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.
Surgery For Trans Men
Common chest procedures for trans men include:
- removal of both breasts and associated chest reconstruction
- nipple repositioning
Breast implants for trans women are not routinely available on the NHS.
Gender surgery for trans men includes:
- construction of a penis
- construction of a scrotum and testicular implants
- a penile implant
Removal of the womb and the ovaries and fallopian tubes may also be considered.
About Starting Gender Confirming Estrogen Hormone Therapy
Beginning feminizing hormone therapy is an exciting and important step in a transgender womans transition, as she becomes her authentic self. But starting estrogen hormone therapy also comes with some risks, challenges and unknowns as a woman literally changes her body chemistry to align with her identity.
Hormones do affect every person differently. But, as the saying goes, in most cases the best surprise is no surprise. So, in this article, the hormone replacement experts at Sotto Pelle explain some of the issue you may experience as you begin to undergo your feminizing estrogen hormone therapy. Having this information and knowing generally what to expect from feminization hormone therapy can help you communicate more effectively with your medical provider as you work together to map out the steps in your transition.
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Emotional Effects Of Gender Confirming Estrogen Hormone Therapy
The impact of hormone therapy on a transgender womans emotional state also varies from person to person. Just like the emotional roller coaster of puberty, the influx of hormones during feminizing therapy can affect your mental state. ;Many women find that you they experience a wider range of emotions or feelings and some even take an interest in new tastes or pastimes!
A great benefit of estrogen is that it increases serotonin, the feel-good chemical in the brain. So female gender affirming hormone therapy typically results in an improvement in overall mood.
Whatever new thoughts and feeling result from your hormone therapy, working with a therapist while in transition can help you get to know and understand your new body and your true self.
Does My Client Need Cervical Cancer Screening
Prostate exam
The risk of prostate cancer is not increased by estrogen use, in fact it is reasonable to assume that the risk is significantly decreased by the associated androgen deprivation. Although rare, there have been cases of prostate cancer reported in trans women, generally occurring in those who started hormone therapy after the age of 50.1, 2 It is important to note that estrogen will lower PSA values even in the presence of prostate cancer, thus impacting its utility in this population. Routine PSA screening is not recommended in trans women in the absence of significant risk factors. There is little evidence to support a role for annual DRE in prostate cancer screening; however, it may be considered according to a providers routine practice with cis men. In clients who have undergone vaginoplasty, the prostate remains in situ and may be palpated anteriorly via digital vaginal exam in a gender affirming lithotomy position.
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What Should I Know Before Starting Feminizing Or Masculinizing Hrt
Before starting hormone therapy, itâs important to learn about the short-term and long-term effects of gender-affirming hormone replacement therapy, as well as the risks associated with this kind of treatment.
Someone may choose to start HRT to ease gender dysphoria or emotional distress associated with societal transphobia. They may also select HRT to improve their social functioning or sexual satisfaction in relation to their gender identity. There are many reasons why people may choose to be on HRTs.
There are several benefits of HRT, including improved psychological and social functioning, sexual satisfaction and overall quality of life. However, there are risks and changes that you should consider before starting HRT. Be sure to think through impacts on fertility, sexual functioning and other health problems with your doctor.
Thus, HRT allows for these hormonal and physical changes to occur and, as a result, decrease gender dysphoria and psychological distress that stems from a transphobic society.
Feminizing HRT can impede the effects of testosterone via hormone blockers and the replacement of testosterone with estrogen. Feminizing treatment can also impact your fertility and sexual functioning.
Masculinizing HRT impedes the effects of estrogen on your system by replacing estrogen with testosterone and encouraging the development of masculine features. This replacement process can also impact your fertility.
Reviewed by:
Thomas Trombetta
Physical Effects Of Hormone Replacement Therapy During Mtf Transitioning
As previously said, the effects from the feminizing HRT depend upon many factors, among which:
- The age of the patient when they begin HRT. If the development of the secondary sexual characteristics is still ongoing, not yet started or has ended already.
- The aesthgetic goal of the patient, which can vary from a mild demasculinization to achieve an androgynous result, to a marked feminization with total demasculinization.
- The subjective response of the patient to the medications, depending upon their own physiology.
In general, the expected physical changes in the MtF transgender patients are the following :
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Transgender Ftm & Mtf Hrt
If youre interested in hormone replacement therapy in Atlanta, you are in good hands. Transitioning is the single-most important decision an individual can make. While transgender hormone replacement therapy is a safe treatment that comes with minimal risks and undesirable side-effects, its important to start HRT with a specialist who can help design your program, all the while providing support and advice.
Whether youre making the transition from male-to-female or female-to-male, as a transgender individual, you need to consider the quality of your overall health care. Unfortunately most general physicians and healthcare providers are not properly equipped to care for transgender patients. In turn, you can benefit from having a supportive and experienced specialist by your side as you begin a new chapter in your life.
Erin Everett, NP-C, AAHIVS, is a provider of healthcare for transgender patients in Atlanta who offers hormone replacement therapy for both transgender men and women. Erin is committed to providing a safe, nondiscriminatory space for everyone to receive the highest quality healthcare especially those within Atlantas LGBTQ community. For more information about transgender hormone replacement therapy in Atlanta, contact Erin to learn more.
How Do I Prepare For Feminizing Hormone Therapy
There are many steps to help you prepare, including:
- Patient education to explain how treatment works and what to expect. This includes reviewing risks and benefits.
- Medical history to check for estrogen-dependent conditions, like certain breast cancers and endometriosis.
- Physical exam to ensure you are healthy enough to start feminizing hormone therapy.
- Lab tests, including a blood panel, urinalysis and liver function test.
- Mental health evaluation to make a gender dysphoria diagnosis. It also confirms your understanding of therapy and ability to agree to it.
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What To Know About Transgender Hormone Therapy Side Effects
Alto Pharmacy
For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you.;
Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.
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
- 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.
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Physical Effects Of Feminizing Estrogen Hormone Therapy
The first changes many transgender women experience when they start estrogen therapy is thinner and drier skin with smaller pores and less oil production. You will also likely sweat much less! You may even be more sensitive to pain and temperature, and/or become more prone to bruising or cuts.
Within a few weeks most women begin to develop small buds beneath their nipples. While they may be slightly tender or even painful when touched, the discomfort will diminish significantly over the next several months.
Just like puberty, breast development varies greatly in timing and degree from person to person. So it is usually a good idea to give yourself a year of being on feminizing hormones before pursuing breast augmentation surgery. Your body will also begin to redistribute weight differently depositing more fat around your hips and thighs, while the muscles in your arms and legs become less defined as your muscle mass and strength decreases.
Estrogen therapy will also cause the hair on your chest, back, legs and arms, to decrease in thickness and grow more slowly. However, feminizing hormone therapy generally will not have any effect on the tone or pitch of your voice. But a good speech and language specialist can help you with this, if this is something you decide you wish to adjust.
When Will These Physical Changes Occur
According to a , a person can expect a decrease in sexual desire and function within 13 months. However, these changes can take 36 years to reach their maximum effect.
After 36 months, a person can expect:
- a decrease in muscle mass
- softer skin
- alleviation of gender dysphoria
The UCSF state that a person may notice that they experience a wider range of emotions. They may also develop different tastes and interests. These emotional changes should settle.
During this time, some people might find it helpful to talk to a mental health professional to help explore and understand these new emotions and thoughts.
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Does My Patient Need Cervical Cancer Screening
Prostate exam
The risk of prostate cancer is not increased by estrogen use; in fact it is reasonable to assume that the risk is significantly decreased by the associated androgen deprivation. Although rare, there have been cases of prostate cancer reported in transfeminine patients, generally occurring in those who started hormone therapy after the age of 50.1, 2 It is important to note that estrogen will lower PSA values even in the presence of prostate cancer, thus impacting its utility in this population. A reduction in the upper limit of normal for PSA to 1 ng/L can be considered in transfeminine patients with low testosterone.3 Routine PSA screening is not recommended in transfeminine patients in the absence of significant risk factors. There is little evidence to support a role for annual DRE in prostate cancer screening; however, it may be considered according to a providerââ¬â¢s routine practice with cis men. In patients who have undergone vaginoplasty, the prostate remains in situ and may be palpated anteriorly via digital vaginal exam in a gender affirming lithotomy position.
Trans Health: Hormone Therapy Starts And Surgery Referral Support
The Trans Health Program offers hormone therapy starts and surgery referral support to trans and non-binary people, ages 17 and up from Ottawa and surrounding areas. We tailor our services to the needs and transition goals of our clients. For example, some of our clients seek maximum feminization/ masculinization, while others seek a more androgynous appearance.
Our service model follows the Sherbourne Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients. Our services are continuously evolving, as we learn from our clients and other experts.
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Undergo Hrt In Atlanta With An Experienced Transgender Care Provider
Over the past few years alone, there have been a number of compelling studies that support the safety and efficacy of hormone replacement therapy. In turn, it has become a common form of treatment in the provision of transgender care.
For transgender patients who seek hormone replacement therapy, initiating and monitoring treatment requires a mindful approach in developing a successful program. This why working with an experienced and proficient primary care provider can work to a patients benefit. From the knowledge and experience that goes into a hormone therapy program to providing an autonomous environment that encourages open communication and understanding, transgender patients should feel as though they can fully trust their healthcare provider.
Erin Everett, NP-C, AAHIVS, is committed to the LGBTQ community, providing a relaxed, supportive, non-judgmental environment where patients can address their health. If you would like to learn more about transgender hormone replacement therapy in Atlanta, such as the cost of HRT or information regarding any of the other primary care services available, visit the contact page.
A Pharmacy Partner You Can Rely On
Alto is here to support your journey with hormone replacement therapy. Our team of patient care pharmacists has experience working with the LGBTQ+ community and is available to answer any questions you have about the process.
We also make it as simple as possible to stay on top of your medications, with same-day delivery and mediation management tools like reminders and auto refills in our app. To learn more or get started, reach out any time via text or phone at 1-800-874-5881, or in-app messaging.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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What Exactly Is Feminizing Hormone Therapy Or Fht
Feminizing Hormone Therapy consists of taking medications to change the balance of sex hormones that are currently present in your body. Altering these hormonal levels will affect your fat distribution, muscle mass, hair growth and other characteristics that are identified with gender.
FHT will effectively make your body feel and look more feminine and less masculine. The result will create changes in your body to match the gender that you more closely identify withfemale. Were talking strictly gender identity herenot sexual preference.
These hormonal medications typically include:
- Estrogen
- Androgen blockers
- Sometimes a progestin is added to the above two
Estrogen is the primary hormone that is responsible for enhancing feminine type traits. It goes to work directly on certain bodily tissues; like breast tissue. Estrogen also indirectly acts as a testosterone suppressant.
Estrogen can be administered:
- Transdermal
- Sublingual
The most common form of estrogen used in FHT is estradiol. But there are other formulations that are sometimes used.
Androgen blockers are necessary in order to inhibit and block testosterone production. They are also referred to as T-blockers, anti-androgens or androgen antagonists.
Anti-androgens are notorious for having a mild feminizing effect. They are effectual in reducing male-type physical traits such as slowing the growth of facial hair and bringing an end to spontaneous morning erections.
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:
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Risks Of Hormone Therapy
There is some uncertainty about the risks of long-term cross-sex hormone treatment. The clinic will discuss these with you and the importance of regular monitoring blood tests with your GP.
The most common risks or side effects include:
- dyslipidaemia
- elevated liver enzymes
- polycythaemia
- hair loss or balding
There are other risks if you’re taking hormones bought over the internet or from unregulated sources. It’s strongly recommended you avoid these.
Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.
The GP can help you with advice about gamete storage. This is the harvesting and storing of eggs or sperm for your future use.
Gamete storage is sometimes available on the NHS. It cannot be provided by the gender dysphoria clinic.
Read more about fertility preservation on the HFEA website.