What it’s like to be a trans man going through menopause

By Tate Smith

“Menopause is often portrayed as something only cisgender women in their 50s experience, but that’s simply not true”

When I started medically transitioning from female to male at 20, I expected changes to my body, but I didn’t foresee the onset of menopause-like symptoms just a year later. At 21, I began experiencing spotting after intercourse, genital dryness, and hot flashes – symptoms that are often associated with menopause. Initially, I thought these symptoms were due to frequent UTIs or side effects of testosterone therapy. After several invasive tests, including an ultrasound and cervical smear returned no abnormality, my GP dismissed my concerns, advising me to “drink more water.”

It wasn’t until I consulted a private endocrinologist that I received a diagnosis. After months of discomfort, I was told I was experiencing vaginal atrophy, a common symptom of menopause, triggered by the suppression of oestrogen caused by testosterone therapy. I was prescribed Ovestin, a topical oestrogen cream, and within weeks, my symptoms improved. I still use the cream today, nearly five years into my transition, and continue to manage hot flashes and brain fog, unsure if they’re due to testosterone therapy or the menopause.

People often ask, “Why take testosterone if it causes these symptoms?” My answer is simple: taking testosterone is essential for my transition and identity, and while these side effects are a nuisance, they are manageable. The menopause would have happened to me eventually as I was assigned female-at-birth; it’s just happening earlier. These symptoms don’t disrupt my daily life as long as I stick to my treatments.

What does impact me is the lack of awareness surrounding menopause in trans men and LGBTQIA people. Menopause is often portrayed as something only cisgender women in their 50s experience, but that’s simply not true. It can affect people of all genders and ages. I’ve met a cisgender woman who went through menopause at 15 and another who entered surgical menopause due to chemotherapy. These experiences, especially in marginalised communities, often go unrecognised. While approximately 13 million women in the UK are currently peri-menopausal or menopausal, according to Wellbeing of Women, there’s limited specific data on trans men and LGBTQI women experiencing menopause. Without comprehensive data, inequalities in healthcare can persist and healthcare professionals are left to form harmful generalisations.

We need to stop thinking of menopause as a one-size-fits-all issue. Cisgender women of colour, for instance, often experience more intense symptoms due to higher natural oestrogen levels. Many diagnostic models are based on heteronormative assumptions which can lead to conversations about managing menopause focusing solely on male partners, excluding anyone who identifies as queer or even asexual. All genders whether they take hormone therapy or not, will have unique symptoms and treatment needs but with menopause remaining under researched and a taboo in everyday conversation, perhaps this is the one area that unites both cisgender people and marginalised communities.

More action is needed to address this: Healthcare providers need to be better trained to recognise and treat menopause in LGBTQIA patients. GPs should avoid making assumptions or letting unconscious biases influence their diagnoses. It’s essential to understand that menopause can happen to anyone and that inclusive language like “menopausal people” rather than “menopausal women” is vital. Allies should adopt this language and stop calling menopause “the change” which trivialises its seriousness. For trans men like me, menopause is a reminder of our sex-assigned-at-birth, which can exacerbate gender dysphoria.

We all have a role in ensuring everyone navigating menopause, regardless of gender or background, receives the support they need. If you’re experiencing menopause, know you’re not alone. As a trans man who suffered in silence, I encourage you to advocate for the care you deserve.