Supporting Trans and Non-Binary Folks with PMDD: A Call for Inclusive, Compassionate Care

Are Premenstrual Dysphoric Disorder (PMDD) is an often misunderstood and deeply distressing condition that affects some people who menstruate. For trans men and non-binary folks, living with PMDD can be especially complex—both emotionally and systemically.

As therapists, we are uniquely positioned to support clients navigating PMDD through a trauma-informed, gender-affirming lens. Yet too often, our mental health systems, training, and language remain rooted in assumptions that menstruation and hormonal cycles only impact cisgender women. This erasure can deepen shame, reinforce gender dysphoria, and leave trans and non-binary clients feeling unseen in their pain.

When PMDD and Gender Dysphoria Intersect

For many trans and non-binary clients, the hormonal fluctuations of a menstrual cycle can intensify distress, particularly when symptoms overlap with or trigger gender dysphoria. Emotional shifts, physical sensations, and body changes can all serve as painful reminders of a body that doesn’t feel like home.

In therapy, we may hear clients speak about feeling “out of control” or “disconnected” during certain times of the month. They may share increased irritability, depression, or even suicidal thoughts that feel cyclical but confusing. Without a space to explore this safely and without judgment, these experiences can be internalized as personal failures or signs of deeper pathology—when, in fact, they may point toward PMDD.

Therapeutic Support That Affirms and Validates

As clinicians, we don’t need to be medical experts in PMDD to offer meaningful support. What we do need is curiosity, humility, and a commitment to holding space for the full complexity of our clients’ experiences. Here are some ways we can show up:

Affirming Identity While Exploring Symptoms

Instead of focusing only on pathology, we can explore how PMDD intersects with a client’s sense of self, safety, and identity. We can ask: How does this time of the month affect your relationship with your body? What supports feel most grounding when things feel overwhelming?

Creating Language Together

Some clients may not have the words to describe what they’re feeling—or may be using medical language that doesn’t align with their identity. Collaboratively building language around their experience can foster agency and insight.

Normalizing and Naming

Many trans and non-binary clients with PMDD have never had a provider name what might be going on. Gently offering possibilities, like PMDD, can be validating and de-pathologizing. It’s not about diagnosing but about inviting exploration.

Centering Safety and Autonomy

For clients exploring treatment options, whether that includes medical interventions, lifestyle changes, or spiritual practices, our role is to walk alongside them without pushing an agenda. Safety and choice must remain central—especially in bodies that have so often been marginalized or controlled.

Moving Toward a More Inclusive Practice

PMDD is not just a physical or hormonal issue—it’s an emotional and relational one, too. As therapists, we can play a powerful role in making sure trans and non-binary clients don’t have to navigate it alone.

This work calls us to deconstruct our assumptions, to expand our understanding of who menstruates, and to build practices that reflect the rich diversity of our clients’ lives.

If you’re supporting trans and non-binary folks in your practice, consider this your gentle reminder: your presence, your validation, and your willingness to see the whole person—they matter. Deeply.