Do Trans Men go through Menopause?

I turned 41 last year.  In my 30’s I found myself really inhabiting all of the tropes of that decade of life.  With the passing of the years, what started as an intense self surveillance settled into a much more laissez faire interest in being perceived.  So as I entered my 40’s I knew that this was middle age!  A lot is supposed to change at this time, and for people who are born with ovaries, one of those things is perimenopause.  

Perimenopause is the period of time (around 10 years) during which one's ovaries wind down their production of estrogen. Menopause is defined as when one has not had a menstrual cycle for one full year.   The reduction of estrogen results in a ton of changes.  There are the ones many of us will have heard about - hot flashes and night sweats, changes in menstruation, brain fog, emotional ups and down, and dryness of skin and vaginal tissue.  There are other patterns that until recently I had no idea had a relationship to estrogen - blood sugar spikes, increased cholesterol, digestion, and raising of blood pressure!  

As estrogen stops being created in one's ovaries it continues to be produced in one's adrenal glands and fat cells - which is why people can put on weight. Their body is keeping fat around to protect estrogen stores.  In fact, body weight is positively correlated with less perimenopause symptoms!

Black cohosh - an ecologically fragile herb worked with frequently during menopause

I have been on testosterone for over 15 years and I wasn’t really sure what I could expect around this time.  Then, a few weeks ago I woke up in the night sweating. I could feel heat radiating off in waves from my body, an unexpected way to feel in the seemingly permanent tundra this winter has been in the Catskills.  I lay there pondering what this meant for me.  The question of having a kid that way had been a conversation between me and my wife, was that now answered by my body?  

The next day I did some research and realized that the hot flashes were likely not a result of age related perimenopause, but instead because I was late on my shot after running out of syringes.  A hot flash is the result of estrogen withdrawal or fluctuation causing the hypothalamus to lose its normal control over temperature regulation.  Three weeks after my last shot, the estrogen was fluctuating!

Hot flashes can also happen in AMAB people who take ADT (androgen deprivation therapy) - a treatment for prostate cancer - which stops the production of gonadal testosterone and also causes fluctuations.  From my research, this does not seem to be a common experience for trans feminine people if they are taking spirolactone without estrogen, as spiro is only a partial suppressant.  However, trans women can experience hot flashes from reducing or stopping their estrogen intake. 

So, was I not perimenopausal?  But then…menopause is a physiological state not a stage of life.  For many years I had struggled with near constant UTI’s, with doctors seeming to have no answer for why that was.  Whereas, it is well known that cis women are more likely to get infections as vaginal tissue becomes more fragile as their estrogen drops.  Now it is much more common for trans men to be prescribed topical estrogen cream to keep that tissue healthy.  

Sea buckthorn berry so juicy and moist!

Testosterone therapy can stop the body from having many of the big age related hormonal transition moments.  However, both perimenopause and testosterone therapy can also result in temporary mood swings, an increase in LDL cholesterol, lowered bone density and increased blood pressure alongside hot flashes.  If you stop suddenly, whether on purpose or not, you might have some peri-menopause symptoms even if you are in your 20’s!  I would love to hear from all trans people what their experiences have been with menopause symptoms, as I know sometimes even on higher levels of T some people can still have regular menstrual cycles, so I’d be curious how that translates when the ovaries start to shut down.

I learned a lot of this information through a class with Kelly of Attic Apothacery, I recommend it for herbalists and non herbalists alike.  This was a class for people who wanted to learn more about their bodies, and I really loved how thorough but non-jargony her information was.  It is a rare skill to communicate something deeply but accessibly!  Another one hasn’t been scheduled yet but she has lots of other classes including some cool free ones on her website. Check them out!