Hormone Replacement Therapy

Hormone replacement therapy (HRT) involves changing the levels of hormones—specifically estrogen, progesterone, and testosterone—in the body. Often used to treat symptoms of menopause and aging, HRT is also often part of the transition process for transgender individuals who wish to use hormones to help align their physical characteristics with their gender identity.

Understanding Hormone Replacement Therapy

Hormone replacement therapy, also called simply hormone therapy, is primarily used in the treatment of menopause symptoms and for gender transition, when an individual desires this type of treatment.

During menopause, the decreasing levels of estrogen and progesterone can lead to uncomfortable symptoms such as hot flashes, vaginal dryness, and mood swings. HRT effectively treats these concerns by replacing the female hormones the body is no longer producing. A doctor may prescribe either estrogen therapy or combination therapy, which involves the use of estrogen, progesterone, and progestin, depending on a woman’s specific symptoms and circumstances.

For many trans people, HRT is one step in the gender transition process. People who receive hormone therapy typically experience a second puberty, during which many of their secondary sex characteristics change to align with their gender identity. Trans women typically receive estrogen in addition to antiandrogens, which block testosterone. Trans men take testosterone, which has the effect of stopping the menstrual cycle, lowering the voice, and facilitating facial hair growth, though there may be other effects as well. Nonbinary individuals may take hormones likely to produce characteristics that align with their identity or eliminate characteristics causing distress or dysphoria. However, it is not possible to choose which characteristics result from HRT, and hormone therapy will affect people in different ways. The effects of HRT can usually be seen in one to three years, but a person receiving hormones will generally continue taking them for the rest of their life in order to maintain the effects of the treatment.

Possible Drawbacks of HRT

There has been some debate about whether HRT’s benefits outweigh its risks, especially for women who are going through menopause. Some studies have shown HRT can increase the risk of developing serious medical conditions such as blood clots, breast cancer, stroke, or heart disease. However, many medical providers believe HRT can not only reduce or eliminate menopause symptoms but may also have benefit to one’s health beyond these effects.

Many trans individuals report hormone therapy is extremely beneficial because it can enable them to maintain a physical appearance that more closely matches their gender identity, thus increasing their comfort with their physical appearance and decreasing dysphoria and distress. The research that has been conducted to this point has included relatively small sample sizes, but the use of HRT for gender transition is largely considered to be safe. The biggest risk associated with HRT use in an increased risk of developing venous thromboembolism (VTE) among those receiving estrogen therapy. However, this risk can typically be addressed through careful monitoring.

Further research on the effects, especially long-term effects, of HRT for trans people, may be helpful for the future, but currently, HRT is considered a safe and effective approach.

Mental Health Benefits of HRT

Many transgender people experience dysphoria, or psychological distress experienced in relation to the discrepancy between the sex they were assigned at birth and their gender identity. Dysphoria is considered a medical issue, not a diagnosable mental health condition, but research shows a high prevalence of associated mental health issues among trans individuals, such as depression, anxiety, and suicidal thoughts.

HRT can reduce distress by helping trans individual achieve a physical appearance that more accurately reflects their gender. A scientific review of HRT showed it often had the effect of significantly reducing depression, anxiety, and sensitivity, along with feelings of hostility. Additionally, HRT often has the effect of increasing self-esteem and feelings of attractiveness.

Choosing HRT

Trans people may seek or participate in any number of interventions to align their physical characteristics with their gender, such as HRT, gender-affirmation surgeries, hair removal, and behavioral adaptations, among others. The choice to use HRT or any other intervention is an entirely personal one. While some use hormones to initiate the transition process before going on to receive surgery, for example, others find the use of hormones alone to be sufficient. Still other people may decide they prefer not to pursue any medical interventions. There is no single right way to affirm one’s gender identity, and it is important for each individual be recognized and encouraged in their choice to utilize whatever treatments feel most right and comfortable for them.

References:

1. Deutsch, M. B. (2016). Supporting evidence for providing gender affirming treatments and procedures. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People, 2. Retrieved from http://transhealth.ucsf.edu/trans?page=guidelines-overview
2. Gender Identity Research and Education Society. (2007). A guide to hormone therapy for trans people. Retrieved from http://www.teni.ie/attachments/9ea50d6e-1148-4c26-be0d-9def980047db.PDF
3. Hormone replacement therapy for menopause. (2016, August 12). Retrieved from http://www.webmd.com/menopause/guide/menopause-hormone-therapy
4. Ashbee, O., & Goldberg, J. M. (2006). Hormones: A guide for MTFs. Retrieved from https://apps.carleton.edu/campus/gsc/assets/hormones_MTF.pdf
5. Klein, S. (2015, November 20). Is hormone replacement therapy safe? Prevention. Retrieved from http://www.prevention.com/health/is-hormone-replacement-therapy-safe
6. Safer, J. D. (n.d.). Transgender hormone therapy is safe when monitored for certain risks. Retrieved from https://www.endocrineweb.com/professional/gender-identity/transgender-hormone-therapy-safe-when-monitored-certain-risks
7. White Hughto, J. M., & Reisner, S. L. (2016, January 13). A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgender Health, 1(1). Retrieved from http://online.liebertpub.com/doi/full/10.1089/trgh.2015.0008

Last Updated: 03-24-2017