Gender-affirming hormone therapy helps transgender and other gender-nonconforming people align their bodies with their gender identity. Not all transgender (trans) people are interested in hormone therapy. However, many transgender people, particularly binary transgender people, turn to hormones to affirm their gender.
Gender-affirming hormone therapy is comprised of masculizing hormone therapy used in trans men and feminizing hormone therapy used in trans women.
This article describes the goals of gender-affirming hormone therapy, how the treatment is administered, and the different types of hormones used. It also explains what to expect when undergoing gender-affirming hormone therapy and the possible risks.
Verywell / Brianna Gilmartin
Definitions
The term “gender affirmation” is preferred over “gender confirmation” because a transgender person does not need to confirm their gender to anyone. The word “confirm” suggests proof, while “affirm” means to assert strongly.
Who Is Gender-Affirming Hormone Therapy For?
Gender-affirming hormone therapy is the primary medical treatment sought by transgender people. It allows their secondary sex characteristics to be more aligned with their individual gender identity.
Gender-affirming hormone therapy comes in two types:
- Masculinizing hormone therapy used to develop typically male sex characteristics
- Feminizing hormone therapy used to develop typically female sex characteristics
Hormone therapy can be used on its own for people who have no interest in pursuing gender-affirming surgery. It can also be used in advance of surgery (usually for six months to one year) to improve the outcomes of surgery, such as breast augmentation.
According to the National Transgender Discrimination Survey, 95% of transgender people and 49% of non-binary people were interested in hormone therapy.
Hormone Therapy vs. Puberty Blockers
Puberty blockers are used to delay the onset of puberty in young, gender-diverse people prior to the start of hormone therapy. They are considered to be a distinct but complementary component of gender-affirmation therapy.
How to Get Started
Gender affirmation is a process in which hormones only play a part. It typically starts with social gender affirmation in which you alter your appearance, wardrobe, and manner of grooming while updating your name, pronouns, and legal documentation.
Medical gender affirmation is typically the next step in which you work with a healthcare provider to identify your personal goals and which type of types of treatments are needed to achieve those goals.
Hormone therapy is typically overseen by a specialist in the endocrine (hormonal) system called an endocrinologist. Other healthcare providers trained in gender-affirming medical care may be equally qualified to administer treatment.
Depending on state law and other factors, healthcare providers may be able to dispense treatment on the same day. No letter from a mental health provider may be needed. Call Planned Parenthood or your local LGBTI organization to learn about the laws in your state.
To receive authorization for insurance coverage, many insurers require a diagnosis of gender dysphoria. To do so, a therapist or mental health professional must confirm that there is a mismatch between a person’s expressed or experienced gender and the gender they were assigned at birth for a period of at least six months.
How to Choose the Right Provider
Not every endocrinologist is equally well-suited to administer gender-affirming hormone therapy. Those who have undergone a comprehensive, multidisciplinary gender-affirmation training program are generally preferred.
Do not hesitate to ask about a healthcare provider’s experience and qualifications in administering gender-affirming care.
Masculinizing Hormone Therapy
Masculinizing hormone therapy uses various types of testosterone to promote masculinizing changes in both binary and non-binary individuals. Testosterone is most often given as an injection, but other formations are available, including pills and creams.
There has been growing interest in the use of subcutaneous pellets for testosterone treatment, as they only need to be inserted two to four times a year. However, they are not always available or covered by insurance.
| Form | Drug | Dose in milligrams (mg) |
|---|---|---|
| Oral | Testosterone undecanoate | 160–240 mg per day |
| Injected | Testosterone enanthate or cypionate | 50–200 mg per week or 100–200 mg every 2 weeks |
| Testosterone undecanoate | 1,000 mg every 12 weeks | |
| Transdermal | Testosterone 1% gel | 2.5 to 10 mg per day |
| Testosterone patch | 2.5 to 7.5 mg per day |
Changes that can be induced by masculinizing hormone therapy include:
- Facial and body hair growth
- Increased muscle mass
- Lowering of the pitch of the voice
- Increased sex drive
- Growth of the glans clitoris
- Interruption of menstruation
- Vaginal dryness
- Facial and body fat redistribution
- Sweat- and odor-pattern changes
- Hairline recession; possibly male pattern
baldness - Possible changes in emotions or interests
Masculinizing hormone therapy cannot reverse all of the changes associated with female puberty. If transmasculine individuals have experienced breast growth that makes them uncomfortable, they may need to address that with binding or top surgery.
Testosterone will also not significantly increase height unless it is started reasonably early. Finally, testosterone should not be considered an effective form of contraception, even if menses have stopped.
Feminizing Hormone Therapy
Feminizing hormone therapy uses a combination of estrogen and a testosterone blocker. The testosterone blocker is needed because testosterone has stronger effects on the body than estrogen.
The blocker most commonly used in the United States is spironolactone, a medication also used for heart disease. The medication used as a puberty blocker, called Supprelin LA (histrelin), can also be used to block testosterone.
Various forms of estrogen can be used for feminizing hormone therapy. In general, injectable or topical forms are preferred as they tend to have fewer side effects than oral estrogens. However, some trans women prefer oral estrogens.
| Form | Drug | Dose in milligrams (mg) |
|---|---|---|
| Oral | Conjugated estrogens | 2.5 to 7.5 mg per day |
| 17-beta estradiol | 2.0 to 6.0 mg per day | |
| Injected | Estradiol valerate | 5.0 to 20 mg every 2 weeks |
| Estradiol cypionate | 2.0 to 10 mg every week | |
| Transdermal | Estradiol patch | 0.1 to 0.4 mg twice weekly |
Changes that can be induced by feminizing hormone therapy include:
- Breast growth
- Softening of the skin
- Fat redistribution
- Reduction in face and body hair (but not elimination)
- Reduced hair loss/balding
- Muscle-mass reduction
- Sweat- and odor-pattern changes
- Decrease in erectile function
- Testicular size reduction
- Possible changes in emotions or interests
Estrogen cannot reverse all changes associated with having undergone testosterone-driven puberty. It cannot eliminate facial or body hair or reverse shoulder width, jaw size, vocal pitch, or facial structure. Many of these can be addressed with aesthetic or surgical treatments.
What to Expect During Treatment
Some hormones used for gender-affirming hormone therapy are self-administered or given by someone you know. Others need to be administered by a healthcare provider.
Thereafter, regular follow-ups are needed to evaluate the effects of treatment and possible side effects. Most healthcare providers recommend visiting every 3 months for the first year and every 6 to 12 months thereafter.
Effects of Therapy
It can take three to five years for your body to show the full effects of gender-affirming hormone therapy. Some changes can occur within the first six months, such as the development of larger breasts. Others, like changes in facial structure, can take years.
In addition to physical changes, hormone therapy can cause emotional changes. If you are sexually active, it may improve sexual satisfaction as well as your overall sense of well-being. Hormone therapy can also help to ease the stress associated with gender dysphoria.
If you discontinue therapy, some changes may be reversible. Others, like changes in bone structure, may be permanent.
Possible Risks
As beneficial as gender-affirming hormone therapy can be, it also carries certain risks depending on which hormone you are taking.
Possible risks of feminizing hormone therapy include:
- High blood pressure
- Blood clots
- Heart disease
- Type 2 diabetes
- Weight gain
- Infertility
- Breast and prostate cancer
Risks of masculinizing hormone therapy:
- Acne
- Male pattern baldness
- High cholesterol
- High blood pressure
- Type 2 diabetes
- Vaginal dryness
- Pelvic pain
- Sleep apnea
- Blood clots
- Interfertility
Access to Gender-Affirming Hormone Therapy
Until relatively recently, access to gender-affirming hormone therapy was largely managed through gatekeeping models that required gender-diverse people to undergo a psychological assessment before they could access hormone treatment.
However, there has been a growing movement toward the use of an informed consent model to better reflect access to other types of medical care. This change has been reflected in the standards of care for transgender health produced by the World Professional Association for Transgender Health (WPATH).
Gender-affirming hormone therapy is considered to be a medically necessary treatment for gender dysphoria. It should be covered by most insurers in the United States after legal changes that occurred as part of the passage of the Affordable Care Act.
However, state laws vary substantially in terms of transgender protections, and some states do allow policies to exclude various aspects of transgender health care, including gender-affirming hormone therapy.
Access to hormone therapy can be prohibitively expensive for many people if they need to pay out of pocket, which may lead some people to try to get these medications from friends or other unlicensed sources.
In addition, individuals who are involved with carceral systems, such as immigrant detention, may be denied access to hormones. This can have significant negative physical and psychological effects.
Summary
Gender-affirming hormone therapy is the primary form of treatment for transgender people. Masculizing hormone therapy involving testosterone is used to develop secondary male sex characteristics like larger muscles. Feminizing hormone therapy involving estrogen and a testosterone blocker is used to develop secondary female sex characteristics like breasts.
Some masculinizing and feminizing effects can occur within months, while others may take years. If you stop treatment, many of the effects will reverse, while some will be permanent. Regular follow-up care is needed to avoid potential side effects and long-term complications.
:max_bytes(150000):strip_icc()/ElizabethBoskeyPhD_660-3602bb6a2edd4f12b085b78ff49f3dc6.jpg)
اكتشاف المزيد من LoveyDoveye
اشترك للحصول على أحدث التدوينات المرسلة إلى بريدك الإلكتروني.