When you think of “The Big M,” you may only think about cisgender (cis)women, meaning women who were assigned female at birth (AFAB), and continue to identify as women. But cis women aren’t the full picture when it comes to experiencing menopause. Menopause occurs due to a decline in certain hormones, especially estrogen and progesterone. The hormonal decline or fluctuation can also occur in cis men, as well as in transgender and non-binary individuals. Although there is not as much data and research on transgender people and menopause (we know, society still has work to do), it is important to understand cis women are not the only people impacted by the menopause transition.
Understanding that transgender individuals may experience menopause allows them to find the right treatment option, such as hormone replacement therapy (HRT), to reduce common symptoms, including the dreaded hot flashes. The bottom line is everyone should feel heard when dealing with health issues, including menopause. Keep reading below as we take a look at how menopause can affect transgender and non-binary people and how to cope with the change.
What Does Transgender and Non-Binary Mean?
Confused by the terms transgender and non-binary? I’ve got you covered. Well, actually, the National Center for Transgender Equality has you covered. I’m going to hand the mic over to them:
- Transgender “people are people whose gender identity is different from the gender they were thought to be at birth. ‘Trans’ is often used as shorthand for transgender. A transgender woman lives as a woman today, but was thought to be male when she was born. A transgender man lives as a man today, but was thought to be female when he was born. Some transgender people identify as neither male nor female, or as a combination of male and female. There are a variety of terms that people who aren’t entirely male or entirely female use to describe their gender identity, like non-binary or genderqueer.”
- Non-Binary “people – including most transgender people – are either male or female. But some people don’t neatly fit into the categories of “man” or “woman,” or “male” or “female.” For example, some people have a gender that blends elements of being a man or a woman, or a gender that is different than either male or female. Some people don’t identify with any gender. Some people’s gender changes over time. People whose gender is not male or female use many different terms to describe themselves, with non-binary being one of the most common. Other terms include genderqueer, agender, bigender, and more. None of these terms mean exactly the same thing – but all speak to an experience of gender that is not simply male or female.”
Do Transgender People Go Through Menopause?
Are people assigned female at birth (AFAB) the only ones who experience menopause? The answer is simple, and in this case, the complete answer is “no.” Transgender and non-binary individuals can (and do!) develop menopausal symptoms.
While not all transgender or non-binary people experience menopause, some may. For example, transgender women who were assigned male at birth may take hormone replacement therapy, along with testosterone-blocking medication to help with feminization and greater alignment with their gender identity.
If a transgender woman stops taking estrogen or decreases their estrogen level, then it is possible to experience menopausal-like symptoms. Similar to cis women, the symptoms of menopause occur due to a response to fluctuating hormone levels, even if the root cause differs.
Some transgender people may decrease their hormones for a few reasons. For example, according to research in Endocrine Reviews, some studies show an increased risk of blood clots for people taking estrogen long-term. In some cases, a recommendation may include lowering the estrogen dose, which may lead to menopause-like symptoms.
Opinions differ on the need to lower or avoid hormones in transgender people. According to Transitional Care at the University of California San Francisco, no research supports the need to stop hormone replacement in older trans women. In many cases, transgender women typically do not go through menopause due to hormone depletion because they take gender-affirming hormones for life.
For transgender men and non-binary AFAB individuals, it can be a different story. Any person with a female reproductive system who still has their ovaries may experience menopause. Also, not all transgender people take gender-affirming hormones, which means female hormones, such as estrogen, continue until decreases realted to menopause occur.
Transgender People and Menopause: What Is the Menopause Experience Like?
A transgender man or non-binary person may develop many of the same menopause symptoms as a cis woman. The onset of symptoms depends on changing hormone levels. Since transgender men often take medications to suppress estrogen production, they may not ever experience many of the common menopause symptoms.
For other individuals, they may develop many of the same menopause symptoms that cis women experience, including but not limited to:
- Hot flashes
- Night sweats
- Mood swings
- Weight gain
Differences in Menopause for Transgender People
Transgender men may have varied emotions surrounding menopause. While physical signs of declining hormones may be the same for a cis woman or a transgender person, other issues may differ.
Some transgender people may hesitate to seek help for menopausal symptoms. The hesitation may occur for a few different reasons. For example, menopause symptoms, such as hot flashes, might remind a transgender man or non-binary person of their born gender they do not identify with. The feeling can cause a sense of anxiety or depression.
Also, a transgender or non-binary individual may feel the average doctor might not understand how menopause is affecting them and the best way to treat symptoms. Treatment for menopause might not involve estrogen replacement since taking the hormone may interfere with an individual’s transition to the gender they identify with.
Despite the hesitation, if menopausal symptoms interfere with the quality of life, seeking support is vital. Finding the right treatment plan may take a little trial and error, but it is worth the effort.
Hormone Replacement Therapy (HRT) as Treatment for Menopause
Treatment for menopause may include HRT. However, for transgender men, taking estrogen might not be the preferred option since it can lead to “feminine” characteristics. If menopause symptoms are difficult to deal with, then finding the right dose of estrogen to alleviate symptoms without increasing feminization is probably the goal.
The type and dose of hormones are critical to achieving the desired result. Bioidentical hormones through a compounding pharmacy are one option since the dose is specific to individual needs.
According to the Mayo Clinic, some studies indicate that HRT can increase a person’s chances of blood clots, strokes, and breast cancer. But, the risks may depend on age, family history, and the type of hormones.
HRT is available in creams, patches, pills, and pellets. Starting with the smallest dose might be the best route to try.
Tips to Deal With Menopause Symptoms
For transgender and non-binary individuals, finding non-hormonal ways to cope with menopause symptoms may be a good option. Work with your healthcare provider to find solutions to symptoms that are concerning. Consider the following tips:
- Avoid caffeine, excess alcohol, and spicy foods, which may reduce the number of hot flashes.
- Get at least 30 minutes of exercise on most days of the week to promote a positive mood and better sleep.
- Sleep in a cool environment and use a fan to help deal with night sweats.
- Stay connected with family and friends to promote a sense of well-being.
- Talk to your doctor about non-hormonal therapies that may reduce symptoms, such as black cohosh. Don’t start taking any supplements until you talk with your healthcare provider.
- Make sure your vitamin D levels are good to help ward off osteoporosis.
Come Join Us!
Whether you are a transgender man or woman, non-binary person, or cis woman, your menopause experience may be unique. There is no one way to go through the change, and you don’t have to do it alone. It is helpful to have support not only from family and friends, but even virtual support can help. We would love for you to be a part of our community. Please feel free to join our Facebook group. https://www.facebook.com/pausemenot.
It’s a Wrap!
Menopause occurs due to a decline in certain hormones, especially estrogen and progesterone. With that said, the hormonal decline or fluctuation can also occur in cis men, as well as in transgender and non-binary individuals. Although there is not as much data and research on transgender people and menopause, it is important to understand cis women are not the only people impacted by the menopause transition.
If you have a feeling you’re going through the menopausal transition, it’s important to track your symptoms, take note of your feelings, and connect with people—community, family, friends, and/or healthcare providers. Get the help you need when you need it, because whatever your gender or part of the menopausal journey, you are important.
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