How the Menopause Affects Transgender People

Transgender individuals can experience menopause or similar symptoms, although the hormonal processes involved may differ from those experienced by cisgender (individuals whose gender identity aligns with their assigned sex at birth) people.

Do Transgender People Experience Menopause?

Transgender people, particularly transgender women (assigned male at birth), may undergo gender-affirming hormone therapy (GAHT), which can cause hormonal changes that might lead to menopause-like symptoms. This article explores how transgender individuals may experience menopause, the role of GAHT, and other relevant information.

As individuals with ovaries age, their ovaries decrease in function, resulting in lower estrogen levels. This hormonal decline triggers the changes associated with menopause.

When it comes to hormonal medication, while formal research is limited, there is sufficient anecdotal evidence suggesting that trans men and nonbinary individuals who choose to do so can take testosterone instead of estrogen to alleviate perimenopausal symptoms. One common side effect of both testosterone therapy for trans men and menopause itself is vaginal dryness. For anyone experiencing this symptom, I recommend vaginal estrogen. Since vaginal estrogen is applied locally, it has minimal systemic absorption, making it a safe and effective option for trans men and nonbinary people as well.

While transgender females may not face menopause directly, some studies have suggested that they don’t see menopause as a significant concern due to biological differences from cisgender women. Instead, transgender women may experience some age-related health conditions, such as cardiovascular disease.

In a 2022 study, researchers found that transgender women receiving lifelong GAHT were less likely to experience menopause-like symptoms but still had to consider other health concerns related to aging.

How Does Hormone Therapy Affect Menopause?

Transgender women (assigned male at birth) undergoing hormone therapy typically receive estrogen and androgen blockers to lower testosterone levels and increase estrogen. These hormonal fluctuations can lead to symptoms that resemble those of menopause or premenstrual syndrome (PMS), such as mood swings, hot flashes, or changes in body composition.

If a transgender woman stops or reduces her hormone therapy, the resulting drop in estrogen may cause menopause-like symptoms.

However, many transgender women continue hormone therapythroughout their lives, which typically prevents menopause-like symptoms from occurring.

Handsam Resources

Example Transgender Equality Policy

DfE: Gender Separation in Mixed Schools: Non-statutory Guidance (2018)

Do Transgender Men Get Hot Flushes?

Transgender men may experience hot flushes, particularly if they have ovaries or have not undergone testosterone therapy. A 2019 case study noted that a transgender man who underwent oophorectomy (removal of the ovaries) experienced hot flashes and night sweats, which were alleviated with hormone therapy.

What Are the Long-Term Effects of Hormone Replacement Therapy?

The long-term effects of hormone replacement therapy (HRT) for transgender individuals are not yet fully understood. However, current evidence suggests that transgender individuals on HRT may face similar risks to their cisgender counterparts, such as cardiovascular disease. Further research is needed to understand the full scope of potential risks.

Gender-Affirming Surgery and Menopause

Transgender individuals who retain their birth-assigned reproductive organs may still experience menopause naturally when they reach a certain age or stop hormone therapy.

• Transgender men who have surgery to remove their ovaries (a procedure often called oophorectomy) may prevent the onset of menopause since their estrogen production ceases.

• Transgender women who stop hormone therapy may not experience traditional menopause symptoms if their birth organs (testicles) remain intact and continue to produce testosterone.

Symptoms of Menopause

Typical menopause symptoms include:

• Mood swings;

• Hot flashes;

• Body composition changes (e.g., reduced muscle tone, increased fat);

• Bladder health issues (e.g., frequent urination or incontinence); and

• Sleep disturbances