“I don't know if I'm a dad, I don't know if I'm a mom, I think I'm both”: Gender identity, parenting desires, and pregnancy among transgender, nonbinary, and gender expansive adults

Many transgender and gender expansive (trans∗) people assigned female at birth retain the capacity for pregnancy and want to become parents, through pregnancy or otherwise. We explored the role of gender in parenting and pregnancy desires among gender minorities theoretically capable of pregnancy. We conducted in-depth, open-ended interviews with 12 trans∗ adults (18–35 years) from July–August 2023 in the US. Interviews focused on gender identity, parenting, and pregnancy decisions. We recorded, transcribed, and analyzed interviews using a combination of thematic and inductive methods. Two related themes emerged: (1) the relationship between gender identity development and parenting and pregnancy desires, and (2) how the gendered nature of pregnancy and obstetric care shaped feelings about pregnancy. Participants had complex feelings about parenting, and some realized they wanted to become a parent only after more fully understanding their gender. Others felt becoming a parent would help them better understand their gender identity. Participants were keenly aware of the gendered nature of parenting and pregnancy, and how their experiences and presentation conflicted with social and gender norms. Gender identity was salient in how participants experienced and made decisions about parenting and pregnancy. Healthcare providers should prioritize providing trans-competent reproductive and obstetric care to ensure trans∗ populations are supported in reaching their reproductive goals. Importantly, broader social and structural changes that allow for expansive gender identity expression in both pregnancy and parenthood are necessary to create safe and healthy environments for trans∗ people to make parenting and pregnancy decisions and pursue parenthood. • Relationship between gender identity and parenting desires is complex, bi-directional. • Trans adults face undue burden achieving reproductive goals. • Prescriptive gender norms may lead some to forego parenthood and/or pregnancy. • Changes in cultural and medical understandings of sex and gender are needed. • Provision of trans-competent reproductive care is imperative to reduce undue burden.