Considering the prevalence of rapid-onset gender dysphoria and the coinciding number of girls choosing to live as male or a so-called third gender, one must ask what the ramifications of transition will be if and when these young people one day decide to start a family.

A case study was recently published in the medical science journal Cureus about an 18-year-old trans man who became pregnant while taking testosterone. When asked during an initial consultation, the person denied partaking in sexual activity that could result in pregnancy. The study reported that a healthy baby girl was delivered at 40 weeks, after about 33 weeks of accidental exposure to the exogenous hormone.

The paper speaks to a new realm of consideration regarding the potential effects of transition-related treatments on a growing embryo or fetus. Many trans men do not undergo a hysterectomy prior to hormonal therapy, which means they will maintain their uterus and ovaries. Patients are additionally going down this path without fully understanding its consequences — research has shown that almost a third of trans men believe testosterone functions as a type of contraception.

Even though testosterone therapy is known to reduce fertility rates by suppressing ovulation, its long-term effects on conception and pregnancy are not yet known. Testosterone is considered a teratogen, which means it has the potential to affect development in utero. Previous research has shown that high testosterone levels prenatally can be associated with masculinization of the fetus, reduced fetal growth, and metabolic and cardiovascular problems later on.

It’s one thing if a trans adult makes the decision to start a family and takes the necessary precautions to do so safely. It’s another can of worms to be sexually active without birth control while taking something that may affect fetal development. Discussions about contraception before beginning treatment can only go so far because clinicians are relying on their patients to be forthcoming regarding their sexual history and activity. It’s also possible that some practitioners may be fearful of retribution if their questions or suggestions are deemed insensitive or contrary to what a person wants to hear.

As academics start questioning whether a person should be required to halt transition-related hormonal therapy while pregnant or breastfeeding, and the viability of uterus implants foretell trans women one day giving birth to their own offspring, my hope is that the most important variable above all — the health of the child — won’t be overshadowed by activist ideology.