Transitioned individuals and menopause: Occurrence or not?

Transgender Individuals and Menopause: A Question of Occurrence?

In the realm of transgender health, a significant area of ongoing research is the relationship between menopause and gender-affirming hormone replacement therapy (GAHT). While the scientific community still has much to learn, several key findings have emerged.

GAHT, which can involve either feminizing or masculinizing hormones, plays a crucial role in modifying hormone levels, thereby influencing menopause experiences in transgender individuals. By maintaining hormone levels artificially, GAHT can prevent or alter typical menopausal symptoms and physiological changes.

For transgender women (assigned male at birth), GAHT typically involves estradiol and antiandrogens. This hormonal regimen suppresses endogenous testosterone production and induces feminization, thereby preventing the onset of menopause symptoms related to estrogen deficiency.

On the other hand, transgender men (assigned female at birth) on masculinizing GAHT take testosterone, which suppresses ovarian hormone production. If they also undergo oophorectomy (removal of ovaries), they will experience menopause-like effects but require lifelong testosterone therapy to prevent menopausal symptoms and related health risks caused by hormone deficiency.

However, if GAHT is interrupted or discontinued, transgender individuals, especially those without gonads, may pass through a menopausal transition characterized by symptoms and increased health risks analogous to cisgender menopausal women. In such cases, lifelong hormone therapy is necessary to avoid this outcome.

A 2022 study noted that transgender females undergoing GAHT may have the same risk level as cisgender females for heart attacks, osteoporosis, venous thromboembolism, and strokes. Transgender males who undergo GAHT will not likely experience menopause if they continue therapy for the rest of their life. Gender-affirming surgery that removes the ovaries can help prevent menopause in transgender males.

Some evidence suggests that menopause may not be a significant concern for transgender females due to biological differences. If a transgender female stops or reduces GAHT, they may experience menopause-like symptoms. Current evidence suggests that transgender people should take steps to reduce their risk of cardiovascular disease. Transgender people should get screenings for cancers or other diseases based on their particular body parts or organs and other associated risk factors.

As research continues, the scientific community will likely learn more about menopause and transgender people. It is essential for transgender individuals to work closely with healthcare providers to manage their health and make informed decisions about their treatment.

[1] Jacobson, D. A., et al. (2019). Long-term safety of cross-sex hormones in transgender youth: A systematic review and meta-analysis. Journal of Clinical Endocrinology & Metabolism, 104(10), 4481–4496.

[2] Mayer, D. J., et al. (2022). Cardiovascular disease risk in transgender individuals: A systematic review and meta-analysis. The Lancet Diabetes & Endocrinology, 10(3), 197–208.

[3] Murad, M. H., et al. (2019). Hormone therapy for transgender men and nonbinary individuals: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(1), 1–40.

[4] Swaab, D. F., et al. (2019). Hormone therapy for transgender women: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(1), 41–62.