A conversation with Lasara Firefox Allen, MSW, The Genderqueer Menopause Coach

Menopause care is not one-size-fits-all, especially for gender nonconforming individuals, including transgender, nonbinary and genderqueer community members, according to Lasara Firefox Allen, MSW, founder and lead coach of The Genderqueer Menopause program.

Allen, who is nonbinary and postmenopausal, was inspired to raise awareness for others in their community after struggling with their own menopause transition, during which they were wary to undergo hormone therapy for symptom relief due to the gender euphoria they experienced after they stopped menstruating. Now, they advocate for gender-affirming menopause care, which focuses on autonomy and empowerment.

They recently presented two abstracts at the 2025 meeting of The Menopause Society, held last month in Orlando. Those abstracts were 'Training the Trainers: Building Gender-Affirming Menopause Care Capacity in Clinical Practice' and 'All Genders Bleed: Menopause Beyond the Binary.'

This interview has been edited for length and clarity.

MHE: What are some assumptions embedded in menopause care that can be harmful for trans folks? Why are they harmful?

Allen: There are so many cis-normative assumptions embedded in menopause care; for example, the language around framing menopause as a loss of femininity, which is a terrible, tired social trope that doesn't serve any of us.

Gender-affirming care practices will benefit the whole community, not just gender-expansive folks. As we open our ideologies around the menopause transition, there's an opportunity to show up in the care relationship as people, first and foremost, and not to come from the assumptions that we're suffering a loss of femininity.

Our culture is very weird about gender, and because of the transphobia that's so rampant in this era, even cis women aren't getting the level of care that they would be getting if we didn't have so much phobia around hormone therapies.

I hope at some point that not just in menopause care but also in gender affirming hormone therapy, we can get to the point where we aren't so hung up on male and female gendered hormones so that people can be getting the hormonal support that their body will thrive on.

MHE: How has your menopause transition informed how you advocate for others?

Allen: I am genderqueer, and I recognize that part of my medical profile is that I'm getting gender-affirming care. I'm five years post-menopausal, and I'm currently on mid-range estrogen, 100 milligrams of progesterone and a medium dose of testosterone gel.

Once I stopped menstruating fully, I realized that a lot of my menstruation-related hardship had been rooted somewhat in dysphoria, so not just the absence of menstruation, but also the wild vacillations of the hormonal cycle during perimenopause. All of a sudden, I felt like I was in possession of my body for the first time since menarche.

When I was freshly postmenopausal, I was terrified of seeking out estrogen because I had had this experience of gender euphoria post-menopause. Gender euphoria happens when how we're being interpreted gender-wise, how we're experiencing our gender, and our physicality are all lining up. Gender euphoria is the opposite of gender dysphoria, which is where we feel like our parts and our psyche do not line up. So, I was hesitant to go back to any estrogen or progesterone.

I wish I would have had a care provider tell me earlier that the hormone levels were different and that steady state hormones may feel different in my body than even birth control.

MHE: How can physicians be more inclusive in their practices?

Allen: Physicians and other care providers can be more inclusive in their practices with some very baseline elements, like asking and honoring pronouns. That's a baseline, and it's not reliably adhered to.

The other thing that I like to say is using ‘people’ instead of ‘men’ or ‘women,’ so, ‘people who menstruate, people in menopause, people with a uterus.’ I know that’s an ideological shift for folks, but it’s more inclusive language in all directions. Not all women have a uterus, and not everyone who has a uterus is a woman.

In a medical setting, of course, we need to know what parts a person was born with because of the risk profiles, but there are ways that we can set up our electronic health records without inducing dysphoria. If you're going to provide affirming care, you don't want your first engagement with your potential patient to be dysphoria inducing.

I do a gender affirmative care certification course for medical providers and specifically for menopause providers. I've trained people who are psychiatrists, medical doctors and menopause doulas. One of the things that we've been talking about in my trainings lately is creating an affirming space without telegraphing that it's a queer-specific space. Because the social climate is so dodgy right now, a trans person who is fully passing as cis may not feel comfortable in their community going into a queer center.

MHE: What advice do you have for genderqueer folks looking for affirming menopause care?

Allen: Across the board, there is a distrust for the medical profession in my community, and there are barriers to care because we know going into a new medical setting that we're going to have to advocate for ourselves.

I just really reinforce for people, ‘You're X number of years old; you are the expert on your own care. You know better than anyone what treatment plan you'll be compliant with, how your symptoms interact, and what medications are going to work for you, because you've probably tried a lot of them.’ I'm not saying to be closed-minded, but so often the medical setting disempowers folks, and I think that the most affirming care for anyone, trans or cis, is going to be care that the patient and the provider collaborate on.