Menstruation Frustration as a Trans Masculine Person: A Logbook
We are told it is something sacred that women go through every month. Something to be celebrated, something that binds women together and is a sign of health and fertility. And, from one perspective, this is true for many people, but not when you’re a trans masculine asexual human with dysphoria. That is a lot of words I just wrote, so let me break down what each of them means for me:
Trans masculine: Someone who does not identify with their gender assigned at birth (trans) and also feels more masculine in their identity and expression
Asexual: Someone who does not experience sexual attraction, or only does so under extremely limited circumstances
Dysphoria: A persistent feeling of distress and incongruity between one’s physical body/characteristics and one’s gender
From the above definitions, you may begin to imagine why I have always found being the owner of a bleeding uterus to be nothing short of traumatic. First of all, even as a child I had a sense of not being a ‘real girl’, so positioning periods as something only experienced by women made me feel uncomfortable without yet being able to understand why. In retrospect, the vivid memory I have of my first time waking up to blood-soaked sheets was doubly traumatic because by this time I had unconsciously assumed that, as someone who was a ‘tom boy’ rather than a woman, periods would not happen to me. It turns out simply wishing for periods to not occur does not prevent them.
I think the hardest part, leaving aside what I now know to be intense dysphoria, was the fact that I was expected to celebrate it. My mother showed me how to use sanitary pads, put my sheets in the wash and left me to it. My comrades in primary school who had beaten me to the bleed had spoken about it as something that made you a real grown up, a truly valid member of society and that my lacking it at that point somehow affected my social status. In high school, whilst there was the bonding of suffering discovery of stains on school dresses or complaining about symptoms, there was still this sense of it being a privilege and something you weren’t allowed to loathe. It was a part of your identity, but for me it was — and still is — a cruel joke of nature I am forced to endure, resulting in me completely disassociating from my genitals.
Of course, here is where I think the asexuality comes in as well, for since I am a sex repulsed asexual (there are sex neutral and sex positive aces), I want nothing to do with my genitals anyway beyond utility and the occasional physical release since the capacity exists (I wouldn’t be devastated if that weren’t an option, however. For me it is something that helps me relax sometimes and not something I want another person involved with). I don’t necessarily think of my female reproductive system as being anathema to my gender identity, however the bleeding and soon-to-be-mandatory-due-to-my-age pap smears along with how these body parts are so heavily sexualised and associated with women does cause me a lot of gender dysphoria and just general distress. So, I have tried many forms of birth control with the sole aim of eliminating bleeding and this is what I will document here since there are so many forms of birth control, so many different bodies and reasons for pursuing said medication, that the more perspectives the better, especially queer perspectives. Without further ado, I will now tell you about my experiences in chronological order:
- Implanon
I had the implanon rod for two years before giving up on the possibility of no periods. I endured approximately 3 months of spotting when I first got it put in as well as I think around a month or so of severe depression, which I didn’t realise was caused by the implanon until I had the same awful depression and anxiety for a month after I got it removed (not fun as the rod got stuck). Once the spotting finally settled down I did have a much lighter flow, but wasn’t lucky enough to have none and didn’t like the feeling of the stick in my arm, so I eventually moved on to try other options.
2. Depo Provera
This is an injection and lasts for 12 weeks, however for me it caused heavy bleeding for over two weeks and then irregular bleeding/spotting. Things might have improved had I given it another shot (no pun intended), however that first experience was incredibly distressing and dysphoric for me and I didn’t want to risk another 3 months (or more) of irregular bleeding. I also found out that I am at risk for low bone density, which is one of the longterm side effects of depo, so probably wouldn’t have been able to continue anyway.
3. The Combination Pill #1
Ironically, this option did stop my bleeding consistently! However the side effect of severe depression was too much for me in terms of my mental health plummeting to the point of being unable to function and engaging in self destructive behaviour. I stuck it out for a few months, but it was too much.
4. The Combination Pill #2 (lower dose)
So, I tried another iteration of the pill at a lower dose, although I knew this meant it was less likely to stop bleeding. At first I had a couple of extra weeks per cycle, which made it worthwhile as a temporary measure, however this soon wore off and the pill was doing nothing for me beyond suppressing my already low libido, which was, for an asexual person who finds such a thing an annoying distraction, a handy bonus. Unfortunately, this pill still meant that PMS and migraine symptoms during my cycle were greatly worsened as even when you take the pill continuously you have to stop after spotting for a few days since this is apparently an indication of uterine lining build-up that needs to be shed. Some people rarely or never get the spotting, but I wasn’t lucky enough with this lower dose.
Untried: IUDs and Endometrial Ablation
I have heard anecdotal evidence for the Mirena IUD stopping periods in many people (the official stats are only around 16% of patients from memory), however I simply cannot abide the thought of anyone interacting with my genitals since I was sexually assaulted and especially any form of penetration as this was always an excruciating and distressing experience for me (couldn’t even use tampons), let alone the dysphoric element. Perhaps I will be compelled to try regardless as from what I can gather from research the only options left all involve at the very least pelvic examination and/or inserting surgical instruments through the vaginal canal. Endometrial ablation involves the latter and is not guaranteed to stop bleeding — and if it does, often not permanently, meaning multiple procedures— even sometimes causing worse symptoms if your body reacts to the scar tissue or if other tissue is accidentally burned. My only hope is that low dose testosterone is enough to stop the bleeding. Which brings me to this last option.
5. Hormone Replacement Therapy (testosterone)
As a non-binary person, I have spent approximately two years contemplating whether I want testosterone or not. For me, a more traditionally masculine appearance is definitely aligned with my identity and something I was always envious of as a child and teenager, however I also feel a kinship with my lived experience as a woman and fear being perceived as a cis man, the accompanying privilege and loss of shared relationship with women in a public setting. Low dose is a good option for someone like me, then, as the effects come very slowly and this dose can even allow someone to maintain a sense of androgyny in terms of voice, hair etc. The big draw cards for me personally are a lower voice, easier muscle mass building and the potential for no more menstruation. God how I hope this works. At the time of writing I am literally only 3 days on a 1/4 of a standard dose (one pump a day), so only time will tell.
I hope this helps anyone who is exploring birth control and other options with a view to ceasing menstruation rather than primarily as a fertility treatment. Every body reacts differently and different methods work well for different people. My body is evidently very sensitive to hormonal changes, hence why the pill and depo didn’t work very well for me as it messes with my mental health. The Mirena would have been a good candidate as the hormones are localised and I believe less potent in general, however my trauma, dysphoria and pain means this option is inappropriate for me, except potentially as a last resort if I can’t get a hysterectomy, which is the only 100% guaranteed way of stopping menstruation permanently, but also carries with it the risk of any surgery.
