Who Is Feminizing Hormone Therapy For
Feminizing hormone therapy is an option for transwomen people who were assigned male at birth but identify as women. This therapy is a common treatment for gender dysphoria .
Nonbinary or intersex people may also choose to undergo feminizing hormone therapy. Nonbinary people have gender identities that dont fit inside traditional male or female categories. Intersex people are born with reproductive or sexual characteristics that dont fit traditional perceptions of male and female bodies. They may have conditions affecting their gonads, external genitals or chromosome patterns.
Stated simply, feminizing hormone therapy is for anyone who feels that theres a mismatch between their external appearance and their authentic sense of gender and self.
Search Strategy And Selection Criteria
This systematic review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two electronic searches of four online databases were completed 15 months apart. The first was performed by BSK in January 2019 and the second by JH in April 2020. The two sets of search results were compared by GLW. The second search identified novel data from three additional studies using the same cohorts as three studies identified in the first search. The more recent search also identified three additional recent papers. Reference lists were also searched for additional citations pertinent to the review. The searches combined terms related to transwomen, GAHT, muscle and blood parameters .
Meeting With A Therapist
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Treatment For Children And Young People
If your child is under 18 and may have gender dysphoria, they’ll usually be referred to the Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust.
GIDS has 2 main clinics in London and Leeds.
Your child or teenager will be seen by a multidisciplinary team at GIDS including a:
- clinical psychologist
- family therapist
The team will carry out a detailed assessment, usually over 3 to 6 appointments over a period of several months.
Depending on the results of the assessment, options for children and teenagers include:
- group work for young people and their parents
- regular reviews to monitor gender identity development
- referral to a local Children and Young People’s Mental Health Service for more serious emotional issues
- a referral to a specialist hormone clinic for hormone blockers for children who meet strict criteria
Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty.
Feminizing Hormone Replacement Therapy Medication And Timing
While your healthcare provider will help you develop an individualized treatment plan, feminizing hormone therapy often begins by taking 100 to 200 milligrams daily of a diuretic called spironolactone to begin blocking male hormone receptors and suppress testosterone production. Some individuals begin taking estrogen immediately, in tandem with spironolactone, to further reduce testosterone production and develop more feminine characteristics. In other cases, estrogen is introduced after several weeks of spironolactone use. Your doctor will recommend the best plan for your needs.
There are various methods for administering estrogen, including orally, by injection, or as a cream, gel, spray, or patch. Commonly used forms of estrogen during a male-to-female transition include:
- Patches: 17B-Estradiol patch
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Hormonal Treatment In Transgender Women
Initial evaluation of transgender women
Transgender women seek hormone therapy to change their physical appearance to better match their gender identity and expression . Furthermore, transgender women experience improved quality of life and a decrease in gender dysphoria upon initiation of hormone therapy . In the United States, Canada, and most of Europe, transgender women must seek medical professionals for hormone therapy because these medications are available only by prescription, but there is a black market also particularly for oral contraceptives. For non-Western countries, hormone therapy is often self-prescribed without supervision by a medical professional. Available evidence from the United States and Europe suggests that hormone therapy initiated and monitored under the supervision of a medical professional is associated with very low rates of adverse events .
Screening for conditions prior to initiation of hormone therapy
Modalities of hormonal therapy in transgender women
There are two main classes of medications used in transgender women: estrogen therapies and androgen-lowering hormone therapies.
In a German cohort, transgender women were treated with a regimen of estradiol valerate at 10 mg IM every 10 days. The authors also reported short-term gains in bone density after 24 months of therapy along with higher body mass index with an increase of fat mass and decrease of lean body mass .
Preparation Before Taking Hormones
Before starting estrogen hormone therapy, it is important to gain as much information as possible. So always discuss the risks and side effects that hormone therapy may cause with a healthcare professional.
It is also essential that a person manages their expectations of when they will begin to see changes. Some people can take hormones for over a year before seeing any noticeable changes.
A persons healthcare provider may ask people to
The cost of estrogen hormone therapy can vary according to a range of factors. These include the type of hormones a person takes and how they use them.
A person wanting to transition must check that their health insurance covers the costs.
People must also check that the healthcare professional or medical center that their doctor has referred them to are in their insurance network.
There are several other gender-affirming procedures that people can opt for.
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Creating A More Inclusive Care Environment
While the cardiovascular effects of gender-affirming hormonal therapy have only been observed in a formal research context since the late 1980s,3 much has been learned over the past three decades. However, much more study is needed in this area, as longstanding biases have often precluded or investigations or limited their usefulness.
While evidence is mounting that long-term hormone therapy comes with cardiovascular risks, stopping needed treatments is not a solution.5 Managing cardiovascular risk factors in transgender medicine is less an analysis of the risk-benefit ratio and more a question of how to surveil and protect patients against those concerns throughout their lifetimes.
Certain strategiesâsuch as adjusting hormone formulation, dose, or modeâmay help balance the risks. These decisions should be individualized and made in tandem with the patient and the broader care team. However, this may be more difficult with existing research, as many studies do not provide sub-analyses of formulation- or dose-specific treatments.
All cardiologists should be prepared to care for trans patient populations and should be aware of the unique concerns, risk profiles, and barriers they face when receiving vital care. Diagnostic tools such ECG will support clinicians in these workups, as will sensitivity and a commitment to creating a more inclusive, equitable care environment.
What Are Commonly Used Medications For Transition
In transgender men, or trans masculine people , the most common medication used for transition is testosterone. Administration of testosterone lowers serum estradiol levels, raises serum testosterone levels, and results in the development of typical male secondary sex characteristics. Irreversible changes include: deepening of the voice, increase in facial and body hair growth, clitoral enlargement , and thickened facial bone structure. Reversible changes include amenorrhea, male-pattern fat distribution, increased muscle mass, vaginal atrophy, and male-pattern baldness. Some trans men also describe changes in emotions as well as increased libido. Adverse effects can include elevations in blood pressure, polycythemia, worsening of lipid profile, elevations in glucose, elevations in transaminases, acne, and effects on fertility .
Finasteride can also be used to prevent male-pattern baldness in transgender men, as it only blocks dihydrotestosterone , not testosterone itself however this will likely slow or decrease secondary hair growth, and may slow or decrease clitoromegaly as well.
GnRH Agonists could also be used instead of Anti-Androgens to block endogenous testosterone production. Lupron is typically given intramuscularly every couple months and is very effective at blocking total testosterone levels. However, it can be difficult to obtain insurance coverage for it, and is otherwise fairly expensive out of pocket.
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What Changes Can I Expect From Feminizing Hormone Therapy
People assigned male at birth produce low levels of estrogen. Feminizing hormone therapy brings about physical and emotional changes that are more consistent with feminine anatomy and behavior.
With this treatment, you will receive hormones and other substances. They include anti-androgens medication, estrogen and possibly progesterone.
Anti-androgen therapy blocks male sex hormone production.
Changes from anti-androgen therapy include:
How To Prepare Before Taking The Hormones
While some people may opt to take hormones they source from online without a prescription, healthcare professionals do not recommend this course of action.
Buying and taking hormones without a prescription can carry many risks, including poor quality, improper doses, and possible harm.
It is important that a person and their doctor discuss when it is the right time to take hormones.
Before starting hormone therapy, a doctor will discuss any risks and determine which treatment is suitable after looking at any health conditions.
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What To Expect From A Regimen Consisting Of An Anti
The degree and rate of physical effects is dependent on the dose and route of administration, as well as client-specific factors such as age, genetics, body habitus and lifestyle.
Physical changes related to androgen blockade and estrogen may take months to appear and are generally considered to be complete after 2-3 years on hormone therapy. Feminizing therapy does not affect the pitch of the voice in trans women. Some clients may obtain benefit from voice therapy with a qualified and supportive speech and language therapist who can work with the client to modify their vocal characteristics.
Typical Changes From Estrogen
|13 months after starting oestrogen||
Table source: Gender Affirming Hormones Prescribers Guide, Version 2, August 2019
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A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms, male, female, or both to refer to sex assigned at birth. .
Estrogen hormone therapy involves an individual assigned male at birth taking the hormone estrogen to develop certain feminine characteristics.
Estrogen stops the pituitary gland from forming gonadotropin, which reduces androgen production. Androgens are a group of hormones that help with reproductive development, among other things. Reducing the number of androgens in the body helps a person transition by encouraging changes in fat distribution, breast development, and male pattern hair growth.
Doctors may also prescribe other anti-androgen drugs to help the transitioning process.
A person may not notice significant changes when starting estrogen hormone therapy. The timeline varies, and some people may see more significant changes than others.
People may notice more changes if they use anti-androgen therapy alongside estrogen therapy.
Estrogen hormone therapy can cause physical changes.
What To Expect
During the visits, in addition to taking estrogen, a person will take an anti-androgen to block testosterone and its effects. Some people may also take other medications, including progesterone.
A few weeks after starting the medication, a person may begin to notice physical effects, such as a decreased libido. Other changes including altered facial appearance, fat distribution, and genitals may not occur for several months or years.
People will have regular checkups with a doctor during hormone therapy in order to monitor the progress of the treatment and check for adverse effects.
Doctors will also recommend screenings, such as bone mineral density and breast cancer and prostate cancer screenings, based on age-appropriate recommendations.
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How To Take It
The standard first-choice gender-affirming hormone treatment for those receiving estrogen hormone therapy involves estrogen in combination with anti-androgens.
A doctor may also monitor health to ensure the body is absorbing medication and to help identify potential health problems.
Estrogen hormone therapy may involve:
Estrogen Supplements For Males Transitioning To Female
Estrogen is the hormone that is primarily responsible to bring about physical feminine changes in ones body during the male to female transition process.
Though estrogen can effective on its own it is best paired with a testosterone blocker which is preferably given weeks prior to starting estrogen hormone therapy.
Estrogen comes in a few different forms which include:
Estrogen pill are the most used method of administering thehormone. Though pills are cheap and effective, doctors believe they can causeyou harm if you are older than 35 and smoke.
Estrogen patches such as climara forte can be very effective and safe but require you to always wear one. However, these patches do have some downside- not only are they prescription only they can also cause skin irritations and rashes.
The majority of transwomen first choice in estrogen hormones to help them transition tend to be interested in getting their estrogen through injections.
Estrogen injections can only be administered by doctors andcan cause a huge fluctuation range in your estrogen levels.
Having unstable estrogen levels is what causes:
Taking a higher doseof estrogen does not mean you will see physical changes faster.
Long term use of prescription estrogen boostingmedication can cause a sever build up of fat inside your heart and or arterieswhich could be fatal.
Taking natural estrogen can trigger your body to be more effective with the hormones that are already produced and produce more of it.
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Working With Young Trans People & Families
A Family Court of Australia ruling , the medical practitioner and the young person themselves with regard to:
The Gillick competence of an adolescent or
A diagnosis of gender dysphoria or
Proposed treatment for gender dysphoria
Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re. Imogen 20206.
Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a childs parents or legal guardians consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers , hormones or surgical intervention without court authorisation.
Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.
Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents 7
For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court must be involved. Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones, or seeking to access them outside of medical care and oversight.
Hormone Replacement Therapy For Transgender Women
Estrogen and testosterone-blocking medications help transgender women develop a more feminized appearance in line with their gender identity while transitioning. It reduces the discomfort of gender dysphoria, the distress caused by having a gender identity that differs from the sex you were assigned at birth. Many transgender women experience less emotional distress, improved personal relationships, and a better overall quality of life as a result of hormone replacement therapy.
Feminizing hormone replacement therapy causes a variety of physical changes like breast development and facial and body hair reduction. You may also experience a loss of muscle tone and changes in your body shape as the body redistributes fat cells.
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What To Know About Transgender Medical Transitioning: Male To Female
Samantha Newman, National Center for Health Research
The focus of this article is medical transitioning from male to female, the process by which transgender individuals change the way they look so that their physical characteristics match the gender they feel. Transgender is defined as individuals whose social or psychological gender identity is different than their sex assigned at birth.
Transitioning isnt necessarily medical. It can involve changing ones name or ones pronouns. It can involve changing the way one dresses. Medical transitioning can involve medical treatments and can involve surgery. Experts agree that there is not one right way to transition. Transitioning can involve any combination of these changes or it can be any change that allows someone to more comfortably present to the world. What is most important is that someones transition process reflects their needs and what works best for them and their body. While there are many social ways to transition, such as coming out to friends, using different pronouns, or using a different name, this article will specifically examine the medical treatment options in the male to female transition process.
Each medical intervention has its own unique recommendations and risks.
For trans women, medical transitioning may include any of the following :
· hormone therapy
· laser hair removal
· tracheal shave
· facial feminization surgery
· breast augmentation
· penile inversion vaginoplasty