Things You Need to Know About Gender-Expansive Menopause

Most menopause conversations assume that everyone going through menopause is a cisgender woman, but menopause is a body transition that does not belong to one gender alone. Transmasculine, nonbinary, and other gender diverse and gender-expansive people experience menopause too, often within systems and conversations that were not designed with us in mind.

When menopause care is framed in strictly cisgender ways, it can feel confusing, alienating, or even unsafe to seek support as a genderqueer, trans, or otherwise gender-expansive person. Understanding gender-expansive menopause starts with recognizing that your experience is real, valid, and deserving of affirming care.

Menopause marketing in a pretty pink wrapper

The first thing to know is that menopause is not inherently cis, and treating it that way causes clinical and emotional harm. Menopause marketing, educational materials, and even menopause-specializing medical providers generally assume a cisgender female audience. Pepto-pink wrapper and all, the menopause market screams: “You can maintain your femininity!”

For many of us who are not interested in performing or inhabiting the space of womanhood, this marketing strategy, and more importantly, this clinical frame, only further alienates us from the experience that is the mainstream menopause market.

How exclusion can cause poor health outcomes

Dangerously, the trans, nonbinary, and otherwise gender-expansive people who are unable to access qualified and competent menopause care may experience missed diagnoses, delayed treatment, and a profound sense of isolation during menopause.

The medical ramifications may range from missed diagnosis of severe cases of genitourinary syndrome (GSM) to the possibility of bone loss (which, without a treatment plan, can lead to osteoporosis), muscle loss (which can increase gender-dysphoria, in addition to other impacts), and even development of serious diseases like cardiovascular disease.¹

In addition to physiological impacts, there are emotional and psychological impacts of feeling and being
unconsidered in a field of care that directly impacts us. A sense of invisibility, alienation, and increased
healthcare distrust all have real-life impacts.

What can we do to find care that serves and fits gender-expansive people?

First, seek out providers who have completed specialized training in gender-affirming menopause care, which are designed to help clinicians offer more inclusive, trauma-informed menopause support.

And second, know how to advocate for yourself. Not great at advocating for yourself? It’s a learnable skill! My book, Genderqueer Menopause (North Atlantic Books, January 2026), offers a whole chapter on self- advocacy. There are also materials on this site that can help you more fully develop your self-advocacy skills.

Gender-affirming medical interventions and menopause may interact

Gender-affirming hormone therapy (GAHT) and gender-affirming surgeries (GAS) are life-saving, essential care for many people of trans experience. And, at the same time, these interventions, in many cases, may have under-discussed and serious impacts on long-term health outcomes.

So where do GAHT, GAS, and menopause intersect? Those of us who choose GAHT may experience menopause-like symptoms as we ramp up on high-dose testosterone, and may experience them again if we are at a sub-optimal dose, or if we taper off hormones.²

Those who elect to undergo a gender-affirming hysterectomy will experience an earlier onset of menopause. In the case of a hysterectomy and bilateral oophorectomy (removal of the uterus and both ovaries), one will experience precipitous and irreversible menopause.³

This means a longer timespan without endogenous estrogen (the kind produced in our bodies), which, in many cases, is part of the goal! However, there are many health factors to consider before undergoing GAS.

The fact is, there are very few studies out there focused on trans health and the possible long-term impacts of GAHT and GAS. This being the case, medical providers may shy away from discussing areas of impact that are not fully clear in the data. So, in many cases, it’s up to us to make sure we’re asking ourselves important questions before undergoing permanent alterations to our hormonal landscapes.

In the case of interventions that will have long-term impact, a few questions to ask yourself might be:

1. Will I have ongoing access to prescribed hormones to take the place of the ones my body produces?
2. Do I know what menopause looks like in my family, and am I prepared to weather the experience?
3. Do I want to, and am I ready to, commit to lifestyle choices that will decrease the long-term health impacts of early-onset menopause?

Moving Forward

My final note for today is that cisnormative assumptions don’t just exclude; they actively degrade our quality of care. But there are things we can do to make sure we’re getting the care and support we need. And until medicine catches up with the glory of our diversity, we’ll be here, supporting one another in advocating for the competent and affirming medical care that we need and deserve.