In western cultures, pregnancy and birth have typically been viewed as inherently feminine activities. However, some transmasculine individuals desire and undergo pregnancy. Our study aimed to explore the experiences of transmasculine individuals with pregnancy and birth. We conducted 22 qualitative interviews and four follow-up interviews with transmasculine individuals who had experienced one or more pregnancies. Our analysis was guided by an intersectional approach, and was led by a transgender community member. The interviews focused on stories about how the study participants built their families and navigated health care systems in the context of being pregnant transgender persons. As part of a larger study that considered the pregnancy, birth and infant feeding experiences of transmasculine individuals, this paper examines three themes that emerged from the narratives: experiences of gender dysphoria, addressing the gender binary, and intersectionality. Experiences of gender dysphoria among transmasculine individuals during pregnancy and birth vary widely. Some trans individuals experience pregnancy as congruent with their masculine gender identity. However, participants reported that some health care providers' strong belief in the gender binary led to inappropriate and oppressive reproductive and perinatal health care.