Medically reviewed by Michelle Forcier, MD, MPH — Licensed in Massachusetts | Last reviewed: June 2026
If you are a trans man, a transmasculine person, nonbinary, gender-expansive, intersex, or Two-Spirit — and you were born with ovaries — menopause may be part of your health picture. Whether it comes from natural aging, surgical removal of your ovaries, or changes in how your body responds to hormones over time, the experience is real. And the healthcare system is, for the most part, not ready for you.
Most menopause content is written for cisgender women. Most menopause providers have little to no training in gender-affirming care. Most gender-affirming care providers have little to no training in menopause. That leaves you in a gap that no one else is going to close unless someone names it and builds care around it.
This article is about menopause for people who are not cisgender women. What it looks like, how it intersects with gender-affirming hormones, what it means for your body and your identity, and what care is actually available. If you are a lesbian, bisexual, or queer cis woman looking for menopause content, we have a dedicated article for you: Menopause for Lesbians and Queer Cis Women.
Who is this article for?
This article is for anyone who was born with ovaries and does not identify as a cisgender woman. That includes, but is not limited to:
- Trans men and transmasculine people — whether or not you are currently taking testosterone
- Nonbinary people — regardless of whether you use hormones or have had surgery
- Gender-expansive, genderqueer, genderfluid, and agender people
- Intersex people who may experience hormonal shifts related to ovarian aging
- Two-Spirit people and others whose relationship to gender does not fit Western binary categories
Your experience of menopause may look very different from what mainstream resources describe. That does not mean it is not happening. It means the conversation has not caught up to you yet.
Can you go through menopause if you are on testosterone?
Yes. This is one of the most under-discussed questions in both trans healthcare and menopause care.
Testosterone suppresses menstrual cycles and reduces estradiol production. But it does not stop ovarian aging. If you have ovaries and you are taking testosterone, those ovaries will still undergo the functional changes associated with getting older. Whether you notice symptoms depends on how much residual estrogen your ovaries are still producing, how your body responds to declining estrogen in the presence of exogenous testosterone, your individual physiology, and how long you have been on testosterone.
Some people on long-term testosterone report no menopausal symptoms at all. The testosterone may functionally override the effects of estrogen decline. Others experience hot flashes, mood changes, brain fog, sleep disruption, or vaginal atrophy that gets worse with age. There is limited formal research on this — most of what clinicians know comes from clinical experience with patients, not from large studies.
This means two things. First: if you are on testosterone and experiencing symptoms that could be perimenopause, that is a valid and important question to bring to a clinician. Second: your clinician needs to have experience with both gender-affirming hormone therapy and menopause. Most mainstream menopause providers do not know how to think about testosterone in this context and they might not offer care to gender diverse people at all. And most gender-affirming care providers may not be thinking about menopause in their care.
What symptoms might you notice?
Some of the symptoms that may signal perimenopause or menopause in someone taking testosterone include:
- Hot flashes or night sweats that are new or worsening
- Changes in sleep quality that are not explained by other factors
- Mood shifts — increased irritability, anxiety, or low mood — that feel different from your baseline
- Brain fog, difficulty concentrating, or feeling cognitively "slower"
- Vaginal or front hole dryness, irritation, or discomfort (sometimes called vaginal atrophy or genitourinary syndrome of menopause)
- Changes in urinary function or increase in frequency of UTIs (urinary tract infections)
- Changes in libido or sexual response
- Joint pain or body aches that are new
- Heart palpitations that are unrelated to cardiovascular disease
The tricky part is that some of these symptoms can overlap with other things: testosterone side effects, stress, depression, thyroid issues, sleep apnea, or just the general experience of being a person in midlife with a lot going on. That is why clinical evaluation matters. You do not need to have it figured out before you ask for help.
Surgical menopause and gender-affirming care
If you have had a bilateral oophorectomy — removal of both ovaries — as part of gender-affirming surgery, you have experienced surgical menopause. This is true regardless of your age and regardless of whether you are taking testosterone.
Surgical menopause is different from natural menopause in one critical way: it is abrupt. Instead of a gradual decline in estrogen over years, your body loses its primary source of estrogen and progesterone all at once. Symptoms are often more intense and more immediate than in natural menopause.
Even if you are on testosterone, the sudden loss of endogenous estrogen can still cause:
- Vasomotor symptoms like hot flashes and night sweats
- Accelerated bone density loss
- Mood changes, including new or worsening anxiety or depression
- Cardiovascular risk changes over time
- Vaginal or front hole dryness and urinary changes
Current medical guidance does not recommend going without sex hormones in early or mid-adulthood. If you have had an oophorectomy and are not on any hormone replacement — including testosterone — this is worth discussing with a clinician. Testosterone alone may be sufficient for many people, but not all. The long-term implications for bone health, cardiovascular health, and overall well-being deserve a real conversation, not an assumption.
If you had your ovaries removed years ago and no one ever discussed menopause with you, you are not alone. This is a gap in care that happens frequently — and it is worth revisiting now, no matter how much time has passed.
Dysphoria and menopause: the part nobody warns you about
Menopause symptoms can trigger or intensify gender dysphoria in ways that catch people completely off guard. Just the reminder of the fact that estrogen has control over how your body feels can be tricky to navigate for some people. This section exists because almost no one talks about it, and it matters.
Hot flashes draw sudden, unwanted attention to your body. Breast tenderness — if you have not had top surgery — can be a visceral reminder of anatomy you may already have a complicated relationship with. Mood swings can feel like losing control of an emotional landscape you have spent years learning to manage. Weight redistribution, skin changes, and shifts in body composition can feel destabilizing.
And then there is the context around menopause itself. The cultural conversation, the marketing, the provider language, the intake forms, the waiting room pamphlets — almost all of it is deeply, relentlessly gendered. Seeking care for your menopause symptoms can mean wading through language that feels alienating, invalidating, or just wrong. That is not a small thing. It can be enough to stop someone from getting care at all.
If menopause is making your dysphoria worse, that is not a sign that something is wrong with you. It is important clinical information. It should inform your treatment plan — the medications your clinician considers, the language they use, the goals they help you set. You should not have to choose between treating your menopause symptoms and honoring your gender. A provider who understands both can help you do both.
And if you are finding that menopause is bringing up new questions about your gender, your body, or your relationship to either — that is also valid. Midlife hormonal shifts can surface things that were always there but never had a name. You are allowed to explore that in your own time, in your own way, with support that does not rush you.
Menopause for nonbinary and gender-expansive people
Nonbinary experiences of menopause are among the least represented in research, clinical training, and public conversation. A 2024 study found that nonbinary people face particular difficulty finding "inclusive resources" and described "challenges in talking about menopause" even with friends and family — let alone with healthcare providers.
If your gender does not fit neatly into a binary, navigating menopause can mean:
- Being told menopause is a "women's issue" when it is happening in your body and you are not a woman
- Having to choose between healthcare spaces that feel wrong and having no care at all
- Struggling to find language for what is happening that feels accurate to your experience
- Encountering providers who default to binary gender frameworks, use only "she/her" in menopause contexts, and do not know how to talk about bodies without making assumptions about identity
Some nonbinary people experience menopause as relatively straightforward. Symptoms show up, treatment helps, life continues. Others find that menopause interacts with their gender identity in complex ways. Some feel more settled in their body after menopause. Others find new discomfort emerging. Some use menopause as an opportunity to explore gender-affirming hormones for the first time. All of this is valid.
The treatment options for nonbinary people are the same as for anyone else: menopause hormone therapy, non-hormonal medications, lifestyle support, mental health care. The difference is having a provider who can discuss these options without misgendering you, who uses anatomical language you are comfortable with, and who centers your goals rather than making assumptions about what you should want.
Treatment: same options, different conversation
The medications and interventions available for menopause do not change based on your gender identity. But how they are discussed, offered, and fitted into your life should.
Here is a brief overview. Each option is covered in more depth in other FOLX articles, and your clinician can help you figure out what fits your specific situation.
Menopause hormone therapy
Estrogen-based hormone therapy is the most effective treatment for hot flashes, night sweats, mood changes, brain fog, and bone health during menopause. For trans men and transmasculine people on testosterone, the idea of adding estrogen can feel complicated — and that is understandable. But low-dose estrogen for menopause is not the same as the estrogen levels your body produced before testosterone. The goals, the doses, and the effects are different.
Some options to discuss with your clinician:
- Local vaginal or front hole estrogen: For dryness, irritation, discomfort, and urinary symptoms. Minimal systemic absorption. Considered very low risk. This is often the easiest starting point for people who are hesitant about estrogen, because so little reaches the rest of your body.
- Systemic estrogen (patch, gel, cream, or pill): For hot flashes, night sweats, mood, sleep, and bone health. The dose used in menopause care is much lower than premenopausal estrogen levels. Whether this fits alongside testosterone depends on your symptoms, your goals, and your health picture. This is a clinical conversation, not a yes-or-no answer.
- Progesterone: Required if you have a uterus and are taking systemic estrogen, to protect the uterine lining. Oral micronized progesterone is taken at bedtime and may also support sleep.
For a detailed look at the evidence on hormone therapy safety, see: Is HRT Safe?
Non-hormonal options
If hormone therapy is not right for you — or if you want to address specific symptoms without hormones — there are effective non-hormonal treatments.
- Veozah (fezolinetant): A newer medication that targets the brain pathway behind hot flashes. Does not affect hormone levels. May be particularly relevant for people who do not want to add estrogen.
- SSRIs (paroxetine, citalopram): Can help with hot flashes and mood symptoms. Paroxetine is FDA-approved specifically for menopausal vasomotor symptoms.
- Gabapentin: Effective for night sweats and sleep disruption. Often taken at bedtime.
Mental health support
Menopause can bring up a lot — emotionally, physically, and in terms of identity. If you are managing menopause on top of existing minority stress, gender dysphoria, discrimination, or the cumulative weight of navigating a world that was not built for you, mental health support is not an add-on. It is part of care.
FOLX offers therapy and mental health medication management with LGBTQIA+-specialized providers who understand what it means to hold all of these things at once.
What FOLX offers
FOLX was built for this exact intersection. Our clinicians include Menopause Society Certified Practitioners who are also experts in LGBTQIA+ health and gender-affirming care. That combination is rare. It means you do not have to educate your provider about your identity before you can talk about your symptoms.
- Telehealth visits from anywhere in the country — no waiting room, no "women's health center" lobby
- Clinicians who understand how gender-affirming hormones interact with menopause
- Inclusive language and anatomical terminology as a default
- A Community Platform where you can connect with other LGBTQIA+ people
- Insurance accepted, with affordable out-of-pocket options starting at $25/month
You do not have to fit into a framework that was not built for you. You do not have to choose between affirming care and competent menopause care. At FOLX, you get both.
Frequently Asked Questions
Can trans men go through menopause?
Yes. Trans men who have ovaries can experience perimenopause and menopause through natural aging, even while on testosterone. If ovaries have been removed, surgical menopause occurs immediately. Testosterone suppresses menstrual cycles but does not fully prevent the hormonal changes associated with ovarian aging. If you are wondering whether what you are experiencing might be menopause, a clinician with experience in both gender-affirming care and menopause can help you figure it out.
Does testosterone replace the need for HRT during menopause?
Not necessarily. Testosterone provides androgenic hormones but does not fully replicate the role estrogen plays in bone health, cardiovascular health, temperature regulation, and other physiological functions. Whether additional hormone therapy is appropriate depends on your symptoms, your anatomy, your age, and your goals. This is a conversation to have with a provider who understands both gender-affirming care and menopause.
Can menopause make gender dysphoria worse?
It can. Menopause symptoms like breast tenderness, hot flashes, mood changes, and the deeply gendered framing of menopause in culture and healthcare can trigger or intensify dysphoria. If this is happening, it is important clinical information that should shape your care plan. You should not have to choose between treating menopause and honoring your gender.
Is it safe to take estrogen for menopause if I am also on testosterone?
In some cases, yes. Low-dose local estrogen — particularly vaginal or front hole estrogen for dryness or atrophy — is generally considered compatible with testosterone and has minimal systemic effects. Systemic estrogen alongside testosterone is a more complex clinical decision that depends on your symptoms, goals, and health picture. FOLX clinicians have specific experience with this.
Do nonbinary people need menopause care?
If you have ovaries and you are experiencing symptoms, yes. Menopause is a physiological process, not a gendered one. Treatment options are the same regardless of gender identity, and you deserve care that does not require you to fit into a binary framework.
What if I had my ovaries removed years ago and no one discussed menopause with me?
This happens more often than it should. If you had a bilateral oophorectomy and have not been evaluated for the effects of surgical menopause — including bone health, cardiovascular risk, and symptom management — it is worth bringing up with a clinician now, regardless of how much time has passed.
What if I am not sure whether what I am experiencing is menopause?
That uncertainty is common, and it is especially common for people whose bodies, hormones, and health histories do not fit neatly into the standard menopause narrative. You do not need to have it figured out before making an appointment. That is exactly what a FOLX clinician is there to help you work through.
FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), menopause care, mental health care, sexual and reproductive health care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more.
