A primer on terminology

Before getting into the details, let’s go over some definitions so we’re all on the same page.

Menopause happens when someone with a uterus and ovaries permanently stops having menstrual cycles. This is marked by 12 consecutive months without a period, usually around ages 40–55, due to decreasing amounts of estrogen made by the ovaries.

“Transgender” is an umbrella term that describes people whose gender identity differs from the sex they were assigned at birth.

Nonbinary can be grouped under the trans umbrella, as the term “nonbinary” means someone’s gender falls outside the binary of female or male and instead exists somewhere on the gender spectrum.

Not everyone with the same identity expresses it the same way. Some folks may be taking hormones or have had surgery; others may not. Any and all of these are valid choices of gender expression.

— Dr. E. Mimi Arquilla, DO

Common misconceptions tend to start right from the core of what exactly being transgender means and how that relates to changes in the body.

Fluctuations in estrogen levels cause symptoms of menopause. Traditionally, medicine has centered this experience around cisgender women and ovary function.

However, transgender individuals using estrogen for hormone replacement therapy (HRT) can also experience similar symptoms of menopause due to their own estrogen level fluctuations.

It’s also common for trans folks not to be asked about their anatomy and related changes. It can sometimes be an avoidance or discomfort surrounding talking with someone about a possible dysphoria or area of unease.

Folks may think that transmasculine people don’t go through menopause or have symptoms related to menopause. In addition, they may have the misconception that transmasculine folks wouldn’t want estrogen treatment to help with menopause symptoms.

Yes! Transmasculine folks can experience menopause in a variety of ways.

The ovaries are the main source of estrogen in the body, so folks who have this anatomy will likely go through some sort of menopause process.

Menopause can happen:

  • when people go through testosterone therapy
  • after the ovaries are surgically removed
  • over time with aging

Folks can! Transmasculine people with ovaries and a uterus — who are not on contraception or HRT — will have the same cycles and ovulation as cisfemales.

Some folks on lower doses of testosterone may have lighter cycles. Higher doses tend to stop cycles.

However, folks can still ovulate while on testosterone, even if they don’t have a cycle.

This means folks on HRT can become pregnant if they are having vagina/front hole sex with a partner who makes sperm. They should be using a birth control method if pregnancy is not desired.

Transwomen can experience menopause symptoms but not menopause itself. This is because they do not have ovaries or a uterus.

Symptoms can come from the fluctuating levels of estrogen related to their HRT. This is commonly seen with changes in dosing or the need to pause HRT before surgery.

Testosterone therapy decreases estrogen levels, which can mimic some menopause symptoms.

This includes loss of cycle, hot flashes, or hair thinning. It may also lead to dryness of the front hole/vagina.

I would start with making sure your symptoms are related to menopause versus other conditions that can look similar, especially for those on HRT.

For hot flashes, you can try wearing lightweight, looser-cut clothing or keeping your bedroom colder overnight.

For front hole/vagina dryness, you may need extra lubrication during sex or topical estrogens to the area. The dose of estrogen is very low, and due to its topical use, it only affects the tissues it’s in contact with and won’t be absorbed through the whole body or affect HRT.

The most important advice I can give is to find someone you feel comfortable talking with, someone who will apologize when they’re wrong and do the work to learn what they don’t know, and in a place where you feel safe.

It can be challenging to find someone who fits. Even as a primary care doctor myself, I struggled with finding my own provider.

Here’s where I’d start: word of mouth. Who do your friends or members of your community recommend? Are there any LGBTQ+ centers near you?

Listen to your body. Know that new symptoms or pain is your body telling you something. Oftentimes, there is something that can be done to help.

Talking about menopause can be challenging and dysphoric, so consider making a game plan before a doctor’s visit for how you’d like to lead the conversation.

You can let healthcare professionals know what language you prefer to use (such as “front hole” instead of “vagina”), write down your concerns ahead of time to keep you on track or have your healthcare professional read, or consider bringing a partner or friend for support.

E. Mimi Arquilla, DO, is an ABMS board certified family medicine physician. They are an assistant professor at the University of Illinois at Chicago College of Medicine. They also practice primary care at Mile Square Health Center, a federally qualified health center that focuses on the needs of the underserved. They have special expertise in LGBTQ+ inclusive healthcare, gender affirming care, addiction medicine, chronic disease management, and care for the homeless.