CARE FOR THE TRANSGENDER PATIENTS (C FERRANDO, SECTION EDITOR) Prepregnancy Counseling for People of All Genders: Enhancing Safe and Accessible Family Building for Transgender, Gender Diverse, and Non-binary Individuals Erica Martinez 1 & Augustus Klein 2 & Juno Obedin-Maliver 1 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Purpose of Review The purpose of this narrative review is to expand routine prepregnancy counseling and anticipatory guidance to include people of all genders. Recent Findings Transgender, gender diverse, and non-binary (TGNB) individuals who were assigned female at birth may wish to parent, conceive, and carry a pregnancy, but are not included in guidelines for routine prepregnancy counseling. In addition to the topics covered in routine prepregnancy counseling, there are several unique considerations for prepregnancy care for TGNB individuals including perinatal testosterone use, gender dysphoria and distress, chest/breastfeeding, and navigation of clinical environments. Summary Research in the area of TGNB medical care continues to grow as the visibility of these communities increases. However, data are limited surrounding pregnancy and prepregnancy-related care. Therefore, we present prepregnancy medical, surgical, social, and practice of care considerations for TGNB populations in light of other known health and healthcare experiences of TGNB patients. We outline several clinical recommendations to support clinicians in providing inclusive prepregnancy care. These recommendations aim to highlight the unique needs of TGNB individuals while recognizing that each patient’s experience and goals must be individualized to them. Keywords Preconception . Transgender . Non-binary . Pregnancy . Fertility . Testosterone Introduction The literature surrounding transgender care continues to grow given the increased visibility of these communities, but there is limited information about pregnancy goals, experiences, and outcomes. Transgender, gender diverse, and non-binary (henceforth TGNB) individuals—people whose gender iden- tity differs from the sex which they were assigned at birth— conservatively account for an estimated 0.5–0.6% of the US adult population, or 1.4 million adults [1, 2]. Many TGNB individuals assigned female sex at birth may want to parent, conceive, and carry a pregnancy similar to cisgender women, or people who identify as women and were assigned female at birth. Obstetrician-gynecologists report insufficient training in reproductive healthcare for TGNB individuals even though many desire care competency [3, 4]. This lack of preparedness is perceived by the patients themselves. In the 2015 United States Transgender Survey (USTS), 24% of 27,715 TGNB respondents reported needing to teach their providers about transgender care [5]. For many TGNB people, the lack of provider training and education coupled with experiences of mistreatment and blatant discrimination in clinical settings discourages seeking preventative care, including prepregnancy care [5–7]. The goal of prepregnancy care is to reduce adverse health outcomes of the gestating patient and fetus by addressing modifiable factors towards a healthy pregnancy [8]. During a prepregnancy visit, several of the following occur: a review of a patient’s medical, surgical, and psychiatric history; review This article is part of the Topical Collection on Care for the Transgender Patients * Erica Martinez eimartin@stanford.edu 1 Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA 2 Hunter College at the City University of New York, New York, NY, USA Current Obstetrics and Gynecology Reports https://doi.org/10.1007/s13669-020-00298-6