When your gender identity differs from the sex you were assigned at birth, hormone therapy and gender-affirming surgeries can help to alleviate gender dysphoria. Once you are living out your chosen gender expression in the way that feels truest to you, what do these hormone therapies or surgeries mean for periods or pregnancy? Do trans women have periods? What is the process for getting pregnant after having undergone gender-affirming care?
Hormonal changes can be an important part of medical transition for trans people and non-binary people. Hormones are chemical messengers produced by the endocrine glands to regulate various bodily functions, including our reproductive health, metabolism, mood, and development. For trans and non-binary people, this can help make the hormone levels in their bodies line up with their gender identity.
There are several different sex hormones that can be used in hormone therapy, and the specific hormones and dosages used will depend on the individual’s needs and goals.
Sexual Hormone Function: Testosterone & Estrogen
For trans men (people who are assigned female at birth but identify as male), testosterone is the main hormone used in hormone therapy. Testosterone can help to masculinize the body by increasing muscle mass, facial and body hair growth, and deepening the voice. It can also reduce breast size and menstrual cycles.
However, taking testosterone does not necessarily eliminate one’s period. Menstruation can cause feelings of serious emotional distress and can affect the health and everyday life of transgender and non-binary people. Gender dysphoria can be alleviated a number of ways, including using a DivaCup or Diva Disc, which means fewer changes and thinking less about your period.
Do Trans Women Have Periods?
For trans women (people who are assigned male at birth but identify as female), estrogen and progesterone are the main hormones used in hormone therapy, as well as anti-androgen medicine to block testosterone.
Estrogen and progesterone help to feminize the body by increasing breast size, reducing muscle mass, and causing the redistribution of fat tissue. Anti-androgen medication will slow or stop the growth of facial and body hair growth, as well as lessen sperm production and testicle size.
Do trans women have periods? Hormone replacement therapy (HRT) will help to feminize the body and can cause a hormonal cycle to start. HRT will simulate the rise and fall of estrogen and progesterone of a typical menstrual cycle, however, bleeding will not occur. People who do not have ovaries and a uterus do not experience bleeds. While bleeding will not occur, symptoms relating to hormonal shifts, like premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) can occur.
For non-binary individuals, hormone therapies can help with the physical changes that will help them align more closely with their gender identity, including menstruation. This could mean helping to start or stop their periods.
Hormones can have powerful effects on the body and potential side effects. It’s important to work closely with health care professionals to monitor hormone levels and overall health and well-being during the process.
Gender-Affirming Care & Pregnancy
Becoming pregnant after gender-affirming care depends on the individual and their hormone therapies and/or gender-affirming surgeries. In some scenarios, pregnancy is possible and in others it could be more difficult.
- Trans men who choose to not have their uterus and ovaries removed could get pregnant, even if testosterone replacement therapy has eliminated a period. The sexual function of these organs may still be intact years after starting testosterone treatment, meaning viable eggs are being produced and can be fertilized.
- Research suggests that in some cases, trans men can choose to stop testosterone replacement treatment in order to get pregnant. How frequent and common ovulation is in these cases is still unclear.
- Trans women may still be capable of producing viable sperm years after starting estrogen replacement treatment and if they are still able to ejaculate could impregnate a partner.
It is, however, always important to discuss the desire for future pregnancy, as well as the potential fertility-preserving options with a healthcare provider before starting hormone therapy or undergoing surgical procedures.
The World Professional Association for Transgender Health has a database so that you can search for a provider in your area. They also provide resources like, the Standards of Care for the Health of Transgender and Gender Diverse People, to ensure you are receiving the highest degree of gender-affirming care.
- “ACOG Releases Guidance on Health Care for Transgender and Gender Diverse Individuals.” Www.acog.org, www.acog.org/news/news-releases/2021/02/acog-guidance-health-care-for-transgender-gender-diverse-individuals.
- Cleveland Clinic. “Gender Affirmation Surgery: What Happens, Risks & Benefits.” Cleveland Clinic, 3 May 2021, my.clevelandclinic.org/health/treatments/21526-gender-affirmation-confirmation-or-sex-reassignment-surgery.
- Harvard Health Publishing. “Testosterone — What It Does and Doesn’t Do.” Harvard Health, 16 July 2015, www.health.harvard.edu/medications/testosterone–what-it-does-and-doesnt-do.
- National Center for Transgender Equality. “Frequently Asked Questions about Transgender People.” National Center for Transgender Equality, 5 Oct. 2018, transequality.org/issues/resources/frequently-asked-questions-about-transgender-people.
- PhD, Elizabeth Boskey, and Oren Ganor MD. “Sexual Health and Gender-Affirming Care.” Harvard Health, 7 Jan. 2021, www.health.harvard.edu/blog/sexual-health-and-gender-affirming-care-2021010721688.
- “WPATH World Professional Association for Transgender Health.” Www.wpath.org, www.wpath.org/.