Not all transgender individuals will choose to medically transition, but those who do are likely to start the process by undergoing hormone replacement therapy. By taking hormonal substitutes and supplements, their bodies will start to change as they gain the secondary sexual characteristics of their aspirant gender appearance, ultimately reducing their gender dysphoria.

 

 

Endocrinological intervention is an important part of gender-affirming care. Endocrinologists who are specialists in transgender care coordinate the hormonal transition of transgender patients, for transgender endocrinology is more complex than trans men need testosterone and trans women need oestrogen – rather, hormone prescriptions need to be carefully planned based on the patients’ bodies, health conditions, ideal timeline, and goal. In the UK, primary care teams will not initiate hormones unless approved by gender identity clinics or endocrinologists.

 

Should a transgender patient begin hormone therapy without consulting an experienced endocrinologist?

Gender-affirming hormone therapy (GAHT) can cause major disruption to their system and can have lasting consequences. Endocrinologists experienced in transgender care can advise, guide and plan their GAHT, as per their need, taking into account their physical health issues, if any, and carefully managing risks.

Before commencing with GAHT, a patient should undergo a psychosocial assessment, mental health evaluation, a detailed medical history review, a physical examination if appropriate, and blood testing – so the endocrinologist can devise a safe treatment plan to which the patient can agree.

For some transgender and nonbinary individuals, hormone therapy is a way to relieve gender dysphoria and alleviate distress. It can improve their psychological and social wellbeing, and greatly improve their quality of life. Many patients who are doing hormone therapy may want to undergo surgical procedures to further affirm their gender identity, such as hair transplants, breast augmentation, and surgery to remove their genitals and replace them with those that align with their ideal body, but it not a necessity and others may feel satisfied with the results of the hormone therapy. 

 

To what effect are hormones gender-affirming care?

Hormones can be administered in many different forms, such as:

• Pills
• Shots
• Topical creams and gels
• Adhesive patches

 

Feminising hormone therapy

Feminising hormone therapy will focus on reducing the level of testosterone in the body while augmenting the presence of oestrogen, typically can be achieved through administering the drug oestradiol, and prescribing anti-androgens. With enough oestrogen and sufficiently suppressed testosterone, feminising characteristics like breast development and less facial hair growth will become apparent. The male sexual organs, such as the testes, will begin to atrophy, and fertility will be negatively impacted, so patients who wish to have biological children in the future may want to consider freezing their sperm before undergoing feminising hormone therapy. Other changes that will occur include:

• Fewer erections and a decreased libido
• Slower loss of scalp hair
• Softer and less oily skin
• Less muscle mass and more body fat
• Body fat redistribution 

 

Masculinising hormone therapy

Masculinising hormone therapy focuses on increasing testosterone levels in the body. This will stop the menstrual cycle and block the ovaries from producing oestrogen, which may also cause infertility, much like feminising hormones, so patients who wish to have biological children in the future may want to consider freezing their eggs before undergoing masculinising hormone therapy. Other changes that occur will include:

• Voice deepening
• Hair growth on the face and body
• Elongation of the clitoris and vaginal dryness
• More muscle mass

 

Decisions about undergoing a hormonal transition should be thoroughly discussed by the patient and their endocrinologist. While the hormones can be stopped at any time and some of the changes will revert to pre-hormone therapy states, others, like breast development, are permanent.