Transgender Menopause: What to Expect

Transgender menopause experience

For transgender people, the journey may be impacted by:

• age of gender-affirming transition – hormone therapy (GAHT) and surgery
• access to high-quality care

Let’s explore each factor and how it can affect your journey, symptoms, and potential health risks as a transgender person.

Impact of hormone therapy and surgery

Gender-affirming hormone therapy (GAHT) is the process of medically adjusting hormones in the body. Trans people use it to:

• make the body more masculine or feminine, depending on the hormone regimen
• address gender dysphoria (emotional/psychological distress related to one’s sex assigned at birth not matching one’s gender identity).

Studies indicate individuals first notice a feeling of being in the wrong body or experience gender dysphoria in early childhood. However, many years may pass before a diagnosis is made or action is taken to officially transition medically and/or surgically for those who choose to do so.

As a result, the onset of menopausal symptoms, or lack thereof, may vary depending on the age of transition.

Trans men and menopause 

Transgender people assigned female at birth with their reproductive birth organs – ovaries and uterus – still intact can still experience the menopause journey.

Surgery

In a study of insured patients, 75% of people who underwent gender-affirming surgery were 40 years of age or younger.

Premature or early menopause may be experienced by trans men who have their ovaries removed prior to the age of 40 (premature) or between 40–45 (early).

And even some people undergoing an ovary-sparing hysterectomy may also have an earlier age of onset of menopause.

GAHT

Some trans men can experience menopausal symptoms like hot flashes when they begin gender-affirming hormone therapy (GAHT) or puberty blockers.

And if changes are made to hormonal dosages or if GAHT is stopped altogether (e.g., prior to surgery to reduce the risk of blood clots after surgery), a trans person can also experience menopausal symptoms.

Trans women and menopause

Transgender women taking GAHT on a lifelong basis usually do not experience menopausal symptoms.

If GAHT is stopped with reproductive organs intact, there also may be no symptoms if testosterone levels are sufficiently high.

Non-binary people and menopause

Non-binary individuals may experience menopausal symptoms depending on their reproductive anatomy, whether or not it is still intact, and the timing/age of any medical and/or surgical treatment.

Potential risks of GAHT

When under the care of an adequately trained healthcare practitioner, use of GAHT is considered safe according to the World Professional Association for Transgender Health (WPATH) and the standards of care it has developed.

However, as with other medical treatment, there are potential risks.

Trans men

In trans men, taking testosterone can lead to symptoms and signs like:

• acne
• male-pattern baldness
• vaginal atrophy

It can also increase the risk of:

• heart attack
• pelvic pain
• abnormally high number of red blood cells (known as polycythemia, which in turn, can increase the risk of blood clots

Trans women

In cis gender women, hormone therapy during the menopause journey may reduce or delay the risk of many chronic physical and mental health conditions. 

There is insufficient research to date to say definitively if the impact may be of the same breadth and level in trans women. And the results of some studies have been conflicting.

However, a study in 2022 found in trans women on GAHT, the risks for conditions like cardiovascular disease, osteoporosis, and blood clots may approximate the risks seen in cis gender women.

GAHT and cancer risk

There is also a lack of sufficient data on the potential impact of GAHT on cancer risk.

And unfortunately, with the exception of breast cancer screening guidelines from the American College of Radiology for transgender people, there are currently no cancer screening guidelines specific to the transgender community.

Until they are developed, transgender individuals are generally advised to adhere to the same applicable cancer screening guidelines as the cis gender population, e.g., Pap smear and HPV testing in the case of cervical cancer.)

Screening is particularly important, as the LGBTQIA+ community experiences health disparities when it comes to cancer.