Medically verified by Dr. Sarah Pickle.
Lisa Scheps, an activist and artistic director, experienced menopausal hot flashes after stopping estrogen for 10 days before surgery.
“I wouldn’t say I went through perimenopause or menopause like a cis woman would, but I certainly know what a hot flash feels like,” said Scheps, 62, a transgender woman who is on hormone replacement therapy ( HRT). for 20 years.
A cisgender (or CIS) person identifies with the gender they were assigned at birth. Transgender (or trans) people whose gender identity and expression do not match the gender they were assigned at birth often use gender affirmative measures such as HRT to help align their bodies with their gender identity.
Transgender women – women who may have been assigned the male gender at birth – are given estrogen, an androgen blocker, and sometimes a progestin to aid in the medical transition.
Similar to how menopausal women can use cis women (HRT) to replace estrogen, trans women can use HRT to raise estrogen levels and lower testosterone levels to aid feminization. Some transgender people choose gender-affirming surgery, but not all can or want to. A trans identity is not dependent on physical appearance.
Menopause revolves around the experiences of cisgender women – in whom menopause is a response to decreased ovarian function – but transgender women can experience symptoms of both menopause and PMS. As with cis women, symptoms respond to fluctuations in hormones, even if the causes are different.
Is This Menopause?
When asked if trans women are going through menopause, Dr. Maria Monge, Assistant Professor of Pediatrics and Internal Medicine at Dell Medical School, who offers gender-affirming care: “Yes and No.” Because menopause is triggered by the decrease in the production of estrogen in the body, trans women can experience similar symptoms when their hormones are interrupted.
Cis women are often instructed to stop HRT after about 10 years to avoid possible health complications. That doesn’t necessarily apply to trans women. According to Transgender Care at UC San Francisco, there is no evidence of continuation or discontinuation of hormones in older trans women. The website notes that no outcome studies have been conducted on injectable estradiol – the primary bioidentical estrogen used to feminize therapy – likely because it is rarely used outside of transgender treatment.
As transgender women get older, some choose to lower their estrogen dose or possibly stop HRT entirely. This can trigger reactions similar to symptoms of menopause, but can be mitigated if they are still producing endogenous testosterone through their organs at birth.
“The return of testosterone to the body is not often desired, so many people choose to keep estrogen on much longer than they would at natural menopause age,” said Monge, adding that there is concern that the greater the risk is The longer women receive estrogen of possible side effects due to other health conditions that can develop with age.
The decision to keep or stop HRT is individual, but Monge is not concerned about transgender women staying on HRT indefinitely.
“For so many it is life-affirming,” said Monge. Despite limited data on how HRT affects trans women, stopping medically necessary care could be harmful and potentially put you at a higher risk of harm than sticking to the medication.
Discrimination in healthcare is a major concern of all transsexuals. A 2015 survey that looked at the experiences of transsexuals in the United States found that a third of respondents had at least one negative experience related to transsexuals – including verbal harassment and refusal of treatment. Another 24% avoided care for fear of abuse.
“In my experience, doctors refused to treat me because they didn’t know enough about ‘transgender’. [a term of ignorance]”said Claire Bow, who began her medical transition in 2013 at the age of 55.
“Discrimination and / or ignorance are always destructive, and not just for trans women. For years, the medical establishment has systematically ignored the health needs of women and minorities, including trans men and women,” Bow said, adding that her best hope now is a provider who is willing to listen and learn even if not trained in trans health.
“When we are just considered transgender, doctors can often overlook basic health needs – vaccinations, colon cancer screenings, or vaginal exams,” Bow explained.
It’s even more difficult for colored trans women. The 2011 National Transgender Discrimination Survey found that “Discrimination was widespread across the sample, but the combination of anti-transgender bias and persistent structural racism was particularly devastating”.
“Overall, there is an embarrassing amount of evidence to suggest ill-treatment and poor medical care for transsexuals,” said Monge. “That, along with systemic racism that exists within the medical infrastructure, makes it very difficult for us [Black, Indigenous and people of color] trust and receive high quality medical care. “
Get the care you need
Holly Bullion, director of clinical quality at Kind Clinic, emphasized that health exams should be based on body parts (e.g., people with breast tissue should get mammograms). For trans women aged 50 and over who have been continuously treated with estrogen for five to ten years, mammograms are a must, according to Bullion.
Additional gynecological care also depends on the anatomy. “When had a woman [gender-affirming] Adequate levels of estrogen after surgery are important to maintain genital tissue health, “said Monge.
For Scheps, who said she’ll never know what it feels like when a woman who has been producing estrogen all her life goes through menopause, her experience of hot flashes is one that she cares about.
“I am often frustrated because I cannot understand what my cis sisters have felt all their lives,” said Scheps. “I don’t know what it feels like to have a period, I don’t know what those cramps feel like. So, that one little thing I have – that I know what a hot flash feels like – I just appreciate.”
National Center for Transgender Equality
Transgender Nursing from the University of California at San Francisco