Experiences with Menses in Transgender and Gender Non-binary Adolescents

Background: Transgender and gender minority patients who are assigned female at birth have anecdotally been reported to have increased gender dysphoria related to menses, but there are very limited data on this subject. There is an even greater paucity of information about the experiences of gender non-binary children and adolescents, and it is unknown whether this population is similarly distressed by menses because they also do not identify as female. The aim of this study is to describe the characteristics, menstrual history, associated dysphoria, and desire for menstrual management in gender minority adolescents and to assess for any differences between those who identify as transgender males and those who identify as gender non-binary.

Methods: This is a retrospective chart review of 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 non-binary, and had achieved menarche. Menstrual characteristics and desire for menstrual management were abstracted and compared between transgender and gender non-binary subgroups using two-sample t-tests for continuous variables and chi-square and Fisher exact tests for categorical variables.

Results: Of the 129 included patients, 116 (89.9%) identified as transgender male and 13 (10.1%) as gender non-binary, with a mean age of 15.0 years. Nearly all were white (90.1%) and non-Hispanic (93%), and the majority (73.4%) were privately insured. Only 12 (17%) had ever been sexually active. Gender non-binary patients were significantly younger than transgender patients (13.9 vs. 15.1, P = 0.009). Menstrual characteristics for the two groups are presented in Table 1. Almost all (92.6%) patients reported menstrually-related dysphoria. The majority (83%) were interested in initiation of menstrual suppression at their first visit (Table 2). The most common reasons for desiring menstrual suppression were to achieve amenorrhea (100%) and for improvement in menstrually-related dysphoria (64.4%). Of patients for whom data were available about parental support for menstrual management, three-quarters of parents were supportive. There were no significant differences in menstrual characteristics or desire or support for menstrual management between the two subgroups.

Conclusion: The majority of gender minority patients assigned female at birth reported dysphoria associated with menses and desired menstrual suppression. There were no differences between transgender males and non-binary patients. This study provides information about a significantly understudied area. Understanding menstrual patterns and correlations with psychological symptoms is the first step in establishing menstrual management in the treatment of gender dysphoria. This may be especially helpful for patients who are not ready for or do not desire gender-affirming hormone treatment.