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Being born assigned female at birth (AFAB) means a lot of things for a lot of people, but most often it means menstruation.

May 20, 2020

Jessi Quinn Alperin
Modified from “The Human Body and Health Revised” published in 1908 by Alvin Davison.

or AFAB people who are either nonbinary or trans men, menstruation is this dark shadowy monster that looms in the background of every month unless or until you’re on testosterone — or certain birth controls. Injectable testosterone is a major part of hormone replacement therapy (HRT) for transmasculine people because it promotes the growth of male characteristics and stops menstruation.

But until then, knowing that “that time of the month” is just around the corner is embarrassing and often defeating. It makes you feel even more powerless in your own body.

I’m nonbinary. When I was in fifth grade, I was playing outside on the playground with a few of my guy friends and one girl and they told me I was no longer allowed to climb with them; I had to go play with the “other” girl. I couldn’t say to them that I wasn’t any different from them because 1) that’s a thing that women say because they are different and simply don’t want to be treated differently, and 2) I did not have a deep enough understanding of gender or myself to be able to articulate that when I was playing with them, I was a boy.

Gender gets worse when you stop being a kid. You have to start making real adult decisions about your health and medical care. You don’t get to cavalierly remove your uterus just because you won’t be using it any time soon.

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Most things stop being fun if you’re queer and between the ages of 10 and 18. Queer kids have most of their autonomy removed from them, whether by parents, society, or nature. Once you realize you are “different”, life feels like it becomes a series of hurdles to try and fit in or hide. Our parents’ expectations for us and what our bodies force upon us are usually the most difficult to reckon with.

When I was 15, I was diagnosed with polycystic ovarian syndrome (PCOS) at the behest of my mother who was very concerned that I was hairy (I’m Jewish), acne-ridden, and not getting my period for long amounts of time. PCOS is really just an imbalance of hormones that causes irregular periods, weight gain, and several other symptoms, but the biggest problem is that it makes it hard to become pregnant. PCOS is extremely common and it is by no means a death sentence.

She dragged me from doctor to blood labs to ultrasounds to prod at every inch of my female-ness. Every second was excruciatingly painful. I would try not to cry in the doctor’s office because my mom was there and I would try not to cry in the car because my mom was there. We went home, I would slam the door, and I would cry. Was this new diagnosis why I was queer? Was my deeply-hidden boyishness actually just “unnatural”?

Eventually my mom scared me into taking an oral birth control. She said to me, “You will probably get cervical cancer if you are not regularly getting your period.” (Don’t worry — this isn’t true.)

Terrified, 15 years old, and uninterested in doing my own research, I started taking an oral birth control in order to regulate my PCOS-riddled body and try to prevent this fictional cancerous future. Oral birth control is usually doctors’ first choice when it comes to regulating PCOS, but it would not have been mine. I began regularly getting my period and in the blink of an eye, my last drop of childhood was gone, and with it my societally-approved boyishness.

There is no narrative trajectory of the next six years. I switched pills a few times for reasons more having to do with migraines than with gender. When Trump was elected, all of my Jewish friends told me I should get an IUD (intrauterine device) because you can keep the Mirena in for longer than a presidential term and in 2016 we had no idea how much reproductive rights legislation would be rolled back.

I came out during my junior year of college after several of my peers had come out as nonbinary. I waited months after their coming-outs because I can’t stand feeling like a copycat, but eventually it got too hard to see them so much happier after coming out and living their truth, while I was still holding back.

I came out as genderqueer in March of 2018 and by April 2018 I had an IUD.

For me, the decision was connected. I needed a different birth control for a lot of health reasons, but deciding to get an IUD inserted and no longer have to take an oral contraceptive every day felt like reclaiming my body and my gender. A bonus for me was also that the IUD was likely to eliminate my periods for the duration of its effectiveness.

Quite frankly, I think I feel the way a cisgender man must feel; free from biological clocks and desires of the moon. A cis man gets up every day and doesn’t need to think about where he is in the month or if he has “the right supplies” should he start bleeding from in between his legs all of a sudden because he miscalculated or his medicine isn’t working right. A man is free from this.

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I am not the only trans person who feels a deep panic over the possibility of ever menstruating again. It’s actually an extremely common experience for trans AFAB people, and more often than not wanting to not menstruate is a determining factor for what contraceptive methods they pursue — and even whether or not they decide to take testosterone. Since I did not want my own experience to speak for everyone, I interviewed several other members of the trans community.

Matthias Vitullo, a trans man living in Pittsburgh, first began taking a progesterone birth control pill “to stop my periods because they made [him] dysphoric.” Though, he stopped taking an oral contraceptive once he got on testosterone since it fulfilled his original goal from taking it.

While I have found my IUD to help with my dysphoria, Vitullo decided to stay away from them in case it could interact with testosterone, and he was afraid of some of the more negative experiences he had heard of.

Riley Galvin, a nonbinary person in Columbus, also went from an oral contraceptive to the Mirena IUD, but had a negative reaction. “For me, [it] was a mistake; not only did Mirena increase my anxiety and led to me gaining weight, but the actual physical feeling of having an IUD consistently gave me some of the worst dysphoria I’ve ever experienced. I got that removed soon after and went back on the pill…and have been on it since.”

Quite often, trans people who are on testosterone opt to use condoms as their sole contraceptive method. Casper Peters, a trans man in New Jersey, uses condoms in order to prevent pregnancy. Peter Fair is a nonbinary person who also does not use hormonal birth control in order to maintain a healthy balance of their testosterone.

But for each one of us, our gender played a prominent role in our contraceptive methods — especially if it meant eliminating periods.

Fair, Peters, and Vitullo all find the use of contraceptives to be inconvenient. For Fair, this means engaging in less sex overall, “as well as choosing to engage in lower risk for pregnancy sex.”

Vitullo finds this to be inconvenient for more than simply needing to have a contraceptive plan in place. “It’s really a constant reminder of what I’ve got going on bodily.”

Galvin echoed this sentiment, “If I had the choice, I would opt to get a hysterectomy, but that’s pretty expensive. And even if I tried to get the procedure done, I doubt I’d be able to, since doctors are known to fight younger AFAB folx every step of the way — because we “might want to have kids one day.” As if we don’t know what’s best for ourselves. That’s a roundabout way of saying that there are permanent options of contraception that I would prefer, where I wouldn’t ever have to think about contraception again, but accessing them is incredibly difficult. So “having” to take contraception in the way I currently am is incredibly frustrating.”

When trans people make decisions about contraception, it isn’t solely about preventing pregnancy. Most of us make contraceptive choices in order to affirm our gender identities. Instead of living on a “rite of passage” pedestal as it so often does in feminist communities, menstruation and everything that comes with it really feels more like an affliction for AFAB people who are trans and nonbinary. Even more than it hurts trans people, it hurts all of us when we force the pinnacle of the “female experience” to center around menstruation as a thing to celebrate. Not everyone who gets a period needs to be happy about it, and not everyone who is a woman needs to bleed.

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