Written by Robin Craig
Menstruation can be particularly tricky to navigate if you’re a trans or non-binary person.
This is because feelings of gender dysphoria — the distress a person feels when the sex they were assigned at birth does not correlate with their gender identity — might be heightened around your period.
Periods can be triggering because they are often considered solely a “women’s issue,” leaving trans or non-binary people who menstruate feeling excluded and othered. The hyper-feminine language and bright colors used on period products also don’t help, often making feelings of unease, upset, and isolation much worse.
Fortunately, there are things trans and non-binary people can do to protect their mental health while menstruating. Keep reading for tips from the experts, plus gender-neutral period product advice, and information on how gender-affirming hormones might affect your cycle.
It’s important to remember that not every trans and non-binary person who menstruates will feel dysphoric about their period. This is because, as Jack Doyle, trans health advocate, explains: “Every trans person has a unique relationship to their body — pretty similarly to cisgender women [someone whose gender identity matches the sex they were assigned at birth]. [That means] there’s a wide range of feelings about periods, and transness isn’t defined solely by dysphoria.”
For those who do experience dysphoria, there are some practical steps you can take to protect your mental well-being. Doyle recommends “building gender affirmation into your routine — like planning gender-affirming outfits, being around other trans people, and cutting out potential dysphoria triggers like social media.” This can help you feel more like yourself.
Painful periods might also act as a trigger for gender dysphoria. Jessee Lovegood, an associate marriage and family therapist who works with trans and non-binary teens, says “it can help to set reminders to take supplements or pain killers or [use] a heating pad or hot water bottle” in order to manage symptoms like cramps. Having a pain-free period can help take your mind off it and allow you to focus on things that can distract you from dysphoria, such as your favorite self-care activities.
Tapping in to a supportive network of trans and non-binary people and allies is also useful. You can read our guide to finding an LGBTQ-inclusive doctor or therapist here. Talking to others with a shared experience can help with the feelings of isolation and loneliness brought on by periods. This network could be in-person (through friends and local support groups for trans and non-binary people) or via online forums and social networks.
“Having a community helps us learn about options for dealing with problems that we may not have been able to come up with alone and to have people to help us feel heard, seen, and understood,” Lovegood explains.
Some period products come in very gendered packaging, but a lot of brands have begun using gender-neutral language that may help you if buying products labelled “for women” makes you feel dysphoric. Some brands have removed gendered language from their products altogether, such as tampon and pad brands Aunt Flow and GladRags, while Always removed the Venus symbol from their packaging in 2019 to be more inclusive of trans and non-binary people who menstruate.
There are a range of period products available depending on your needs and preferences. Many people use tampons, which are soft cotton or rayon-based products inserted into the vagina to absorb blood. Tampons must be changed every four to eight hours, but while inserted they cannot be felt, so it can be easy to forget that you are menstruating.
Similarly, menstrual cups are inserted into the vagina to catch blood as it flows from the uterus. Menstrual cups are flexible funnel-shaped cups made of rubber or silicone that are inserted by folding them in half and inserting them like a tampon. They can be worn for 6–12 hours before needing to be emptied, washed, and reinserted. You can buy gender-neutral menstrual cups from Lunette.
For those who are not able to use insertable period products, pads are an alternative option. Pads are rectangles of soft material that stick to your underwear and catch period blood. They need to be changed approximately every six hours during the day and are available in disposable or washable form.
Period underwear are another option for managing menstruation. They have an absorbent gusset that soaks up blood the same way a pad does, but they should feel dry unless it’s time to change them. Period underwear needs to be changed and washed after about six to eight hours, depending on flow and absorbency, so having multiple pairs is best. They come in a range of different styles: TomboyX offers absorbent boxer briefs, and Thinx sells absorbent boyshorts for trans and non-binary people.
If a trans man or non-binary person begins gender-affirming testosterone therapy, it can take a few months for their periods to stop. Exactly how long it takes depends on the person, as gender-affirmative health care specialist Dr. Adrian Harrop and consultant endocrinologist Dr. King Sun Leong explain: “[It] does tend to vary quite a lot from person to person; however, in most cases, we would usually expect periods to stop within three months of starting testosterone.”
It is still possible to have periods or breakthrough bleeding while taking testosterone. Dr. Harrop and Dr. Leong say breakthrough bleeding “is mostly seen in those patients who are not taking an adequate or fully-optimized dose of testosterone.” They add that bleeding is most common in the first few months of treatment “while your body is adapting to the changes in your internal hormone balance.”
People don’t always realize that taking very high doses of testosterone can actually result in periods restarting, because the excess testosterone gets converted back into estrogen. This is because, as Dr. Harrop and Dr. Leong explain, “a person’s body can only use so much testosterone at any one time.” They recommend discussing unexpected episodes of bleeding straight away with your doctor or the gender-affirmative care provider prescribing your hormone therapy.
If you have been taking testosterone and decide to stop, Dr. Harrop and Dr. Leong say that “in general, a person who has been taking testosterone at an optimized dose would normally expect their periods to resume after a few months of not taking it.” It tends to take longer for periods to return for people who have been on testosterone for longer periods of time, they add, and in some cases, particularly in older patients, periods may not return at all.
Remember that trans men and non-binary people on testosterone can still become pregnant. In fact, a recent U.S. study found that 61 percent of pregnant trans men and non-binary people surveyed had used testosterone before becoming pregnant, and of these pregnancies, a quarter were unplanned. That’s why it’s so important to keep using contraception if you are sexually active to prevent unplanned pregnancy.
While periods might be difficult to navigate if you are a trans or non-binary person who experiences period-related dysphoria, there are steps you can take to protect your mental health during your cycle.
Building gender affirmation into your routine and mitigating pain can help, as can using gender-neutral period products. If you decide to use gender-affirming hormone therapy, your periods will usually stop altogether after a few months.
Please note these resources are just for reference and are in no way associated with Flo
If you’ve been affected by anything in this piece or are struggling with your mental health and would like to speak to someone, Flo has gathered links to support services that might be helpful. Please visit this page for helplines in different countries.