Short Answer
Perimenopause and menopause can affect queer, transgender, nonbinary, and gender diverse (TGD) people in many different ways. Some people experience symptoms while taking testosterone. Others experience menopause after surgery, while others may begin gender affirming hormone therapy during perimenopause or menopause. The most effective care is individualized based on a person’s anatomy, hormone exposure, health history, and gender affirmation goals.
At QueerDoc, we love working with people who are experiencing perimenopause and menopause to help them both navigate bothersome physical symptoms and support their gender identities and bodily experiences.
We like to call this “Pause” care or “QueerPause” or “Queering the Pause!’
Table of Contents
- What Is Perimenopause?
- What Is Menopause?
- Why Menopause Can Feel Different for Transgender and Nonbinary People
- Can You Experience Menopause While Taking Testosterone?
- Common Menopause Symptoms in Trans People Taking Testosterone
- Genitourinary Syndrome of Menopause (GSM)
- Menopause After Hysterectomy and Oophorectomy
- Hormone Therapy Options During Menopause
- Bone Health, Heart Health, and Aging
- When to Talk to a Healthcare Provider
- Frequently Asked Questions
What Is Perimenopause?
Perimenopause is the transition leading up to menopause. During this time, hormone levels fluctuate and people may begin experiencing symptoms such as:
- Hot flashes
- Night sweats
- Sleep disturbances
- Mood changes
- Anxiety
- Brain fog
- Weight changes
- Genital dryness
- Changes in sexual function
- Changes in size, shape, and fullness of genitals
- Irregular menstruation
Perimenopause can start several years before menopause occurs.
Menopause is defined as twelve consecutive months without a menstrual period due to declining ovarian function.
For transgender and gender-diverse people, however, menopause may not always look the way it is described in traditional medical literature.
“Menopause” may look and feel different to you if you already don’t menstruate or don’t have regular periods. It may look and feel different if you’re taking testosterone or other gender affirming medications.
Why Menopause Can Feel Different for Transgender and Nonbinary People
Most menopause resources assume that everyone experiencing menopause identifies as a cis or a straight woman. This can leave queer, transgender, nonbinary, and gender diverse people feeling invisible.
Research suggests two themes commonly emerge when LGBTQ+ people discuss menopause:
1. Embodied Identity
The physical changes associated with menopause may influence how people experience their gender.
Some individuals report feeling more settled in their identity. Others find that menopause raises new questions about gender or creates a stronger desire for gender affirmation. Some people may start hormonal therapy during the pause and discover that it really works for them in ways they didn’t expect and that leads to new gender exploration or understanding.
2. Navigating Gender Norms
Many transgender and nonbinary people struggle to find menopause resources that feel relevant. Traditional medicine is highly gendered and menopause may not even be discussed with you by your doctors. Or any discussion may be worded in ways that don’t reflect your body or how you life your life.
Because menopause is often framed exclusively as a cis women’s health issue (and often as a loss of identity,) some people report difficulty finding community, education, and healthcare providers who understand how it might be experienced differently by transgender, nonbinary, gender diverse and otherwise queer people.
Can You Experience Menopause While Taking Testosterone?
Yes!
Many transgender people taking testosterone experience symptoms that overlap with menopause, even before the age at which menopause would traditionally occur. Some people experience these symptoms because testosterone suppresses ovarian hormone production. Others may experience symptoms related to hormone fluctuations, dosing schedules, or changing hormone levels over time.
Common symptoms include:
- Hot flashes
- Night sweats
- Sleep disruption
- Mood changes
- Anxiety
- Depression
- Hair loss
- Genital dryness
- Vulvar discomfort
- Genitourinary symptoms (We’ll discuss these are below!)
Importantly, these symptoms should not automatically be dismissed as “just testosterone.”
What Are Some Common Menopause Symptoms in People Taking Testosterone?
Vasomotor Symptoms (Hot Flashes and Night Sweats)
Hot flashes and night sweats are among the most common complaints.
Before assuming these symptoms are caused by menopause alone, clinicians should consider how testosterone and other factors might be affecting the individual:
- Testosterone dosing frequency – changing dose frequency might help!
- Peak and trough hormone levels – they may be able to be smoothed out.
- Sleep disorders
- Alcohol use
- Caffeine use
- Stimulant medications
- Other medical conditions
Treatment options may include adjusting testosterone therapy, adding progesterone or estrogen, nonhormonal medications, sleep interventions, or other individualized approaches.
Sleep Problems
Poor sleep may result from:
- Night sweats
- Hormonal changes
- Sleep apnea
- Stress
- Mental health concerns
Addressing the underlying cause of poor sleep is often more effective than treating insomnia alone.
Mood Changes
Most people find testosterone supports their mood; however, occasionally people have worsening mood or different mood patterns on testosterone. Mood symptoms may include:
- Anxiety
- Irritability
- Depression
- Quickly changing emotions
- Difficulty concentrating
For some people, symptoms improve with hormone optimization. Others benefit from therapy, exercise, medications, mindfulness-based interventions, or a combination of approaches.
What Is Genitourinary Syndrome of Menopause (GSM)?
One of the most under-recognized aspects of transgender medicine is genital atrophy and tissue changes in patients using systemic testosterone therapy. This presents very similar to Genitourinary Syndrome of Menopause (GSM), which is a set of symptoms often experienced during perimenopause and menopause. Genitorurinary symptoms can happen in patients taking testosterone much younger than in people not taking testosterone. Many transgender people experience these symptoms while taking testosterone.
Symptoms can include genital and urinary symptoms:
- Dryness
- Burning
- Irritation
- Pain with penetration
- Urinary urgency
- Recurrent urinary tract infections
- Pelvic discomfort
- Changes in genital tissue size, shape, and fullness.
Treatment options may include:
- Local estrogen therapy
- Moisturizers
- Lubricants
- Pelvic floor physical therapy
- Ospemifene (ospemifene is an oral Selective Estrogen Receptor Modifier (SERM) that narrowly targets vaginal tissues without affecting uterine tissue.) (More on SERMs here.)
For many patients, local estrogen therapy can significantly improve symptoms without interfering with gender affirmation goals.
Menopause After Hysterectomy and Oophorectomy
Transgender and gender diverse people who have undergone hysterectomy with removal of one or both ovaries may experience surgical menopause or primary ovarian insufficiency.
Symptoms can resemble both traditional menopause and testosterone-associated symptoms, including:
- Hot flashes
- Sleep disruption
- Mood changes
- Genitourinary symptoms
- Changes in sexual function
In these situations, treatment plans often require careful consideration of both gender affirmation goals and menopause symptom management.
Do I Have To Be On Testosterone To Get Gender Affirming Perimenopause and Menopause Support?
No! Perimenopause is a time when both the amount of and ratio of hormones present in the body can change rapidly while also decreasing. Gender affirming care is for everyone, and can be particularly powerful for gender diverse people who are experiencing hormonal fluctuations.
Gender Affirming Hormone Therapy During Perimenopause and Menopause
Traditional cis perimenopause and menopause hormone care is estrogen-based. Not all queer, transgender, nonbinary, and gender diverse people seeking support during perimenopause or menopause want estrogen-based hormone replacement therapy.
Some people enter perimenopause or menopause without previously using gender affirming hormones and find that hormonal changes bring new opportunities to explore what feels most affirming in their bodies. Others may have longstanding gender identities that become more important to them during this stage of life. Gender identies may also shift during perimenopause and menopause.
While estrogen can be an excellent option for many people, it is not the only option.
Depending on a person’s goals, treatment approaches may include:
- Testosterone therapy alone
- Estrogen therapy alone
- Testosterone and estrogen together
- Testosterone and progesterone together
- Estrogen and progesterone together
- Individualized combinations of hormones
- Nonhormonal approaches to symptom management
For example, some people may seek low-dose testosterone to support energy, libido, mood, or body composition while also addressing menopausal symptoms. Others may prefer estrogen, progesterone, nonhormonal medications, or a combination approach.
The most appropriate treatment is not determined by a person’s sex assigned at birth. Instead, treatment should be guided by the individual’s anatomy, symptoms, health history, goals, values, and desired relationship with their body.
Menopause can be an opportunity not only to manage symptoms, but also to create a hormone regimen that better reflects who a person is and how they want to experience their body moving forward.
Hormone Therapy During Menopause
There is no single “right” hormone regimen.
The best approach depends on:
- What body parts the person has.
- What their current hormone situation is.
- Gender identity
- Desired physical changes
- Medical history
- Personal risk tolerance
Some queer, transgender and nonbinary people may choose:
- Testosterone alone
- Testosterone plus estrogen
- Testosterone plus progesterone
- Estrogen plus progesterone
- Other individualized approaches
Our goal is not to create a standardized menopause experience. We hope to help each person feel comfortable in their body while protecting their long-term health.
Bone Health, Heart Health, and Healthy Aging
Risks of osteoporosis and cardiovascular disease increase with age. Hormone therapy may help lower risks due to aging. Current evidence does not suggest that testosterone therapy increases cardiovascular risk, although transgender people experience higher rates of cardiovascular disease overall, likely due in part to minority stress and healthcare inequities. As family medicine-trained physicians, we believe in monitoring disease risks and discussing interventions that can help to lower risk when appropriate. Some of the risks we want to keep an eye on include:
- Cardiovascular health
- Blood pressure
- Cholesterol
- Diabetes risk
- Bone density
- Vitamin D status
Frequently Asked Questions
Can testosterone stop menopause?
No. Testosterone may change how menopause presents, but it does not prevent aging or eliminate menopause-related health considerations.
Can estrogen stop menopause?
No. Estrogen may help lessen some symptoms of menopause, but does not stop the process.
Can I use local estrogen while taking testosterone?
Many transgender people safely use local estrogen therapy for GSM symptoms while continuing testosterone.
Can menopause worsen gender dysphoria?
Yes. Some people find that hormonal and physical changes during menopause increase dysphoria, while others experience greater comfort in their bodies.
Is there a standard menopause protocol for transgender people?
No. Menopause care should be individualized based on anatomy, hormone exposure, health history, and personal goals.
The Bottom Line
Perimenopause and menopause are not experiences limited to cisgender women. Transgender, nonbinary, and gender diverse people also navigate hormonal changes, aging, and menopause-related symptoms.
The most effective menopause care starts with curiosity, respect, and individualized treatment plans that honor both physical health and gender affirmation goals.
Created in June, 2026.
