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. 

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.

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.

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.

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

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.

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 within 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.

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.

How to access telemedicine abortion services

YYou 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 within 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, a secure messaging app, or a phone call. Note that if you are using insurance, you may be required to have a phone or 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 1-5 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.

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 after taking the medication, you can proceed as planned. 

Step 2: Choose how you will take misoprostol

There are a few different ways you can take misoprostol. You can take the medication under your tongue (sublingually), between your cheeks and gums (buccally), or vaginally. Taking your medication vaginally may reduce nausea. However, if vaginally inserting a medication may cause trauma and/or gender dysphoria, choose another method. Each method is equally effective. 

Step 3: Take misoprostol

Using your preferred method, take 4 800 mg misoprostol pills. You can learn more about how to take the pills sublingually, buccally, or vaginally here.

Intense cramping and heavy bleeding usually begins 4-6 hours after taking misoprostol, but may take up to 24 hours to begin. Heavy bleeding typically lasts around 6 hours, but may also last up to 24 hours. Occasional spotting or episodes of heavier bleeding after this period is normal. Prepare ahead of time with heavy-flow pads.You may also want to have pain medication like Tylenol or Ibuprofen,a heating pad, and warm tea or soup on hand to soothe cramps. 

In some cases, if the pregnancy is further than 9 weeks or if you haven’t started to bleed within 24 hours of taking the misoprostol, you may need to take an additional dose to ensure the abortion is completed. You can learn more about how to determine if you need additional misoprostol here.

‍

Any pregnancy symptoms, like breast tenderness or nausea, should start to resolve 24 hours after treatment. Pregnancy tests will remain positive for four weeks after your treatment, so there’s no need to take a pregnancy test during that time. To learn more about what to expect during and after a medication abortion, read our guide here.

How to prepare for your abortion

Now that you know what to expect during your medication abortion, here are a few ways you can prepare to make the experience more comfortable.

1. Identify a safe place to take your pills

Taking your abortion pills is a process that occurs over a few days. Before you begin your treatment, identify a safe, comfortable place with access to an inclusive and/or private restroom. Set up your rest area with pillows, blankets, plushies, and anything else that helps you feel cozy. Find some books, movies, or TV shows that help you relax.

2. Plan your meals in advance

Because you may experience intense cramping and bleeding, it’s a good idea to have some meals accessible. Think comfort foods that are easy on the digestive system, like warm soup, or snacks like saltines. 

3. Lean on your community

Whether your circle consists of friends, chosen family, or biological family, don’t be afraid to ask for help. Establish who (if anyone) you want to be present during your treatment. Ask your community for support with preparing meals, rubbing your back through the cramps, and anything else you need. Hey Jane’s team can offer you emotional support and connect you to others with shared experience in The Lounge, our anonymous forum for peer-to-peer support (including a dedicated LGBTQIA+ channel). If you need more support, you can reach out to local LGBTQIA+ community centers or explore our Resources page for talk and text lines.

4. Create a safety plan

Telemedicine abortions are extremely safe. However, just in case, locate the nearest emergency room in case of an emergency. Make a plan for transportation, should you need it (via Uber, Lyft, a friend or family member with a car, etc.)

Paying for your abortion

Trans adults are more likely to be uninsured and more likely to report cost-related barriers to care than cisgendered adults. If you aren’t covered by health insurance or your insurance plan doesn't cover abortion, your procedure can run up a hefty bill. However, there are resources available to help you pay for treatment.

Procedural abortion can cost anywhere from $415-$960 in the first trimester per ANSIRH.Medication abortion tends to be more affordable, with an average cost of $568 as of 2021. At Hey Jane, care can cost as little as $0 and can be paid with debit, credit, HSA/FSA, Apple Pay and Apple Pay Later. Hey Jane’s sliding scale determines the cost of your treatment based on your personal financial circumstances to ensure everyone has access to the reproductive care they need. If you’re unable to cover the cost of your abortion, one of our abortion fund partners may be able to help. 

Every person deserves access to safe and affordable abortion procedures, including trans, nonbinary, and gender expansive individuals. Hey Jane is committed to upholding affirming practices that make reproductive care comfortable and accessible for all people, regardless of gender.