Original Articles| Volume 35, ISSUE 4, P450-456, August 2022

Experiences with Menses in Transgender and Gender Nonbinary Adolescents

Published:February 02, 2022DOI:


      Study Objective

      To describe menstrual history, associated dysphoria, and desire for menstrual management in transgender male and gender diverse adolescents who were assigned female at birth


      Retrospective chart review


      Tertiary care children's hospital


      All patients seen in a multidisciplinary pediatric gender program from March 2015 through December 2020 who were assigned female at birth, identified as transgender male or gender nonbinary, and had achieved menarche



      Main Outcome Measures

      Patient demographics, menstrual history, interest in and prior experiences with menstrual management, parental support, and concerns about menstrual management


      Of the 129 included patients, 116 (90%) identified as transgender male and 13 (10%) as gender nonbinary, with an average age of 15 (SD 1.6) years. Almost all (93%) patients reported menstrual-related dysphoria. Most (88%) were interested in menstrual suppression. The most common reasons for desiring suppression were achievement of amenorrhea (97%) and improvement of menstrual-related dysphoria (63%).


      Most gender diverse patients assigned female at birth reported dysphoria associated with menses and desired menstrual suppression. This information can encourage physicians to raise this topic and offer menstrual management for gender diverse patients who experience distress related to menses, especially for those who are not ready for or do not desire gender-affirming hormonal treatment. Future research is needed to better understand patients’ experiences with menses and to determine the optimal menstrual management methods. This could be an important intervention to improve outcomes for this vulnerable population.

      Key Words

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        • Rafferty J.
        Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents.
        Pediatrics. 2018; 142e20182162
        • Almeida J
        • Johnson RM
        • Corliss HL
        • et al.
        Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation.
        J Youth Adolesc. 2009; 38: 1001
        • Perez-Brumer A
        • Day JK
        • Russell ST
        • et al.
        Prevalence and correlates of suicidal ideation among transgender youth in California: findings from a representative, population-based sample of high school students.
        J Am Acad Child Adolesc Psychiatry. 2017; 56: 739
        • Day JK
        • Fish JN
        • Perez-Brumer A
        • et al.
        Transgender youth substance use disparities: results from a population-based sample.
        J Adolesc Health. 2017; 61: 729
        • Richards C
        • Bouman WP
        • Seal L
        • et al.
        Non-binary or genderqueer genders.
        Int Rev Psychiatry. 2016; 28: 95
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Association, 2013
        • Pradhan S
        • Gomez-Lobo V
        Hormonal contraceptives, intrauterine devices, gonadotropin-releasing hormone analogues and testosterone: menstrual suppression in special adolescent populations.
        J Pediatr Adolesc Gynecol. 2019; 32: S23
        • Carswell JM
        • Roberts SA
        Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents.
        Transgend Health. 2017; 2: 195
        • de Vries ALC
        • Cohen-Kettenis PT
        Clinical management of gender dysphoria in children and adolescents: the Dutch approach.
        J Homosex. 2012; 59: 301
        • Chrisler JC
        • Gorman JA
        • Manion J
        • et al.
        Queer periods: attitudes toward and experiences with menstruation in the masculine of centre and transgender community.
        Cult Health Sex. 2016; 18: 1238
        • Armuand G
        • Dhejne C
        • Olofsson JI
        • et al.
        Transgender men's experiences of fertility preservation: a qualitative study.
        Hum Reprod. 2017; 32: 383
        • Thorne N
        • Witcomb GL
        • Nieder T
        • et al.
        A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary.
        Int J Transgend. 2019; 20: 241
        • Newcomb ME
        • Hill R
        • Buehler K
        • et al.
        High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults.
        Arch Sex Behav. 2020; 49: 645
        • Ahmad S
        • Leinung M
        The response of the menstrual cycle to initiation of hormonal therapy in transgender men.
        Transgend Health. 2017; 2: 176
        • Deutsch MB
        • Bhakri V
        • Kubicek K
        Effects of cross-sex hormone treatment on transgender women and men.
        Obstet Gynecol. 2015; 125: 605
        • Pelusi C
        • Costantino A
        • Martelli V
        • et al.
        Effects of three different testosterone formulations in female-to-male transsexual persons.
        J Sex Med. 2014; 11: 3002
        • Nakamura A
        • Watanabe M
        • Sugimoto M
        • et al.
        Dose-response analysis of testosterone replacement therapy in patients with female to male gender identity disorder.
        Endocr J. 2013; 60: 275
        • Spratt DI
        • Stewart II
        • Savage C
        • et al.
        Subcutaneous injection of testosterone is an effective and preferred alternative to intramuscular injection: demonstration in female-to-male transgender patients.
        J Clin Endocrinol Metab. 2017; 102: 2349
        • Cocchetti C
        • Ristori J
        • Romani A
        • et al.
        Hormonal treatment strategies tailored to non-binary transgender individuals.
        J Clin Med. 2020; 9: 1609
        • Olson J
        • Schrager S
        • Belzer M
        • et al.
        Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria.
        J Adolesc Health. 2015; 57: 374
        • Harris PA
        • Taylor R
        • Thielke R
        • et al.
        Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377
        • SAS® 9.4 Statements
        SAS Institute Inc., Cary, NC2013
        • Elmaoğulları S
        • Aycan Z
        Abnormal uterine bleeding in adolescents.
        J Clin Res Pediatr Endocrinol. 2018; 10: 191
        • American College of Obstetricians and Gynecologists
        Committee Opinion No. 760: Dysmenorrhea and endometriosis in the adolescent.
        Obstet Gynecol. 2018; 132: e249
        • Vichnin M
        • Freeman EW
        • Lin H
        • et al.
        Premenstrual Syndrome (PMS) in adolescents: severity and impairment.
        J Pediatr Adolesc Gynecol. 2006; 19: 397
        • Altshuler AL
        • Hillard PJA
        Menstrual suppression for adolescents.
        Curr Opin Obstet Gynecol. 2014; 26: 323
        • American College of Obstetricians and Gynecologists
        Committee Opinion No. 668: Menstrual manipulation for adolescents with physical and developmental disabilities.
        Obstet Gynecol. 2016; 128: e20
      1. U.S. Census Bureau: 2012-2016 American Community Survey five-year estimates. 2017,