The Shared Frontier of Menopause and Gender-Affirming Care

Gender-affirming care is a much broader category than what often comes to mind. We generally think of gender-affirming care as a category of medicine that is reserved for trans people; gender-affirming hormone therapy (GAHT), surgical interventions, feminizing and masculinizing cosmetic surgeries. But the fact of the matter is, gender-affirming care is a category of medicine that’s accessed by people of all genders.

For example, when a cis man (especially one over a certain age–but really at any time) supplements their endogenous testosterone with the pharmaceutical version, that cis man is accessing gender-affirming care. Not only that, the numbers show that substantially more cis men than trans men, nonbinary people, or other gender-expansive people avail themselves of gender-affirming top surgeries. When a cis woman avails herself of menopausal hormone therapy (MHT), that’s gender-affirming care. Breast implants are another obvious category. For many, so are Botox, neck lifts, BBLs, and more.

The double standard

However, the sad truth is that when cis people access gender-affirming care, it’s sacrosanct. When trans people do, that’s when gender-affirming care becomes controversial. As a trans person, an expert who is helping to shape the field of gender-affirming menopause care, and the founder of the Genderqueer Futures Gender-Affirming Menopause Care Certification Course, I believe a solid solution to this quandary — one that will level the playing field, protect trans people, and allow us all to more easily access the care we need and deserve — is to acknowledge this category of care for what it is: gender-affirming care. And to name it that, regardless of who is on the receiving end of the interventions being implemented.

Moving toward a more neutral healthcare

Gender-affirming care, whether in menopause care or elsewhere, has the potential to improve care for patients across the board. This is especially so when assumptions about gender and desired outcomes are set aside, and each patient is engaged with as a unique person with unique care goals. When providers begin treating this as a value-neutral field of care that is truly accessible to everyone, the climate will slowly shift. And over time, it will become safer and easier for trans people to access the life-saving care that cis people access so easily and readily.

Healthcare equity, menopause, and gender-affirming care

When it comes to menopause care, trans and gender-expansive people deserve to treat the impacts of menopause in ways (and in settings) that feel congruent to our gender experience, treatment goals, and desired gender outcomes. If that means having access to GAHT and MHT simultaneously, so be it. (Many an endocrinologist is already fully capable of administering this line of treatment.) If it means treating the ramifications of early menopause via gender-affirming hysterectomy, that is a choice we need to be supported in finding our way through.

Trans people deserve equitable access to life-saving care across the lifespan. We need and deserve the same quality-of-life improvements and adjustments that cis people access regularly without a second thought. Whether GAHT, Botox, or breast augmentation for the dolls, or top surgery, a firmer jawline, or a gender-affirming hysterectomy for the guys, we deserve the same, often superior, and always more easily accessed standard of care that is offered to cis people in nearly every case.