Mind & Body

Gender affirming hormone therapy: How does it work?

Gender affirming hormone therapy treats gender dysphoria effectively and safely for some trans people. Not only that, it allows some trans people to express their true selves to the world through their bodies. Not all trans people choose to pursue gender affirming hormone therapy. It can be life changing for the better for the people who need it, a potentially life-saving medical treatment.

This post is all about gender affirming hormone therapy: feminization, masculinization, blockers, access, and resources.

This post discusses medical care, but please keep in mind I am not a doctor or medical professional! This post is not medical advice and should not be treated as such.

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Gender affirming hormone therapy: How does it work?

What are hormones?

Hormones are chemical messengers in your body. They affect your growth, mood, and reproduction. Testosterone and estrogen are the “famous” hormones affecting your secondary sex characteristics (traits like facial hair or the shape of your chest and hips). But your body needs many other hormones as well. Did you know insulin is a hormone? So are Vitamin D, melatonin, cortisol, oxytocin, and the thyroid hormones.

So if you take vitamin D supplements, technically, you’re on hormone therapy. But generally, gender-affirming hormone therapy refers to feminizing or masculinizing hormones.

Who gets gender-affirming care?

Gender-affirming healthcare is primarily for trans or nonbinary people. This necessary medical care can reduce painful gender dysphoria and improve mental and physical health. Many cis people take hormone therapy, but it’s not referred to as gender-affirming for them. Gender-affirming hormone therapy changes characteristics of someone’s body to make it feel better and more aligned with their internal sense of gender.

Primary care physicians can prescribe gender-affirming hormone therapy, as can Planned Parenthood and specialized clinics like Plume or Folx. The requirements may vary in your state (in the US) whether you are allowed to sign some paperwork yourself (informed consent) or if you need a letter from a mental health professional before starting hormone therapy.

Gender-affirming hormone therapy is not right for everyone! Some trans people do not react well to hormone therapy and discontinue use. It does not make you more or less trans if you take hormone therapy.

Feminizing hormone therapy

Feminizing hormone therapy may include estrogen (estradiol), progesterone, and/or spironolactone. These hormones and testosterone blockers override most effects of testosterone in the body. The dose of estrogen has to be relatively high (much higher than a birth control pill dose, for example).

Potential effects of feminizing hormone therapy:

  • Softer skin and hair texture
  • Redistribution of body weight from the belly to the hips
  • Breast growth
  • Improved mood for trans people
  • Infertility
  • Lower strength and size muscles

Masculinizing hormone therapy

Masculinizing hormone therapy consists of testosterone. Testosterone can be taken by injection or gel spread on the skin. The testosterone used for hormone therapy is bioidentical to the hormone produced by your body, unlike synthetic steroids.

Potential effects of masculinizing hormone therapy:

  • Thicker facial and body hair
  • Deeper voice
  • Reduced or stopped menstrual cycles (although not effective as a birth control method)
  • Stronger muscles with exercise
  • Bottom growth (you know, down there)
  • Improved mood for trans people
  • Redistribution of body weight from hips to belly

Low dose hormone therapy

Some trans people are eager to transition as fast and as much as possible. Others would like to experience more gradual or partial effects. The dose amount can be customized for each person’s desired effect. Some people also stop or restart hormone therapy, sometimes many times. You can choose, every time you receive a dose of medication, whether you wish to continue with hormone therapy at that time.

Hormone blockers

Hormone blockers are a fairly expensive treatment that can delay the onset of puberty in children and teens. This gives trans teens (and their families) a bit more time to figure out whether they should have an estrogen or testosterone puberty.

Other hormone therapy: birth control

Another common hormone therapy is taking birth control medication. Typically this is not a gender-affirming treatment, but it can be. Taking birth control continuously can stop your period and prevent PMS or PMDD, also reducing gender dysphoria in some people. Birth control, although it contains a small dose of “feminizing” hormones (usually estradiol and progesterone), prevents your body from producing its own huge spikes of these hormones. This treatment actually reduces the total amount of feminizing hormones in the body, and certainly smooths out the day-to-day levels.


Planned Parenthood – Transgender Hormone Therapy

WPATH standards of care for transgender people

Trans Lives, Trans Selves: A Resource by and for Transgender Communities

This beautiful book explains many aspects of the trans experience including medical transition.

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