After a decade working as an obstetrician-gynecologist, Marci Bowers thought she understood menopause. Whenever she saw a patient in her 40s or 50s, she knew to ask about things such as hot flashes, vaginal dryness, mood swings, and memory problems. And no matter what a patient’s concern was, Bowers almost always ended up prescribing the same thing. “Our answer was always estrogen,” she told me.
Then, in the mid-2000s, Bowers took over a gender-affirmation surgical practice in Colorado. In her new role, she began consultations by asking each patient what they wanted from their body—a question she’d never been trained to ask menopausal women. Over time, she grew comfortable bringing up tricky topics such as pleasure, desire, and sexuality, and prescribing testosterone as well as estrogen. That’s when she realized: Women in menopause were getting short shrift.
Menopause is a body-wide hormonal transition that affects virtually every organ, from skin to bones to brain. The same can be said of gender transition, which, like menopause, is often referred to by doctors and transgender patients as “a second puberty”: a roller coaster of physical and emotional changes, incited by a dramatic shift in hormones. But medicine has only recently begun connecting the dots. In the past few years, some doctors who typically treat transgender patients—urologists, gender-affirmation surgeons, sexual-medicine specialists—have begun moving into menopause care and bringing with them a new set of tools.
“In many ways, trans care is light years ahead of women’s care,” Kelly Casperson, a urologist and certified menopause provider in Washington State, told me. Providers who do both are well versed in the effects of hormones, attuned to concerns about sexual function, and empathetic toward people who have had their symptoms dismissed by providers. If the goal of menopause care isn’t just to help women survive but