A bloodless menstrual cycle? The perceived and hormonal menstrual cycle-like experiences of transgender women in the United States

Introduction and research questions Menstruation is typically constructed as a biological hallmark of cisgender womanhood, excluding transgender women from menstrual cycle-related experiences. However, anecdotal reports suggest that transgender women on gender-affirming hormone therapy (GAHT) may experience cyclical, menstrual cycle-like symptoms. This mixed-methods study investigates whether transgender women experience such symptoms, whether symptom timing correlates with hormonal patterns, and how women interpret these symptoms in relation to their gender identity. Methods We conducted semi-structured interviews with 20 transgender women in the United States, collected prospective symptom-tracking data from 19 of these participants, and analyzed daily dried urine samples from 14 of them for 24 hormone metabolites. Results Participants reported a wide range of emotional, cognitive, and physical symptoms, including those typically associated with the luteal phase in cisgender women—such as cramps, tender breasts, and cravings. These symptoms tended to occur when estradiol levels were lower than participants’ personal averages, although patterns varied by individual. Discussion and conclusion Through case studies integrating hormone levels, symptom data, and interviews, we show that some participants conceptualized these symptoms as “cycles” that affirmed their womanhood, while others were ambivalent or dismissive. Our findings challenge cisnormative definitions of menstrual cycles by documenting the presence and gendered meaning-making of cyclical experiences among transgender women. This work expands understandings of menstrual and hormonal health and embodiment and calls for inclusive frameworks that recognize gender-diverse experiences of hormone cycles and identity.