Periods, Testosterone & Transition: A Guide for Trans Men & Transmasculine People

17 min read
Period care and testosterone information for trans men and transmasculine people

Periods don’t belong to one gender.

Trans men, transmasculine people and non-binary people can menstruate, and how that feels is incredibly individual. For some people, a period is simply a bodily function. For others, bleeding, buying period products or using them can trigger significant gender dysphoria.

Starting testosterone often changes menstruation and, for many people, eventually stops it. But it doesn’t happen at exactly the same time for everyone, and some people continue to have spotting or periods for months after starting testosterone.

This guide looks at what can happen to periods before and after starting testosterone, what to do if bleeding continues or comes back, period-product options, pregnancy and contraception, genital dryness and when it’s worth talking with your healthcare provider.

When discussing anatomy, we sometimes use terms such as vagina, front hole, uterus and cervix so it’s clear which body part we mean. Use whatever words feel right for your own body.

Key takeaways

  • Testosterone often makes periods lighter and eventually stops them, but timing varies considerably.
  • An Australian study found that around 62% of participants stopped menstruating within 1 to 3 months of starting testosterone, while almost 23% reported bleeding continuing beyond 6 months.
  • Continuing to menstruate doesn’t mean testosterone isn’t working or that your transition has failed.
  • Periods can sometimes return after they’ve stopped, and breakthrough bleeding can also occur after longer-term testosterone use.
  • Testosterone isn’t reliable contraception. Ovulation and pregnancy can still be possible even without regular periods.
  • You can choose whatever period product feels most comfortable and least dysphoric for you.
  • Testosterone can make genital or vaginal tissue drier and more sensitive, which may change how cups, discs, tampons or penetrative sex feel.
  • Menstrual suppression options are available even if you don’t use testosterone.

On this page

Periods, gender and dysphoria

Menstruation is a body process, not a gender.

Some trans men and non-binary people are completely comfortable menstruating. Others find periods one of the hardest parts of living in their body before or during transition.

Dysphoria can come from the bleeding itself, cramps or other cycle symptoms, but sometimes it’s the surrounding experience that feels difficult: buying heavily gendered period products, carrying them into a bathroom, seeing packaging covered in traditionally feminine language or needing to insert a product into a part of the body you’d rather not focus on.

Research into transgender and gender-diverse experiences of menstruation consistently shows that there is no single “trans period experience”. Menstrual care works best when it’s based on what feels comfortable for the individual.

If your period doesn’t bother you, you don’t need to feel as though it should. And if you desperately want it to stop, that’s valid too.

What happens to periods when you start testosterone?

Masculinising testosterone usually changes the menstrual cycle.

Periods may become:

  • lighter
  • shorter
  • less regular
  • more like occasional spotting
  • absent altogether

Many people eventually stop menstruating completely while using testosterone, but there is no exact timeline that applies to everyone.

How long does it take for testosterone to stop periods?

A large Australian study of trans people using testosterone gives us a useful picture of how much the timing can vary. Among participants whose bleeding stopped:

  • 61.7% reported that menstruation stopped within the first 1 to 3 months
  • 15.5% reported that it stopped between 3 and 6 months
  • 22.8% reported menstruation continuing beyond 6 months

So while stopping within the first few months is common, continuing to bleed after six months isn’t rare either.

How quickly periods stop can be influenced by your testosterone dose, formulation, how your body responds to it, your reproductive anatomy and other health factors.

Most importantly, there isn’t a correct timetable you need to meet.

What if your period doesn’t stop on testosterone?

Having periods or spotting after starting testosterone doesn’t mean testosterone isn’t working and it certainly doesn’t mean you are somehow transitioning incorrectly.

Some bodies simply take longer to reach menstrual suppression.

If bleeding continues and you want it to stop, talk with the clinician who manages your testosterone.

They may look at things such as:

  • your testosterone levels
  • your dose and dosing schedule
  • the type of testosterone you use
  • whether you had irregular or heavy periods before testosterone
  • whether another health condition could be contributing

Don’t increase your testosterone dose yourself to try to stop your period faster.

Other options can be added

Sometimes testosterone alone doesn’t completely suppress menstruation.

A clinician may discuss adding another form of menstrual suppression, such as a progestogen-based treatment or a hormonal IUD.

There are several possible approaches, and the best one depends on your body, your feelings about different hormones or procedures, whether contraception is also important and whether you want the option of pregnancy in the future.

Menstrual suppression can be part of gender-affirming care. You don’t have to justify wanting your periods to stop.

What if bleeding comes back after your periods have stopped?

Periods and spotting can occasionally return even after you’ve been using testosterone for some time.

This can be frustrating and, for some people, intensely dysphoric.

It doesn’t automatically mean something serious is wrong.

Breakthrough bleeding can happen with long-term testosterone and may sometimes be related to hormone levels, changes in dose, missed or delayed doses or the way testosterone is being absorbed.

But new or persistent bleeding after a long period without it is worth mentioning to your testosterone prescriber or GP.

There are also the same non-trans-specific reasons for abnormal bleeding that anyone with a uterus can experience, including fibroids, polyps, adenomyosis, infection, pregnancy and other gynaecological conditions.

Your healthcare provider can work through the likely causes without assuming that every episode of bleeding requires an invasive pelvic examination.

Choosing period products during transition

There is no “best period product for trans men”.

The best product is the one that manages your flow while making menstruation as physically and emotionally comfortable as possible.

For some people, that means avoiding internal products. Others prefer a cup or disc because it can mean thinking about their period less often.

Cloth pads

Reusable cloth pads can be a good option if you don’t want to insert anything into the vagina or front hole.

They may also suit you if testosterone has made internal tissue more sensitive.

Some people prefer reusable pads because they can keep their own supply at home without repeatedly buying heavily gendered disposable period products.

Menstrual cups

Menstrual cups sit inside the vaginal canal and collect menstrual fluid.

A cup may suit you if you’re comfortable with insertion and want a reusable option that can hold more than many disposable products and may mean fewer bathroom changes, depending on your flow and the cup instructions.

They aren’t the right choice for everybody.

If using an internal product increases dysphoria, causes pain or simply feels like more interaction with that part of your body than you want, there’s no reason to force yourself to use one.

Menstrual discs

Menstrual discs are another internal option. They sit higher in the vaginal canal at the vaginal fornix and tuck behind the pubic bone.

Unlike menstrual cups, discs don’t rely on suction to stay in place.

Some people prefer the shape or feel of a disc, while others find cups easier. Anatomy matters far more than gender when it comes to fit.

If you’re not sure what might suit your body, Period Shop’s Menstrual Product Comparison Hub can help you compare the options.

What if period products themselves trigger dysphoria?

You’re not imagining it.

Research involving trans and gender-diverse people has found that carrying, buying and using menstrual products can itself contribute to gender dysphoria.

A few things that may make periods feel more manageable include:

  • buying products online rather than in-store
  • choosing neutral colours and packaging where possible
  • keeping a discreet period kit in your bag, car or workplace
  • using a higher-capacity product if that means fewer bathroom changes
  • choosing an external product if insertion feels dysphoric
  • choosing an internal product if not seeing or feeling external bleeding feels easier for you

There is no more gender-affirming choice between those options. It’s about what makes your period easier for you.

Testosterone, genital dryness and internal period products

Testosterone can change vaginal or front-hole tissue.

Lower local oestrogen can make the tissue thinner, drier, less elastic or more sensitive to friction. Some people notice burning, irritation or discomfort during penetrative sex or when inserting a tampon, cup, disc or other product.

You may have used a menstrual cup comfortably before testosterone and suddenly find insertion or removal doesn’t feel as easy.

That doesn’t necessarily mean there is anything wrong with the cup.

Lubricant can help

A small amount of water-based lubricant around the vaginal opening or on the rim of a cup or disc can make insertion more comfortable.

Take your time and stop if something hurts. Lubricant should make insertion easier, not help you push through persistent pain.

Our guide to vaginal and genital dryness explains moisturisers, lubricants and treatment options in more detail.

Local oestrogen can sometimes help

If testosterone-related tissue changes are causing ongoing dryness, irritation or pain, a clinician may suggest low-dose local oestrogen.

Local vaginal or genital oestrogen has very little systemic absorption and is generally not expected to interfere with the desired masculinising effects of testosterone.

If the idea or language around vaginal treatment feels uncomfortable, talk with your clinician about what formulations and ways of using it feel acceptable to you.

Cramps and pelvic pain on testosterone

Some people continue to experience menstrual-like cramps or pelvic pain even when bleeding has become lighter or stopped.

Others notice cramping associated with testosterone dosing, orgasm or penetration.

Pelvic pain has many possible causes, and being trans doesn’t change that.

Possible contributors can include:

  • menstrual or uterine cramping
  • testosterone-related genital dryness or tissue irritation
  • pelvic floor muscle tension
  • endometriosis
  • adenomyosis
  • ovarian cysts
  • bladder or urinary conditions
  • infection

If pelvic pain keeps returning or is affecting your quality of life, it’s worth getting it assessed rather than assuming testosterone is simply something you have to tolerate.

A pelvic health physiotherapist can also help when pelvic floor muscle tension is part of the problem.

Can you get pregnant on testosterone?

Yes.

Testosterone is not reliable contraception.

Even when your periods have stopped, ovulation can still sometimes occur. It’s also possible to ovulate without having had a noticeable period first.

If you have ovaries and a uterus and have sex in a way that could introduce sperm into the reproductive tract, pregnancy may still be possible.

If you don’t want to become pregnant, discuss contraception with your GP, sexual health clinician or gender-affirming hormone prescriber.

Contraceptive options can include:

  • condoms and other barrier methods
  • hormonal IUDs
  • copper IUDs
  • contraceptive implants
  • contraceptive injections
  • progestogen-only pills
  • some combined hormonal contraceptives where appropriate

Your choice can take into account menstrual suppression, gender dysphoria, pregnancy prevention, future fertility plans and how you feel about particular hormones or procedures.

Read our guide to contraception in Australia for an overview of the options.

Can you stop periods without starting testosterone?

Yes.

You don’t have to start testosterone to be able to ask for menstrual suppression.

Some trans and non-binary people aren’t ready for testosterone, don’t want all of its effects or simply want to stop menstruating regardless of whether gender-affirming hormone therapy is part of their plans.

Medical options can include progestogen-based treatments, hormonal IUDs and other contraceptive methods that reduce or stop bleeding.

Research in trans and gender-diverse young people has found that menstrual-management treatments can improve bleeding, period pain and menstrual-related dysphoria, with high satisfaction among people who found an approach that suited them.

Talk with a gender-affirming GP or sexual health clinician about what you want from treatment. “I want my periods to stop” is a valid healthcare goal.

Hysterectomy, ovary removal and periods

These surgeries are sometimes spoken about as if they do the same thing, but they don’t.

Hysterectomy

A hysterectomy removes the uterus.

Without a uterus, menstrual bleeding permanently stops.

If the ovaries are left in place, they may continue producing hormones and ovulating until natural menopause. A hysterectomy alone therefore doesn’t automatically cause menopause.

Removal of both ovaries

Removing both ovaries stops ovarian hormone production and causes surgical menopause.

For someone already using testosterone, the experience may be different from someone who isn’t on gender-affirming hormone therapy, but the loss of ovarian function still has implications for hormone management and long-term health including bone health.

The decision to have gender-affirming surgery is highly personal and shouldn’t be reduced to simply getting rid of periods.

Do trans men need cervical screening?

If you have a cervix, cervical screening can still be relevant regardless of your gender or whether you take testosterone.

Australia’s National Cervical Screening Program recommends routine screening for eligible people with a cervix aged 25 to 74 who have ever had sexual contact.

Testosterone doesn’t remove the risk of cervical cancer.

Self-collection is an option

Eligible people can choose to collect their own vaginal/front-hole sample using a simple swab rather than having a clinician insert a speculum to collect the sample from the cervix.

For some trans and gender-diverse people, self-collection can make cervical screening considerably more comfortable and less dysphoric.

Testosterone can also make vaginal tissue drier and more sensitive, which may make speculum examinations uncomfortable. If you need clinician-collected screening, let the provider know if dryness or discomfort is a concern so they can discuss ways to make the examination easier.

Read our guide to self-collected cervical screening for more information.

When should you talk with your doctor?

You don’t need to see a doctor simply because you still have a period while transitioning.

But it’s worth talking with your testosterone prescriber or GP if:

  • you want your periods to stop and they’re still continuing after several months of testosterone
  • bleeding returns after being absent for a long time
  • you have very heavy bleeding
  • you bleed between periods or frequently
  • you develop new or significant pelvic pain
  • you have genital burning, dryness or pain that isn’t improving
  • you have unusual discharge, fever or other signs of infection
  • pregnancy could be possible

Not every episode of bleeding means something is wrong. Sometimes adjusting hormone treatment or adding menstrual suppression is all that’s needed.

You also have the right to gender-affirming healthcare. If an examination is suggested, you can ask why it is needed, what alternatives are available and what can be done to make the experience more comfortable.

Frequently asked questions

Will testosterone stop my period?

For most people, testosterone makes periods lighter, less regular or stops them altogether, but the timing varies. In an Australian study, around 62% of participants stopped menstruating within three months, another 16% between three and six months and almost 23% reported bleeding continuing beyond six months.

How long does it take for periods to stop on testosterone?

Many people stop within the first few months, but it can take six months or longer. Your testosterone formulation, dose, hormone levels and individual physiology can all influence how quickly bleeding stops.

Why am I still getting my period on testosterone?

Your body may simply need more time, or your hormone dose, formulation or levels may be contributing. Some people need additional menstrual suppression. Continuing to menstruate doesn’t mean testosterone has failed or that your transition isn’t working.

Why has my period suddenly come back on testosterone?

Breakthrough bleeding can occur even after longer-term testosterone use. Changes in hormone dose or timing may contribute, but there are other possible causes too. If bleeding returns after being absent for a long time or keeps happening, mention it to your hormone prescriber or GP.

Can I ovulate even if testosterone has stopped my periods?

Yes. Testosterone can suppress ovulation, but it doesn’t guarantee that ovulation has stopped completely. Ovulation can also occur without a preceding period.

Can I get pregnant while taking testosterone?

Yes, if you have a uterus and ovaries and have sex in a way that can result in pregnancy. Testosterone isn’t contraception, even when you no longer get periods.

Can I use a menstrual cup or disc while taking testosterone?

Yes, if it feels comfortable for you. Testosterone can make vaginal or front-hole tissue drier or more sensitive for some people, so you may find a little water-based lubricant helps. Stop if insertion or removal becomes painful and consider another product or talk with your healthcare provider if discomfort continues.

What period product is best for trans men?

There isn’t one best product. Some people prefer pads because they avoid insertion. Others prefer cups or discs because they can mean less frequent interaction with their period. Choose according to your anatomy, flow, comfort and what feels least dysphoric for you.

Can I stop my periods without taking testosterone?

Yes. Menstrual suppression can be achieved using several hormonal methods even if you don’t want testosterone. A GP or sexual health clinician can help you choose an option based on your health, preferences and whether contraception is also important.

Does taking testosterone mean I’m going through menopause?

No. Testosterone may stop menstruation and cause some tissue changes that resemble menopause, but period suppression from testosterone isn’t the same as natural menopause. If both ovaries are surgically removed, that does cause surgical menopause.

Is FTM the same as trans man?

FTM, meaning female-to-male, is an older term that some people still use for themselves and search for online. Many people now prefer terms such as trans man, transgender man or transmasculine because they describe who someone is without defining them primarily by the sex they were assigned at birth. The best term is always the one a person chooses for themselves.

Do trans men still need cervical screening?

If you have a cervix and are eligible for Australia’s National Cervical Screening Program, yes. Testosterone doesn’t remove cervical cancer risk. Self-collection with a simple swab is now an option for routine screening for most eligible people.

Your period doesn’t define your gender

Having a period doesn’t make someone a woman, and wanting your period to stop doesn’t make you any more or less trans.

For some people, testosterone makes menstruation disappear quickly and that brings enormous relief. For others it takes longer. Some people choose additional menstrual suppression, some continue to menstruate and some never use testosterone at all.

The same flexibility applies to period products.

You can use a pad, cup, disc or whatever else feels right for your body. You can choose the option that means interacting with your period as little as possible, or simply the one that feels most comfortable.

At Period Shop, we believe period care should be about bodies and individual needs, not gender.

If you’re trying to work out which reusable option may suit your anatomy and preferences, visit our Menstrual Product Comparison Hub.

Related reading

Sources and further reading

This article provides general educational information and isn’t a substitute for individual medical advice or gender-affirming healthcare.