From the Guidelines
Transgender men can effectively manage menstruation through testosterone therapy, which is the primary method, typically administered as weekly or biweekly injections, topical gel, or patches, and can stop menstruation within 3-6 months by suppressing ovulation and thinning the uterine lining 1.
Methods for Managing Menstruation
The following methods can be used to manage menstruation in transgender men:
- Testosterone therapy: administered as weekly or biweekly injections (50-100mg per week or 100-200mg every two weeks), topical gel (50-100mg daily), or patches 1
- Progestin-only methods: such as the Depo-Provera injection (every 3 months), hormonal IUDs (Mirena, Kyleena, or Liletta, lasting 3-7 years), or the progestin-only pill (taken daily without breaks) 1
- Combined hormonal contraceptives: containing estrogen and progestin, which can also be used but may counteract some masculinizing effects of testosterone 1
- Hysterectomy: surgical removal of the uterus, a permanent cessation option 1
Importance of Menstruation Control
Menstruation control is crucial for alleviating gender dysphoria, improving quality of life, and mental health in transgender men 1. Regular medical supervision is essential when using these hormonal methods to monitor for side effects and ensure effectiveness 1.
Potential Side Effects
Testosterone therapy can have adverse effects, including polycythaemia, reduced high-density lipoprotein cholesterol, androgenic alopecia, acne, gynaecological effects, and potentially increased risk of myocardial infarction 1. However, the benefits of testosterone therapy in managing menstruation and improving quality of life in transgender men outweigh the potential risks 1.
From the FDA Drug Label
ADVERSE REACTIONS Endocrine and Urogenital, Female – The most common side effects of androgen therapy are amenorrhea and other menstrual irregularities, inhibition of gonadotropin secretion, and virilization, including deepening of the voice and clitoral enlargement.
The methods that can be used to manage menstruation in transgender men (transgender males) include hormone therapy, specifically androgen therapy, which can cause amenorrhea (cessation of menstruation) and other menstrual irregularities. This is a common side effect of androgen therapy, as stated in the drug label for testosterone enanthate (IM) 2.
From the Research
Methods for Managing Menstruation in Transgender Men
The management of menstruation in transgender men can be achieved through various methods, including:
- Hormone therapy: Testosterone therapy can lead to menstrual cessation in the majority of patients by 6 months and nearly all by 1 year 3
- Menstrual suppression: Options include depot-medroxyprogesterone acetate, levonorgestrel intrauterine systems, progestin-only contraceptive pills, and combined hormonal contraceptives 4
- Non-contraceptive options: Norethindrone acetate, oral medroxyprogesterone acetate, gonadotropin-releasing hormone analogues/agonists, and danazol can be used to suppress menses 4
- Non-pharmacologic interventions: Specialty menstrual underwear can be beneficial for some patients 4
Considerations for Transgender Men
Menstruation can be a source of dysphoria, anxiety, depression, and suicidal ideation for transgender men, making it essential to address their menstrual needs with sensitivity and respect 5
- Fertility and contraception: Transgender men may require guidance on fertility preservation and contraception options 5
- Gender-affirming care: Obstetricians and Gynecologists can play a crucial role in providing gender-affirming hormone therapy and care to transgender men 6
Importance of Shared Decision-Making
Shared decision-making between the clinician and patient is vital in determining the best approach for managing menstruation in transgender men 4