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Throughout history, getting your period has almost always been synonymous with the female experience. Schools would often split health classes up by gender, with the girls watching awkward videos about menstruation and receiving even more awkward lessons about how to use tampons and maxi pads.
While cisgender men and transgender women cannot menstruate – menstruation is impossible for those born without a uterus and vagina – limiting periods to a female-only experience is an outdated practice. Menstruation is not and should not be related to one’s gender identity, especially now that gender-affirming care is under attack across the United States.
In addition to cisgender women, transgender men and non-binary people (specifically, those born with a uterus and vagina) can indeed menstruate and get pregnant, even if they are undergoing gender-affirming hormonal therapy. But menstruation cycles can vary depending on what stage people are in their hormone-therapy treatment.
To better understand how menstruation affects transgender men, and how they can continue to menstruate after transitioning, Rescripted spoke with K. Ashley Brandt, DO, a board-certified OB/GYN and fellowship-trained gender-affirming surgeon practicing in West Reading, PA.
So, can men have periods?
Although Dr. Brandt confirms that neither cisgender men nor transgender women can menstruate, she says that transgender men, as well as non-binary patients assigned female at birth, can continue having a monthly cycle after beginning testosterone hormone therapy. But, “most patients typically achieve amenorrhea” – the absence of periods – “within six months.” Cases can differ, though: Dr. Brandt explains that amenorrhea can occur as quickly as within one month of testosterone therapy, or it can take as long as one year. Also, patients undergoing hormone therapy can experience shorter and lighter periods before their cycles stop altogether. “Breakthrough bleeding can occur on testosterone,” adds Dr. Brandt, “although it is rare.”
Transgender men and periods
Amenorrhea may come about more slowly for some men and non-binary people depending on a multitude of factors, says Dr. Brandt: “The dose of testosterone, route of administration (injectable, patch, or gel), frequency of administration (weekly or biweekly), or pre-existing structural or nonstructural medical conditions that affect cycles, such as PCOS, obesity, fibroids, etc.” If a patient continues having monthly cycles “despite having testosterone levels in the cis-male range for 6-12 months and has suppressed the luteinizing hormone (LH) and the follicle-stimulating hormone (FSH),” then this is considered abnormal bleeding and Dr. Brandt recommends speaking to your medical provider for further evaluation.
Since a continued monthly cycle can be a source of dysphoria for transgender men and some non-binary people, make sure to discuss your preferences and medical conditions with your doctor before beginning testosterone therapy.
Why bother stopping your menstrual cycle?
As mentioned above, Dr. Brandt explains that continued menstruation can cause gender dysphoria, so “menstrual suppression is often a goal in many transgender men.” More importantly, even though getting a period shouldn’t be characterized as a female-only occurrence, this is still a prevalent attitude in today’s global society. Therefore, achieving amenorrhea will (hopefully) help transgender men feel more comfortable in their own skin. “The goal of gender-affirming hormone therapy overall is to induce physical changes that more closely align the patient with their gender identity,” says Dr. Brandt. In addition, she emphasizes that “gender-affirming therapy has also been shown to reduce symptoms of anxiety and depression, decrease social distress, and improve overall quality of life.”
Benefits of hormone therapy
Permanent effects of testosterone therapy include body/facial hair, voice deepening, and bottom growth. “These are often many of the traits that these patients desire,” says Dr. Brandt. In addition to the cessation of monthly cycles, Dr. Brandt says other preferred positive effects of gender-affirming hormone therapy for transgender male patients are increased muscle mass and libido, and a redistribution of body fat to a more male pattern.
Potential side effects
On the flip side, there are potential side effects from undergoing masculinizing hormone therapy, but always speak to your doctor about any concerns you may have. Dr. Brandt says patients can experience pelvic pain while on testosterone therapy, but this “usually self-resolves around the time amenorrhea is achieved.” Vaginal atrophy, alopecia, acne, weight gain, worsening of sleep apnea, increase in blood pressure, polycythemia, and increases in cholesterol are also possible.
Can men transition without hormone therapy (and continue menstruating)?
Absolutely! “The decision to start or stop hormone therapy is individualized and largely dependent on what the patient’s goals are for their own transition,” says Dr. Brandt. She goes on to explain that the main reason a person wouldn’t want to take hormones is because they already feel comfortable with their bodies just the way they are. Another option is for transgender patients to stop hormone therapy “after they have undergone desired gender-affirming surgeries (such as top surgery or hysterectomy).” Remember, however, that if a patient elects to have a hysterectomy, their periods will stop permanently.
Can trans men still get pregnant?
Yes, and this is true even if transgender men are on testosterone therapy and have achieved amenorrhea. “According to a study,” says Dr. Brandt, “20% of pregnancies in transgender men occurred while they were amenorrheic and 24% of pregnancies were unplanned.” So Dr. Brandt emphasizes the importance of medical providers discussing contraception with patients who are transgender men, “particularly if patients are engaging in penile-vaginal sex.”
If you are a transgender man or non-binary person who wants to get pregnant, Dr. Brandt advises stopping testosterone therapy “pre-conceptually and during pregnancy.” This is because testosterone is a teratogen, a substance that can potentially cause congenital disorders in a developing embryo or fetus.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.