I feel as though I digressed a bit during my last post. But there’s a potent intersectionality between figuring out that I’m trans and having that realization be part of how I’m now understanding other areas of my life. It’s like being trans was this huge part of me that was dormant, and it engulfed other aspects of my identity that couldn’t manifest themselves – like I couldn’t fully know myself without this one major piece coming into alignment. And now, it’s as if all of the other pieces of my life are beginning to shift into place in ways that they couldn’t before. I almost feel like I’m in the type of self-discovery mode of a twenty-something. I now have greater access to my own self-awareness and potential, which is helping me to move forward in my life, and that feels pretty awesome.

Anyway, in this post I want to talk about menopause. I’ve mentioned it as being one of the reasons why I started this project, but haven’t yet elaborated. I haven’t really come across content from other transmasculine people who have acknowledged a link between going through menopause and their self-discovery of being trans. The two may seem very unrelated, but for me personally, this was one of the keys in how I was finally able to understand myself.

Before explaining why, I need to backtrack a bit and give you some context. In my teens, twenties, and thirties, I suffered greatly from endometriosis. For most of that time, it went undiagnosed and I wasn’t even aware that I had it. My pain and symptoms were always brushed off by doctors as being “just bad menstrual cramps,” a common disservice that unfortunately happens to millions of AFAB people experiencing the effects of endo. In my mid-thirties, I was trying to get pregnant, and my ex-wife and I needed the assistance of a fertility clinic. It was these doctors that suspected I had endo and informed me as much. I ended up being infertile, and over the next few years my endo symptoms progressed rapidly. I was in constant, debilitating pain, and knew I needed excision surgery to regain my quality of life. During the time of my pre-op appointment with the surgeon, he informed me that going through the surgery without also having a hysterectomy would be mostly pointless. Keeping my uterus would only allow the endometriosis to continue developing all throughout my pelvic cavity. With that knowledge, I opted for the hysterectomy. I kept my ovaries in an attempt to still maintain my hormone levels and go through a natural menopause. The problem was that they stopped functioning about three years after the surgery. This wasn’t surprising. Both ovaries had been covered in endometriomas, and essentially were mutilated during the excision process, so it’s no wonder they stopped producing hormones so quickly. (As an aside, the surgeon I went to, Dr. Seckin, has devoted his career to researching and treating endo, and is one of the world’s leading experts on the disease. His website is a fantastic resource: https://drseckin.com/endometriosis/  If you’re curious, I had Stage IV and was on the brink of developing Frozen Pelvis.)   

I’ll momentarily digress by mentioning how, now that I know I’m trans, I look back on my severe endometriosis and inability to become pregnant with a new perspective. It almost feels as though these were two notable ways that my body was rejecting my binary female gender. It’s kind of like my brain was blocking out my ability to understand my gender identity, so my body took over in trying to get me to pay attention. It ended up working – it just took a while.

When I was 41, I went into full menopause. My PCP at the time did blood work that confirmed this. He prescribed me an estrogen patch to try and provide my body with some symptom relief. Not only did this not work, but my skin also reacted to the adhesive. It wasn’t very long before I stopped using the patches altogether. I adopted the mindset that women have gone through menopause since existence, and never used hormone therapy. HRT wasn’t even a thing until the 1940’s. I also knew that using it long-term could actually end up causing other very serious health problems. However, it was a bit foolish for me to not account for other impacts of our modern world on women’s health. Among many other factors, our degraded food system and high-stress lifestyles alone can wreak major havoc with our hormones. At the time, I was mostly oblivious to this truth, and never thought to consider other methods of proactively supporting my hormone levels. My western-trained PCP also did not suggest alternatives. 

Over the three years since that time, my body has gone through a lot and has changed drastically. Not all of these changes are attributed to my hormone imbalance – 3 bouts of COVID have been a very significant factor. Each time I’ve contracted it, there have been post-illness side effects that last for months to years. Combined with vaccine injury, Lyme disease, and the midlife changes of menopause, I look and feel like a completely different person than I was a short while ago. In 2020, I had recovered enough from my endometriosis that I was able to start exercising again. Hiking and weight lifting became regular practices that were very beneficial to my physical and mental health. I progressed to the point of nearly being able to run up the nearby 4300’ mountain. I was ascending trails multiple times each week, enjoying both sunrises and sunsets at the summits. I felt incredibly strong, healthy, and vibrant. I was 41 years old and in the best shape of my entire life, which is saying a lot since I was an athlete all throughout my teenage years. I almost couldn’t believe the level of fitness I had been able to achieve after having felt so sick and incapable for so many years. 

Distressingly, my optimal health was extremely short-lived. During that same summer my menopause symptoms began to develop, and they have continued to become more exacerbated as time has elapsed. The summer of 2023 is when I really started to notice that my body was ceasing to positively respond to a healthy diet and exercise. There were the added stressors of having our house flood while simultaneously planning a wedding for that September, so there wasn’t time for my long hikes up the mountains. I was still lifting weights and walking, but this didn’t seem to matter. Then in November of 2023 I signed up for a travel tech assignment and moved two hours away from home. It was extremely difficult and highly stressful to not only be away from my home and the love of my life, but to also be working once again in the medical field that I had intentionally stepped away from one year prior. I took advantage of a few opportunities to hike the local mountains, and was discouraged to realize how much my stamina and agility had deteriorated. To make matters worse, the magnificent mountain wilderness of the area where I was living meant that it was also a food desert. Access to healthy options was extremely limited, which made eating a nutritious diet very challenging. Between that and my constant traveling to and from home on the weekends, I was not doing a great job at properly fueling my body. Add in my severely imbalanced hormones, and this was a recipe for becoming very unhealthy. 

As the months of this past winter wore on, I became increasingly heavier and out of shape.I grew out of all of my clothes and had to increase the size of my scrubs twice between November and June (the beginning and end of my travel gig). At one point mid-spring, I had gone to see my naturopath and lamented about how I couldn’t stop gaining weight. She largely attributed this to my hormone issues, and said the best thing I could do as a postmenopausal person was to perform weight-bearing exercises and drastically increase my daily protein intake to 1.6 grams of protein for each kilogram of body weight. For me at that time, this equated to roughly 120 grams of protein per day which felt nearly impossible for me to achieve. I was also very limited in my ability to perform weight-bearing exercises due to severe muscle and tendon problems resulting from my 3rd COVID infection. I did what I could, but it wasn’t enough and the weight never went down. I felt unbelievably uncomfortable in my body. The weight, of course, mostly showed in all of the “womanly” areas like my chest, hips, and thighs. Initially, I recognized all of my discomfort as feeling defeated in my ability to be physically active, since that had recently been such a large part of my daily life. I couldn’t stand it that I wasn’t able to provide myself with the physical and mental therapy of exercise. It was beyond depressing to not fit in my clothing. I hated being able to feel the weight on my body as I walked and moved about through my days. I tried to give myself the grace of being gentle on myself, but that effort was futile. My weight had always fluctuated up and down for my entire life, but this time it was bothering me in a way that it was constantly infiltrating my awareness.

In other blog posts I’ve mentioned how I had been questioning my gender identity for many years. In the past, I had tamped those feelings down out of the way without giving them space to be fully acknowledged and explored. Last winter, these feelings had materialized once again, except this time they were far too potent to ignore. I began searching for clarity by reading about transgender people and following their content on social media. The more I absorbed, the more I felt a parallel connection to their experiences and stories. I had obviously heard the term “dysphoria” and intellectually understood its broader meaning in the context of other people. But I didn’t understand it enough to know if it applied to me. It was when I took a deep dive down that rabbit hole that many of my aha moments began to burst into my conscious awareness. When I took a closer look at how dysphoria can manifest, it became crystal clear to me that my issue with my weight gain isn’t just about the weight. It’s that the weight has morphed me into looking more female than I ever have before. It has given me curves in all the wrong areas. The worst part of all is my breast tissue. My chest is the largest it has ever been, and it’s not a point of pride for me. Quite the opposite. When I look in a mirror, my eyes are immediately distracted by the fact that my boobs aren’t small enough to be inconspicuous like they were in 2021. There are so many things I can’t stand about them: the fact that I have them; the sight of them; the feeling of them being in the way when I cross my arms; the sensation of the tissue moving when I walk… I am constantly reminded that they’re there. Binding would be one way to help alleviate that dysphoria, but for me it’s not an option. I have hot flashes regularly, and I know that having a tight, restrictive, unbreathable layer on while this is happening would be utterly intolerable. I’ve taken to only wearing oversized, black t-shirts because that’s how I feel my chest is the least noticeable, at least to me.

The change in my physical appearance is one way that menopause contributed to me figuring out that I’m trans. The other way is due to me realizing that my body was desperate for HRT to help support my physiology. I wasn’t crazy about the prospect of going back on estrogen, especially since it hadn’t really helped me in the past. As I was going through the process of researching HRT options, I came across a few websites that talked about low-dose testosterone support for postmenopausal people. The interesting thing for me was the realization that these articles were not related in any way to transgender people – they were specifically targeting cisgender, AFAB women. I had no idea that low-dose T was a potential treatment option for any postmenopausal person. The ovaries of AFAB people not only produce estrogen and progesterone, but they also produce testosterone, albeit at a low level. When hormone production begins to decline as a result of menopause, it decreases the levels of all hormones. Therefore, it’s actually more common than you may think for cisgender women to be prescribed micro-doses of T to help treat their menopause symptoms. (You can read more about this here: https://my.clevelandclinic.org/health/diseases/24897-low-testosterone-in-women )

I experienced a fairly immediate and instinctual response to this new knowledge, and understood that testosterone was not only what my body physically needed – it was also what I psychologically wanted. When I began seriously considering going on T, I noticed a positive energy shift in myself that was absolute. Still, it took me a few months of embracing this energy shift while simultaneously trying to fully comprehend what this meant for me. I had to spend a lot of time imagining what it would feel like to experience the physical changes that would result from being on T, even at a low dose. There were obvious positives that I didn’t have to question, like having my libido and sexual function return. But I did have to seriously contemplate whether I’d be okay with having facial hair, a deeper voice, and possibly a receding hairline as time goes on. I had already determined that I am a nonbinary person with no desire to fully transition into a binary male, so these were very significant considerations to grapple with. For me, being nonbinary and feeling like an equal mix of masculine and feminine was making it more difficult to determine how I want my appearance to be presented to the outside world. After sitting with this for some time, I was able to derive that my feminine energy is sensed very internally, while my masculine energy manifests itself very externally. I fully understood this throughout my being. It was this recognition that helped me decide to pursue taking T, knowing that any possible physical changes would align with my desire to appear more masculine. 

There are a variety of epiphanies that led me to understanding that I’m trans, but the dysphoria and severe hormone imbalance stemming from my menopause were two unexpected and major components that helped me bring my gender identity into full light.

In my next blog post, I’ll be writing about the changes I’ve experienced so far after seven weeks on T.