The Last Menstruators Episode 2 - Transmen experience of periods in Pakistan

An in-depth interview with Pakistan’s leading voice on transgender issues Mani AQ who is the Program Executor at HOPE. Have Only Positive Expectations (HOPE) is a community-based organization seeking to advance the human rights of socioeconomically disenfranchised groups in Pakistan. The organization began its operations in 2018 with the founding team envisioning a safe space for people discriminated against based on their body, gender, and sexuality.

Mani: I was raised as a girl in my family but with time, I started exploring myself and the conflict began rising between my family and me. At one point, I decided to sacrifice for the family or sacrifice the family. So I decided to sacrifice the family and focused on my life. This was a big step (decision) in my life. I started from scratch and it has now been a 7 years-long journey of my transition.

After leaving my family, I began working for an NGO. But I found a lack of work related to Trans Men as the organization's most work was related to HIV service delivery at the government level, Men who have sex with men (MSM), and Transgender. I used to feel left out among them. In fact, I started feeling like I was the only Trans man and most of our community people feel the same that they are the only ones facing such conditions. Gradually, I began working on Trans Men and people with similar issues joined. I feel so honored to get such a chance in Pakistan to speak up and start a movement for Trans Men. As a result, today Trans Men have equal share and rights in Transgender Act. Now, I am striving to include this in the provincial act. I just want to continue working for the Trans men.

I remember the time when I had my first menstrual cycle. I was so upset as my mother or sisters never told me about this before. But I think people used to avoid talking about this earlier or my family did not want to discuss such matters. So I had no idea what happened to me! It was like an incident for me when I had experienced this for the very first time; I reached home and told my sister to take me to the hospital as I was bleeding. They told me that this happened to me because I was growing up. During that time, I was emotionally disturbed.

Then, I also became a patient of Polycystic ovary syndrome (PCOS) for a long time. I faced heavy bleeding for consecutive 40 days and this was the most depressing and painful time for me. Even, I faced the PCOS problem when I started medical transition but thanks to my partner who belongs to the medical field. She is so understanding and caring that she never made me feel that I was a girl because I menstruated.

We are living in the 21st century, we have advanced technology and we have become advanced but still, we don’t speak up on such matters. Thankfully, I am not having periods now. But five years ago, It was such a difficult time for me but I still have this fear. It’s because every Trans Man who opts for transition has to go through some surgeries and during surgeries, if some steps are missed out then there are chances of reversal. For example, I take hormones and if I skip these doses for a couple of months then there could be a chance that I will menstruate again. Bleeding for consecutive 40 days is not an easy thing. So, I don’t want it. After the transition, it’s more difficult to manage. The initial stage of transition includes social transition that means one must behave as he wants people to notice him. One has to wear T-shirts and pants as every man wears in our society. I think the traditional women's clothing helps to cover more as compared to pants and shirts so there are such challenges while transitioning. I never wanted to disclose that I am having my periods because acceptance is itself a challenge for people like us. After all, we usually deny revealing such things that we also face menstruation during the transition.

“There were all male employees where I used to work. They gave me respect and treat me like a man, although they knew the fact that I was a Transgender Man. So, it was so awkward for me to talk about menstruation with them. Whenever I talk with Trans Women, I feel strange because they want to experience menstruation!

I suppose that Trans Men who still have their ovaries and uterus inside the body feel the menstrual cramps. It may be due to the fact that the organs are present but we have kept them inactive with the support of medication. But, yes we face menstrual cramps during the days when we are supposed to take hormones.

Saba: Can you speak a little about other people’s experiences of your community. Do they feel that menstruating during transition is a reminder to them that they have not transitioned completely and whether they feel frustrated about it?

Mani: Yes, I don’t know a single person who is happy with it. Every time Trans Men want to go for transition, the first thing they ask is when the menstruation would stop. After this, they ask about other things including hairs, voice changes. But the first question is always about menstruation. It’s basically the issue of the body and its changes. I know the people who successfully got rid of creepy periods right after the first medication of transition in the initial months. At the same time, I know the people who took 1.5 years to stop having menstrual periods.

There are stages to follow in social transition before taking hormones. Social transition basically prepares oneself for the upcoming life changes. When one is ready then he starts taking Testosterone hormones. Its effect is for 21 days so one must have to take a dose after every 21 days. Initially, it starts with lesser doses and then gradually it increases. So, as I mentioned earlier the menstruation and its stoppage depends on the medication and body reaction. Other than this, the people start having their beards, the voice also changes and some people become bald like me. 

Certainly, people link taking hormones with mood swings. For example, they relate that hormones can cause aggressive behavior in Trans Men, but it’s not the reality. They don’t realize other factors that actually cause anger. One must have done something to make them angry. For example, if I am laughing now, does that mean that I am laughing because of hormones? So linking aggressive behavior with hormone doses is a weird thing. Though, Trans Men could behave more masculine because they had to act like a man. He does not have masculinity like other males. The same goes for Trans Women; they apply loud makeup to show people that they are women. They all have to keep working hard. I know this is stupid but it exists.

Binders have a specific material that is not available in Pakistan. It’s available internationally through AliExpress, Ali Baba, Amazon and other platforms. So people buy through these platforms or else I try to get these things from donors during my foreign visits to help people here. But, one cannot wear that material during summers here. Though it's elastic, it’s very irritating to wear. Due to unavailability, people use other alternatives like bandages. Personally, I used to face bloating while binding myself. It’s because anything that presses my stomach, the bloating happens. I am never comfortable with binders; even I barely used binders during my transition period. I used to wear belts named as men slim and fit and I used to wear 2 times smaller belts than my actual size to cover certain body parts. But still, it caused problems of bloating, so yes! bloating itself is an uncomfortable condition.

I am talking about such things for the very first time, so I don’t know to what extent I should reveal the problems. In cabins, we don’t find dustbins so we can throw the used tissues under the seats or just flush it out in the toilets but you can’t flush out the pads. If one Trans Man is using the men’s toilet then there are chances that the bin would not be available. Whenever I travel, I use handicapped toilets because such toilets are not used by many people and are cleaner. I keep myself prepared to be asked if I am handicapped that I am using this washroom. But this is something many people face and it’s painful.

I took so long to talk on this matter and I think it’s now easy to talk about this matter because it's no longer my issue. If I still faced this issue then I would have behaved differently or perhaps I would not have spoken. But, I am married now and I am having a baby so in the future, I can easily talk to my daughter about this matter. Possibly, she can feel odd that her father is talking to her about this but I am happy to have a conversation with my daughter.

Saba: I think we should talk about menstruation normally with females and males because it’s not an awkward issue anymore.

Mani: It depends on a certain group of people, if you find a group that can talk about Menstruation and Transition then they can discuss. But I feel that it would be very difficult to share their experiences.

Saba: Well, you also talked about the support of a partner and its importance during the transition. Can you tell a bit more about how family can be more supportive?

Mani: It's difficult for families to give a comfortable environment and support to their daughters facing menstruation so I don’t know how a family will support a member who has masculine expressions! Generally, I would say that whoever is going through such a state, then understanding the problem and giving an individual space could help out. It's now very easy for people to identify their actual gender at an early age, even before puberty. I know many Trans Men whose family support them so they can discuss with their families about menstruation. But I didn't even want to discuss it with my family. I remember that my sister shared about menstruation with my brother. She can easily tell him to buy pads for her. Women feel shy to purchase such stuff even if they are shopping from malls. Malls have separate counters for such things but still, women feel shy to purchase. My wife also feels shy but why should women feel shy about this?

Nowadays, TikTok has spread some awareness. I remember when we used to watch television in our lounge and a commercial for pads used to come, we changed the channel or talked about anything else to avoid the ad. Such subjects were never discussed before, but now they are shown through TikTok, regardless of whether the content is humiliating or amusing. Earlier, there was no such conversation or discussion. Pads were covered in black shoppers and brown envelopes. So, I think we need to make that space a little more comfortable. In Hinduism practices, women are still not allowed to enter the kitchen during they menstruate. In some old rituals, women were kept alone, away from home during their menstruation. God has not disallowed them to go in the kitchen but rather it's their time to take a rest. People, on the other hand, overlook the rest and associate menstruation with other issues, including uncleanliness. I believe we have modernized our appearance, but we must still modernize our minds, this can solve the problem.

Saba: Absolutely, many participants shared that they almost keep fast during menstruation because they could not disclose about skipping our fasts due to periods before their brothers and fathers during Ramadan. They could not eat during the day rather eat on Sehri and Aftari to hide. We have made it awkward to discuss the menstruation topic that is explicitly stated in the Quran. With that, I hope any conversation was not triggering or too much for you. Thank you so much for your time.

Mani: No problem, Thank you for starting such a conversation on this subject on which few people talk.