This summer, I started going through perimenopause.
But as a non-binary trans masculine person, I’m not exactly what springs to mind when you think of the menopause. And therein lies the problem…
Despite deserving fully inclusive care – just the same as anyone else – the research and resources that currently exist to tackle this turbulent life change just aren’t made for people like me.
I say, that has to change.
When I came out as trans in the summer of 2021, I knew I needed to go on hormones to feel happy in my body.
Fortunately, I started hormone replacement therapy (HRT) through a private service in December that same year. I soon started growing the body hair and musculature that had me looking in the mirror with a joy I never knew I could feel.
Then, last year, my periods stopped.
This respite from the heavy flow I used to have has been such a relief, though I still sometimes get period pain and mood swings at my time of the month.
Knowing I still had some kind of menstrual cycle, if not an actual period, it didn’t cross my mind I’d be in for perimenopause anytime soon.
Still, I realised that being on testosterone (T) could kick-start the menopause, as I’d heard a few stories from other trans masculine people about their own experiences.
Some had needed localised oestrogen treatment to combat symptoms like the increased risk of UTI. But others do get by without symptoms altogether, if their T prescription smooths over the drop in oestrogen associated with ovary failure and menopause.
Two and a half years into my HRT, nothing and no one truly prepared me for the symptoms I would experience.
For weeks my life was disrupted by pain, illness and sheer exhaustion and, at first, I still didn’t even consider this could be the start of the perimenopause. I just thought I’d caught a stomach virus.
I had diarrhoea, bloating and pain in my lower abdomen. I did find it strange that, instead of lasting the usual day or two, they affected me intermittently for almost a week.
About a fortnight later, I woke up after a glorious weekend of sunshine and Pride celebrations with heat exhaustion.
I’d suffered this a couple of times before due to my own carelessness in too much sun, but it had never drained me the way it did that Monday.
After throwing up, I spent the rest of the day in bed. I only just about had the energy to take paracetamol and stomach settling medicine with drinks of water and peppermint tea.
It took days for my appetite to recover fully.
My energy levels never really did.
Even after I began to feel better, I had disturbed sleep, hot flushes, and digestive discomfort in fits and starts.
By the time another week of this had gone by, on top of a couple of hits of cystitis, the lingering on-and-off mixture of symptoms had me thinking I was in fact experiencing perimenopause.
Usually, the symptoms take place in a variable stretch of months or years before menopause makes periods stop for good. But as HRT stopped my periods in 2023, I was technically menopausal before being perimenopausal.
As uncomfortable and irritating as it’s been, going through this 10 or so years earlier than the average cisgender woman – I’m only 32 – it’s nowhere near enough to make me regret my medical transition.
The main problem I do have is finding support that’s inclusive of trans people.
For a start, when I booked my GP appointment, the care navigator I spoke to on the phone was audibly apologetic when they said they’d need to refer me to women’s health.
At this point, what with having other ‘women’s health’ needs like smear tests, I’m used to facing this kind of gendered language and treatment for certain medical appointments.
Though, that’s not to say I’d be opposed to the medical industry moving to gender neutral terms across the board to avoid this.
Yes, along with smear tests and family planning, I’m saying this is yet another area that doesn’t need any gendered language. Not when discussing these things in general terms.
No matter what people might read or hear, it’s still perfectly fine for a cis woman to be called a woman.
But I can’t rely on the existing definitions or treatments of menopause because my body, hormone treatment, and my very being as a non-binary person, upends all binary gendered assumptions.
My hormone balance works completely differently to the assumed cis female norm. And because I’m already on gender-affirming HRT, I can’t have the hormone therapy that’s usually prescribed to women for menopause, in case taking oestrogen has unwanted effects on my body or health.
It also means that, courtesy of my already non-existent periods, I have no way of guessing when my symptoms will stop or even out.
So how can I be helped and treated?
Well, I was sent off by my doctor to try herbal remedies, which could take as many as six months to work, and I was also signposted to generic web pages.
However, these sites are largely made to reassure middle-aged (mostly white, heterosexual and non-disabled) women that there’s a whole community of other women like them, feeling like forgetful, tearful, hot and sweaty messes with dry vaginas.
Of course I’m glad these resources exist for so many older cis women who are no doubt as emotionally and physically vulnerable, or even more so, than I am right now. But it’s plain they aren’t for me.
I’m not thought of when medical professionals and copywriters are aiming to give relief, or comfort. Someone like me doesn’t even cross their mind as they try to lend their best practice to perimenopause.
It’s hard to describe how deeply that hurts – not being seen as worth noticing, let alone receiving care that acknowledges the transgender experience.
For trans+ people like me to be humanely treated for menopause, we need our care to be seen as valid, and there needs to be medical research.
This hasn’t happened yet and, with trans+ gender-affirming healthcare under threat of misinformation, anti-trans legislation, and medication bans, it isn’t likely to happen anytime soon. But I hold on to the hope that it will happen, one day.
For the time being, even acknowledging that not just cis women go through menopause would go a long way to making medical help and advice more welcoming.
Until people with power over our healthcare start taking notice, I’ll keep speaking out as a perimenopausal, non-binary, trans masculine person. Because we all deserve care and healing that accepts and values us, for our full selves and life experiences.
Do you have a story you’d like to share? Get in touch by emailing [email protected].
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