In a society where women’s menstruation, which ought to be a celebration, remains a source of discrimination, the menstruation of transgender men is driving them to the brink of mental exhaustion.

Pratik Thapa Magar was born 29 years ago in Baglung as the sixth child of his family. Born biologically with a vagina and a uterus, he was his parents’ youngest daughter. Raised just like a son alongside his older brothers, he wore boys’ clothing from early childhood.

At the age of 12, he menstruated for the first time. During his first period, he was isolated and barred from entering the kitchen. This had never been done to his brothers. Consequently, the 12-year-old adolescent mind was filled with suffocating distress.

He recalls how the family’s behavior brought him even more pain back then. As menstruation recurred repeatedly, this treatment would also repeat. He would lock himself in a dark room, remaining entangled in the conflict between his mind and his body, unable to share his feelings with anyone. He was pushed into an identity crisis.

Now, at 29, he is aware and mature, and has realized his identity. Yet, he has not escaped the troubles caused by menstruation. “Menstruation reminds me of what I am not,” says trans man Pratik.

For women, menstruation is a natural process. Because society does not accept it as a natural process, menstruation has become a vehicle for discrimination. In a society where women’s menstruation, which ought to be a celebration, remains a source of discrimination, the menstruation of transgender men (trans men) is driving them to the brink of mental exhaustion. Pratik shares that even hearing the word ‘menstruation’ is emotionally painful.

Sudip Gautam, president of Unity for Change, an organization advocating for the rights of transgender men, states that menstruation is a constant trigger for trans men. Because of this, he notes, transgender men describe their menstrual period as a dark time in their lives.

Pratik, who perceives himself entirely as a man when not menstruating, is flooded with self-doubt the moment his period begins. He says, “Am I not a man? Am I incomplete? Do I not have a penis? Am I not whole?”

According to Pratik, just like cisgender women born biologically female, trans men are also subjected to the tradition of being hidden away in someone else’s house for five, seven, or even 22 days during their very first period. In subsequent periods, restrictions such as staying isolated, not entering temples, and being barred from the kitchen are imposed. He notes that forcing these discriminatory rules, typically targeted at women, upon them deals a massive blow to their actual identity.

A study conducted by Unity for Change and the Radha Paudel Foundation on menstrual discrimination faced by trans men reveals that for them, this discrimination is even more complex and invisible. The study concludes that they endure a dual discrimination based on both gender identity and menstruation. It highlights that discriminatory practices like isolation during menstruation, restriction from religious or public places, and bans on certain foods (like milk and fruits) are also imposed on trans men.

Furthermore, many trans men fear facing harassment when buying menstrual pads and because public toilets are not gender-neutral. The study mentions that due to this fear, they are forced to use a single menstrual pad all day, leading to infections.

According to the study, not just during menstruation but even under normal circumstances, the lack of gender-neutral public toilets and the fear of violence in men’s restrooms forces many trans men to hold their urine for 9 to 10 hours.

The study concludes that menstruation, among other factors, causes gender dysphoria in transgender men, an experience Pratik has lived through firsthand. Gender dysphoria is a severe mental and emotional distress that arises when a person’s biological sex assigned at birth does not match their internal gender identity. For a trans man, this condition is not merely a matter of the mind but a reality entangled with social, legal and physical challenges.

According to Dr. Jasmin Ma, a psychiatrist working at Norvic Hospital, one individual who came to her for counseling hated having breasts. When going out, he would bind his chest tightly, causing him physical distress. He wanted to undergo chest reconstruction surgery (top surgery), but due to lack of money, the surgery could not take place. This was causing him not just physical discomfort but mental health issues as well.

She adds that trans men also visit her for psychological counseling because their families do not understand or accept them.

The study on menstrual discrimination among trans men notes that due to societal, familial and physical challenges, trans men develop negative thoughts, isolate themselves, suffer from depression and even attempt suicide. To escape these struggles, the study mentions that many trans men have recently started relying on hormonal therapy to adopt masculine characteristics (growing facial hair and undergoing chest reconstruction).

The struggle for identity        

Even though he perceived himself as a man, the monthly recurrence of menstruation left Pratik confused about his gender identity. One day, he read a story about a transgender woman in a newspaper. That was when he realized he belonged to the same community.

During his bachelor’s studies, he got a smartphone and gained access to the internet. He searched online for stories of people with experiences similar to his. Following this, he guessed he might be a lesbian.

While still in college, he attended a Blue Diamond Society program through his friends, where he met other people like himself.

He discovered that other peers like him also felt their identity was being compromised by menstruation. It was only then, at the age of 18, that he identified himself as a trans man.

However, the periods continued.

He could not open up about his inner turmoil to his family, friends or society because he was born as a daughter. He lived in fear that society would call him crazy if they found out. Entangled in his own emotions, he was breaking down mentally.

To escape this agony, he decided to embrace masculine features (voice and facial appearance) and began using hormonal medication. Three to four months after taking the hormones, his menstruation stopped. Gradually, his voice began to change.

He was undergoing changes just like boys maturing during adolescence. He was overjoyed because the element that reminded him of being a woman was gone. Along with that, he no longer had to face harassment when buying menstrual pads, did not have to wear pads at all, and didn’t have to fear staining his clothes anywhere.

He says, “At that time, I felt free.”

However, time did not continue smoothly.

Financial constraints, the compulsion to live outside Kathmandu, and new complications brought on by the hormonal treatment forced him to repeatedly start and stop taking hormones.

In the midst of this, he secured a banking job and moved to Sindhupalchok. He had run out of hormones and his period returned. That day, he was wearing white pants. When a colleague pointed out that there was blood on them, it felt like the ground had slipped from beneath his feet. He was thrown right back into absolute emptiness.

After that, his periods became continuous. During that time, countless storms raged in his mind. “What happens if someone finds out? I felt a deep sense of social insecurity,” he says. “Many times, I felt like jumping into the Sunkoshi River.”

According to him, even going to buy menstrual pads was difficult. “Everyone knew me there and everyone knew I lived alone,” he says. “Fearing I would be questioned about who they were for, I never gathered the courage to buy pads in Sindhupalchok.” He notes that he would always buy pads whenever he visited Kathmandu and carry them back with him.

While still in Sindhupalchok, he also hit a crisis of playing a dual identity. His joy when a colleague addressed him as ‘Sir’ for the first time did not last even a moment. He was completely crushed when another person working there called him ‘Miss’.

Just like his coworkers, some clients would address him as ‘Sir’ while others called him ‘Miss’. He was driven to the brink of despair with each passing moment. Caught repeatedly in the whirlpool of gender dysphoria, he could no longer continue with his job.

He quit his job and returned to Kathmandu.

He resumed his hormones and began preparing for the civil service (Public Service Commission) examinations.

Then came another obstacle, which was documentation. He shares that when filling out the online forms, his application was rejected with a message stating, ‘Please upload your own photo.’

He stopped taking hormones once again.

His period returned. This time, the bleeding was different, it felt like an injury. His ovaries also hurt severely. Upon getting a medical checkup, it turned out that one side of his ovary was swollen.

He was advised to come for a follow-up uterine scan six months after starting hormones. However, he had not gone for regular follow-ups.

When health complications arose, he visited a gynecologist and an endocrinologist. “When I asked what effects the hormonal medication could have and explained what I was experiencing, they (the doctors) wouldn’t give me a definitive answer,” he says. “They would only say, ‘If you want to be a man, take it. If not, it’s better not to take it’.”

A study titled ‘A Qualitative Analysis of the Process of Identity Development in Transgender Men’, published in the Archives of Medical Research, indicates that using hormones arbitrarily without expert guidance during the female-to-male (transgender man) transition process can lead to physical and mental health impacts. Hormone use can severely and negatively affect fertility and egg preservation. Therefore, the study emphasizes that expert consultation is essential during such hormone therapy.

Pratik, however, laments that he could not get any expert advice regarding hormone therapy and was forced to use it on his own.

Society dictates that if you are a female, you must only do certain things and if you are a male, you must only do specific tasks. Patriarchal thinking, which dictates that a female must marry, go to another house, bear children and manage a household, refuses to accept the identity of trans men. Because of this, Sudip explains, families also fear for their social reputation and fail to accept their children if they belong to the gender and sexual minority.

He adds that although many realize they are different from others since childhood, they are forced to struggle for years to express their identity due to the gender boundaries imposed by society.

According to Sudip, because trans men dislike their breasts, they use binders to conceal them. Since binders are extremely tight, they lead to physical complications such as chest pain, breathing difficulties and lumps in the breasts.

Sudip explains that trans men face harassment even when visiting hospitals for these issues. When going to a gynecologist for STDs, they are told ‘this is not the men’s line’, or doctors simply say ‘I do not treat men’. He adds that even when they disclose their identity to seek psychological counseling, the use of group sessions violates their right to privacy.

He further notes that healthcare workers themselves often cross professional boundaries by asking irrelevant questions like, “How do you have sex?” As a result, Sudip shares, many individuals choose to endure various health complications rather than visit a healthcare institution.

A study titled ‘The Need for LGBTQ+ Curriculum in Nepalese Medical Education’, published in the National Library of Medicine, points out that access to healthcare for this community remains unequal in Nepal. The study attributes this to barriers in access, discrimination and the impact of biases among healthcare professionals.

According to the study, LGBTQ+ topics are treated superficially in Nepali medical colleges, often limited only to HIV and STDs, which leaves students with a negative outlook. This hampers comprehensive care. To address these issues, changes in medical education are essential. LGBTQ+ content must become a mandatory part of the curriculum, awareness of sexual orientation and gender identity needs to be expanded, and training must be provided to deliver inclusive and respectful healthcare services.

The study on menstrual discrimination among trans men in Nepal highlights that transgender men like Pratik must navigate not only biased healthcare institutions but also socio-cultural and legal complexities related to menstrual discrimination.

In search of inclusivity

There is no exact data on how many trans men in Nepal face struggles similar to Pratik’s. For the first time, Nepal’s 2021 National Census included the population of gender and sexual minorities, reporting a total of 2,928 individuals. However, those working for the rights of the gender and sexual minority community consider this data incomplete.

They estimate that this number could be as high as 2.5 million. Their argument is that many individuals hesitated to disclose their identity due to social stigma and privacy concerns, leading to an undercount in the census. Similarly, various global studies indicate that roughly 2% of the world’s population identifies as a gender and sexual minority.

The study on menstrual discrimination among trans men conducted by Unity for Change and the Radha Paudel Foundation states that due to menstrual discrimination alone, at least 14 fundamental rights of trans men are being violated, including the right to live with dignity, the right to freedom, the right to equality, the right to social justice, and the right to safe motherhood and reproductive health.

Furthermore, Sudip argues that to include trans men, existing laws focused exclusively on men and women regarding reproductive rights need to be amended by either adding the term ‘gender and sexual minorities’ or using the phrase ‘individuals assigned female at birth’. They demand that school curriculums include topics on gender diversity to build an inclusive society.

When the Curriculum Development Center implemented the new curriculum in 2019, it included introductory topics on the gender and sexual minority community in the ‘Sexual Orientation, Gender Identity’ unit of the Grade 7 textbook Health, Physical and Creative Arts.

Although terms like homosexual, transgender, intersex and bisexual are included in units such as Health and Physical Education for Grades 6-8, Social Studies for Grades 9-12, and ‘Gender Issues’ in Grade 12, the curriculum faces constant criticism for being incomplete and fragmented.

Pratik and Sudip emphasize that to ensure safe and respectful healthcare services, comprehensive and in-depth content regarding this community must be integrated into the medical education curriculum.

The constitution guarantees the rights to equality, citizenship and social justice under Articles 12, 18 and 42. However, Pratik and Sudip state that full implementation is required by removing discriminatory procedures related to citizenship, marriage registration and medical certification.

According to them, trans men have pursued education up to bachelor’s and master’s levels. They demand that inclusive policies be adopted in employment, startups and economic frameworks to ensure their economic inclusion.

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