Transmasculine Flow: Let's Talk Periods

For all the body positivity of our modern era, we still don’t hear many public conversations about periods. To open up spaces for clear, comprehensive discussions about menstruation⁠ and how it impacts our self-esteem often requires wrestling with centuries of stigma. In fact, it’s so off-limits that the English word “taboo” likely comes from a set of Tongan religious practices that addressed periods. In many parts of the world, people are and have long been cut off from resources and education about periods: and the more marginalized the person, the more cut off they’ve usually been. The push for greater access to period⁠ information, like using language when we talk about periods that includes everyone who can have them, has also resulted in its own backlash.

So how are you supposed to cope, particularly when you’re a transmasculine person who menstruates, and especially if it’s a major source of dysphoria for you? First; if you’re reading this hoping to get some advice for yourself, take a big breath. I want you to remember that you are not alone.

Let’s have an honest discussion about what periods are, some of the unique challenges that transmasculine people who menstruate can grapple with, and how to address them.

I think it’s helpful to realize that a lot of the stigma around periods has to do with the fact that for centuries, humans had no idea why people menstruated. If you’ve ever had a period or any other part of a menstrual cycle⁠ , you’ve probably remarked on the cognitive dissonance between the clinical and detached way that we talk about reproduction in medical settings and the feelings you yourself are dealing with about the process! We didn’t always have modern science to provide a background for our understanding, and people’s imaginations ran wild. Here’s a brief look at some outlandish things that people have believed about periods throughout history. For a more in-depth dive that might make you laugh, I would recommend the Sawbones podcast episode on the topic. (Please note that the hosts use gender⁠ normative language in this episode, but have worked to be more inclusive in the years following.) The cultural perception of menstruation as a whole stems from millennia of misinformation, so it’s not that useful to us if we want to think about bodies and how they work.

Do you have to have a period?

First, a little backstory.

Periods are a naturally occurring (read: something bodies often just do, entirely on their own)  phenomenon and humans evolved to have them, unlike most animal species. Scientists aren’t sure why, but human embryos are more prone to complex chromosomal abnormalities. But because human embryos are very taxing on the parent whose body they inhabit, it’s not practical for people to carry every possible pregnancy⁠ to term. Uterine lining evolved to proactively thicken before the arrival of an embryo⁠ to help mitigate the damage it could cause in utero. As an additional precautionary measure, the uterus⁠ evolved to flush out⁠ (in other words, to miscarry) embryos that were less likely to be viable and likely take a big toll on the body. For a look at how people who menstruate experience these changes, check out Scarleteen’s guide to menstruation.

People who are pregnant or breastfeeding don’t (usually) have periods, so for much of human history, they were a far more infrequent occurrence than they are now. In modern times, they can be experienced as a serious nuisance to cis and trans people alike. They can create additional challenges — emotional, social, cultural — for transmasculine people. Dealing with periods for years can be costly, uncomfortable, and sometimes painful. But most people don’t necessarily have to menstruate regularly if you don’t want to. Not having a period isn’t likely to be hazardous to most folks’ health in any way.

Now, you might not have access to a medical intervention for a period, or you just started taking testosterone⁠ , or maybe you just don’t want any of those things. Bodies are also complicated cocktails of hormones⁠ and other chemicals, and no two people are alike in their composition, so it might, for instance, take some experimenting to find a dose of testosterone (T) that lets you maintain your transition⁠ goals and to cease menstruation entirely. Or you might have an underlying medical condition that would make it complicated or impossible for you to pursue any of these options.

Two common ways that transmasculine people who want to avoid having a period can pursue are to use certain methods of birth control⁠ or to go on  what’s currently called Hormone Replacement Therapy (HRT). Both methods rely on prescribed doses of hormones — estrogen⁠ and progestin, and testosterone respectively, to disrupt signals that get sent to the uterus and drive the menstrual cycle. The methods of contraception⁠ that can be used to suppress or limit menstrual⁠ periods are combined hormonal methods (like the pill⁠ ) and one kind of IUD⁠ . Some folks opt to have an elective hysterectomy⁠ , or a removal of the uterus and sometimes the ovaries⁠ , to avoid periods forever (when the ovaries are also removed) and affirm their gender. There are still others — of every gender — who have hysterectomies at a the direction of a doctor because of uterine problems.

Coping with tough feelings, thoughts and bathrooms during periods

What else can you do to deal with dysphoria and negative thoughts you might associate and experience with menstruation? Something that may help you feel more in control of your situation is to reframe and rethink some of the gender normative things you’ve been told about menstruation.

A ciscentric and heteronormative society teaches us to assume a lot about people’s bodily functions based on their appearance or their body parts, but that method of gendering and categorizing a person, or a bodily process, doesn’t hold up to scrutiny. Periods don’t themselves have gender and don’t and can’t assign a gender to us that isn’t ours.

We can’t determine someone’s chromosomal makeup just by looking at them, and most people don’t have the kind of X-ray vision that would permit them to ascertain what bodily organs another person has just by looking at them. Intersex people, who are as common as redheads in our communities, can’t be accurately described by the “conventional” wisdom of making assumptions based on a person’s looks. Besides, bodies are always changing. This idea that “periods are a sign of being a woman” ignores, for example, the fact that cisgender⁠ women don’t menstruate after menopause. What about a young cis woman who has a hysterectomy to prevent her uterine cancer from coming back? Is she no longer a woman without a uterus? No! If someone who is postmenopausal or who has a hysterectomy identifies as a woman, they absolutely are. Not everyone who repeats these outdated adages means to reduce someone’s entire worth and being to their ability to have a baby, but that’s what these kinds of arguments ultimately do. They’re sexist, ignore modern science, and don’t edify the people they claim to revere and protect. Bodies or things that they do or don’t do don’t determine gender, people, whole people, do.

But sometimes even when we have reframed all of this for yourselves, physically dealing with a period can still be a visceral and dysphoria-inducing experience for some that is tough to get through.  Period stigma has made a joke of advertisements for menstrual products, arguably the most public acknowledgement of the process most people encounter. The ads reduce period blood to a clean⁠ and contained bottle of mysterious blue fluid that gets poured onto pads. Menstrual products can help contain the mess, but they can’t eliminate the smell of what you need to throw away or make that whole process less conspicuous.

Dealing with bathrooms is one of those things that’s often going to be hard in this world no matter what. I wish I had more tried and true strategies on how to navigate bathrooms with more confidence, how to dispose of menstrual products without detection, how to escape the notice of peers, and how to not be harassed by cis people.

But the truth is that our culture in the moment is growing and going through some pretty nasty growing pains when it comes to transgender⁠ people.

Some cis people have long decided to make it tough for trans people to even just use the bathroom. It’s not fair, and it puts an undue burden on us. It can make the most mundane day extremely stressful and complicated, especially when you have a period. All you wanted to do was use the bathroom, and suddenly you have to become attuned to the movements of everyone in the vicinity and think about the way the whole building is laid out. I can say from personal experience that spending half the day worrying about this can take a real toll on a person if the people around you have made it clear that they won’t try to help you navigate the situation.

If you’re worried about your safety, please ask for help. You don’t have to do this by yourself. Help might come from a hotline, the internet, or some kind of mental health professional. (Don’t forget that you can always check out Scarleteen’s direct services. The team at Scarleteen is happy to help you brainstorm strategies for things just like this.) But be smart and think about what will keep you most safe; you might just have to use the wrong bathroom in certain spaces in the short term. When my employer told me at the beginning of my transition that I would be responsible for addressing any conflicts that came up in the bathrooms of my office building, I turned to my mom, my friends, and therapist for support and advice. (Fortunately, I work for a different organization now which is much more trans-friendly!)

If you’re worried being outed in the bathroom by your period, you can try to change your bathroom schedule or location. Try to consider the environment you’re in. Will you be more inconspicuous in a busy, crowded bathroom, or will it be easier to escape attention in one that gets less traffic? If it’s possible, it might make you feel a little better to walk to the other side of the hallway to use a different bathroom. You might decide that it’s easier to unwrap a pad while the other boys are being loud after lunch than another time. Maybe you slip a used menstrual product in your pocket and then into the cafeteria trashcan on your way back from the bathroom if you’re worried about the smell (and you don’t think this will draw other unwanted attention.) It’s also worth noting a strong smell is often the result of a chemical reaction between commercial menstrual products and periods, and that other options — washable pads or underpants, a cup — don’t result in as strong of a smell. Be sure that you’re changing your products regularly. Most doctors recommend changing a tampon every 4-8 hours to avoid toxic shock syndrome, which can be introduced to your system via a bacterium. Some trans people just avoid using the bathroom in public spaces to avoid gender dysphoria⁠ or conflict, and that’s just not a viable strategy when you have your period.

Changing your language can change your experience

It may also help you to think critically about the language that you and the people around you use to talk about this part of your life that will help you feel less dysphoric.

I think many of us could point to overly-flowery terms that get used in marketing for menstrual products that try to tap into some universal idea of womanhood and fertility⁠ . If having a period makes you feel dysphoric, you’ll probably want to avoid these words. You can take some time to think of some other words that feel more neutral to you that you can suggest instead. The two terms that I hear the most often that feel this way to me are “cycle” and “menstruation,” but that might still feel gendered to you. I’ve seen multiple trans guys in Facebook Groups refer to process as their “shark week,” which I love because it reaches for extreme language to correct dysphoria, which like unnecessarily named deodorant brands, eventually becomes comedy.

You don’t have to use conventual terms to refer to the process or sanitary product, either. When I was growing up, my mom and I had code words in case I ever needed to ask for a pad in a potentially embarrassing context. “Falling off the roof,” was code for “getting your period,” and “turkey sandwich” was code for a pad.  So, you would say “Hey Mom, I fell off the roof, and I need a turkey sandwich.” Yes, it is silly, but it made me feel like I could have some privacy if I needed it! (Fortunately, this did not result in me tempting fate and actually falling off a roof somewhere.)

You can ask your loved ones to change their language when they’re with you, too. You can let them know that that using different words for periods and menstruation with you is a simple something that can demonstrate their commitment to your comfort and peace.

But reevaluating the language you use to talk about menstruation is just one tool in your toolkit. It’s important to build a solid support system for yourself, work on managing your feelings and expectations, build out your resources, and reframe how you think about your circumstances. None of that is easy work, but it can help you go from feeling awful or bad about this process to “Okay” or “meh”. Ultimately, you want to surround yourself with people who affirm your gender expression⁠ and who don’t upset you or make you feel bad about yourself.

Using other tools might mean talking to people you’re close to about your dysphoria and asking for help when you’re feeling down, or relying on other trans and gender nonconforming⁠ friends for assurance about your gender expression. It might mean trying to come up with things to tell yourself about how menstruation isn’t gendered if you get into a negative thought spiral. You can ask your healthcare providers not to use gendered language for you or when talking about anatomy⁠ . However you use the tools, please be kind to yourself when you’re facing your feelings. Some people can really struggle to like themselves when they feel dysphoric. Once I heard someone recommend treating yourself like someone else you care about or a small child when you are low or having a hard time, and it’s something I think about often as someone who deals with chronic pain. Take the extra time to help that person wash up, eat a full meal, get ready for the day. Be gentle with yourself. You deserve a chance to breathe.

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  • Gabriel Leão

Professor Ana Gabriella Sardinha and her team have been developing The Menstrual ConSCIENCE Trail game to teach Brazilian young people about menstrual cycles.