Considering hormone therapy
Hormone therapy is used to relieve dysphoria by promoting physical characteristics that reflect one’s gender.
Many trans people are comfortable with their bodies without hormone therapy. Others seek hormone therapy to bring their bodies into alignment with their gender. You are the best judge of what is right for you.
What is hormone therapy?
Hormone therapy (sometimes referred to as HRT) is the use of sex hormones (such as estrogen and testosterone) to alter secondary sex characteristics. Hormone therapy can be used to promote physical characteristics reflective of one’s gender and relieve dysphoria.
To help meet their gender-affirming goals, an individual may take:
- Estrogen — Often used in combination with a testosterone-blocking medication, estrogen reduces testosterone-related features and induces estrogen-related features such as softer skin, thinner body hair and reduced muscle mass.
- Testosterone — Testosterone reduces estrogen-related features and induces testosterone-related features such as deeper voice, increased muscle mass and facial hair growth.
- Puberty blockers — Puberty blockers are medications that suppress the sex hormones that are produced by the body. These medications can be started soon after puberty begins.
Why might someone want hormone therapy?
If you experience discomfort or distress because your gender and the sex you were assigned at birth are different, hormone therapy may provide significant comfort.
Hormone therapy may help you to feel more at ease in your body, which can have positive effects on your emotional wellbeing. It may also improve your ability to be read by others as your affirmed gender.
Some people choose to continue hormone therapy for the rest of their lives. Others may want to bring about changes (such as a deepened voice with testosterone or breast growth with estrogen) and then discontinue hormone therapy. And finally, there are some who may want more subtle or a slower onset of effects. For people with these kinds of goals, hormones can be used in lower doses or for a short amount of time.
How to decide if hormone therapy is right for you?
The decision to start hormone therapy is yours. Your health care provider’s role is to encourage, guide and assist you in making fully informed decisions and becoming adequately prepared.
The best way to approach the decision is to gather information by speaking with your health care provider. You can ask them about:
- The effects you can expect
- The timing of changes to your body
- The ongoing monitoring that is needed
- Any risks associated with hormone therapy
- Other medical considerations related to your health
You can also speak with a counsellor about social and emotional changes that come with hormone therapy.
Finally, peer support is a good way to connect with others who may have similar questions and experiences.
Monitoring hormone therapy
If you choose hormone therapy or puberty blockers, you will need to have regular follow-up appointments. Typically people will have this follow-up with whoever prescribes their hormones, such as their nurse practitioner, family physician, pediatrician or endocrinologist. Sometimes more than one health care provider is involved in monitoring hormone therapy, for example a pediatric endocrinologist and a nurse practitioner.
The frequency of your follow-up appointments will differ depending on your health needs and the providers involved in your care. You can expect to have more frequent follow-up appointments when you first start treatment. These will usually become less frequent once you are on a stable dose.
Your prescribing provider may order blood work at some of your follow-up appointments. Bloodwork is needed more often early on in treatment or when doses are being adjusted, and then less over time once a stable dose has been achieved.