Transgender menstruation: the men who have periods and the women who don’t

In June, Cancer Research UK tweeted: “Cervical screening [or the smear test] is relevant for everyone aged 25 to 64 with a cervix.” The choice of language – “everyone” rather than “women” – was a deliberate attempt by the charity to be inclusive.

Likewise, the social enterprise Bloody Good Period, that provides sanitary protection to asylum seekers in Britain, uses the term “menstruators” rather than “women”.

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This shift in language reflects the idea that it is not just women that get their periods. Transgender men and ‘non-binary’ people – who may see themselves as both feminine and masculine at once – menstruate too.

While there have been advancements in attitudes towards menstruation and the transgender community in the West, education in Hong Kong is lacking.

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“I remember our teacher separated the girls from the boys, and took us to a private room when we were given the talk about periods,” says Joyce Fung, founder of MenstruAction, a social platform aimed at challenging current attitudes toward menstruation.

“It just reiterates that menstruation is supposed to be just a women’s issue, leaving no room to account for people that identify as anything else,” she continues.

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Hong Kong competitive bodybuilder and gender studies scholar Law Siu-fung was born female but identifies as gender-queer, and is seen as male in social settings, although she has recently started using the female pronoun. 

“Menstruation is rarely spoken about within the transgender community, especially with trans male individuals,” says Law.

She says there is an added layer of social shame for trans men who menstruate, as they need to hide their periods from society.

“They may experience pain and discomfort, but feel like they cannot speak to doctors about it, in fear of being exposed as a transgender,” says Law. “On top of that, some doctors might not be the most understanding.”

Despite acceptance from her own family and friends, Law has been subject to rude interrogations by others. She recalls a time when she was questioned by a health care professional during a body check-up.

“My doctor told me I was too ‘masculine’, and made some comments about my gender expression,” she says. “She told me, if I menstruate, that means I’m a woman.”

“I tend to laugh these comments off, and try to help people understand that some of us are different.”

Public toilets prove to be another concern, as there are no means to dispose of sanitary products in male restrooms.

“It can be very embarrassing when – as a trans male – you have to use a public toilet during your period,” says Law. “Sometimes you just have to wrap the item in loads of tissue, and hold it until you find a dustbin.”

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“Additionally, there are such few product choices readily available in Hong Kong, that trans men have to use pads sometimes [instead of tampons or other internal solutions]. That also adds a risk of being exposed. It’s a reminder that they were born in a body that they do not identify with.”

For Brenda Alegre, a university lecturer and transgender woman who was born and raised in Manila, her relationship with menstruation was much different. “I wasn’t born with a vagina, and I don’t menstruate, so I’ve had to justify myself to others as female my whole life,” she says.

Alegre never identified as male, and recalls that as a young trans woman, she thought she would feel more feminine if she wore sanitary pads.

“In the Philippines, ads were very glamorised and featured beautiful celebrities. I remember watching them and thinking that I’d be more womanlike if I used them,” she reminisces.

Alegre would – when she could afford to – wear sanitary pads to feel more confident of her femininity.

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Some trans women take it one step further and use food dyes to mimic period blood. “It’s a way for them to experience menstruation, in some shape or form,” says Alegre.

And although trans women taking hormone replacement therapy (HRT) are not able to experience the shedding of their uterine lining, there have been instances where they have experienced symptoms comparable to premenstrual syndrome.

“They are embarking on studies to determine whether HRT can facilitate menstruation symptoms,” says Alegre, who herself took hormones from 1998 to 2001. “The studies aren’t conclusive yet, but it will be a step forward if we had more scientific backing on the subject.”

But historically, the transgender community has been met with opposition when discussing their medical needs, making a study like this difficult to bring to fruition.

“Education should start at the primary school level,” says Alegre. “We need to have a more inclusive approach to sex education.”