What it's Like Experiencing the Menopause as a Trans Person

The menopause is underreported as is. We speak to people even more confused by it: trans people

8 Minute ReadFeature by Vic Parsons

25.02.22

“Even though I see my body as a trans masculine body, I know that other people will see me go through menopause and see me as a woman.”

Bethany is 27, and although was assigned female at birth, now identifies as male. He is already worrying about the menopause, knowing his experience of the menopause is likely to be a bit different to that of the cisgender women.

“Really, the anxiety that comes with menopause for me is people's perceptions of me,” he says. “While I'm fine being as masculine as I want to be without medically transitioning, the menopause sort of just hangs there in my head. If I talk about my menopause, it would confirm in [cis people’s] heads that I'm a woman, when I'm not, I’m trans masculine.”

He is also concerned about how it might affect his mental health. “I know the menopause can trigger depression and anxiety in people,” he says. “I have depression and anxiety already and it’s something that runs in my family. So, that's something that I do worry about more.”

There is a saying: a worry shared is a worry halved. But Bethany doesn’t know any trans people who’ve gone through the menopause who he could talk to. Instead, he plans to go to therapy when the time comes.

“I know of an online GP that offers therapy, they're really good and they're always really understanding,” he says. “They’re called GenderGP.”

GenderGP

GenderGP is a private transgender clinic run by Dr Helen Webberley, which offers trans people a range of gender-affirming healthcare – hormones, puberty blockers, counselling, blood tests and monitoring, speech therapy, surgical referrals and advice. It’s one of several private clinics that have sprung up in the UK in recent years in response to the trans healthcare crisis: NHS cuts coupled with a lack of gender specialists and time-consuming gatekeeping around who can access healthcare mean that the waiting time for a first appointment at an NHS gender clinic is more than five years in some parts of the country.

As well as the exhausting waiting times, trans people in the UK often face discrimination when seeking treatment. GenderGP is known in the trans community for making healthcare more accessible, and particularly for Dr Webberley’s work supporting trans youth.

Dr Webberley confirms that trans men and trans masculine people who still have periods will go through the menopause. “Menopause has traditionally meant ovarian failure. They stop producing oestrogen,” she explains.

A lack of public health messaging

But – just like the lack of public health messaging aimed at encouraging trans men to go for cervical cancer screenings – there’s very little information available about what going through the menopause looks like for trans men.

For trans men who take testosterone and whose periods have stopped, they won’t notice the natural drop in oestrogen, Dr Webberley says, “because their ovaries stopped producing hormones years ago”.

But a trans masculine person who is not on hormones will have ovaries, which were producing oestrogen, which then stop or slow down. “That causes the same issues whether you're trans masculine or a cis female: you get the hot flushes, the dryness down below, the lack of libido, tiredness. And because it's so insidious, it creeps up on you, you don't know that it's there.”

The menopause for trans men

For Verity, a 40-year-old trans man, the menopause was “absolutely horrid”. He went through it suddenly, aged 22, when he had a surgical hysterectomy prompted by the severe PCOS he’d experienced since he was 17.

“Afterwards I was so tired, lethargic, my mood completely dropped, you’ve got night sweats and brain fog and you’re just dragging yourself out to try and play sports or go to the gym or have time with your friends,” he remembers. “It's like learning your whole body again because everything moves and drops down. There's just no support at all for it and they don't really tell you what you're going to go through.”

Complications from the hysterectomy, on top of menopausal symptoms, were so bad that Verity had to drop out of university for a year. He still suffers now: from a prolapsed womb, dryness, trouble sleeping and hot sweats, and if his testosterone shot is late the symptoms worsen. On top of that, as a trans man, he’s struggled to access support because he looks different to how clinicians expect someone who’s had a hysterectomy to look.

“As you go through ‘the change’, when you look like this and go into women’s health services… you get everybody looking because you’re right in the middle of all these women,” Verity says. “I know a lot of trans men that won't go to appointments now because of how they look and how it's perceived when they go.”

And while Verity’s experience of an early menopause might be uncommon, now that more trans men feel safe to come out and are coming out younger, he worries that others will go through a similar experience to him – and face a similar lack of support and understanding.

Transitioning and the menopause

“The next generation are going to be younger [when they medically transition],” he points out. “When they’re getting these surgeries, they do need to know what the menopause is about, have these conversations, so they’re ready for what’s going to come because it’s very scary,” Verity says. “On a night when you’re alone, going through those hot sweats, you can't sleep or cool down, you're agitated and you're struggling to eat.”

One change in particular he’d like to see is an effort from workplaces to become more inclusive of trans men’s experiences. “They're going to be going through the menopause at a younger age and workplaces need to believe that this is happening, it's not an excuse,” he says.

Workplace policy needs to change

Emma Cusdin of Global Butterflies, an organisation that helps businesses become more inclusive towards their trans and non-binary employees, agrees. “Whether you're cis or trans, man or woman or non-binary or something else, you will have hormonal changes sometimes through your career and through your life,” she says. Bigger companies increasingly have “menopause policies”, Emma explains, in recognition that “this issue impacts millions of people globally”.

But within that, there needs to be an awareness that the menopause doesn’t only effect cis women. “If you're trans and you're not out in the organisation, that's a really hard conversation. Because ultimately you're outing yourself at the same time as wanting to have a conversation about the menopause,” Emma says.

“We always say to HR teams: you are no longer the expert in the room,” she explains. “You are an expert on how the organisation is going to respond.”

“So think about how you help and support, ask those open questions, be empathetic, non-judgmental. This is somebody whose experience is not yours. Think about what the organization's values are, think about how they can support – whether that's time off, recharge days, flexibility for seeing doctors and medication, conversation around how people are.”

Problems within the community

The stigma of being a trans man going through the menopause also creates all sorts of difficulties that cis women won’t experience. Bethany says that, in their experience, this stigma comes not only from cis people, but from within the trans community itself.

“How menopause has been de-stigmatised for cis women is great,” he says. “It makes me think about how, even in trans circles, if you try and talk about periods with trans men and non-binary people then everyone tends to get uncomfortable.

“It’s almost like there’s a stigma within the trans community – people don’t want to talk about periods or the menopause in general, because not only can it trigger trans men and trans masculine people, it might also end up triggering trans women and trans feminine people.”

He adds: “I think it’s really important to say that the conversation around - and view of - menopause needs to accept people of all genders and gender expressions.”

What to do when you're (not) expecting

Leo, 34, is a trans man who doesn’t think he will go through the menopause because he’s on testosterone. But despite being legally prescribed hormones, he says he “can’t think of a conversation I’ve actually had with a clinician around menopause… it’s not something that’s been brought up in conversation”.

As a result, he’s actually unsure of what to expect as he gets older – and he’s had no guidance from his doctors. “There's an extent to which I find it easier not to think about these parts of my body that I've struggled to live with at points,” he explains. “So it can be difficult to take a lead in doing my own healthcare research on a subject like the menopause. Having a bit of guidance from a clinician would be helpful.”

Like Verity, Emma and Bethany, Leo thinks that conversations about the menopause need to become more comprehensive. He says: “The importance of us being included in those conversations is a continuation of the importance of us being included in conversations around things like smear tests. In all areas of health, I think everyone who has those body parts should be included in the conversation.”

The importance of hormonal changes

He also points out that starting testosterone was a big change for him, and wonders whether there are some lessons that could be taken from those who’ve gone through a medical transition and applied to those going through the menopause, whatever their gender.

“I experienced some of the significant hormonal changes I’ve undergone as challenging at points,” Leo says. “But those challenges have also made space for experiencing life in new and positive ways. I think there's a positive lesson in human endurance and life's transformations that we can take. That relates to hormonal changes, but also the trans experience.

“As trans people we tend to overcome a lot, and I think that's something that others can take from us.”

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