You Weren't Meant to Be Human by Andrew Joseph White

Festering masses of worms and flies have taken root in dark corners across Appalachia. In exchange for unwavering loyalty and fresh corpses, these hives offer a few struggling humans salvation. A fresh start.

It's an offer that none refuse. Crane is grateful. Among his hive's followers, Crane has found a chance to transition, to never speak again, to live a life that won't destroy him.

He even met Levi: a handsome ex-Marine and brutal killer who treats him like a real man, mostly. But when Levi gets Crane pregnant-and the hive demands the child's birth, no matter the cost-Crane's desperation to make it stop will drive the community that saved him into a devastating spiral that can only end in blood.