Menopause is a natural phase of life, when a person’s ovaries stop producing eggs, leading to a significant drop in estrogen and progesterone levels, and resulting in the loss of periods and fertility. Menopause can occur between the ages of 45 and 55, and is accompanied by symptoms like hot flashes, mood changes and changes in vaginal health. 

In Canada, more than 10 million cis women are of menopausal age—about one-quarter of the population, according to Statistics Canada. And while society has framed menopause as a life milestone that only affects cis women, it also impacts the lives of trans people, both those who medically transition and those who don’t. 
 

So what do you need to know about menopause if you take gender-affirming hormone therapy (GAHT)? Script spoke to Dr. Elijah Salzer, a physician’s assistant and clinical professor at Pace University with a specialty in obstetrics and gynecology to break down what trans people can expect from menopause.
 

What is menopause? 

The first stage of menopause is called perimenopause. “Perimenopause is the period of time in which you’re starting to see some fluctuation in ovarian function, which can be accompanied by irregular bleeding,” says Salzer, and can last between four to eight years leading up to menopause. 
 

When a person hasn’t had their period in more than a year, they’re considered to have reached menopause, which on average occurs at the age of 51. Every day after this milestone is considered postmenopause. “As I say to my patients, you may have left menopause, but menopause has not left you,” says Salzer. Symptoms of menopause include hot flashes, trouble sleeping, brain fog and vaginal dryness. Several hormonal and non-hormonal treatment options exist for managing these symptoms, including estrogen hormone therapy. 
 

There is little research surrounding perimenopause, menopause, trans people and the impact of GAHT on aging. Every person’s journey with menopause will look different, depending on their hormone usage, potential birth control usage and additional lifestyle factors.
 

What if I take testosterone and no longer get my period? 

As mentioned above, menopause is defined in relation to a “final” menstrual period, but transmasculine people taking T may no longer experience periods—and therefore may not experience traditional symptoms of perimenopause or menopause. Salzer says that once a person who is not getting their period due to their transition reaches menopausal age, “we would consider that person post-menopausal.” 

However, Salzer says that people who take testosterone can still develop a common menopausal symptom known as vaginal atrophy, as a result of transition care, before they reach menopause or perimenopause. Vaginal atrophy is a series of changes of the vagina that occur after a significant drop in estrogen, including thinning, drying and inflammation. “Some transmasc patients on T will choose to use vaginal estrogen, like estradiol,” to deal with vaginal atrophy, says Salzer. Vaginal estrogen is low-dose estrogen used in the form of a tablet, topical cream or vaginal ring that sends estrogen to the vaginal tissues to relieve discomfort caused by vaginal atrophy. This treatment doesn’t interfere with GAHT in any way.
 

For some transmasculine and non-binary people, taking low doses of testosterone (i.e., micro-doses) are enough to achieve their desired transition goals. Salzer says if you’re microdosing T and still get your period, you may still go through a traditional menopause. 
 

Will my experience with menopause be different if I was once taking T, but stopped?

Salzer says it can depend on how much time has passed since a person has stopped taking testosterone. “If someone tried T, didn’t like it, went off it and isn’t taking hormonal birth control, that person may well return to ovarian function and go through menopause as any cis woman not on hormones would,” says Salzer. But, if you’re taking a hormonal birth control like Depo-Provera or have a progesterone-containing-IUD that stops you from having a period, you may go through menopause without ever knowing it. That’s because progesterone and estrogen in birth control may mask the symptoms associated with the start of menopause. 
 

What if I’ve had a hysterectomy? 

If just the uterus is removed during a hysterectomy and you’re not on GAHT, you’re still likely to go through traditional menopause. “The ovaries continue to function as if the uterus were there, because they have nothing to do with each other in that way,” says Salzer. “They’re neighbours but they’re not inextricably involved in each other’s lives.” 

Salzer says that cis patients who get their ovaries removed feel intensely menopausal, because of the sudden and enormous drop in sex hormones—but “if you’re on testosterone, that should be reduced because you’re using another sex hormone,” says Salzer. That means your body isn’t going through such a drastic change. If a person has received a full hysterectomy, they shouldn’t feel any menopausal symptoms once they reach menopausal age since the ovaries control menopause. 
 

I’m transfeminine and take estrogen. Do I need to worry about menopause? 

A 2017 survey of 67 trans women in the U.K. found that the majority of participants reported not thinking much about menopause as they found it irrelevant to their own transition. But some survey participants reported menopause symptoms in their mid-life, including mood swings and lowered sex drive, and many had no idea what to expect about reaching “menopause age.” 

Salzer says that while transfeminine people don’t go through a traditional menopause, those who take estrogen would feel menopausal symptoms should they decide to stop. This would occur for similar reasons cis women experience symptoms after a natural drop in estrogen. 
 

As a trans person, how can I navigate discussions of menopause with my doctor? 

Whether you’re transfeminine or transmasculine, it’s important to have open conversations with your doctor about menopause and long-term use of GAHT. 

That may be easier said than done. A small 2024 study of trans, gender nonconforming and non-binary people found that many respondents had difficulty finding support and resources for navigating menopause. There are a growing number of online resources designed for trans people (and other LGBTQ2S+ patients) to learn about menopause. Queer/LGBTQIA+ Menopause, started by U.K.-based psychotherapist Tania Glyde, has resources ranging from peer-reviewed scientific research, articles, books and documentaries on queer-inclusive menopause. 
 

Resources like these can help you come prepared for doctor’s appointments. “I tell my patients all the time, knowledge is power,” says Salzer. “I don’t think there’s anything wrong with coming in with information.” 
 

For trans people looking for trans-inclusive primary care doctors, gynecologists and endocrinologists, check out the “search for providers” tool at the World Professional Association for Transgender Health or Canadian-based organizations Rainbow Health Ontario and TransCare+. If you have a primary care doctor who isn’t experienced with trans health, schedule a time to meet with them to discuss only menopause and go to that meeting prepared with questions and resources.