Transgender people can experience menopause or similar symptoms, though the underlying hormonal processes may differ from those a cisgender person experiences.

“Transgender” refers to people whose gender expression and identity do not match the sex doctors assigned them at birth. “Cisgender” refers to those whose gender expression and identity match their assigned sex at birth.

People who are transgender may undergo gender-affirming therapy, which often includes hormone therapy. In transgender females, this therapy can lead to hormonal fluctuations that can cause symptoms similar to those of menopause.

This article explores how transgender people can experience menopause and its symptoms, how gender-affirming therapy affects menopause, and more.

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As people with ovaries age, their ovary functions reduce, leading to lower estrogen levels in the blood. This drop in estrogen triggers biological changes associated with menopause.

A transgender person may undergo certain forms of gender-affirming care, such as gender-affirming hormone replacement therapy (GAHT) and surgery. This kind of care helps people align their bodies with their gender identity.

Whether or not a person receives gender-affirming care will affect whether they experience menopause or related symptoms.

How does GAHT affect menopause?

During GAHT for transgender females, doctors may prescribe estrogen, androgen blockers, and progesterone to help lower testosterone and increase estrogen levels.

Hormonal fluctuations can cause transgender females having GAHT to experience symptoms similar to those cisgender females experience around menopause and as a result of premenstrual syndrome (PMS).

If a person decides to stop GAHT or lower the amount of estrogen they receive, the drop in hormone levels could cause menopause-like symptoms. However, many people decide to continue GAHT for the remainder of their life due to the life-affirming aspect of the care.

Transgender females who receive GAHT are not likely to experience menopause-like symptoms if they continue with the therapy for the duration of their life.

Transgender males who undergo GAHT will also not likely experience menopause if they continue therapy for the rest of their life.

Gender-affirming surgery

People assigned female at birth who still have their birth organs or do not receive GAHT will start menopause following their final menstrual cycle as their estrogen levels drop.

Gender-affirming surgery that removes the ovaries can help prevent the occurrence of menopause in transgender males.

A transgender female who stops GAHT may not experience menopause-like symptoms if their organs from birth are still intact and producing testosterone.

Concern about menopause

Some evidence suggests menopause may not be a significant concern for transgender females. In a 2019 study, transgender females reported that they did not feel menopause was an issue due to biological differences between transgender and cisgender females.

Another study from 2022 also noted that transgender females often do not experience menopause due to lifelong GAHT. However, the study noted that other conditions associated with aging may be an issue, such as cardiovascular disease.

Research is still lacking regarding menopause and transgender people. In the coming years, the scientific community will likely learn more about how GAHT, gender-affirming surgeries, and other factors influence aging in the transgender population.

LGBTQIA+ resources

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There are several signs and symptoms associated with menopause.

These can include:

Cisgender females may also experience changes in their periods leading up to menopause. Once it starts, they may notice vaginal dryness and pain during sex.

Learn more about menopause symptoms.

A growing healthcare challenge involves providing adequate care for transgender people.

Menopause and other age-related issues among the transgender population are not yet well understood in the scientific community. This could lead to issues in care and potentially higher risks for certain age-related disorders.

A 2022 study noted that transgender females undergoing GAHT may have the same risk level as cisgender females for:

Transgender males undergoing GAHT may have a higher risk of:

The study’s authors point out that all people need to take steps to manage cardiovascular risk as they age.

Transgender people should get screenings for cancers or other diseases based on their particular body parts or organs and other associated risk factors. For example, a transgender male with ovaries will need to follow screening recommendations for ovarian cancer.

This section answers questions people commonly ask about transgender people and menopause.

Do transgender males get hot flashes?

Transgender males may experience hot flashes.

In a 2019 case study, researchers reported that a transgender male experienced hot flashes and night sweats shortly after the removal of his ovaries. Treatment with transdermal estradiol and other GAHT stopped these symptoms from occurring.

Transgender males whose birth organs are still intact and those not undergoing hormone therapy may also experience hot flashes due to menopause or other hormone fluctuations.

What are the long-term effects of hormone replacement therapy?

The effects of long-term hormone replacement therapy are still unclear. The scientific community has not conducted extensive research into this area yet.

Current evidence suggests that transgender people should take steps to reduce their risk of cardiovascular disease. They may also be at risk of developing some of the same conditions as cisgender people with the same gender identity.

Transgender people will likely not experience menopause if they undergo gender-affirming care. This care may involve surgery to remove the reproductive organs that were present at birth and ongoing gender-affirming hormone replacement therapy (GAHT).

If they do experience menopause, it may be due to not receiving or stopping gender-affirming hormone therapies or still having sexual organs that were present at birth.

The scientific community still needs to conduct research into the effects of GAHT on aging transgender people. This includes the effects on menopause as well as other age-related health concerns.