TRANSGENDER HEALTH

There isn’t currently much data about transgender health and menopause.

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To determine your health care needs, find a provider who understands your health issues and with whom you feel comfortable sharing your history and concerns. Once you've established a relationship with your provider, share the history of your past and current gender-related use of hormones and surgical interventions. Knowing your current anatomy is important for your doctor to offer appropriate screening and treatment.

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Transgender women don't undergo perimenopause as their estrogen level is constant through their estrogen therapy. It is reasonable in transgender women who have undergone gonadectomy to consider decreasing or stopping hormone therapy around the age of menopause--52- but it is also reasonable to continue on hormones. If hormones are stopped, some women have hot flashes and night sweats. They can last for a few months or many years. They can come and go over time. They can be mild or quite severe.  Generally, they reduce in frequency and severity over time. There is no evidence to support continuing or stopping hormones for older transgender women.

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Transgender women who retain their gonads but withdraw hormone therapy may experience return of virilization. They may wish to continue on hormone therapy to prevent this.

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Transgender men might need cancer screening tests. Anyone with a female reproductive anatomy may need routine cancer surveillance testing.

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The process of going through perimenopause and into menopause is a continuum and one can experience a variety of symptoms at various stages of this process. These symptoms typically become milder over time and can last from a few months to many years. 

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For transgender men, the use of testosterone has an effect on vaginal tissue by inducing a hypo-estrogenic state which can increase urogenital symptoms. There are local hormonal and mechanical treatment options available.

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A discussion of the pros and cons of options with individualized and shared decision making is recommended.