Hormone Therapy for Transgender Individuals
What is gender-affirming hormone therapy?
Gender-affirming hormone therapy (GAHT) is a treatment in which people take hormones such as estrogen or testosterone, or hormone blockers, that help achieve physical characteristics that are more masculine or feminine. Hormone therapy for transgender and gender-fluid people can improve mental well-being and quality of life by more closely aligning someone’s outer appearance with their gender identity.
GAHT uses medicine to replace or suppress the hormones your body makes, typically estrogen and testosterone, that influence your outward appearance after puberty. During puberty, your body increases production of hormones that cause either feminine or masculine characteristics to become more pronounced. These include a lowered voice, body hair, increased muscle mass or breast growth.
If your body has gone through puberty but you haven’t had genital surgery, taking GAHT can suppress some physical traits created by your body’s hormones. If you have had genital surgery, taking GAHT replaces hormones that your body no longer makes, which is important for bone health.
Prescribed by a primary care provider or endocrinologist, GAHT can be part of a presurgical plan or a stand-alone service for adult patients.
Who may be a candidate for gender-affirming hormone therapy?
Hormone therapy may be part of a transition for gender-fluid individuals. It may be used in conjunction with transgender surgical procedures, but these procedures are not a requirement for receiving GAHT.
Patients interested in hormone therapy for gender affirmation must meet the following criteria:
- Have a diagnosis of gender dysphoria or incongruence from an experienced health professional
- Be able to make an informed decision and consent to treatment
- Have a thorough discussion about medical history, including mental health history, with your doctor and receive a physical exam to identify any conditions that could affect your GAHT treatment
Administration
Hormones are typically administered through various routes, including oral pills, transdermal patches, injections, or topical creams/gels. The choice of administration method depends on factors such as individual preference, effectiveness, and potential side effects.
Hormone therapy is usually initiated at a low dose, gradually increasing to achieve desired effects while minimizing risks.
It’s important for individuals undergoing hormone therapy to follow their healthcare provider’s instructions regarding dosage, administration, and monitoring.
Feminizing Hormone Therapy (MtF)
- Estrogen is used for hormone replacement, but avoid oral estrogen (Ethinyl estradiol) due to the increased risk of blood clots. Different estrogen preparations exist; discuss the best option with your doctor.
- Anti-androgen medication helps suppress testosterone
– Spironolactone inhibits testosterone but monitors blood pressure and electrolytes.
– Cyproterone acetate is effective, but watch for liver issues.
– GnRH agonists block testosterone release but are costly and typically given as injections.
– 5-alpha-reductase inhibitors have various benefits for hair growth and skin.
Masculinizing Hormone Therapy (FtM)
Testosterone can be taken orally, through the skin, or by injection. Aim for the lowest effective dose over time to achieve desired results while preserving bone density.
Physical Effects of Hormone Therapy
- For FtM patients, this means a deeper voice, possible clitoral enlargement, more body hair, menstruation stops, less breast tissue, and increased muscle mass.
- For MtF patients, this includes breast growth, reduced erectile function, smaller testicles, more body fat, and less muscle mass.
Changes occur gradually over about two years but vary for each person.
What to expect when starting hormone therapy for gender affirmation
You can expect to have several follow-up visits with your doctor. Most likely, you’ll meet every three months for the first year, every six months for the second year, and yearly from then on. GAHT for gender affirmation is a lifelong treatment for some people. Other people may take hormones for a period of time, until they achieve their desired changes, then stop.
Risks of Gender-Affirming Hormone Therapy
While the risks of untreated gender dysphoria can be severe, there are also risks with taking hormones. You should discuss how these risks might impact your personal health with your doctor.
Only take gender-affirming hormones that are prescribed by a medical doctor. Taking hormones not prescribed to you can lead to serious health risks.
Depending on preexisting conditions and age, you may be at a higher risk of serious cardiac events, such as heart attacks, strokes and pulmonary embolism.
Health Monitoring
Regular monitoring of hormone levels and overall health is essential to ensure the safety and effectiveness of hormone therapy. This may include blood tests to assess hormone levels, liver function, lipid profiles, and other relevant parameters.
Healthcare providers may also monitor for potential side effects or complications associated with hormone therapy, such as changes in blood pressure, cholesterol levels, or risk of blood clots.
It’s important to recognize that hormone therapy for transgender individuals is a complex and individualized process. Risk assessment and modification strategies should be tailored to each individual’s medical history, risk factors, preferences, and treatment goals. Collaboration between transgender individuals and healthcare providers is essential to ensure safe and effective hormone therapy initiation and management.
At Kamol Hospital, we prioritize the well-being of our patients who choose to undergo hormone therapy. We take pride in providing comprehensive and multidisciplinary care.
