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Transgender and The Menopause

This week we have a topic I have never really talked about until I met someone who made me think about it. What about transgender (mostly men) and menopause?

A transgender person is a person who does not recognise him/herself with their birth sex. Therefore, women usually transition into men (either just hormonally or chirurgical), and men usually transition into women. The latest usually undergo less problems in terms of menopause than the first: in fact, as long as they continue to take oestrogen they are pretty safe. For example, if transgender women were to stop taking oestrogen and then received reassignment surgery, then symptoms can rise like the very common mood swings and also vaginal dryness. If they are only taking the hormones, without undergoing any surgery it’s unlikely they will go through menopausal symptoms, so the situation, it’s kind of “easier” for them, speaking in terms of hormones.

On the other hand, the situation is a bit more complicated for those women who transition into men. The transition can be hormonal, surgical or just cross dressing, or starting with hormonal and then the woman will decide to have a surgery. It is the very same path for the other type of transition (men to women), but we are concentrating on transgender men because it is the one which will give all the menopausal symptoms because, in one way or another, you will reach menopause.

A transgender man will normally take testosterone (masculinising hormones). Females produce a  small amount of this too, but it predominantly a male hormone.

The physical and emotional changes you may experience after the hormonal therapy include:

  • beard and body hair growth
  • development of male pattern baldness
  • slight increase in the size of your clitoris
  • increased libido
  • increased muscle mass
  • deepening of your voice, but not usually to reach the pitch of other men
  • cessation of periods especially if you are pre-menopausal
  • development of acne

Breasts will not reduce in size so, after some time of living as a trans man, some people decide for want reconstruction surgery. This removes breast tissue, reduces nipple size and contours a masculine-looking chest wall. However, hormone therapy may be the only treatment you want to have to live with your gender variance, but surgery to create a penis (phalloplasty), or construct a scrotum (scrotoplasty), and testicular implants, is possible.

Issues to consider and discuss with doctor, particularly if you feel, or see anything unusual, include:

  • bone strength and osteoporosis risk
  • Huge side effects associated with testosterone therapy
  • lifestyle issues –smoking, diet and exercise
  • blood pressure
  • Vaginal health (if you still have a vagina) this include vaginal dryness, very common
  • Whether or not to undergo a hysterectomy
  • Need for smear tests periodically if you have not had a full hysterectomy
  • Urethral stones, if you had instead genital reconstruction
  • Breast cancer screening (even when breasts are removed with chest surgery, not all potentially cancerous glands are removed)

One of the most important points which needs to be considered is menopause. You will still undergo menopause, and, there is very little help out there. Mood swing, hot flashes, vaginal dryness, night sweats are just few of the 34 symptoms you can go through.

Moreover, it has to be considered that, the use of testosterone has a dose dependent effect on vaginal tissue by inducing a hypo-estrogenic state (very low dose of oestrogen) which promotes atrophy, increases vaginal pH and therefore increases the possibility of having vaginitis and cervix problem. Prior surgery may cause adhesions, scar tissue, bladder dysfunction, or also nerve injury, which may give rise and to pelvic pain.

The use of testosterone also, often results in oestrogen deficiency, atrophic vaginal tissues very similar to what’s happen in post-menopausal state. These atrophic vaginal tissues have also a decline in tissue resilience, skin barrier function, and more susceptible to altered microbial environment (basically Ph) and resistance which may give rise to bacterial vaginosis, or cystitis. Additionally, atrophic vaginal tissues which become very thin, are more prone to traumatic irritation derived from friction and sexual contact, which may result in atrophic dyspareunia. Symptoms are often described as feeling “rough” “sand-paper” and “burning” or “dry” vaginal irritation.

Some of the most common therapeutic approaches may include vaginal lubricants or vaginal moisturizers. You can have a look at my range of natural moisturiser here: https://shop.megsmenopause.com/collections/intimate.

Whatever your situation or stage of menopause or pre-menopause, my advice is always to seek for help. Menopause is a very stressful time for anyone.