Transgender & PMDD

Hormone therapy, transitioning and PMDD

PMDD is a hormone based-mood disorder, and those with PMDD have a sensitivity in the brain which causes a severe negative reaction to the typical hormone fluctuations which occur in the luteal phase of the cycle when ovulation occurs. 

It makes sense then that manually caused fluctuations (such as starting/stopping/changing doses of hormone therapy), can be difficult for those with PMDD. 

However, recent studies ALSO show that these negative emotional reactions usually go away about one month after starting, or making any changes to hormone replacement therapy (HRT). Therefore, if you can tolerate the symptoms in the first month following the start of HRT (or any changes in HRT), symptoms usually subside once the levels are steady and fluctuations are not occuring. Do work with your provider to ensure extra support and reassurance is put in place during this process. 

Testosterone therapy

According to published guidelines from the Center of Excellence for Transgender Health, there is no clear evidence that testosterone therapy is directly associated with the onset of or worsening of mental health conditions, including PMDD. In fact, it has been found that transgender men experience improvements in social functioning and reduced anxiety and depression once testosterone therapy is begun.

Everyone will have individual responses to hormone therapy, so like with the menstrual cycle,  it is helpful to track mood and other symptoms across starting new hormone regimens to determine their impact. If someone notices mood changes that coincide with taking testosterone, it is important to speak with your doctor about whether changes in dose might be appropriate and/or to get support in managing side effects. It is  important to note that not all all symptoms of depression, anxiety, rage, or suicidal ideation experienced by trans individuals and those on testosterone therapy are due to HRT or being transgender. Psychiatric care (therapy and/or medication) to treat or help manage other psychological issues or stressors may be needed for some individuals. It can be reasonable to get a second opinion or try a different provider (if possible) if it seems like a mental health provider is ignoring is not understanding the full picture. 

Independent of any direct hormone-related effects on mood, it is positive to note that many trans individuals (men, women, and nonbinary) do report a lessening of symptoms from transition-related healthcare including hormone therapy and gender-confirming surgery, due to reductions in gender dysphoria and related distress. 

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Additional support

Peer Support

We're here to help, talk, and listen. Click here to contact our Peer Support Team. Peer Support is always confidential, free of charge, and offered by trained individuals with lived experience of PMDD/PME. It is an inclusive service - we ask and offer pronouns and we have LGBTQIA+ folk and allies volunteering as peer support providers. 

Online PMDD Support

Crisis Support

Our peer support service is not a substitute to crisis support. If you identify as transgender and are experiencing suicidal ideation or a mental health crisis, please reach out for support by contacting Trans Lifeline at:

United States Trans Lifeline - (877) 565-8860 

Canada Trans Lifeline - (877) 330-6366 

A list of international crisis centres/phone numbers can be found here

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Further Reading

Gender dysphoria and your cycle »  

Testosterone and your cycle » 

9 LGBTQ People Speak Out About Premenstrual Dysphoric Disorder » 

Online Learning for Professionals » Acknowledging Gender and Sex

Have other suggestions to be added here? Let us know here.

Back to topGender dysphoria and your cycle »  Testosterone and your cycle » 

Can cis men have PMDD?

A cis man is someone who was assigned as male at birth (AMAB) and their gender identity is also male. A cis man cannot have PMDD as they do not have female reproductive organs and therefore do not have a menstrual cycle. That is not to say that they cannot have a sensitivity to hormone fluctuations, but they would not have the regular and cyclical pattern of a menstrual cycle.

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Can transgender men have PMDD?

Yes. A trans man is someone who was AFAB (assigned female at birth) but their gender identity is male. Some transmasculine individuals may identify as nonbinary (i.e., an AFAB person not identifying as either a man or woman and whose gender expression is more masculine). Non-binary individuals may or may not choose to undergo physical transition steps (such as hormones or surgery).  

If individuals still have ovaries (or an ovary), then they will still have a menstrual cycle (unless controlled by cycle suppression i.e. continuous birth control) and therefore they can, of course, have PMDD. For some transmasculine individuals, menstruation also causes distress through increased gender dysphoria. Transgender individuals with PMDD often do not receive the support that they need and deserve, and they may feel unwelcome or excluded from spaces providing PMDD support if language that assumes female gender identity is used. At IAPMD, we work to create spaces welcoming to all genders affected by PMDD.

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Can a transgender woman have PMDD?

A trans woman is someone who was AMAB (assigned male at birth) but their gender identity is female. Someone who was born without ovaries cannot have PMDD as there is no menstrual cycle to trigger the cyclical symptoms. 

However, some transgender women do report PMS like symptoms when using hormone therapy, which typically involves taking some form of estrogen and possibly progesterone and/or testosterone-blocking medications. It is possible that hormone therapy may induce PMDD-like symptoms if the individual has a neural hormone sensitivity, similar to those that cause PMDD in AFAB individuals. Further research is needed as this is currently not well understood. 

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Being an ally

Suicide attempts among trans men are slightly higher than trans women, at 46 percent to 42 percent respectively. The overall rate of transgender suicide is 41 percent, which vastly exceeds the 4.6 percent of the overall U.S. population who report a suicide attempt in their lifetime. These are scary statistics and ones we want to remedy. No-one with PMDD should have to experience exclusion or have extra barriers in getting the support and care they need and deserve. 

Please join us in being allies to the transgender and non-binary PMDD community. Here are some simple steps you can take:

• Welcome them into our thriving community. Introducing yourself as a cisgender person (if you are one!) with your pronouns (e.g., I am Jane (she/her)) - which are words that are used to refer to someone without using their name - can make a more inclusive and safe environment for trans people to also share their pronouns. By normalizing the practice of sharing your pronouns in your communities, you lighten the pressure on trans people. This also lowers the chance for unintentional misgendering to happen.

• Use gender neutral language in support groups For example you could say: “Hey folks/everyone!” instead of “Hey ladies/girls!”;  “Fellow friends with PMDD” instead of “fellow sisters with PMDD”;  “uterus/ovaries/vagina/etc” instead of “lady parts”. Whilst it may not be a big deal to you, it can make a difference to making others feel welcome and not excluded.

• We switched from the common #PMDDsisters hashtag to #PMDDpeeps across our social media to make it more inclusive. Use this across social media to connect with others!

• Listen to what the trans and non-binary people in the PMDD community are saying, and make sure that in your work as an ally, you are centering them and not yourself.

• Don’t expect to be perfect - keep learning and being open minded. Apologise if you slip up and move on.

• Read more about how to be a ally here:

At IAPMD, we recognize that inclusivity is an ongoing process. We encourage you to get in touch with us with feedback and suggestions about how to better support all people with PMDD/PME. Email us here.

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Updated 12th November 2020 - Dr Tory Eisenlohr Moul Ph.D & Dr Jessica R. Peters, Ph.D.