Gender-diverse adolescents and young adults’ experiences and attitudes toward menstruation.

Objective: Describe how menstruation affects the gender identity of gender-diverse adolescents and young adults who were assigned female at birth and now seek gender-affirming care. Method: Patients at a multidisciplinary pediatric gender program, ages 12–20 assigned female at birth and identified as gender diverse, and had reached menarche were recruited via purposive sampling. Thirty-six patients completed semistructured qualitative interviews about their experiences and attitudes toward menstruation. Open coding procedures, constant comparative method of ground theory, and inductive thematic analysis were used for analysis. Results: Four major themes were identified: (a) language, (b) first periods, (c) periods now, and (d) ways to cope. The association of menstruation with femininity was a source of discomfort. This was reinforced through language, menstrual products, and public bathrooms. Participants were uncomfortable with words related to menstruation but accepted their use with healthcare providers for menstrual management. Many participants noted that their discomfort with menstruation and its association with femininity confirmed their gender identity. A minority of participants expanded their definition of masculine to include people who menstruate. Participants coped with the discomfort of menstruation with distractions, avoidance, menstrual management, testosterone, mental reframing, gender-affirming clothing, and social support. Conclusions: Gender-diverse youth have a diversity of experiences and attitudes toward menstruation. Menstruation is not only a source of dysphoria; it can be a catalyst of exploration and confirmation of gender identity. Psychologists can help gender-diverse adolescents and young adults explore how menstruation influences their identity and identify strategies to cope with their discomfort.