The Periods We Create: Lived Experiences, Lack of Research, and Transphobic Narratives
It started subtly at first, a fleeting feeling here, a twinge there, but over the past two months, it’s become impossible to ignore. This month, it hit me like a freight train—a tidal wave of emotions and physical sensations that left me reeling. I’m incredibly thankful it coincided with the winter break; had it happened during term time, I don’t know how I would have managed. As a teacher, the idea of navigating this at school, with its constant demands and sensory challenges, is daunting to say the least.
This experience feels significant, not just personally, but as part of a broader narrative that often goes unspoken. I’m an autistic trans woman, and I’ve been on HRT for over seven months. Whilst I knew to expect changes—softer skin, redistributions of fat, breast growth, shifts in mood—nothing prepared me for this: a recurring, undeniable rhythm of intense emotions and physicality that feels, for all intents and purposes, like a period. Of course, there’s no bleeding, but the rest is there—the crashing emotions, the fatigue, the sensitivity. And yet, when I searched for answers, all I found were roadblocks, the conversation dominated by far-right rhetoric or a dismissive silence from mainstream research.
I’m sharing this not to present answers, but to contribute to the conversation. My experience may be unique, but it speaks to something larger: the profound absence of research into the lived realities of trans women on HRT. By telling my story, I hope to validate others who might be going through something similar and to highlight the need for more inclusive, thoughtful exploration of our experiences. If science isn’t ready to look, then we must be willing to stand up and say, “This is happening.”
What I’m Experiencing
Over the past few months, I’ve become increasingly aware of a profound shift within myself—one that feels entirely new and stands in stark contrast to the decades I’ve spent navigating and understanding my autistic system prior to HRT. These changes are not subtle; they are vivid, undeniable, and transformative. My emotions, once consistent and easier to categorise, have become sharper, deeper, and more layered, almost as if a veil has been lifted. They are strikingly different from anything I’ve experienced before—alien in their intensity yet unmistakably mine.
There’s a build-up that unfolds over several days, a slow crescendo of emotional and physical sensations that culminates in a peak where everything feels amplified. Joy, sadness, anger, and vulnerability all seem to arrive at once, demanding my full attention. Some moments are defined by an overwhelming sadness, where events—big or small—trigger waves of uncontrollable tears. I find myself crying in ways I never have before, raw and unguarded, as if the act itself were a release my body had been waiting for. Yet, at other times, there’s an uncontainable euphoria that surges through me, unmatched by anything I’ve felt before HRT. These moments feel like pure, unfiltered elation, as though I’ve stumbled into a world brighter and richer than I ever thought possible.
The physical sensations accompanying these emotional shifts are equally striking. There’s a bone-deep exhaustion that often takes over, as if my body were asking for rest after expending so much energy navigating these changes. Occasionally, there’s cramping—not severe, but enough to make me stop and notice. And then there’s this heaviness, an almost gravitational pull, that seems to settle in my body during certain times, as if it were mirroring the weight of my emotions. These sensations, combined with the unmistakable rhythm of these patterns, have grown too consistent to be dismissed as mere coincidence.
This process feels like something my body is actively creating—a hormonal rhythm that is entirely its own. It doesn’t mimic a menstrual cycle; it’s not trying to be one. Instead, it feels as though my hormonal environment, shaped by HRT, has carved out a cycle that is unique to me. It’s a profoundly new way of experiencing myself, one that reshapes not only how I feel but also how I understand and inhabit my own body.
Again, this isn’t mimicry of a menstrual cycle, nor is it an attempt to compare or appropriate. Rather, it feels like my hormonal environment has created a rhythm that is uniquely mine—a rhythm that mirrors aspects of cycles I’ve read about but is rooted entirely in the chemistry of my own body responding to HRT. It’s not a shadow of something else; it’s an active process, an expression of my body’s internal logic that has emerged organically. Whilst there’s no bleeding (obviously), the emotional shifts, physical sensations, and profound intensity of these moments are undeniable. It’s a cycle that feels every bit as real, and just as consuming, as the experiences shared by cis women—uniquely mine, yet recognisable within a broader human experience.
For me, as an autistic person, encountering such a profound change in my internal environment naturally led to one thing: a deep dive into understanding it. This wasn’t a passive curiosity; it was an urgent, almost compulsive need to make sense of what was happening. The intensity of these experiences demanded patterns, explanations, and frameworks to help me navigate the unfamiliar. Autistic processing thrives on this kind of focus, and I immersed myself in research, scouring for any information that could illuminate these shifts. I pieced together fragments of scientific studies, anecdotal reports, and my own observations, trying to construct a coherent narrative.
But this wasn’t just about satisfying intellectual curiosity—it was about grounding myself in something deeply personal and new. The process felt as though it were rewriting the way I experience myself and the world around me, challenging my understanding of emotions, sensations, and how my body works. Making sense of it wasn’t just important; it was essential for my sense of self. This cycle isn’t just a curiosity or a novelty—it’s an integral part of who I am now, and understanding it feels like the next step in truly inhabiting this version of myself. And that’s no small thing.
My Research Journey
When I first set out to research what I was experiencing, I naively thought it might be relatively straightforward. After all, I can’t be the only trans woman on HRT who has noticed a distinct rhythm to their emotional and physical changes. However, my initial searches were met with an overwhelming amount of unhelpful or outright harmful content. Broad search terms like “trans women periods HRT” or “cyclic changes transgender HRT” seemed to trigger the algorithm into surfacing far-right propaganda and inflammatory narratives. These results, dismissing trans women’s experiences entirely, framed menstruation and emotional cycles as the exclusive domain of cisgender women—often in starkly misogynistic terms. They cast periods as nothing more than inconvenient interruptions to men’s lives, reinforcing outdated stereotypes about gender and emotion.
I quickly realised that the problem wasn’t just the lack of accessible research but the cultural framing surrounding these discussions. Anything hinting at the complexity of hormonal or emotional changes in trans women was either co-opted into transphobic discourse or buried beneath mountains of irrelevant noise. This initial hurdle was disheartening but not unexpected; it only sharpened my resolve to refine my approach and dig deeper.
Adjusting my search terms became essential. I started using more clinical phrases like “cyclic mood changes transgender women HRT” or “emotional patterns feminising hormone therapy.” These helped filter out some of the more blatantly harmful results, though the success was still limited. Narrowing further, I included terms like “endocrinology” and “oestrogen effects,” which yielded studies tangentially related to my experience, though none that addressed it directly. What I found were breadcrumbs—small pieces of information that hinted at broader possibilities but never explicitly explored the phenomenon I was investigating.
The search terms used at ProQuest, Google Scholar, and ConsensusGPT:
Emotional cycles HRT transgender women
Hormone replacement therapy monthly mood changes trans women
Cyclic emotional changes transgender HRT
Transgender women PMS-like symptoms HRT
Emotional effects estrogen therapy transgender women
Monthly hormonal fluctuations transgender women HRT
Cyclic mood changes estrogen HRT transgender women
PMS symptoms in transgender women on HRT
Hormonal rhythms transgender women estrogen therapy
Trans women HRT mood and emotional patterns
Among the references I collected, a few stood out for their potential relevance. Studies like Backstrom et al. (1983) and Hammarbäck et al. (1985) discussed cyclical mood changes in cisgender women, particularly during the luteal phase, offering insights into the role of hormonal rhythms in emotional shifts. Others, like Björn et al. (2003), explored how oestrogen dosages can impact mood during hormonal therapy, while Prior (2019) highlighted the importance of progesterone in transgender women’s health, even though I’m not on progesterone myself. More recent studies, such as those by van Dijk et al. (2019) and Yaish et al. (2023), examined subjective effects of HRT in trans people, but their focus was broad, offering little on the cyclic patterns I was observing.
The references I found:
Backstrom, T., Baird, D. T., Carstensen, H., & Sundström, I. (1983). Endocrinological aspects of cyclical mood changes during the luteal phase in normal women. Psychoneuroendocrinology, 8(4), 299-312.
Björn, S., Sundström Poromaa, I., Bixo, M., & Nyberg, S. (2003). Increase of estrogen dose deteriorates mood during progestin phase in sequential hormonal therapy. Psychoneuroendocrinology, 28(3), 331-347.
Chiu, Y. M., Kim, B., Qu, X., & Amorapanth, P. X. (2017). Acute onset of psychotic symptoms following abrupt discontinuation of hormone replacement therapy in a transgender woman with traumatic brain injury: A case report. PM&R, 9, 58.
Defreyne, J., Van De Bruaene, L., Rietzschel, E., Van Schuylenbergh, J., & T’Sjoen, G. (2019). Effects of gender-affirming hormones on lipid, metabolic, and cardiac surrogate blood markers in transgender persons. Clinical Chemistry, 65(1), 119–134.
Deutsch, M. B., Bhakri, V., & Kubicek, K. (2015). Effects of cross-sex hormone treatment on transgender women. Journal of Clinical Endocrinology & Metabolism, 100(2), 256-266.
Glintborg, D., & T’sjoen, G. (2021). Management of endocrine disease: Optimal feminizing hormone therapy in transgender people. European Journal of Endocrinology, 184(3), R69–R80.
Hammarbäck, S., Bäckström, T., & Lindhe, B. (1985). Cyclical mood changes as in the premenstrual tension syndrome. Acta Psychiatrica Scandinavica, 72(4), 430–438.
Hoyer, J., Burmann, I., Kieseler, M., et al. (2013). Menstrual cycle phase modulates emotional conflict. Journal of Women’s Health, 22(4), 385–391.
Kirey-Sitnikova, Y. (2024). The impact of feminizing hormone replacement therapy (HRT) on risks of cancer, venous thromboembolism, and osteopenia: A systematic review. Astana Medical Journal.
Nguyen, N. T., & Loughead, T. M. (2018). What has sex got to do with it? The role of hormones in the management of gender dysphoria. Endocrinology & Metabolism Clinics of North America, 47(3), 471-485.
Prior, J. C. (2019). Progesterone is important for transgender women’s health. Maturitas, 121, 94–104.
Randolph, J. F. (2018). Gender-affirming hormone therapy for transgender females. Endocrine Reviews, 39(2), 136–152.
Soares, C. N., & Frey, B. N. (2010). Is there a role for estrogen in treating depression during menopause? Journal of Psychiatry & Neuroscience, 35(6), E6–E7.
Tangpricha, V., & den Heijer, M. (2017). Oestrogen and anti-androgen therapy for transgender women. The Lancet Diabetes & Endocrinology, 5(4), 291–300.
van Dijk, D., Dekker, M. J. H. J., Conemans, E. B., et al. (2019). Explorative prospective evaluation of short-term subjective effects of hormonal treatment in trans people—Results from the European Network for the Investigation of Gender Incongruence. The Journal of Sexual Medicine, 16(3), 442–450.
Wierckx, K., Van Caenegem, E., Schreiner, T., et al. (2014). Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up. The Journal of Sexual Medicine, 11(8), 1999–2011.
Yaish, I., Keltch, G., Greenman, Y., & Tordjman, K. M. (2023). Evaluation of the emotional and cognitive effects of hormone therapy in transgender men and women. Journal of the Endocrine Society, 7.
What became clear from my research was not just the absence of answers, but the absence of the question itself. None of the studies I encountered directly addressed the possibility of hormonal cycles in trans women on HRT. The general focus remained on broad psychological and physical outcomes of hormone therapy, leaving experiences like mine unexplored. This gap in the research speaks volumes—not about the validity of my experience, but about the priorities of a medical and scientific community that has yet to fully consider the nuanced realities of trans lives.
Commentary and Reflection
The lack of research into the lived experiences of trans women, particularly those on HRT, is glaring. It feels as though the medical and scientific communities are more interested in framing trans healthcare around assimilation—“passing” as cisgender—than exploring trans identities as valid destinations in and of themselves. Much of the focus is on how to align trans women’s appearances or hormonal profiles with cisgender norms, but what about the uniquely trans experience? What about the ways our bodies respond to HRT in ways that cis bodies never could? By failing to consider trans as a valid and complete state of being, a vast part of our lives goes uninvestigated and unacknowledged. The medical community’s narrow focus leaves us to piece together our experiences through anecdote and shared narratives, navigating uncharted waters without the benefit of scientific insight.
This oversight has real consequences. Without research that considers the full spectrum of trans experiences, medical understanding of our needs remains incomplete, and support systems fall short. For those of us experiencing hormonal rhythms that mimic or mirror aspects of cycles traditionally associated with cisgender women, this absence leaves us with more questions than answers. Is this a normal part of HRT? Should it be expected or monitored? Are there ways to manage the more overwhelming aspects of these cycles? Without acknowledgment or inquiry, these questions remain unanswered, leaving us to navigate our experiences largely alone.
The cultural framing of periods in the Global North exacerbates this gap. Conversations about menstruation and the associated emotional shifts are often centred on how these experiences inconvenience men or how they can be commodified for profit. Period products, hormonal birth control, and even societal attitudes around menstruation are shaped by a capitalist framework that sidelines the lived experiences of women. For cis women, this manifests as a dismissal of their struggles; for trans women, the dismissal is even more profound, framed as an invalid claim to something we couldn’t possibly understand. The far-right and religious right (redundant?) are quick to weaponise this narrative, portraying trans women’s discussions of periods as a threat to the very concept of womanhood. Rather than engaging with the nuance of our experiences, these groups shout us down, leaving no space for genuine exploration or understanding.
In the face of this silencing, sharing lived experiences becomes essential. Without formal research, our stories become the foundation for understanding the diversity of hormonal and emotional experiences among all women, cis and trans. They validate what might otherwise feel isolating and provide a sense of community in the absence of institutional support. More importantly, they challenge the idea that womanhood is a monolith, bound by biology and defined by a narrow set of experiences. By sharing these narratives, we create space for more inclusive conversations—ones that recognise the complexity of our bodies and our lives, while affirming that our experiences are every bit as real and valid as those the world has traditionally been willing to accept.
Final thoughts …
The dismissal or silencing of narratives like mine has broader implications than many realise. It’s not just about denying the validity of one experience—it’s about erasing an entire spectrum of possibilities for understanding human lives. When the medical and scientific communities fail to investigate or acknowledge experiences that fall outside traditional frameworks, they perpetuate a cycle of exclusion. This silence doesn’t just leave individuals like me feeling unseen; it denies all of us, cis and trans alike, a richer understanding of what it means to live in a body shaped by hormones, identity, and emotion.
These gaps in research and discourse are not inevitable—they are the result of choices. Choices to prioritise certain perspectives over others. Choices to view trans identities as deviations rather than destinations. Choices to cater to societal norms rather than challenge them. But just as these silences are constructed, they can also be dismantled. By sharing our lived experiences, we push back against the erasure, creating space for stories that challenge and expand the narratives society is comfortable hearing.
There’s a hopeful note in all of this: community and advocacy have always been the lifeblood of progress in marginalised spaces. Where institutions fall short, we find each other. We share our stories, build support networks, and insist on our right to be heard. Every anecdote shared, every conversation started, and every moment of connection strengthens the case for inclusion. The gaps left by academic and medical institutions are real, but they are not insurmountable.
In telling my story, I hope to contribute to that collective push toward understanding. I hope to encourage others to speak up, to add their voices to the chorus demanding change. And I hope to remind anyone reading this that our experiences—however unique, however unconventional—are valid. Together, we can make the silences smaller, the spaces of understanding larger, and the world a little more welcoming for all of us.