This has been living in my head for a long time.
The way we talk about perimenopause and menopause still feels narrow. Predictable. Scripted. It assumes one identity and one experience. And that’s simply not how the world works anymore.
I coach nonbinary and trans athletes too. Their stories, their bodies, and their hormonal transitions don’t fit neatly into the “women’s midlife” narrative everyone still uses. And recently, a conversation in our run group brought that reality back into focus in the gentlest way.
They were asking about perimenopause — curious, thoughtful, and trying to understand what this next phase could look like. They were also honest about how their identity intersected with that curiosity. For someone who doesn’t identify as a woman, the idea of losing estrogen wasn’t wrapped up in womanhood, aging, or “the next chapter.” It came with a different mix of feelings entirely.
That moment reminded me of something important:
the physiology may be the same,
but the meaning isn’t.
Hormone shifts aren’t inherently gendered.
They’re human.
But the way someone experiences them is shaped by identity, culture, and the body they’re trying to live authentically in.
And right now, the broader conversation barely touches that.
When Nonbinary Athletes Move Through Perimenopause
Someone who doesn’t identify as a woman can still experience all the fluctuations of perimenopause:
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changes in temperature regulation
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disrupted sleep
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mood swings
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muscle recovery shifts
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bone density vulnerability
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tendon changes
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decreased estrogen availability
But they don’t necessarily experience the emotional or social narrative that cis women attach to menopause. They’re not entering “the next phase of womanhood.” They’re experiencing a hormonal recalibration the same way any other human with ovaries would.
This deserves a different kind of conversation — one that isn’t tied to gender, fertility, or traditional womanhood, but instead acknowledges the physical experience without assuming a shared identity.
It isn’t about neutralizing the language.
It’s about widening the frame.
When Someone Adds Estrogen During Transition
Right alongside this are athletes whose bodies are shifting in the opposite direction — adding estrogen as part of gender-affirming care.
They’re not experiencing menopause. But they are entering a new hormonal ecosystem, and their bodies adapt in ways that meaningfully impact training and performance.
Estrogen affects:
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metabolism
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mood regulation
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temperature sensitivity
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fat distribution
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lean mass
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tendon behavior
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recovery
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sleep
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bone density
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blood markers
This isn’t weakness. This isn’t fragility. This is adaptation.
For someone transitioning, these changes can feel deeply affirming, but they can also surprise them. A body that used to respond one way to training now responds another. Strength may feel different. Endurance pacing may change. Heat tolerance may shift.
The medical world doesn’t prepare transitioning athletes for this.
The athletic world definitely doesn’t.
So they’re left to navigate a new physiology without a roadmap — one that aligns beautifully with their identity but requires new strategies to support performance, recovery, and health.
When Someone Removes Estrogen and Boosts Testosterone
And then there are athletes transitioning in the other direction — removing estrogen as much as possible, adding testosterone, or using testosterone as their primary hormone.
This brings a completely different set of adaptations:
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muscle mass and strength increase
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fat distribution shifts centrally
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red blood cell count rises
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tendons and ligaments stiffen
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recovery patterns change
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mood can stabilize or fluctuate
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menstruation stops
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heat tolerance shifts
Again, none of this is “masculinizing” in the stereotyped way people imagine.
It’s regulatory. It’s adaptive. It’s your body moving toward alignment.
For athletes, this can feel empowering and stabilizing. But it can also bring challenges — strength may build quickly while tendons adapt more slowly. Endurance may feel different in a heavier or more muscular body. And without estrogen, bone density and cardiovascular health still need monitoring.
There’s nuance here, and athletes deserve to understand that nuance.
Training Through Hormonal Transition — For Every Athlete
Regardless of the direction of change, hormone transitions impact training. Here’s what holds true across all paths:
Strength training is essential
Two to three days a week protects muscle, bone, and tendon health.
Fueling matters more than ever
Protein, carbs, and consistent fueling support the body’s adaptation.
Sleep and recovery drive performance
Hormonal shifts make quality sleep a bigger part of training success.
Bloodwork is a tool, not a judgment
Estradiol, testosterone, SHBG, ferritin, vitamin D, thyroid markers, hematocrit, and lipids all tell the story of how the body is adjusting.
Emotional bandwidth counts as data
Mood shifts aren’t a personality flaw. They’re part of the process.
Every athlete moving through hormonal change — whether through age, surgery, suppression, or transition — deserves guidance that reflects their reality.
What’s Still Missing From the Larger Conversation
Even with all this information, we’re still leaving out huge pieces of the story.
One of the biggest gaps is the lack of clinician literacy around hormone therapy for gender-diverse athletes. Providers understand menopause. They understand transition. But very few understand how these hormonal realities intersect with endurance training, strength training, RED-S, or high-volume athletic goals.
Partners and families need more support, too. Transition impacts the entire relational system. Identity shifts can reshape roles, communication patterns, and emotional landscapes. Everyone involved deserves tools, not silence.
Transitioning athletes often hesitate to talk about symptoms because they fear their feelings will be misinterpreted as hesitation or regret. We need to normalize the truth that joy and struggle can coexist.
There’s also a gap around athletic identity. PRs shift. Strength shifts. Bodies change. That doesn’t mean an athlete is “losing capacity.” It means they’re building a new athletic identity that matches the body they’re creating.
And then there’s safety — gyms, group runs, bathrooms, race-day logistics. Feeling physically and emotionally safe is part of performance, not a side note.
Finally, we need to talk about long-term health. Hormonal transition isn’t just about the first year or the first stage. It’s about decades of cardiovascular health, bone density, mental well-being, and metabolic function in a gender-affirming body.
This is what the conversation needs to include if we’re serious about supporting athletes across the full spectrum of hormonal change.
Why This Belongs in Athletic Spaces
Bodies in transition — whether menopausal, surgical, nonbinary, trans, suppressing hormones, adding estrogen, or boosting testosterone — deserve the same level of care, nuance, and support as any other athlete.
We don’t need to erase womanhood or neutralize the conversation.
We just need to widen it.
Consider the full spectrum.
Honor every identity.
Respect every physiology.
Hormone transitions aren’t fringe.
They’re human.
And athletes are living through them every day.
The least we can do is talk about it with honesty, clarity, and compassion — and finally give people the roadmap they should’ve had all along.