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Gender-Affirming Hormone Therapy

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Additional Information

Feminizing hormone therapy

When you receive feminizing hormone therapy, it induces physical changes caused by female hormones during puberty (secondary sex characteristics) to promote matching your gender identity and your body (gender congruence).

If you start therapy before the changes of male puberty begin, you may avoid male secondary sex characteristics, like increased body hair and changes in voice pitch.

Feminizing hormone therapy can be completed alone or in conjunction with feminizing surgery. During therapy, a patient receives medication to block the action of testosterone and promote estrogen. This decreases testosterone production and influences feminine secondary sex characteristics. The changes caused by the medications may be temporary or permanent.

Feminizing hormone therapy isn't right for all transgender women. It may affect your fertility, sexual function, or cause other health problems. Talk to your doctor about the risks and benefits.

Therapy can:

  • Make an incidence of gender dysphoria less severe
  • Reduce your psychological or emotional distress
  • Improve your psychological and social functioning
  • Increase your sexual satisfaction
  • Improve your quality of life

Research suggests that feminizing hormone therapy can be safe and effective.

Your doctor might discourage therapy if you:

  • Had or have a hormone-sensitive cancer
  • Have a thromboembolic disease, such as deep vein thrombosis or a pulmonary embolism
  • Experience uncontrolled behavioral health conditions
  • Have uncontrolled significant medical conditions
  • Have a condition that limits your ability to provide informed consent

What to Expect

You should notice changes to your body within weeks to months. Here are some of the changes:

You will notice these one to three months after treatment begins.

  • Decreased libido
  • Fewer spontaneous erections
  • Slower scalp hair loss

After three to six months of treatment:

  • Softer, less oily skin
  • Testicular atrophy
  • Breast development
  • Redistribution of body fat
  • Decreased muscle mass

After six to 12 months:

  • Decreased facial and body hair growth

During your first year of therapy, you'll need to visit your doctor for a checkup quarterly, as well as when you change your hormone regimen.

You will need to diligently maintain routine preventive care visits, including:

  • Breast cancer screening
  • Supplementation – particularly vitamin D for bone density
  • Prostate cancer screening

Masculinizing hormone therapy

This therapy induces the typical physical changes in your body during puberty (secondary sex characteristics) to promote the matching of your gender identity and body (gender congruence). If you start therapy before the changes of female puberty begins, you can avoid female secondary sex characteristics, such as breast development.

During masculinizing hormone therapy, you'll be given testosterone, which suppresses your menstrual cycles and decreases the production of estrogen from your ovaries. The changes caused by the medications may be temporary or permanent. Hormone therapy may be completed alone or in combination with masculinizing surgery.

Masculinizing hormone therapy can:

  • Make your gender dysphoria less severe
  • Lessen your psychological and emotional distress
  • Improve your psychological and social functioning
  • Enhance your sexual satisfaction
  • Improve your overall quality of life

Therapy isn't appropriate for all transgender men. It can affect your fertility, sexual function, or cause other health problems. Talk to your doctor about the risks and benefits.

What to Expect

You should notice changes to your body within weeks to months. Here are some of the changes:

  • Your period stops. Within two to six months of treatment.
  • Your voice deepens. Three to 12 months after treatment. The maximum effect - within one to two years.
  • Facial and body hair growth. Begins three to six months after treatment. The maximum effect - within three to five years.
  • Body fat redistribution. Begin within three to six months. The maximum effect - within two to five years.
  • Clitoral enlargement and vaginal atrophy. Begin three to 12 months after treatment. The maximum effect - within one to two years.
  • Increased muscle mass and strength. Begins within six to 12 months after treatment. The maximum effect - within two to five years.

You will need to meet with your doctor on a regular basis and get routine preventive care if you haven't had certain surgical interventions.

  • Breast cancer screening
  • Cervical cancer screening
  • Evaluation of vaginal bleeding
  • Supplementation

Meet Your Team

Your expert team offers integrated medical, psychosocial and surgical intervention to individuals with gender dysphoria or incongruence and to those with differences of sexual development (intersex).

Lydia Ann Fein, MD, MPH
Lydia Ann Fein, MD, MPH
Obstetrics and Gynecology
Judith Seline Simms-Cendan, MD
Judith Seline Simms-Cendan, MD
Obstetrics and Gynecology, Pediatric and Adolescent Gynecology