utilizando el método que prefiera, tome 4 pastillas de misoprostol de 800 mcg. Puede obtener más información sobre cómo tomar las pastillas de forma sublingual, bucal o vaginal aquí.

Los cólicos intensos y el sangrado abundante suelen comenzar entre 4 y 6 horas después de tomar el misoprostol, aunque pueden tardar hasta 24 horas en aparecer. El sangrado abundante suele durar unas 6 horas, pero puede prolongarse hasta 24 horas. Es normal tener manchas ocasionales o episodios de sangrado más intenso después de este periodo. Prepárese con antelación con toallas sanitarias para flujo abundante. También puede tener a mano analgésicos como Tylenol o ibuprofeno, una almohadilla térmica y té o sopa caliente para aliviar los cólicos. 

En algunos casos, si el embarazo tiene más de 9 semanas o si no ha comenzado a sangrar dentro de las 24 horas posteriores a la toma del misoprostol, es posible que necesite una dosis adicional para asegurar que el aborto se complete. Puede obtener más información sobre cómo determinar si necesita misoprostol adicional aquí.

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Cualquier síntoma de embarazo, como sensibilidad en los senos o náuseas, debería comenzar a desaparecer 24 horas después del tratamiento. Las pruebas de embarazo seguirán dando positivo durante cuatro semanas después del tratamiento, por lo que no es necesario que se haga una prueba durante ese tiempo. Para obtener más información sobre qué esperar durante y después de un aborto con medicamentos, lea nuestra guía aquí.

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Cómo prepararse para su aborto

Ahora que sabes qué esperar durante tu aborto con medicamentos, aquí tienes algunas formas de prepararte para que la experiencia sea más cómoda.

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1. Identifica un lugar seguro para tomar tus pastillas

Tomar las pastillas para el aborto es un proceso que dura unos días. Antes de comenzar el tratamiento, identifica un lugar seguro y cómodo que tenga acceso a un baño privado y/o inclusivo. Prepara tu zona de descanso con almohadas, mantas, peluches y cualquier otra cosa que te ayude a sentirte a gusto. Busca libros, películas o series que te ayuden a relajarte.

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2. Planifica tus comidas con antelación

Como es posible que experimentes cólicos intensos y sangrado, es buena idea tener algunas comidas a mano. Piensa en alimentos reconfortantes que sean fáciles de digerir, como una sopa caliente o snacks como galletas saladas. 

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3. Apóyate en tu comunidad

Ya sea que tu círculo esté formado por amigos, familia elegida o familia biológica, no tengas miedo de pedir ayuda. Define quién (si es que alguien) quieres que esté presente durante tu tratamiento. Pide a tu comunidad que te apoye preparando comidas, dándote masajes en la espalda para los cólicos o cualquier otra cosa que necesites. El equipo de Hey Jane puede ofrecerte apoyo emocional y conectarte con otras personas que han pasado por lo mismo en The Lounge, nuestro foro anónimo de apoyo entre pares (que incluye un canal dedicado a la comunidad LGBTQIA+). Si necesitas más apoyo, puedes contactar a centros comunitarios LGBTQIA+ locales o explorar nuestra página de recursos para encontrar líneas de ayuda por llamada o mensaje de texto.

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4. Crea un plan de seguridad

Los abortos por telemedicina son extremadamente seguros. Sin embargo, por si acaso, localiza la sala de emergencias más cercana. Haz un plan de transporte por si lo necesitas (Uber, Lyft, un amigo o familiar con coche, etc.).

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Cómo pagar tu aborto

Los adultos trans tienen más probabilidades de no tener seguro médico y más probabilidades de reportar barreras relacionadas con los costos a la atención médica que los adultos cisgénero. Si no cuentas con seguro médico o tu plan no cubre el aborto, el procedimiento puede resultar costoso. Sin embargo, existen recursos disponibles para ayudarte a pagar el tratamiento.

El aborto quirúrgico puede costar entre $415 y $960 durante el primer trimestre, según ANSIRH. El aborto con medicamentos suele ser más asequible, con un costo promedio de $568 a partir de 2021. En Hey Jane, la atención puede costar desde $0 y se puede pagar con tarjeta de débito, crédito, HSA/FSA, Apple Pay y Google Pay. La escala móvil de Hey Jane determina el costo de tu tratamiento según tu situación financiera personal para garantizar que todas las personas tengan acceso a la atención reproductiva que necesitan. Si no puedes cubrir el costo de tu aborto, uno de nuestros fondos de aborto asociados puede ayudarte. 

Todas las personas merecen acceso a procedimientos de aborto seguros y asequibles, incluidas las personas trans, no binarias y de género expansivo. Hey Jane se compromete a mantener prácticas afirmativas que hagan que la atención reproductiva sea cómoda y accesible para todas las personas, independientemente de su género.