Contraception for transgender and gender diverse people

INTRODUCTION: Contraceptive counselling and contraception prescription in transgender and gender-diverse (TGD) individuals remain an underrecognized aspect of TGD care, and dedicated recommendations are still limited. METHODS: This Expert Opinion aims to provide up-to-date practical guidance for clinicians on this topic, based on a comprehensive review of the available literature, current international recommendations, and the authors' clinical experience. RESULTS: It reviews the available contraceptive options, including short-acting and long-acting reversible contraceptives, barrier methods, and permanent contraception, discussing their advantages, limitations, and clinical applicability in the context of gender-affirming hormone therapy (GAHT). Particular attention is paid to contraceptive counselling, menstrual suppression, management of unscheduled bleeding, and practical aspects that may influence contraceptive choice and adherence in TGD population. CONCLUSION: This Expert Opinion provides practical recommendations to support individualised contraceptive counselling and evidence-informed contraceptive prescribing, with the aim of improving reproductive healthcare and promoting informed shared decision-making for TGD individuals.