November 3, 2025 • 43 mins
Start with the lived experience, not the label. We sit down with gender-affirming menopause educator and advocate Lasara Firefox Allen to reframe menopause as a human transition that deserves respect, nuance, and choices. From the first hot flash to postmenopausal clarity, we map the terrain for trans, nonbinary, and gender-diverse people who are too often erased by narrow clinical language and outdated protocols.
Lasara shares how dysphoria and euphoria can shape the menopause arc, why “hormones have no gender,” and how surgical or chemical menopause intersects with identity and safety. We break down what affirming care looks like in real clinics: pronouns honored, intake forms that fit, and treatment menus that don’t force people into boxes. You’ll hear the tough realities—erratic bleeding for transmasculine folks in unsafe environments, GSM that worsens on testosterone without local estrogen, and the data on late ADHD and autism diagnoses—paired with clear, actionable guidance.
We dive into hormone strategy with a practical lens, exploring when high-dose testosterone, physiologic-dose estradiol, and micronized progesterone make sense, and why prior side effects with birth control don’t predict menopausal HRT outcomes. We cover workplace disclosure, accommodations that reduce risk, and the hidden burden of eating disorders in the trans community. Access matters, so we point to resources you can use now, including Planned Parenthood and FOLX telehealth, plus training pathways for providers who want to deliver competent, compassionate care.
This conversation is about more than symptoms; it’s about agency. Menopause can surface grief—about fertility, identity, and change—while opening real space for post-traumatic growth. If you’re seeking care that fits who you are, or you’re a clinician ready to do better, you’ll leave with language, tools, and a roadmap. If this resonates, subscribe, share with a friend, and leave a review to help more people find affirming menopause care.
Lasara Firefox Allen (they/them/theirs / Mx.) is a gender-affirming menopause educator, coach, writer, and advocate committed to uplifting genderqueer, trans, and queer-bodied folks navigating perimenopause, menopause, and beyond. With a foundation in social work and lived experience in midlife transition, Lasara centers marginalized voices and reclaims menopause beyond binary narratives.
Website: https://www.genderqueermenopause.com/
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MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
Welcome to the Medovia Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
SPEAKER_02 (00:15):
Welcome back, everybody.
Welcome to the show today.
April is not able to be here, soit's just me, and we're going to
have a great time.
I am joined today by LasaraFirefox Allen.
Lasara is a gender-affirmingmenopause educator, coach,
writer, and advocate tocommitted to uplifting
(00:35):
gender-queer, trans, andqueer-bodied folks navigating
perimenopause, menopause, andbeyond.
With a foundation and socialwork and lived experience in the
midlife transition, Lasaracenters marginalized voices and
reclaims menopause beyond binarynarratives.
Welcome to the show, Lassara.
(00:55):
We're happy to have you.
SPEAKER_00 (00:56):
Thank you so much, Cam.
It's a pleasure to be here.
SPEAKER_02 (00:59):
Yeah.
Hey, for our listeners, youshould know that I stalked
Lasara for a very long time tocome on our show.
So I'm really excited to haveyou here.
Could you, you know, introduceyourself beyond what I said and
how your journey led you to findthe genderqueer menopause coach,
genderqueer features work thatyou're doing?
SPEAKER_00 (01:17):
Yeah, absolutely.
So um I'm uh let's see, where doI start?
I'm 54 and I'm uh solidlypostmenopausal now.
Um as a genderqueer personentering into perimenopause, I
became aware that I was inperimenopause uh in 2016.
(01:38):
Um, and but I had already beenexperiencing the impacts of
perimenopause for quite a longtime at that point.
I realized, you know, now frommy more educated um standpoint,
uh, I had already beenexperiencing perimenopause for
quite a long time by then.
And, you know, the the thingthat finally clued me in was my
first real full-blown hot flash.
(02:00):
But before that, I had beenexperiencing extreme PMDD, so
premenstrual dysphoric disorder,which I think also, you know, as
I've learned more, may have beenmore um solidly classified as
PME or premenstrual exacerbationsyndrome.
Um, and it took me a long time.
(02:21):
Actually, I didn't realize untilpost-menopause that uh that I
was, I I had identified asgenderqueer like basically my
whole adult life.
Uh, even as a child, I was notcompliant with gender norms, um,
always was very sort of uh uh,you know, ambiguous and
(02:42):
androgynous in my sortorialsense.
I loved wearing ties.
My parents were hippies, so itwas hilarious that I loved
wearing ties.
Um uh so from the time that Iwas very small, I sort of like
gender didn't make a lot ofsense to me, um, roles, uh,
identity, any of it.
Um, but I didn't realize untilum postmenopause that I had been
(03:05):
that part of my PMDD and PME wasactually gender dysphoria.
Um, and so that's something thatI hope we'll talk about a little
bit more today, a little bitlater on.
But uh suffice it to say that asa genderqueer person in
perimenopause in you know, 2016,there were literally no
resources for me that wereaffirming to my gender identity.
(03:29):
Uh, I would go into appointmentswith providers and I would say,
I'm genderqueer, my pronouns arethey, them, and they would say,
my ladies this and my womenthat, and um, you know, use
female pronouns for me.
And I don't fault them.
I don't, you know, it's notentirely their fault, it's a
(03:50):
systemic issue.
Um, and so coming out of thatlong experience of just a ton of
like low to medium to high levelmedicalized trauma, um, I
decided that I wanted to changethe landscape for my community
and make it so that there wereat least minimum resources
(04:11):
available, which is why Idecided to write the book,
Gender Core Menopause.
And I started coaching mycommunity members in the
menopause transition.
Uh, but since I wrote the book,I actually realized that my work
really lies with medicalprofessionals uh and and
menopause supporters, uh, youknow, whether they're coaches or
(04:33):
doulas or midwives.
Um and the reason for that isthat I teach a lot about
self-advocacy in my work with mycommunity members and in the
book.
I realized part way throughwriting the book that I don't
want to have to educate mycommunity on self-advocacy all
the time.
(04:53):
I want there to be options wheremy community does not need to
self-advocate for basic levelsof affirming care.
SPEAKER_02 (05:02):
I love when people see a gap and it's just like,
I'm gonna go solve this problem.
That's so that's so good.
And I love your story.
Tell me or tell our audience,there's a couple of terms that
you use that um are not everydayterms that people may not um
connect with easily.
Talk about gender dysphoria.
What does that mean and whatdoes that look like?
SPEAKER_00 (05:24):
Sure.
So um before we talk aboutgender dysphoria, I want to say
that I think that themedicalization of trans identity
is problematic.
And I think that definingtransness by dysphoria is a
terrible model.
I do not think that the theexperience of dysphoria is what
defines someone as trans.
(05:45):
Unfortunately, that's currentlythe metric that we have on a
social, you know, on a medicaland social basis.
So dysphoria is, and genderdysphoria specifically is what
I'm talking about.
Dysphoria is is a sense ofextreme discomfort with one's uh
physicality.
Uh people can experiencedysphoria separate from gender.
(06:08):
Uh cis people can alsoexperience gender dysphoria.
Um, some of the basic levels ofmenopause uh might induce
dysphoria for a cis woman, forexample, with all of the front
loading.
Uh, you know, we're we're we'retaught to believe that we're
gonna lose our sexual relevance.
We're taught to believe thatwe're gonna, you know, that so
(06:29):
much of our identity is tied upin our reproductive capacity.
Um, so cis folks may experiencegender dysphoria and menopause.
Gender dysphoria currently isthe sort of um litmus test for
trans identity in a medicalizedsetting.
SPEAKER_02 (06:47):
And that is your brain and body don't match.
SPEAKER_00 (06:52):
Exactly.
So you experience your body asnot being aligned with your
inherent sense of yourself.
SPEAKER_02 (07:02):
And someone not experiencing that has a really
hard time imagining how that'seven a thing.
SPEAKER_00 (07:08):
Correct, which is why I kind of love to sort of
push the edges out on it alittle bit and give people a
place where they may understandto some extent what gender
dysphoria, full-blown genderdysphoria would feel like.
Um, when for a lot of cis women,I think, uh especially the way
that menopause is currentlypackaged socially, you know, and
(07:31):
and advertising-wise, um thatit's such a hustle to try and
maintain our, you know, ouryouthful identity and our
youthful relevance.
And because in this culture,unfortunately, aging in the
female population and theassigned female at birth
population is tied toirrelevance.
(07:52):
We are expected to step back, weare expected to become
invisible, we're expected to beall right with that, which is
absolutely bullshit, right?
So we're we're gonna we're gonnacall that out for what it is.
Um that experience may givesomeone a template for kind of a
little tiny taste of what genderdysphoria would feel like, where
(08:13):
your experience of yourself isnot lining up with how other
people are perceiving you.
SPEAKER_02 (08:17):
Yeah, interesting.
Okay.
So what do you mean bygender-affirming menopause care?
And why is it important thatthat we focus on that as a part
of the you know change thatyou're advocating?
SPEAKER_00 (08:31):
Absolutely.
So gender-affirming care ingeneral is medical care or other
forms of care that takesomeone's gender into account in
a proactive way.
So, for example, um, as I wassaying in my story, right, an
example of non-affirming care isme going into a provider,
(08:52):
stating my pronouns and mygender identity and not having
that respected.
Yeah.
Right.
That's the opposite ofgender-affirming care.
Sure.
Um, gender-affirming care wouldbe me walking into a provider's
office, knowing from the outsetthat they are going to
understand my identity, thatthey're going to respect my
pronouns at base level, and thatthey're going to give me care
(09:14):
options that fit with myidentity.
SPEAKER_02 (09:16):
Yeah, I don't, that makes sense.
And it's hard enough to find amenopause doctor if you're a cis
woman, a cis white woman, right?
Um, but when you add in thegender issues, you add in the
race issues, and finding adoctor that can meet you where
you are is really tough.
(09:37):
So um how help help my help meunderstand how menopause can be
different if you're trans, nine,non-binary, gender diverse.
How is it different for thatgroup of people rather than the
cis woman?
SPEAKER_00 (09:54):
Oh my gosh, it can be different in so many ways,
literally so many ways.
One of the things that I like topoint out is that folks who um
are trans may experiencevariations on menopause multiple
times in their gendertrajectory.
So, for example, some folks,when they if if someone is
(10:14):
transmasculine and they startusing high-dose testosterone for
gender-affirming hormonetherapy, they may go through a
period of time that feels verysimilar to menopause.
And honestly, the long-termimpacts of, you know, we don't,
we don't know too everythingthere is to know about gender
medicine yet, gender-basedmedicine, right?
(10:35):
So the some of the long-termimpacts of uh high dose
testosterone can be similar tosome of the long-term impacts of
uh menopause, post-menopause.
So like cardiovascular,increased cardiovascular risk,
uh, increased risk ofosteoporosis.
Um, I my my hope and belief isthat someday we'll we'll be able
(10:58):
to move away from such extremegenderization of hormones,
right?
Uh Dr.
Kasperson likes to say hormoneshave no gender.
I completely agree.
And I have adopted thatterminology myself in my work.
Hormones have no gender.
Um, our ovaries produce allthree of the dominant sex
(11:22):
hormones, so estrogen, uhprogesterone, and testosterone,
right?
Uh the majority of our of ourendogenous testosterone, as cis
women even, is produced by ourovaries.
So as, and this is not paidattention to in our culture in a
way that makes sense becausewe're so phobic around
(11:43):
transness, honestly.
I believe that that's the cruxof it.
Um, but that said, uh, as ourovaries start sort of slowing
down and coming to a kind of ahalt over time, uh, we're not
just becoming deficient in thelevels of estrogen that our
(12:04):
bodies are used to orprogesterone.
We're also becoming deficient inthe levels of testosterone that
our bodies are used to producingand having on board.
So it's worth taking a reallycomprehensive look at that and
saying, you know, this this issomething that we need to
update.
Um, to get back to the conceptof where trans folks and and
(12:26):
gender-expensive folks ingeneral may experience menopause
differently, in addition tochemical menopause, right, which
may be gender-affirming hormonetherapy, it may be induced by um
cancer treatments too.
It can be induced by chemicalmenopause can be induced by a
lot of things.
Um in addition to that, surgicalmenopause is something that a
(12:50):
trans person may experience.
So a trans person, atransmasculine person or trans
non-binary person who hasovaries and a uterus and elects
to have them removed, willexperience surgical menopause if
they have a bilateraloophorectomy.
So if they have both ovariesremoved with their hysterectomy,
(13:11):
they will experience precipitousmenopause.
So that's where you don't haveany perimenopausal symptoms.
You just go from zero to ahundred.
You're like pre-menopausalpremenopausal to postmenopausal,
literally in a matter of hours.
Um, and that can be verychallenging.
And I I think it is reallyimportant for you know any any
(13:33):
gender-affirmed care providerswho are listening to this um
segment to um to realize thatthat uh probably a little bit
more extensive counseling aroundthe menopause transition in
those cases of surgicalmenopause would be really
helpful for for most people.
And I've heard honestly of an afew cases of folks who had zero
(13:56):
counseling about menopausebefore their uh hysterectomy.
So it is it, and even at base,right, if the provider is is
going to give a uh a surgerythat results in chemical in
surgical menopause, taking amenopause history, right, would
(14:18):
be a great practice to integratebecause we have no way of
knowing what that person's riskfactors are for cardiovascular
disease or any of the otherlong-term impacts unless we do
that work beforehand, right?
And I think also a certainamount of counseling around what
the menopause transition canlook like in a precipitous way.
(14:39):
Um, so those are a couple ofways that trans folks and
gender-expensive folks mayexperience menopause differently
than cis women.
Um, there are other ways.
So, and some of them are softer,right?
They're not as sort of pragmaticand medicalized.
They're more like um theexperience of gender dysphoria
in the arc of menopause orperimenopause, the experience of
(15:00):
gender euphoria, which I talkedabout a little bit, um, I think
maybe I didn't.
So, gender euphoria is theopposite of gender dysphoria.
It's where our gender identityand our experience of our gender
and how our gender is beingreceived is all lining up and it
feels euphoric.
It produces a sense of euphoria.
So for me, when I um steppedinto my post-menopausal reality,
(15:26):
I had like a very profoundexperience of gender euphoria,
which was actually the triggerthat made me realize that I'd
been experiencing genderdysphoria previously.
SPEAKER_02 (15:37):
It makes a lot of sense.
And I can't, and I can onlyimagine that if you had gender
dysphoria for all your life,that when you're able to match
that up, that that is definitelya place of euphoria.
Um and some of the things thatyou talked about with chemical
um in that induces menopause arevery similar for for cis women
(16:01):
as well, because they go throughthose surgeries and no one ever
talks about what's going tohappen after the fact.
SPEAKER_00 (16:06):
Right.
SPEAKER_02 (16:07):
But add on that some you know, gender identity
issues, and I can see that thatthat's a case for uncomfortable,
uncomfortable.
SPEAKER_00 (16:17):
If if there's another component that I think
is really important to talkabout too, and especially I talk
about this with providers whoare who are preparing to work
with gender-expansive folks.
Um one of the elements ofdysphoria in the perimenopause
transition for a trans masculineperson um may be tied to erratic
(16:41):
bleeding, which not only isgoing to cause like a higher
level of anxiety because of thedysphoria, often related to not
all people have menstrualdysphoria who are trans, right?
I don't want to say that, butthere are folks who are trans
who experience dysphoria withtheir menses.
So erratic bleeding can causethat level of anxiety.
(17:04):
But I want to point out thesocial climate right now,
obviously, is not doesn't feelsafe for trans folks.
And so a trans masculine personwho is actually passing as a cis
man, for example, in a climatethat is socially not
(17:24):
progressive, may actually havefears of their safety around
erratic bleeding.
Right.
Say they don't have access tohormonal um options for
gender-affirming care where theyare, right?
Say they don't, say that theydon't have a medical profile
(17:47):
that allows them to do high-dosetestosterone or suppress their
menses in another way.
Um, right.
There are a lot of reasons thata trans person would not be on
high dose testosterone and mightexperience mences just like a
cis woman would, you know, on aregular basis, et cetera.
As that trans masculine persongoes into perimenopause, they're
(18:08):
gonna experience the same thingof erratic bleeding, long, you
know, more bleeding, uh, youknow, hemorrhaging, all of those
things that are possible in inperimenopause, but they're gonna
experience it with an added edgein some cases of physical
danger.
SPEAKER_02 (18:23):
Yeah.
Oh man.
We talk in our training about,you know, everyone's menopause
experience is different.
And if you're trans masculineand you're trying to be trans
masculine and all of a suddenyou're having menopause symptoms
at work, and you're not right,you don't want to come out and
you don't want to talk about itat work.
I can only imagine the challengethat that must be for someone
(18:47):
trying to just be themselves,you know?
SPEAKER_00 (18:50):
Absolutely.
And and so one of the thingswhen I in gender care menopause
and my chapter on self-advocacy,um, you know, studies do show
that actually um being openabout the menopause transition
in the workplace uh leads tobetter outcomes uh uh across the
board.
So the work that y'all are doingis so important.
Um and I do encourage those whofeel safe coming out in that way
(19:18):
at work to do so if it is safeto do so, right?
Um, because the accommodationsthat will be available to them
are different, because the uh,you know, um the symptom, you
know, one of the things that youknow that I that that is true
about perimenopause andmenopause is the like the
(19:39):
increase in diagnosis ofneurodivergence, right?
So there's a statistical umincrease in diagnosis, late,
late diagnosis of ADHD, um, youknow, menopause-related anxiety,
right?
Perimenopause-related anxiety umis a thing, um uh autism.
(20:01):
Uh, and also there's astatistical increase in uh
recurrence or onset of eatingdisorders.
And in the trans community, umthe the instances of eating
disorders are I think eighttimes higher than in the cis
community.
(20:22):
Um and and interestingly, right,and maybe obviously, but not to
everyone, um, the sort of thethe etiology or the the sort of
progression of of an eatingdisorder, why it starts, how it
happens, what the what the um uhreasons for it are are different
from cis folks.
(20:42):
So when a trans person who hasan eating disorder seeks care,
if they do not have agender-affirming eating disorder
specialist, they may actuallyget advice that is going to
compound their problem, not makeit better.
So all of these things comingup, right?
The the the complications of um,you know, I mean, I don't want
(21:05):
to make it all sound torhorrible, but but there, but
there's a lot that is complexabout the uh gender expansive
experience of menopause.
That said, I do also think it isone of the most empowering
opportunities forself-knowledge.
SPEAKER_02 (21:26):
I like that.
That's a that's a I mean that'sa good way to look at that.
And I'm sure that you're ifyou've been battling this,
battling is not the right word,but if you've been challenged
with this your whole life, youhaven't even considered what
menopause is going to be to looklike, you know, all of those
kinds of things.
SPEAKER_00 (21:44):
Right.
Well, and there hasn't been aresource to even point you in
the right direction until now.
SPEAKER_02 (21:51):
Oh man, I love that you're doing this work.
But you talked about this alittle bit.
What but what role does mentalhealth, trauma, body dysphody
dysphoria play in the menopausefor people and how do you
support them during this time?
SPEAKER_00 (22:08):
Yeah, well, I mean, again, it it it I mean,
honestly, it comes down tohealthcare providers being
prepared to um, you know, treatgender, queer, and trans and
expansive folks in an affirmingway.
And that doesn't just meanlearning how to use the right
pronouns, right?
(22:29):
That's the baseline.
Like if there are providerslistening and you take one thing
away from today's segment, youknow, it's people who
menstruate, not women whomenstruate.
SPEAKER_02 (22:42):
Is that the right way?
Or people born with ovaries?
SPEAKER_00 (22:46):
That's usually what absolutely.
That is an absolute, but I'mjust saying a lot of people say
women, it's like a mantra, womenwho menstruate, women in
menopause.
And and we need to move beyondthat frame.
It's very limiting.
And I believe that if we canmove beyond that frame and see
people as people, everyone'sgonna get better care, not just
(23:07):
trans folks.
Um because the options fortreatment will open up.
SPEAKER_02 (23:12):
Well, sorry, that is a crazy idea.
Treat people like people.
SPEAKER_00 (23:16):
I know, wild, right?
Yeah.
Um, so so you know, so so it'slike I said, you know, that kind
of languaging is is thebaseline, but the but the deeper
levels of affirming care dependon your specialty.
unknown (23:32):
Yeah.
SPEAKER_00 (23:33):
So if you're a mental health provider, your
your training toward genderaffirming care is going to have
a different context and flavorthan a surgeon or a medical
provider or a coach or um, youknow, or an eating disorder
specialist, right?
An eating disorder specialist,if they are going to specialize
in trans health care, has awhole other area of study and
(23:56):
research to look into to becomean affirming care provider.
Yeah.
SPEAKER_02 (24:03):
What would you say are the biggest barriers to
integrating integrating thatinto the healthcare system?
SPEAKER_00 (24:10):
Um implicit bias is the first one, right?
That's that's the comprehensiveone.
But I think, you know, that goestandem with socialization.
Right.
They're they're veryinterconnected.
So implicit bias, our owninternal process about uh, you
(24:30):
know, our our limitations, sortof putting us into a, you know,
having blinders on that don'tallow us to see outside of our
spectrum, right?
So implicit bias coupled withsystematic oppression.
SPEAKER_02 (24:48):
You're you're out to change big things.
SPEAKER_00 (24:51):
I mean, hopefully we all are, right?
SPEAKER_02 (24:54):
No, yeah, I know.
But I mean, they're there, Imean, it's hard enough, as I
said earlier, finding a medicalsupport person than to find
someone that can meet you whereyou are.
SPEAKER_00 (25:04):
Yeah, well, and on on that note, I do want to give
a shout out to two really greatresources for folks that that
don't have easy access toaffirming care.
And those two resources arePlanned Parenthood, which is
absolutely a standby.
I got my early gender affirmingcare from Planned Parenthood in
a rural community.
(25:24):
And they were amazing and umhonestly, you know, turned
turned turned the corner for me,right?
That care, that affirming carewhile in a rural community um
made things possible for me thathadn't been before.
Um, and the other resource, ifyou do not have a Planned
Parenthood near you, is Folks FO L X.
(25:47):
And Folks is a telehealth uhagency, that medical agency that
is available in every state inthe union at this point in time.
And they started out as a genderaffirming care um telehealth uh
organization, I believe, duringearly COVID.
Um, and they've grown, you know,extensively and they've branched
(26:12):
out and they do offer affirmingmenopause care, which, you know,
there there are very, very, veryfew, especially national
resources that are operating onthat level.
But Planned Parenthood and uh,you know, and again, you know, I
mean, with Planned Parenthood,even your your mileage may vary,
but but if you find the rightprovider, um, they do have more
(26:35):
training than your averageclinic in gender-affirming care.
Fulks is 100% gender-affirmingin their practice, and they do
offer menopause support.
So that's that's where Irecommend for folks who are um
don't have uh an in-personoption.
SPEAKER_02 (26:50):
That's great.
Thank you for that.
Um, still staying on the medicalpiece, but slightly taken a
left, if you will.
Um, what are some of the uniqueconsiderations when combining
gender-affirming hormone therapywith menopause hormone therapy?
Is it different?
Is it the same?
What do I think about?
What does that mean?
SPEAKER_00 (27:10):
Yeah, that's such a great question.
And um it brings me back to apoint that I was circling around
earlier with the whole hormoneshave no gender comment.
Um as I said earlier, like wedon't know everything there is
to know about gender-affirminghormone therapy yet, right?
(27:30):
We don't have enough, therehasn't been enough money put
into it, there hasn't beenenough research.
It's, you know, in some ways, Imean, it has a long and august
history, but but it but it's inin the levels that we're seeing
it performed now, it's arelatively young art, a young
science, right?
(27:51):
So there's a lot for us stillleft to to learn um collectively
as as a as a as as as humanity,right, around that around that
topic.
My my hope and my hunch is thatas we sort of move societally
(28:11):
away from this hyper-gendered umreality around hormones, that
there may be room for folkstreating uh trans folks who are
seeking gender-affirming hormonetherapy with a combination
potentially of high-dosetestosterone and low-dose
(28:32):
estrogen.
Um, and and there hasn't been alot of research done on this
yet.
We don't know if it would behighly effective.
Um my hope is that sooner orlater there will be enough
research put into it that wewould have a definitive answer
on whether high-dosetestosterone coupled with
(28:53):
low-dose estrogen might uhremove some of the long-term
impacts uh that are lesspositive for our bodies.
Um, and you know, I don't know.
I'm not a doctor, I'm not aresearcher, but but that's, you
know, I have looked at theresearch that's out there and
they're it's not exhaustive.
It's not to the point where wecan make a call on that one.
(29:16):
Um, but right now, where thingsare at, um uh if someone is in
perimenopause, um, I want tosay, like for a lot of us in
perimenopause, our genderjourney just keeps moving,
right?
So we may hit perimenopause andrealize, oh, I actually want to
(29:36):
be on high dose testosterone.
That is a valid way to treatmenopause symptoms.
So um it'll be more effectivefor some and less effective for
others, but it is absolutely avalid way for a practitioner to
help you attain your genderoutcomes that you're seeking
(29:57):
while also treating menopausalsymptoms.
Um, so that's one way that itcan be different.
Uh, for me, as a non-binarytrans person, I uh I use all
three of the hormones I of theof the you know sex hormones.
I I take uh medium dose ofestrogen as a patch.
(30:19):
I use bioidenticals because I'mmore comfortable with it, but
and they have a different umrisk profile a little bit and a
different feeling in my body.
Personally, I'm very hormonallysensitive.
So um I was very hesitant, bythe way, to use estrogen at all
after I had been postmenopausaland was like, oh my god, I own
my body for the first time in 40years, you know, um, or 35
(30:42):
years, whatever it is.
Um uh I was very hesitant to umto try estrogen.
But I wish someone would havetold me earlier on that just
because I had had negativeexperiences with estrogen
previously didn't mean that theywould graph over.
(31:02):
Um they they it's not the sameexperience.
So uh hormonal birth controlalways made me homicidal and
suicidal, honestly.
Made me, you know, it reallyworked.
It was like, don't touch me, youknow.
But um that experience is notwhat uh having steady state low
(31:23):
to medium dose estrogen on boardis like for me at all.
It actually feels great.
Um, so I so I use a medium doseuh estrogen patch twice a week.
I use I'm I'm on a hundredmilligrams of progesterone a day
because my uterus is stillintact.
I thought about having it takenout, but I've had too many
(31:44):
surgeries for them to feelreally safe doing that.
Um, and then I take a moderatedose of topical application
testosterone.
I also use estrogen genitally tocounteract any risk.
And I did experience GSM, sogenital urinary syndrome of
(32:07):
menopause.
I did experience that prettyseverely in my early
postmenopause trajectory,partially because I was on a
pretty good dose oftestosterone, and partially
because I just wasn't takingcare of my anatomy in the way
that it needed to be taken careof.
So I use a pretty substantialdose of um genitally applied
(32:30):
estrogen as well.
So I use a tablet internally andI use a gel externally.
SPEAKER_02 (32:37):
Uh, that's a great story because I was very nervous
about all of those hormones too,especially estrogen.
And now you're gonna have totake it out of my dead cold
hand.
All right, exactly.
I've probably said that amillion times on our podcast.
It's just it made a world ofdifference for me.
SPEAKER_00 (32:53):
Yeah.
Right.
And and so, you know, because wehaven't been having these
conversations, none of us knowthat.
Right.
And also because there's been somuch negative press around
hormonal sub, you know, hormonalum therapies, uh, because of
that one bad study that happenedin the 70s, um, you know, uh,
(33:16):
that we're having to do a lot oflike um rehab around that.
And and anyone who doesn't haveupdated menopause information,
any provider who is not stayingup to date with menopausal news
and training is going to have anoutdated opinion about hormones.
SPEAKER_02 (33:34):
Yeah.
Talk about all the time abouthey, if you're if you know you
want to do this and your doctorsays no, it's okay to divorce
your doctor and find one thatwill listen to you, right?
It's just so important.
SPEAKER_00 (33:47):
Yeah, coupled with that, the the other thing is
like, um, you know, for me, Iknow now that I was entering
into perimenopause in probablymy late 30s or, you know, my my
very early 40s, and I didn'tknow it until I was in my
mid-40s, and I didn't gettreatment until I was almost
postmenopausal.
Right.
So that's practically 15 yearsof not getting adequate care.
(34:11):
Um, and so uh, you know, if youthink that you might be
experiencing symptoms ofperimenopause, you probably are.
It doesn't matter that you're38, it doesn't matter that
you're 41.
Go get the help that you need,get the support that you need,
get the medical consult that youneed.
(34:33):
Don't suffer.
SPEAKER_02 (34:34):
For sure, don't suffer.
So, given this politicalenvironment um and where we're
where we are right now, where doyou see the field of queer
affirming menopause care in thenext five, 10, 10 years?
SPEAKER_00 (34:51):
Yeah, that's a that's a hard one.
Um, I uh I think that it will,you know, we've always been
here.
We've always been here.
Trans people have always beenhere, and we've always found
ways to get the care that weneed.
It's evolved over time.
Sometimes it's been underground.
Lately it's been more aboveground, but that doesn't mean
it's gonna stay there.
(35:11):
Um, so we all know how to getthe care that we need, even
unfortunately, the moreunderground it goes, the less
accessible it is, um, you know,financially uh as well as like
just circumstantially.
Um, I do not know.
I I don't have a crystal ball toconsult on this one, but but I
would say that the social trendsare definitely pointing toward
(35:36):
more of a an undergroundspecialization.
Um, and I don't see at thispoint in time um wholesale uh,
you know, um adoption of genderaffirming menopause care in the
next three to five years in thiscountry.
Um that said, I'm gonna still domy work and I'm gonna still
(35:56):
educate whoever's willing tolisten.
And uh, you know, I have acourse coming up starting the
28th of October.
Oh, this will probably come outafter that, but um I have a
course, a certification coursefor gender-affirming care for
providers, uh, menopause careproviders specifically.
So everyone from doctors tocoaches to midwives, as I said
earlier, anybody who wants tobecome a certified
(36:19):
gender-affirming menopause careprovider should get in touch
with me.
We can do work one-on-one, wecan do work in a classroom
setting on Zoom.
Um, you know, uh the only way toget to the point of feeling
competent and capable uh oftreating trans folks and
(36:43):
menopause with care andcompassion is by getting the
training that you need.
SPEAKER_02 (36:48):
Yeah.
I mean, there's so much unlessyou're in that place that you
don't understand.
You can't possibly understand ifyou've never been in that kind
of situation that you're, youknow, gender dysphoria is if
you've never experienced thatbefore in a way that you
understood, then it's hard to beable to be understand what
someone needs at that point.
(37:09):
So I love that you're doingthat.
Okay, so given that, where canpeople find you?
SPEAKER_00 (37:14):
Uh, they can find me.
My Linktree is the thing that Iupdate the most often.
I just have so many things goingon in so many different places
that I just drop my my linksinto my Linktree.
And that's my Linktree is atLasara Firefox Allen.
Folks can find me at LasaraFirefox Allen on most of the
socials uh or at genderqueermenopause, um, or both.
(37:35):
So um I have a really minorTikTok presence.
I'm not there as often as I as Icould be.
Um, I have a more consistentInstagram presence and uh
intermittent Facebook presence.
Uh so um any of those optionsare good, but my LinkTree is the
space that is updated the mostoften.
And I believe you can subscribeto my Linktree.
(37:58):
Um so uh that would be probablythe best option for ongoing
updates.
SPEAKER_02 (38:04):
Okay, so if you are a gender queer person
approaching perimenopause, inperimenopause, on the other
side, trying to navigatesymptoms, identity, et cetera,
what what piece of advice wouldyou give someone on how to
self-care in in this time oftheir life?
SPEAKER_00 (38:21):
I mean, honestly, my my point blank would be get a
gender-affirming care provider.
And and if you can't figure outa way to access a
gender-affirming care provider,find a gender-affirming coach or
or doula who can help you toadvocate for yourself in a
medicalized setting.
And how do I find that?
(38:42):
Um, you know, that again isgonna be uh you can find me and
I can help you locate someone ifI'm not available.
Uh, I do occasionally still takea one-to-one coaching client.
Um, in the case that they don'thave other resources available.
Uh, there are not many of us uhdoing this work yet, but that
will change over time.
(39:03):
Um, and and again, if you're aprovider and you want to be
doing this work, find me and andlet's make it happen because
we're needed.
Yeah.
SPEAKER_02 (39:14):
Oh man, I love this conversation.
I could talk to you about thisfor a long time.
This is most people don't knowall there is to know about
menopause and then top it on topof that with all of the things
that we discussed today.
It's a challenge to be able totalk about and do something
about and feel supported.
So thank you.
Thank you for the work thatyou're doing.
(39:35):
Now we thank you.
Yeah.
Well, okay, so you know, we endall of our podcasts with the
question what's the best pieceof advice you've ever received?
And and I know when we when weopened up this before we pushed
go, you were thinking of a fewof them.
So where'd you land?
SPEAKER_00 (39:52):
Yeah, I mean, I think one thing we didn't get a
touch on today um was uh therole of grief in menopause.
And it is a very substantialone, I believe, uh whether your
grief is like endemic to themenopause experience and being
caused by your relationship withyour menstruation or your
(40:12):
reproductive capacity, right?
A lot of folks have grief thatcomes up around that, grief
about identity, grief about um,you know, sexual um realities,
uh, all of that, right?
Uh and because it is asubstantial amount of time and
it is placed at a time in ourlife when we're gonna be
(40:34):
experiencing losses, right?
External loss also plays a rolein the menopause trajectory.
And grief and menopause canexacerbate each other.
So the the intensity of griefcan exacerbate our menopause
experiences, and our menopauseexperiences can exacerbate our
(40:55):
experience of grief.
I think the thing that has been,and I I personally experienced a
very severe loss in in mymenopause trajectory.
I think the two things that Iwould say about that are one,
the concept of post-traumaticgrowth and how we sort of can
(41:18):
lay the ground for that umpotentiality um is is so
essential.
And so I actually heard aboutpost-traumatic growth on NPR on
a radio show while I was deep ingrief.
And it I think it might havesaved my life.
Right.
(41:39):
Um and the other thing is as faras grief goes, we don't we don't
get over it.
We don't get past it.
You know, at best we integrateit and we go grow grow around
it.
Um, but that loss will define usand uh and it will temper us.
(42:01):
And how how how what kind ofimpact that has, we do have some
engagement with.
We can do things, we can adoptuh protocols that will help us
to grow out of that rather thanshrink.
SPEAKER_02 (42:17):
Uh that feels like a whole other podcast to me.
I'll come back if you want me.
I would love it.
That would be great.
Well, thank you for your time.
It was um it was well worth thewait, Lisara, as I was stalking
you across all the internets.
But thank you for joining ustoday.
And to our audience, until wemeet again, go find joy in the
(42:38):
journey.
Take care.
SPEAKER_01 (42:40):
Thank you for listening to the Medovia
Menopause Podcast.
If you enjoyed today's show,please give it a thumbs up,
subscribe for future episodes,leave a review, and share this
episode with a friend.
Modovia is out to change thenarrative.
Learn more at Medovia.com.
That's M I D O V I A.com.
Welcome to the Medovia Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
SPEAKER_02 (00:15):
Welcome back, everybody.
Welcome to the show today.
April is not able to be here, soit's just me, and we're going to
have a great time.
I am joined today by LasaraFirefox Allen.
Lasara is a gender-affirmingmenopause educator, coach,
writer, and advocate tocommitted to uplifting
(00:35):
gender-queer, trans, andqueer-bodied folks navigating
perimenopause, menopause, andbeyond.
With a foundation and socialwork and lived experience in the
midlife transition, Lasaracenters marginalized voices and
reclaims menopause beyond binarynarratives.
Welcome to the show, Lassara.
(00:55):
We're happy to have you.
SPEAKER_00 (00:56):
Thank you so much, Cam.
It's a pleasure to be here.
SPEAKER_02 (00:59):
Yeah.
Hey, for our listeners, youshould know that I stalked
Lasara for a very long time tocome on our show.
So I'm really excited to haveyou here.
Could you, you know, introduceyourself beyond what I said and
how your journey led you to findthe genderqueer menopause coach,
genderqueer features work thatyou're doing?
SPEAKER_00 (01:17):
Yeah, absolutely.
So um I'm uh let's see, where doI start?
I'm 54 and I'm uh solidlypostmenopausal now.
Um as a genderqueer personentering into perimenopause, I
became aware that I was inperimenopause uh in 2016.
(01:38):
Um, and but I had already beenexperiencing the impacts of
perimenopause for quite a longtime at that point.
I realized, you know, now frommy more educated um standpoint,
uh, I had already beenexperiencing perimenopause for
quite a long time by then.
And, you know, the the thingthat finally clued me in was my
first real full-blown hot flash.
(02:00):
But before that, I had beenexperiencing extreme PMDD, so
premenstrual dysphoric disorder,which I think also, you know, as
I've learned more, may have beenmore um solidly classified as
PME or premenstrual exacerbationsyndrome.
Um, and it took me a long time.
(02:21):
Actually, I didn't realize untilpost-menopause that uh that I
was, I I had identified asgenderqueer like basically my
whole adult life.
Uh, even as a child, I was notcompliant with gender norms, um,
always was very sort of uh uh,you know, ambiguous and
(02:42):
androgynous in my sortorialsense.
I loved wearing ties.
My parents were hippies, so itwas hilarious that I loved
wearing ties.
Um uh so from the time that Iwas very small, I sort of like
gender didn't make a lot ofsense to me, um, roles, uh,
identity, any of it.
Um, but I didn't realize untilum postmenopause that I had been
(03:05):
that part of my PMDD and PME wasactually gender dysphoria.
Um, and so that's something thatI hope we'll talk about a little
bit more today, a little bitlater on.
But uh suffice it to say that asa genderqueer person in
perimenopause in you know, 2016,there were literally no
resources for me that wereaffirming to my gender identity.
(03:29):
Uh, I would go into appointmentswith providers and I would say,
I'm genderqueer, my pronouns arethey, them, and they would say,
my ladies this and my womenthat, and um, you know, use
female pronouns for me.
And I don't fault them.
I don't, you know, it's notentirely their fault, it's a
(03:50):
systemic issue.
Um, and so coming out of thatlong experience of just a ton of
like low to medium to high levelmedicalized trauma, um, I
decided that I wanted to changethe landscape for my community
and make it so that there wereat least minimum resources
(04:11):
available, which is why Idecided to write the book,
Gender Core Menopause.
And I started coaching mycommunity members in the
menopause transition.
Uh, but since I wrote the book,I actually realized that my work
really lies with medicalprofessionals uh and and
menopause supporters, uh, youknow, whether they're coaches or
(04:33):
doulas or midwives.
Um and the reason for that isthat I teach a lot about
self-advocacy in my work with mycommunity members and in the
book.
I realized part way throughwriting the book that I don't
want to have to educate mycommunity on self-advocacy all
the time.
(04:53):
I want there to be options wheremy community does not need to
self-advocate for basic levelsof affirming care.
SPEAKER_02 (05:02):
I love when people see a gap and it's just like,
I'm gonna go solve this problem.
That's so that's so good.
And I love your story.
Tell me or tell our audience,there's a couple of terms that
you use that um are not everydayterms that people may not um
connect with easily.
Talk about gender dysphoria.
What does that mean and whatdoes that look like?
SPEAKER_00 (05:24):
Sure.
So um before we talk aboutgender dysphoria, I want to say
that I think that themedicalization of trans identity
is problematic.
And I think that definingtransness by dysphoria is a
terrible model.
I do not think that the theexperience of dysphoria is what
defines someone as trans.
(05:45):
Unfortunately, that's currentlythe metric that we have on a
social, you know, on a medicaland social basis.
So dysphoria is, and genderdysphoria specifically is what
I'm talking about.
Dysphoria is is a sense ofextreme discomfort with one's uh
physicality.
Uh people can experiencedysphoria separate from gender.
(06:08):
Uh cis people can alsoexperience gender dysphoria.
Um, some of the basic levels ofmenopause uh might induce
dysphoria for a cis woman, forexample, with all of the front
loading.
Uh, you know, we're we're we'retaught to believe that we're
gonna lose our sexual relevance.
We're taught to believe thatwe're gonna, you know, that so
(06:29):
much of our identity is tied upin our reproductive capacity.
Um, so cis folks may experiencegender dysphoria and menopause.
Gender dysphoria currently isthe sort of um litmus test for
trans identity in a medicalizedsetting.
SPEAKER_02 (06:47):
And that is your brain and body don't match.
SPEAKER_00 (06:52):
Exactly.
So you experience your body asnot being aligned with your
inherent sense of yourself.
SPEAKER_02 (07:02):
And someone not experiencing that has a really
hard time imagining how that'seven a thing.
SPEAKER_00 (07:08):
Correct, which is why I kind of love to sort of
push the edges out on it alittle bit and give people a
place where they may understandto some extent what gender
dysphoria, full-blown genderdysphoria would feel like.
Um, when for a lot of cis women,I think, uh especially the way
that menopause is currentlypackaged socially, you know, and
(07:31):
and advertising-wise, um thatit's such a hustle to try and
maintain our, you know, ouryouthful identity and our
youthful relevance.
And because in this culture,unfortunately, aging in the
female population and theassigned female at birth
population is tied toirrelevance.
(07:52):
We are expected to step back, weare expected to become
invisible, we're expected to beall right with that, which is
absolutely bullshit, right?
So we're we're gonna we're gonnacall that out for what it is.
Um that experience may givesomeone a template for kind of a
little tiny taste of what genderdysphoria would feel like, where
(08:13):
your experience of yourself isnot lining up with how other
people are perceiving you.
SPEAKER_02 (08:17):
Yeah, interesting.
Okay.
So what do you mean bygender-affirming menopause care?
And why is it important thatthat we focus on that as a part
of the you know change thatyou're advocating?
SPEAKER_00 (08:31):
Absolutely.
So gender-affirming care ingeneral is medical care or other
forms of care that takesomeone's gender into account in
a proactive way.
So, for example, um, as I wassaying in my story, right, an
example of non-affirming care isme going into a provider,
(08:52):
stating my pronouns and mygender identity and not having
that respected.
Yeah.
Right.
That's the opposite ofgender-affirming care.
Sure.
Um, gender-affirming care wouldbe me walking into a provider's
office, knowing from the outsetthat they are going to
understand my identity, thatthey're going to respect my
pronouns at base level, and thatthey're going to give me care
(09:14):
options that fit with myidentity.
SPEAKER_02 (09:16):
Yeah, I don't, that makes sense.
And it's hard enough to find amenopause doctor if you're a cis
woman, a cis white woman, right?
Um, but when you add in thegender issues, you add in the
race issues, and finding adoctor that can meet you where
you are is really tough.
(09:37):
So um how help help my help meunderstand how menopause can be
different if you're trans, nine,non-binary, gender diverse.
How is it different for thatgroup of people rather than the
cis woman?
SPEAKER_00 (09:54):
Oh my gosh, it can be different in so many ways,
literally so many ways.
One of the things that I like topoint out is that folks who um
are trans may experiencevariations on menopause multiple
times in their gendertrajectory.
So, for example, some folks,when they if if someone is
(10:14):
transmasculine and they startusing high-dose testosterone for
gender-affirming hormonetherapy, they may go through a
period of time that feels verysimilar to menopause.
And honestly, the long-termimpacts of, you know, we don't,
we don't know too everythingthere is to know about gender
medicine yet, gender-basedmedicine, right?
(10:35):
So the some of the long-termimpacts of uh high dose
testosterone can be similar tosome of the long-term impacts of
uh menopause, post-menopause.
So like cardiovascular,increased cardiovascular risk,
uh, increased risk ofosteoporosis.
Um, I my my hope and belief isthat someday we'll we'll be able
(10:58):
to move away from such extremegenderization of hormones,
right?
Uh Dr.
Kasperson likes to say hormoneshave no gender.
I completely agree.
And I have adopted thatterminology myself in my work.
Hormones have no gender.
Um, our ovaries produce allthree of the dominant sex
(11:22):
hormones, so estrogen, uhprogesterone, and testosterone,
right?
Uh the majority of our of ourendogenous testosterone, as cis
women even, is produced by ourovaries.
So as, and this is not paidattention to in our culture in a
way that makes sense becausewe're so phobic around
(11:43):
transness, honestly.
I believe that that's the cruxof it.
Um, but that said, uh, as ourovaries start sort of slowing
down and coming to a kind of ahalt over time, uh, we're not
just becoming deficient in thelevels of estrogen that our
(12:04):
bodies are used to orprogesterone.
We're also becoming deficient inthe levels of testosterone that
our bodies are used to producingand having on board.
So it's worth taking a reallycomprehensive look at that and
saying, you know, this this issomething that we need to
update.
Um, to get back to the conceptof where trans folks and and
(12:26):
gender-expensive folks ingeneral may experience menopause
differently, in addition tochemical menopause, right, which
may be gender-affirming hormonetherapy, it may be induced by um
cancer treatments too.
It can be induced by chemicalmenopause can be induced by a
lot of things.
Um in addition to that, surgicalmenopause is something that a
(12:50):
trans person may experience.
So a trans person, atransmasculine person or trans
non-binary person who hasovaries and a uterus and elects
to have them removed, willexperience surgical menopause if
they have a bilateraloophorectomy.
So if they have both ovariesremoved with their hysterectomy,
(13:11):
they will experience precipitousmenopause.
So that's where you don't haveany perimenopausal symptoms.
You just go from zero to ahundred.
You're like pre-menopausalpremenopausal to postmenopausal,
literally in a matter of hours.
Um, and that can be verychallenging.
And I I think it is reallyimportant for you know any any
(13:33):
gender-affirmed care providerswho are listening to this um
segment to um to realize thatthat uh probably a little bit
more extensive counseling aroundthe menopause transition in
those cases of surgicalmenopause would be really
helpful for for most people.
And I've heard honestly of an afew cases of folks who had zero
(13:56):
counseling about menopausebefore their uh hysterectomy.
So it is it, and even at base,right, if the provider is is
going to give a uh a surgerythat results in chemical in
surgical menopause, taking amenopause history, right, would
(14:18):
be a great practice to integratebecause we have no way of
knowing what that person's riskfactors are for cardiovascular
disease or any of the otherlong-term impacts unless we do
that work beforehand, right?
And I think also a certainamount of counseling around what
the menopause transition canlook like in a precipitous way.
(14:39):
Um, so those are a couple ofways that trans folks and
gender-expensive folks mayexperience menopause differently
than cis women.
Um, there are other ways.
So, and some of them are softer,right?
They're not as sort of pragmaticand medicalized.
They're more like um theexperience of gender dysphoria
in the arc of menopause orperimenopause, the experience of
(15:00):
gender euphoria, which I talkedabout a little bit, um, I think
maybe I didn't.
So, gender euphoria is theopposite of gender dysphoria.
It's where our gender identityand our experience of our gender
and how our gender is beingreceived is all lining up and it
feels euphoric.
It produces a sense of euphoria.
So for me, when I um steppedinto my post-menopausal reality,
(15:26):
I had like a very profoundexperience of gender euphoria,
which was actually the triggerthat made me realize that I'd
been experiencing genderdysphoria previously.
SPEAKER_02 (15:37):
It makes a lot of sense.
And I can't, and I can onlyimagine that if you had gender
dysphoria for all your life,that when you're able to match
that up, that that is definitelya place of euphoria.
Um and some of the things thatyou talked about with chemical
um in that induces menopause arevery similar for for cis women
(16:01):
as well, because they go throughthose surgeries and no one ever
talks about what's going tohappen after the fact.
SPEAKER_00 (16:06):
Right.
SPEAKER_02 (16:07):
But add on that some you know, gender identity
issues, and I can see that thatthat's a case for uncomfortable,
uncomfortable.
SPEAKER_00 (16:17):
If if there's another component that I think
is really important to talkabout too, and especially I talk
about this with providers whoare who are preparing to work
with gender-expansive folks.
Um one of the elements ofdysphoria in the perimenopause
transition for a trans masculineperson um may be tied to erratic
(16:41):
bleeding, which not only isgoing to cause like a higher
level of anxiety because of thedysphoria, often related to not
all people have menstrualdysphoria who are trans, right?
I don't want to say that, butthere are folks who are trans
who experience dysphoria withtheir menses.
So erratic bleeding can causethat level of anxiety.
(17:04):
But I want to point out thesocial climate right now,
obviously, is not doesn't feelsafe for trans folks.
And so a trans masculine personwho is actually passing as a cis
man, for example, in a climatethat is socially not
(17:24):
progressive, may actually havefears of their safety around
erratic bleeding.
Right.
Say they don't have access tohormonal um options for
gender-affirming care where theyare, right?
Say they don't, say that theydon't have a medical profile
(17:47):
that allows them to do high-dosetestosterone or suppress their
menses in another way.
Um, right.
There are a lot of reasons thata trans person would not be on
high dose testosterone and mightexperience mences just like a
cis woman would, you know, on aregular basis, et cetera.
As that trans masculine persongoes into perimenopause, they're
(18:08):
gonna experience the same thingof erratic bleeding, long, you
know, more bleeding, uh, youknow, hemorrhaging, all of those
things that are possible in inperimenopause, but they're gonna
experience it with an added edgein some cases of physical
danger.
SPEAKER_02 (18:23):
Yeah.
Oh man.
We talk in our training about,you know, everyone's menopause
experience is different.
And if you're trans masculineand you're trying to be trans
masculine and all of a suddenyou're having menopause symptoms
at work, and you're not right,you don't want to come out and
you don't want to talk about itat work.
I can only imagine the challengethat that must be for someone
(18:47):
trying to just be themselves,you know?
SPEAKER_00 (18:50):
Absolutely.
And and so one of the thingswhen I in gender care menopause
and my chapter on self-advocacy,um, you know, studies do show
that actually um being openabout the menopause transition
in the workplace uh leads tobetter outcomes uh uh across the
board.
So the work that y'all are doingis so important.
Um and I do encourage those whofeel safe coming out in that way
(19:18):
at work to do so if it is safeto do so, right?
Um, because the accommodationsthat will be available to them
are different, because the uh,you know, um the symptom, you
know, one of the things that youknow that I that that is true
about perimenopause andmenopause is the like the
(19:39):
increase in diagnosis ofneurodivergence, right?
So there's a statistical umincrease in diagnosis, late,
late diagnosis of ADHD, um, youknow, menopause-related anxiety,
right?
Perimenopause-related anxiety umis a thing, um uh autism.
(20:01):
Uh, and also there's astatistical increase in uh
recurrence or onset of eatingdisorders.
And in the trans community, umthe the instances of eating
disorders are I think eighttimes higher than in the cis
community.
(20:22):
Um and and interestingly, right,and maybe obviously, but not to
everyone, um, the sort of thethe etiology or the the sort of
progression of of an eatingdisorder, why it starts, how it
happens, what the what the um uhreasons for it are are different
from cis folks.
(20:42):
So when a trans person who hasan eating disorder seeks care,
if they do not have agender-affirming eating disorder
specialist, they may actuallyget advice that is going to
compound their problem, not makeit better.
So all of these things comingup, right?
The the the complications of um,you know, I mean, I don't want
(21:05):
to make it all sound torhorrible, but but there, but
there's a lot that is complexabout the uh gender expansive
experience of menopause.
That said, I do also think it isone of the most empowering
opportunities forself-knowledge.
SPEAKER_02 (21:26):
I like that.
That's a that's a I mean that'sa good way to look at that.
And I'm sure that you're ifyou've been battling this,
battling is not the right word,but if you've been challenged
with this your whole life, youhaven't even considered what
menopause is going to be to looklike, you know, all of those
kinds of things.
SPEAKER_00 (21:44):
Right.
Well, and there hasn't been aresource to even point you in
the right direction until now.
SPEAKER_02 (21:51):
Oh man, I love that you're doing this work.
But you talked about this alittle bit.
What but what role does mentalhealth, trauma, body dysphody
dysphoria play in the menopausefor people and how do you
support them during this time?
SPEAKER_00 (22:08):
Yeah, well, I mean, again, it it it I mean,
honestly, it comes down tohealthcare providers being
prepared to um, you know, treatgender, queer, and trans and
expansive folks in an affirmingway.
And that doesn't just meanlearning how to use the right
pronouns, right?
(22:29):
That's the baseline.
Like if there are providerslistening and you take one thing
away from today's segment, youknow, it's people who
menstruate, not women whomenstruate.
SPEAKER_02 (22:42):
Is that the right way?
Or people born with ovaries?
SPEAKER_00 (22:46):
That's usually what absolutely.
That is an absolute, but I'mjust saying a lot of people say
women, it's like a mantra, womenwho menstruate, women in
menopause.
And and we need to move beyondthat frame.
It's very limiting.
And I believe that if we canmove beyond that frame and see
people as people, everyone'sgonna get better care, not just
(23:07):
trans folks.
Um because the options fortreatment will open up.
SPEAKER_02 (23:12):
Well, sorry, that is a crazy idea.
Treat people like people.
SPEAKER_00 (23:16):
I know, wild, right?
Yeah.
Um, so so you know, so so it'slike I said, you know, that kind
of languaging is is thebaseline, but the but the deeper
levels of affirming care dependon your specialty.
unknown (23:32):
Yeah.
SPEAKER_00 (23:33):
So if you're a mental health provider, your
your training toward genderaffirming care is going to have
a different context and flavorthan a surgeon or a medical
provider or a coach or um, youknow, or an eating disorder
specialist, right?
An eating disorder specialist,if they are going to specialize
in trans health care, has awhole other area of study and
(23:56):
research to look into to becomean affirming care provider.
Yeah.
SPEAKER_02 (24:03):
What would you say are the biggest barriers to
integrating integrating thatinto the healthcare system?
SPEAKER_00 (24:10):
Um implicit bias is the first one, right?
That's that's the comprehensiveone.
But I think, you know, that goestandem with socialization.
Right.
They're they're veryinterconnected.
So implicit bias, our owninternal process about uh, you
(24:30):
know, our our limitations, sortof putting us into a, you know,
having blinders on that don'tallow us to see outside of our
spectrum, right?
So implicit bias coupled withsystematic oppression.
SPEAKER_02 (24:48):
You're you're out to change big things.
SPEAKER_00 (24:51):
I mean, hopefully we all are, right?
SPEAKER_02 (24:54):
No, yeah, I know.
But I mean, they're there, Imean, it's hard enough, as I
said earlier, finding a medicalsupport person than to find
someone that can meet you whereyou are.
SPEAKER_00 (25:04):
Yeah, well, and on on that note, I do want to give
a shout out to two really greatresources for folks that that
don't have easy access toaffirming care.
And those two resources arePlanned Parenthood, which is
absolutely a standby.
I got my early gender affirmingcare from Planned Parenthood in
a rural community.
(25:24):
And they were amazing and umhonestly, you know, turned
turned turned the corner for me,right?
That care, that affirming carewhile in a rural community um
made things possible for me thathadn't been before.
Um, and the other resource, ifyou do not have a Planned
Parenthood near you, is Folks FO L X.
(25:47):
And Folks is a telehealth uhagency, that medical agency that
is available in every state inthe union at this point in time.
And they started out as a genderaffirming care um telehealth uh
organization, I believe, duringearly COVID.
Um, and they've grown, you know,extensively and they've branched
(26:12):
out and they do offer affirmingmenopause care, which, you know,
there there are very, very, veryfew, especially national
resources that are operating onthat level.
But Planned Parenthood and uh,you know, and again, you know, I
mean, with Planned Parenthood,even your your mileage may vary,
but but if you find the rightprovider, um, they do have more
(26:35):
training than your averageclinic in gender-affirming care.
Fulks is 100% gender-affirmingin their practice, and they do
offer menopause support.
So that's that's where Irecommend for folks who are um
don't have uh an in-personoption.
SPEAKER_02 (26:50):
That's great.
Thank you for that.
Um, still staying on the medicalpiece, but slightly taken a
left, if you will.
Um, what are some of the uniqueconsiderations when combining
gender-affirming hormone therapywith menopause hormone therapy?
Is it different?
Is it the same?
What do I think about?
What does that mean?
SPEAKER_00 (27:10):
Yeah, that's such a great question.
And um it brings me back to apoint that I was circling around
earlier with the whole hormoneshave no gender comment.
Um as I said earlier, like wedon't know everything there is
to know about gender-affirminghormone therapy yet, right?
(27:30):
We don't have enough, therehasn't been enough money put
into it, there hasn't beenenough research.
It's, you know, in some ways, Imean, it has a long and august
history, but but it but it's inin the levels that we're seeing
it performed now, it's arelatively young art, a young
science, right?
(27:51):
So there's a lot for us stillleft to to learn um collectively
as as a as a as as as humanity,right, around that around that
topic.
My my hope and my hunch is thatas we sort of move societally
(28:11):
away from this hyper-gendered umreality around hormones, that
there may be room for folkstreating uh trans folks who are
seeking gender-affirming hormonetherapy with a combination
potentially of high-dosetestosterone and low-dose
(28:32):
estrogen.
Um, and and there hasn't been alot of research done on this
yet.
We don't know if it would behighly effective.
Um my hope is that sooner orlater there will be enough
research put into it that wewould have a definitive answer
on whether high-dosetestosterone coupled with
(28:53):
low-dose estrogen might uhremove some of the long-term
impacts uh that are lesspositive for our bodies.
Um, and you know, I don't know.
I'm not a doctor, I'm not aresearcher, but but that's, you
know, I have looked at theresearch that's out there and
they're it's not exhaustive.
It's not to the point where wecan make a call on that one.
(29:16):
Um, but right now, where thingsare at, um uh if someone is in
perimenopause, um, I want tosay, like for a lot of us in
perimenopause, our genderjourney just keeps moving,
right?
So we may hit perimenopause andrealize, oh, I actually want to
(29:36):
be on high dose testosterone.
That is a valid way to treatmenopause symptoms.
So um it'll be more effectivefor some and less effective for
others, but it is absolutely avalid way for a practitioner to
help you attain your genderoutcomes that you're seeking
(29:57):
while also treating menopausalsymptoms.
Um, so that's one way that itcan be different.
Uh, for me, as a non-binarytrans person, I uh I use all
three of the hormones I of theof the you know sex hormones.
I I take uh medium dose ofestrogen as a patch.
(30:19):
I use bioidenticals because I'mmore comfortable with it, but
and they have a different umrisk profile a little bit and a
different feeling in my body.
Personally, I'm very hormonallysensitive.
So um I was very hesitant, bythe way, to use estrogen at all
after I had been postmenopausaland was like, oh my god, I own
my body for the first time in 40years, you know, um, or 35
(30:42):
years, whatever it is.
Um uh I was very hesitant to umto try estrogen.
But I wish someone would havetold me earlier on that just
because I had had negativeexperiences with estrogen
previously didn't mean that theywould graph over.
(31:02):
Um they they it's not the sameexperience.
So uh hormonal birth controlalways made me homicidal and
suicidal, honestly.
Made me, you know, it reallyworked.
It was like, don't touch me, youknow.
But um that experience is notwhat uh having steady state low
(31:23):
to medium dose estrogen on boardis like for me at all.
It actually feels great.
Um, so I so I use a medium doseuh estrogen patch twice a week.
I use I'm I'm on a hundredmilligrams of progesterone a day
because my uterus is stillintact.
I thought about having it takenout, but I've had too many
(31:44):
surgeries for them to feelreally safe doing that.
Um, and then I take a moderatedose of topical application
testosterone.
I also use estrogen genitally tocounteract any risk.
And I did experience GSM, sogenital urinary syndrome of
(32:07):
menopause.
I did experience that prettyseverely in my early
postmenopause trajectory,partially because I was on a
pretty good dose oftestosterone, and partially
because I just wasn't takingcare of my anatomy in the way
that it needed to be taken careof.
So I use a pretty substantialdose of um genitally applied
(32:30):
estrogen as well.
So I use a tablet internally andI use a gel externally.
SPEAKER_02 (32:37):
Uh, that's a great story because I was very nervous
about all of those hormones too,especially estrogen.
And now you're gonna have totake it out of my dead cold
hand.
All right, exactly.
I've probably said that amillion times on our podcast.
It's just it made a world ofdifference for me.
SPEAKER_00 (32:53):
Yeah.
Right.
And and so, you know, because wehaven't been having these
conversations, none of us knowthat.
Right.
And also because there's been somuch negative press around
hormonal sub, you know, hormonalum therapies, uh, because of
that one bad study that happenedin the 70s, um, you know, uh,
(33:16):
that we're having to do a lot oflike um rehab around that.
And and anyone who doesn't haveupdated menopause information,
any provider who is not stayingup to date with menopausal news
and training is going to have anoutdated opinion about hormones.
SPEAKER_02 (33:34):
Yeah.
Talk about all the time abouthey, if you're if you know you
want to do this and your doctorsays no, it's okay to divorce
your doctor and find one thatwill listen to you, right?
It's just so important.
SPEAKER_00 (33:47):
Yeah, coupled with that, the the other thing is
like, um, you know, for me, Iknow now that I was entering
into perimenopause in probablymy late 30s or, you know, my my
very early 40s, and I didn'tknow it until I was in my
mid-40s, and I didn't gettreatment until I was almost
postmenopausal.
Right.
So that's practically 15 yearsof not getting adequate care.
(34:11):
Um, and so uh, you know, if youthink that you might be
experiencing symptoms ofperimenopause, you probably are.
It doesn't matter that you're38, it doesn't matter that
you're 41.
Go get the help that you need,get the support that you need,
get the medical consult that youneed.
(34:33):
Don't suffer.
SPEAKER_02 (34:34):
For sure, don't suffer.
So, given this politicalenvironment um and where we're
where we are right now, where doyou see the field of queer
affirming menopause care in thenext five, 10, 10 years?
SPEAKER_00 (34:51):
Yeah, that's a that's a hard one.
Um, I uh I think that it will,you know, we've always been
here.
We've always been here.
Trans people have always beenhere, and we've always found
ways to get the care that weneed.
It's evolved over time.
Sometimes it's been underground.
Lately it's been more aboveground, but that doesn't mean
it's gonna stay there.
(35:11):
Um, so we all know how to getthe care that we need, even
unfortunately, the moreunderground it goes, the less
accessible it is, um, you know,financially uh as well as like
just circumstantially.
Um, I do not know.
I I don't have a crystal ball toconsult on this one, but but I
would say that the social trendsare definitely pointing toward
(35:36):
more of a an undergroundspecialization.
Um, and I don't see at thispoint in time um wholesale uh,
you know, um adoption of genderaffirming menopause care in the
next three to five years in thiscountry.
Um that said, I'm gonna still domy work and I'm gonna still
(35:56):
educate whoever's willing tolisten.
And uh, you know, I have acourse coming up starting the
28th of October.
Oh, this will probably come outafter that, but um I have a
course, a certification coursefor gender-affirming care for
providers, uh, menopause careproviders specifically.
So everyone from doctors tocoaches to midwives, as I said
earlier, anybody who wants tobecome a certified
(36:19):
gender-affirming menopause careprovider should get in touch
with me.
We can do work one-on-one, wecan do work in a classroom
setting on Zoom.
Um, you know, uh the only way toget to the point of feeling
competent and capable uh oftreating trans folks and
(36:43):
menopause with care andcompassion is by getting the
training that you need.
SPEAKER_02 (36:48):
Yeah.
I mean, there's so much unlessyou're in that place that you
don't understand.
You can't possibly understand ifyou've never been in that kind
of situation that you're, youknow, gender dysphoria is if
you've never experienced thatbefore in a way that you
understood, then it's hard to beable to be understand what
someone needs at that point.
(37:09):
So I love that you're doingthat.
Okay, so given that, where canpeople find you?
SPEAKER_00 (37:14):
Uh, they can find me.
My Linktree is the thing that Iupdate the most often.
I just have so many things goingon in so many different places
that I just drop my my linksinto my Linktree.
And that's my Linktree is atLasara Firefox Allen.
Folks can find me at LasaraFirefox Allen on most of the
socials uh or at genderqueermenopause, um, or both.
(37:35):
So um I have a really minorTikTok presence.
I'm not there as often as I as Icould be.
Um, I have a more consistentInstagram presence and uh
intermittent Facebook presence.
Uh so um any of those optionsare good, but my LinkTree is the
space that is updated the mostoften.
And I believe you can subscribeto my Linktree.
(37:58):
Um so uh that would be probablythe best option for ongoing
updates.
SPEAKER_02 (38:04):
Okay, so if you are a gender queer person
approaching perimenopause, inperimenopause, on the other
side, trying to navigatesymptoms, identity, et cetera,
what what piece of advice wouldyou give someone on how to
self-care in in this time oftheir life?
SPEAKER_00 (38:21):
I mean, honestly, my my point blank would be get a
gender-affirming care provider.
And and if you can't figure outa way to access a
gender-affirming care provider,find a gender-affirming coach or
or doula who can help you toadvocate for yourself in a
medicalized setting.
And how do I find that?
(38:42):
Um, you know, that again isgonna be uh you can find me and
I can help you locate someone ifI'm not available.
Uh, I do occasionally still takea one-to-one coaching client.
Um, in the case that they don'thave other resources available.
Uh, there are not many of us uhdoing this work yet, but that
will change over time.
(39:03):
Um, and and again, if you're aprovider and you want to be
doing this work, find me and andlet's make it happen because
we're needed.
Yeah.
SPEAKER_02 (39:14):
Oh man, I love this conversation.
I could talk to you about thisfor a long time.
This is most people don't knowall there is to know about
menopause and then top it on topof that with all of the things
that we discussed today.
It's a challenge to be able totalk about and do something
about and feel supported.
So thank you.
Thank you for the work thatyou're doing.
(39:35):
Now we thank you.
Yeah.
Well, okay, so you know, we endall of our podcasts with the
question what's the best pieceof advice you've ever received?
And and I know when we when weopened up this before we pushed
go, you were thinking of a fewof them.
So where'd you land?
SPEAKER_00 (39:52):
Yeah, I mean, I think one thing we didn't get a
touch on today um was uh therole of grief in menopause.
And it is a very substantialone, I believe, uh whether your
grief is like endemic to themenopause experience and being
caused by your relationship withyour menstruation or your
(40:12):
reproductive capacity, right?
A lot of folks have grief thatcomes up around that, grief
about identity, grief about um,you know, sexual um realities,
uh, all of that, right?
Uh and because it is asubstantial amount of time and
it is placed at a time in ourlife when we're gonna be
(40:34):
experiencing losses, right?
External loss also plays a rolein the menopause trajectory.
And grief and menopause canexacerbate each other.
So the the intensity of griefcan exacerbate our menopause
experiences, and our menopauseexperiences can exacerbate our
(40:55):
experience of grief.
I think the thing that has been,and I I personally experienced a
very severe loss in in mymenopause trajectory.
I think the two things that Iwould say about that are one,
the concept of post-traumaticgrowth and how we sort of can
(41:18):
lay the ground for that umpotentiality um is is so
essential.
And so I actually heard aboutpost-traumatic growth on NPR on
a radio show while I was deep ingrief.
And it I think it might havesaved my life.
Right.
(41:39):
Um and the other thing is as faras grief goes, we don't we don't
get over it.
We don't get past it.
You know, at best we integrateit and we go grow grow around
it.
Um, but that loss will define usand uh and it will temper us.
(42:01):
And how how how what kind ofimpact that has, we do have some
engagement with.
We can do things, we can adoptuh protocols that will help us
to grow out of that rather thanshrink.
SPEAKER_02 (42:17):
Uh that feels like a whole other podcast to me.
I'll come back if you want me.
I would love it.
That would be great.
Well, thank you for your time.
It was um it was well worth thewait, Lisara, as I was stalking
you across all the internets.
But thank you for joining ustoday.
And to our audience, until wemeet again, go find joy in the
(42:38):
journey.
Take care.
SPEAKER_01 (42:40):
Thank you for listening to the Medovia
Menopause Podcast.
If you enjoyed today's show,please give it a thumbs up,
subscribe for future episodes,leave a review, and share this
episode with a friend.
Modovia is out to change thenarrative.
Learn more at Medovia.com.
That's M I D O V I A.com.
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