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Menstrual Periods and Testosterone Gender-Affirming Hormone Therapy

Updated: Nov 18


Content Warnings: This article discusses menstruation (periods), reproductive anatomy, sexual activity, and other sexual health topics. When referring to specific parts of the body, we use anatomical/medical terms e.g. uterus and vagina. People who have a history of eating disorders may find the topic of period suppression difficult. If this is the case for you, the resources on this page might be helpful.


 

A non-binary transmasculine person holding their stomach
A non-binary transmasculine person holding their abdomen.

One of the commonly desired effects of testosterone gender-affirming hormone therapy (GAHT) is that it usually stops menstrual periods. While many people find their periods stop soon after they start testosterone, others find that their periods don’t stop, or that they stop and start intermittently.


To try and get a better understanding of what might be going on, we recently surveyed just over 400 trans and gender-diverse people using testosterone about their periods before and after starting hormone therapy. A big thank you to everyone who responded to this survey! Your input is incredibly valuable and helps us to keep our communities better connected and informed.


 

Three tampons, a menstrual cup, a cloth, and pads on a table
Menstrual supplies on a table.

How long does it typically take for menstrual periods to stop after starting testosterone?


Our research shows that for about 3 in 4 people (75%), their periods will stop within the first six months of starting testosterone. However, just under 1 in 4 people (25%) report that it takes longer than six months for their period to stop. Some people experience regular bleeding or spotting even after years of using testosterone. These findings were similar to a US study, where 1 in 4 (25%) people had 1 or more episodes of ‘breakthrough bleeding’, after more than 12 months using testosterone.


 

A doctor showing his patient a diagram on a digital tablet
A doctor showing his patient a diagram of reproductive anatomy.

I want to understand the science. How does testosterone stop periods?


Periods are driven by internal hormonal changes. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH), released from the pituitary gland, are the hormones responsible for stimulating ovarian egg development, and ovulation. Ovulation is when an egg is released approximately each month by the ovaries. In preparation for the egg to settle into the uterus, the uterus lining thickens. If the egg is not fertilized with a sperm, the egg will die and it is shed from the uterus with the lining – this causes menstruation, or a period.


Comparatively, when taking testosterone, the increased levels of testosterone will prevent the production of LH and FSH from the pituitary gland. The inhibited production of these hormones due to testosterone will usually suppress ovulation and menstruation. However, it’s important to remember that testosterone isn’t a reliable contraceptive, and pregnancy may still be a possibility. You can find more information about contraception for trans people on our sexual and reproductive health resources page


 

A person cupping transparent gel in their palm
Testogel is a clear, colourless gel which can be prescribed for gender affirmation.

Are there factors that impact whether your periods stop or not, when taking testosterone?


There are a number of factors that may influence whether or not and how long it takes your periods to stop after starting testosterone.


Our research comparing differences between people’s whose periods stopped within 6 months of starting testosterone and those whose periods continued beyond 6 months, found that it may take longer for people who use testosterone gels (Testogel or Testavan) and creams (Androforte), than those who use testosterone injections (Primoteston, Sustanon or Reandron).


Similarly, a European study found that lower testosterone levels might contribute to periods persisting after 6 months, as well as using testosterone gel (rather than testosterone injections). As with our study, this might suggest that the type of testosterone formulation used influences the testosterone levels achieved, which might, in turn, be linked to periods stopping within 6 months. However, there are a number of factors that influence this and more research is needed.


Important, too, is that we found no link between the regularity of periods prior to starting testosterone, or the age at which testosterone is started and whether periods stop within the first 6 months.


 

Gloved hands holding an ultrasound transducer, resting against an ultrasound machine
A healthcare worker holding a transducer, preparing to perform an ultrasound examination.

I want my periods to stop but they haven’t. What are my options for stopping them?


As you can tell, the physiology behind periods is pretty complicated and there are a number of different reasons why your periods might not stop despite taking testosterone. Additionally, not all bleeding from this area will be menstrual, and it can sometimes be related to other things like dryness or thinning of the vaginal lining (atrophy). For this reason, it’s best to chat to a doctor about your individual health. Generally, this would be a GP, Gynaecologist, Endocrinologist, or Sexual Health Physician.


To narrow down what might be causing the bleeding, your doctor might ask questions about:

  • Whether there have been any changes to your periods since starting testosterone

  • How long you’ve been taking testosterone

  • What kind of testosterone you use, and how often (e.g. injections or gel)

  • Whether you take any other medications or supplements


Your doctor might also do some further investigations, such as blood tests to look at hormone levels, or refer you for a pelvic ultrasound. Sometimes a doctor will recommend an internal pelvic ultrasound (also known as transvaginal ultrasound), where the images are collected by inserting an ultrasound tool into the vagina/front hole. Let your doctor know if you don’t feel comfortable having this procedure, as you might be able to get a transabdominal ultrasound instead (where the images are taken from the outside, through your lower belly).


The above questions and tests will gather information to help you and your doctor decide what the best approach will be to stop your periods.


For some people, low testosterone levels might be the cause of persistent periods, but this isn’t always the case. It’s important that you chat to your doctor and investigate the underlying cause, because higher testosterone levels aren’t necessarily the solution for everyone, and may cause other side-effects.


A key finding in our recent study was that people who take testosterone in the form of gels or creams had higher odds of experiencing persistent menstruation compared to people who have testosterone injections. If appropriate, your doctor might suggest switching from gels/creams to injections, to see if that helps suppress your periods more effectively.


There are also other hormones involved in the menstrual cycle which are generally effective at stopping periods, such as progestins. These can be prescribed (without oestrogen) in pill form, as implants, intrauterine devices, or as a long-lasting injection.


There are also surgical options, such as hysterectomy (removal of the uterus) or endometrial ablation (removal of the endometrium, which lines the inside of the uterus). These surgeries have an irreversible effect on your ability to carry a pregnancy, so usually involve in-depth discussions with your doctor about the risks and benefits of the procedure to make sure that you’re able to consent in a fully informed way.


 

A doctor handing pads and tampons to a genderqueer person
A genderqueer person receiving menstrual products from a doctor.

After years without a period, I have started bleeding again. What is going on?


While breakthrough bleeding while using testosterone is quite common and not necessarily cause for concern, there are sometimes more serious reasons behind it, so it’s a good rule of thumb to check in with a doctor if you experience it. Generally, this would be a GP, Gynaecologist, Endocrinologist, or Sexual Health Physician.


The doctor might ask you questions about:

  • How long you’ve been taking testosterone

  • What kind of testosterone you use and when your last dose was

  • If there have been any recent changes to your other medications or recent vaccinations

  • Whether you have/had any other reproductive health issues

  • Your cervical cancer screening history

  • Any recent surgeries, particularly on reproductive organs (e.g. hysterectomy)

  • How long it’s been since the last time you bled in this way

  • Whether you might have some genital atrophy (dryness) and if there could have been any friction in the area (e.g. penetrative sex)

  • If there have been any recent changes to your mental or physical stress levels

 

In summary, although most people taking testosterone gender affirming hormone therapy will find that their periods stop in the first 6 months, it’s not uncommon for periods to persist or for people to experience some occasional breakthrough bleeding. There are many potential causes for this, as well as many potential solutions. By chatting with your doctor, you’ll be able to find the best approach to stopping your periods.


You can find additional trans-affirming resources about sexual and reproductive health here.

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