LGBTQ+ Considerations

Perimenopause resources often assume a particular reader: a cisgender, heterosexual woman in a relationship with a man. If that’s not you, you’ve probably noticed. The pronouns don’t fit. The relationship advice doesn’t apply. The assumption that you want to preserve fertility or please a husband sits wrong.

You deserve information that sees you as you are.

If You’re a Lesbian or Bisexual Woman

Much of the symptom information in this guide applies to you regardless of sexual orientation. Your body is doing what bodies do during this transition.

Where things may differ:

Relationships and Desire

The libido section discusses changes in desire, but much of the partner advice assumes a male partner who experiences desire differently. In same-sex relationships:

• You may both be going through perimenopause at similar times—the “dual menopause” phenomenon
• Your partner may understand your experience more intuitively, or you may both be struggling simultaneously
• The spontaneous/responsive desire framework still applies, but the dynamics may look different
• Communication about what’s changing may be easier—or harder—depending on your relationship

Finding Affirming Healthcare

Not all healthcare providers are LGBTQ+-competent. You may face:

• Assumptions about your sexual history and practices
• Intake forms that don’t include your reality
• Providers who don’t understand how to counsel you about your specific concerns
• The exhausting work of educating providers about your identity during a medical appointment

Look for LGBTQ+-friendly providers. GLMA (Health Professionals Advancing LGBTQ+ Equality) maintains a provider directory. Planned Parenthood locations are often knowledgeable.

Hormone Therapy Decisions

Your decisions about hormone therapy are yours to make based on your symptoms, health profile, and preferences—just like anyone else’s. Your sexual orientation doesn’t change whether HT is appropriate for you.

However, if you’ve been on hormone-based contraception for contraceptive reasons, remember that you may not need it for pregnancy prevention in a same-sex relationship. You might choose hormonal options for symptom management instead.

If You’re Transgender or Nonbinary

Perimenopause in trans and nonbinary bodies is an emerging area with limited research—but your experience is real and deserves attention.

Trans Men and Transmasculine People

If you were assigned female at birth and have ovaries, you can experience perimenopause.

If you’re on testosterone (T):

• You may have already experienced changes in menstruation (lighter, irregular, or stopped periods)
• Perimenopause can still happen—your ovaries are still aging, even if T has suppressed some of their function
• The hormonal fluctuations of perimenopause may mean your previously stable T dosing needs adjustment
• You might notice symptoms you hadn’t expected—hot flashes, mood changes, sleep disruption
• Tracking symptoms can be harder when you’re already on hormone therapy

If you’ve had a hysterectomy or oophorectomy:

• Removing ovaries triggers immediate menopause—see surgical menopause
• You may need to adjust T dosing, as your ovaries were contributing some hormones
• Symptoms may be more intense due to the sudden hormonal shift

Treatment considerations:

• There’s a misconception that trans men wouldn’t want estrogen for menopause symptoms. Some don’t; some would accept it for symptom relief if offered
• Non-hormonal options like NK3 antagonists, SSRIs, and gabapentin are available
• Discuss options with a provider who understands both trans healthcare and menopause—this may require finding someone specialized

Trans Women and Transfeminine People

If you were assigned male at birth and are on estrogen-based feminizing hormone therapy, you may experience menopause-like symptoms if your estrogen levels fluctuate or if you reduce or stop estrogen.

Estrogen fluctuations can cause:

• Hot flashes
• Mood changes
• Sleep disruption
• Cognitive symptoms

As you age:

• Providers may recommend reducing estrogen doses after age 50, similar to the natural decline in cis women
• If you’ve had an orchiectomy, you’ll need at least minimal hormone support to prevent bone loss until around age 50
• Cardiovascular and clotting risks from estrogen increase with age—transdermal delivery (patches/gel) is generally safer than oral

The conversation with providers:

• Not all menopause providers understand trans health
• Not all trans health providers understand menopause
• You may need to advocate for understanding both aspects of your care
• UCSF’s Center of Excellence for Transgender Health has good clinical resources

Nonbinary People

If you have ovaries and didn’t want to read a guide that constantly assumes you identify as a woman—I see you.

Your perimenopause experience depends on your anatomy and any hormone therapy you’re using. The biology sections of this guide apply to bodies with ovaries regardless of gender identity. The experience sections may or may not resonate.

Specific challenges:

• Healthcare spaces are often highly gendered
• Menopause is culturally coded as a “woman’s issue,” which may feel alienating
• Forms, pronouns, and provider assumptions may all be wrong
• Discussing testosterone for symptom relief may be complicated—for some, masculinizing effects might be welcome; for others, not

Find providers who can separate biological care from gender assumptions.

Healthcare Access Challenges

LGBTQ+ people face documented healthcare disparities:

• Discrimination: Past negative healthcare experiences lead to avoiding care
• Lack of competent providers: Many providers aren’t trained in LGBTQ+ health
• Insurance barriers: Especially for trans individuals, coverage for hormone therapy and related care varies
• Geographic access: In many areas, LGBTQ+-competent menopause care simply doesn’t exist locally

Telehealth menopause services may help bridge geographic gaps—just verify they’re LGBTQ+ affirming.

Finding Community

Mainstream menopause support groups may not understand your experience. Seek out:

• LGBTQ+-specific menopause communities (they exist, though they’re smaller)
• Online forums where you can connect with others navigating similar intersections
• LGBTQ+ health organizations that address aging and menopause

A Note on Research

This means:

• Clinical recommendations may not account for your specific situation
• Your provider may not have evidence to guide them
• You may need to be part of advocating for better research

Your experience is valid even when the research hasn’t caught up.

Perimenopause is a biological process that happens in bodies with ovaries. It doesn’t care about your gender identity or sexual orientation.

But the experience of perimenopause—navigating healthcare, finding support, understanding yourself—is shaped by who you are. You deserve care that acknowledges all of you, not just the parts that fit conventional expectations.

Whoever you are, however you identify, whatever your body is doing: you belong here. This guide is for you too.