The Auti Peri Q&A: Greg
“One of the barriers to talking about it for a lot of us trans guys is the dysphoria, and knowing that it's a traditionally (cis) female experience.”
Hi, I’m Sam (she/her). A late diagnosed neurodivergent woman, a tenacious midlife struggler, and an advocate for people in autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression AKA The Auti Peri.
I am delighted to be the host of The Auti Peri Q&A Series!
In this series, I host a Q&A interview with a fellow autistic person about their experience of the menopause transition.
Everyone’s experience of the autistic menopausal transition is different. I aim to elevate the voices, lived experiences and reflections of autistic people’s menopausal transition.
Autistic perimenopause is a highly individual, dynamic and sometimes prolonged life stage caused by reproductive hormonal fluctuations. As autistics can be highly sensitive to bodily and environmental, we may experience fluctuations as physical, psychological and cognitive symptoms.
Academic research into auti peri is in it’s early stages, yet it is a matter or urgency that we bust the social taboo and get used to talking about this.
Today’s guest is Greg* (they/he) and they live in Aotearoa New Zealand. They have this message to share with you:
“Sam very kindly invited me to talk about my experiences with perimenopause, as a nonbinary trans masc person**.
Since transitioning, I’ve been the happiest I’ve ever been, but it’s come with some surprising and unexpected challenges, including perimenopause.”
*Not their real name.
**Here is more information if you’ve got questions about the terminology they use to describe their queerness:
Fun fact: The Autistic Perimenopause: A Temporary Regression is fuelled by caffeine. If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️
What does “autistic perimenopause” mean to you?
For me, it means the million different effects of my hormones being out of wack.
When did your autistic perimenopause symptoms start and what were they?
Perimenopause symptoms hit particularly hard, and all at once, after having a gender-affirming hysterectomy in March 2022. Soon after that, my GP and I decided to switch my testosterone medication, which took 12-18 months to bring my T (testosterone) levels into the cis male range.
My symptoms are everything - low energy, brain fog, can sleep all day and still be tired, ADHD meds don't work nearly as well, very limited appetite, much lower sensory tolerance, and so on. Also higher-than-usual anxiety and lower-than-usual mood/depression.
I also have (ongoing) vaginal atrophy - the change in hormones means that I'm a lot less lubricated. As well as the gender dysphoria, this makes it really hard when I need smear tests etc, but I've found something that makes a huge difference: Lignocaine (Lidocaine) lube!
Most doctor's practices have it on hand, and the hospital (including ultrasound section) have it easily available, as it's often used to reduce pain & discomfort when inserting urinary catheters. It has a numbing effect, meaning that I don't feel anything, besides pressure.
What happened if/when you presented with autistic perimenopause to a healthcare professional?
Later in 2022, I told my doctor that I had concerns about my T levels from a blood test, but she kept focusing on how I was feeling rather than what the numbers were suggesting. The trouble is that how I feel is so variable, depending on the day/week/month, and sometimes even just the time of day, so between that and being autistic, I wanted to look at it in a more black & white way.
Despite that early hiccup, my GP did listen to me, and eventually went back to the endocrinologist and discussed how my T dose could be modified.
We now have a very high-trust relationship, and I appreciate the ability to adjust any/all of my meds as needed, with my GP providing information around safe & reasonable dose ranges, and prescribing what I need to live the life of my choosing.
What was your treatment protocol for managing your autistic perimenopause? (Medical/lifestyle/alternative therapies etc.)
Testosterone/HRT. Also being mindful of when my next T dose is due, and taking that into consideration when I notice I'm struggling.
I've now moved to T gel, which is taken every day (rather than every 6-12 weeks), and my T levels feel (& are) far more consistent.
How was your everyday life impacted by autistic perimenopause (your caring/employment responsibilities, hobbies, mental health, relationships etc.)?
When I was taking T every 6 weeks, I'd have an initial surge where my T levels were "normal", and then they'd drop down until I had absolutely no energy whatsoever. During the initial surge, I'd feel motivated and ready to conquer the world, and it was during these periods that I'd want to make changes to my life and business, but couldn't trust that I would continue to have those levels of energy, meaning that I couldn't make meaingful change.
Same with hobbies - I'd start getting into something when my T levels were good, but then not be able to work on them after 2-3 weeks as my T levels dropped, and the things which used to bring me joy, would just bring frustration and disappointment because my body/brain was letting me down.
Being trans has complicated things way more, because while it seems socially acceptable for a middle-aged cis woman to mention "personal summers" and how frustrating they can be, it's not nearly as socially acceptable for a 20-something year old, cis-passing dude [looks like a cis male when you see them out & about] to do that.
And also I had a client end of last year who was all "OMG hormones make my anxiety way worse" and I was like "argh yeah tell me about it" but then realised that sounds weird if you don't know that I'm going through the same thing...which I am.
So I feel like I can't say anything without having to disclose a whole pile of very personal medical information, meaning that it makes me feel like I'm going through this journey completely alone.
Were there things that made your menopause transition especially difficult for you as an autistic person? If so, what kinds of things?
I don't know if it's the autism or the gender dysphoria, or something else, but living with a medical condition that is generally only experienced by women, is really hard.
Additionally, the hormone changes definitely make my autistic traits (and with that, my challenges and support needs) more pronounced.
Were there things that could have made your menopause transition easier for you as an autistic person? If so, what kinds of things?
More conversation/awareness within the trans community and the clinicians that work with us, for sure! I think one of the barriers to talking about it for a lot of us trans guys is the dysphoria, and knowing that it's a traditionally (cis) female experience.
Of the trans community, those who have gone through menopause are quite the minority - not all trans people choose/are able to have surgeries, and of those surgeries, probably around a quarter are hysterectomies.
What supports, resources and services are/were available to people experiencing autistic perimenopause where you live?
Without blowing my anonymity I don't think there are any local resources or services!
Something that's helped though was going to the local sexual health clinic and seeing a doc who had seen tons of trans patients and even more who were having funky genital stuff going on. She recommend I get Replens, a vaginal moisturiser, and it's significantly reduced the number of times I've had BV (bacterial vaginosis) this year (vaginal atrophy likely a big part of that).
Also Lignocaine lube for any physical exams - it means I only feel pressure, not pain or sensations really at all during an exam which helps a lot with navigating physical exams, autism, and gender dysphoria!
What kinds of services, resources or supports would you have found most helpful?
Articles - both by trans people themselves, and knowledgeable clinicians - talking through experiences, what worked/didn't work, and most of all - giving hope!
Talking about how things will get better, the joys in the middle, etc.
With the proportion of trans people hovering around 1% of the population, globally, it's easy to feel alone, and it's made even more challenging because we don't exactly have a flashing neon sign, visible only to other trans people! (Yes - we have a trans version of the "gaydar", although it's not nearly as reliable unfortunately.)
What is the easiest way for you to access information about autistic menopause?
Facebook/online in general.
What would you wish for all people to know about autistic perimenopause?
Hormone swings happen to guys as well, for lots of reasons!
Is there anything else you’d like to share regarding your autistic experiences of menopause?
The majority of trans people who take hormones will have experienced, or be experiencing, perimenopause, and it's terrifying to watch politicians across the world, as well as in Aotearoa New Zealand, make it increasingly difficult to access hormones and hormone therapy.
Without access, so very many of us will be plunged into immediate and relentless perimenopause, so please don't let them do that to us. Woops sorry that got polticial!
I hope you enjoyed this Q&A. If you would like to be featured as part of this series, please message me. I’d love to share your story!
TY for including trans experience - so often overlooked!
Thank you so much Greg and Sam for this excellent interview and sharing all this information. I really appreciate hearing about perimenopause from a transmasculine perspective.