What is Hormone Replacement Therapy?

Many folks who are transgender or gender non-conforming (GNC) seek out Hormone Replacement Therapy as part of their gender-affirming health care. While HRT is not a viable option for all trans and GNC folks, whether due to personal choice, medical risk, or other factors, it is an important option while transitioning.

Read on to learn about how Hormone Replacement Therapy is part of transgender health care.

What Is HRT?

The Mayo Clinic explains that Hormone Replacement Therapy is used to medically alter one’s hormone levels to more accurately match their gender identity. There are two major types of HRT:

• Feminizing Hormone Therapy (estrogen)
• Masculinizing Hormone Therapy (testosterone)

No matter which form of hormone therapy you choose, you can expect to experience changes in four key areas of your health: Physical, emotional, sexual, and reproductive.

Why Do People Use HRT?

Just as every trans and GNC experience is different, so are each person’s reasons for considering HRT. It’s important to note that not every trans person will choose to use HRT, and that each trans experience is valid and unique. For many trans folks, HRT can greatly improve their quality of life by:

• Reducing gender dysphoria
• Reducing stress and anxiety
• Increasing mood and happiness
• Improve sexual satisfaction

HRT is a tool that can be used by trans and GNC folks to achieve gender congruence (the matching of one’s gender to their body). This can allow them to feel like their true and best selves -- something that everyone deserves.

Hormone replacement therapy is not only utilized by trans and GNC folks. For example, The Mayo Clinic notes estrogen hormone therapy can be used by older cisgender women to replace the estrogen their body stops making after menopause, relieving symptoms such as hot flashes and vaginal discomfort.

It is important to note that hormone replacement therapy can have health risks associated with them, including but not limited to blood clots, weight gain, and increased risk of certain cancers. Taking HRT can also affect your fertility, so be sure to discuss this with your provider if this is a concern to you, or if you plan on having children in the future. In order to use HRT, it must be medically approved and monitored by your doctor.

Feminizing Hormones

There are three major medications that are utilized for feminizing hormone therapy, that we’ll cover below:

• Estrogen
• Testosterone blockers
• Progesterones

What Is Estrogen?

Estrogen is the primary “female” sex hormone. It can be used to help a person develop female secondary sexual characteristics. Estrogen can cause a series of physical changes including but not limited to:

• Breast growth
• Increased body fat
• Slowed growth of body and facial hair
• Decreased testicular size and erectile function.

What are Testosterone Blockers?

In addition to estrogen, some people may choose to take anti-androgens, or testosterone blockers, to suppress “masculine” features.

How Do You Take Testosterone Blockers?

There are several types of testosterone blockers, such as Spironolactone and leuprolide, that are taken as pills and sometimes nasal sprays. Each comes with a number of side effects, so talk to your doctor about whether anti-androgens are right for you.​​​​​​

What Is Progesterone?

Progesterone is a hormone that is found in cisgender women, that supports pregnancy and maintains balance in the uterine lining. This can be used by trans women as a partial blocker of testosterone, in cases in which other blockers have proven to be ineffective.

How do you take Progesterone?

Progesterone is usually taken as a pill. Typically it is added into a regimen after one’s estrogen and testosterone hormones have been stabilized.

Masculinizing Hormones

What is Testosterone?

Testosterone is the primary “male” sex hormone, and is often referred to as “T.” It can be used to suppress female secondary sex characteristics and masculinize transgender men. Examples of its effects include:

• Cessation of menses (menstrual cycle and period)
• Thickening of the vocal cords (leading to a more “male-sounding” voice)
• Increased muscle mass
• Body and facial hair that is darker, thicker, and faster-growing

How do you take Testosterone?

You might automatically think testosterone is taken orally in pill form. Although this method exists, many medical professionals advise against it because it can have negative effects on the liver. However, there are several other options in which testosterone can be taken:

• Skin Patch (transdermal): This is a patch that is applied to the skin once a day. It is typically worn on the arm or upper body.
• Injections and implants: This is a common option that allows absorption of testosterone directly into the bloodstream. This is done by injecting T directly into the muscles, or implanting T as pellets in the soft tissues.
• Topical Gel: Using this method, testosterone is absorbed directly through the skin by applying a clear gel to your skin or inside the nose once per day.
• Mouth patch: This is a tablet that sticks to the upper gums and releases testosterone through the oral tissues. It is typically applied twice per day.

How to Get HRT

Starting HRT is a big decision for any trans person, and must be medically approved and monitored by your medical provider. If you’re interested in starting HRT, schedule an appointment with your primary care doctor. If you don’t have a primary care doctor, you can reach out to Apicha CHC and become a patient.

It’s important to note that with each HRT option, there are potential side effects, which you should discuss with your doctor to find the best fit for you.

How Apicha Can Help You

For trans and GNC folks, gender-affirming, inclusive, and competent care is so important and should be available to all trans people. Apicha CHC’s Transgender Health Clinic does everything it can to overcome health barriers and provide our patients with everything they need to get everyday primary care, and services to help them transition.

Apicha CHC provides comprehensive primary care to address the distinct needs of trans and GNC individuals. Our Transgender Health services include:

• Personalized primary care
• Routine check-up and immunizations
• Initiation and maintenance of HRT
• Short-term behavioral health services
• Legal document assistance (such as name change)
• HIV/STD Testing
• Care management
• Transgender support groups
• Referrals to gender-affirming surgeons
• Referrals to specialists

Click here to request an appointment at Apicha CHC today.