Accurate information on hormones and their effects on trans-women specifically seems difficult to find. Specialists use hormones to lessen the distress caused by Gender Dysphoria in some trans-women. That stated, I keep seeing so many people attempting Do-It-Yourself hormone therapies. Hormones control literally your entire life. Every aspect of your bodily functions comes from hormone impulses released by various glands, and attempting to manipulate them without medical supervision risks ruining that.
Medical Readiness Before Hormones
You should know before you read on that I am not a medical professional. The following outline details research combined with my own experiences. Always consult your own doctor before you begin any sort of medical changes or treatments, especially hormones. That stated, your doctor would do something like the following.
Initially, your physician or provider will ask you about your personal and family medical history. They need to know if taking hormones will place you at risk for blood clots, hormone-sensitive cancers, and impulse control issues. For your safety, and that of those around you, tell your doctor the truth about everything.
Next, your provider should give you a thorough physical exam. This should include an external assessment of your reproductive organs, immunizations, and age-appropriate screenings (like prostate and testicular cancer). Then, they should conduct a series of blood and urine tests to check lipids, blood sugar, blood count, liver enzymes, electrolytes, and the hormone prolactin. Additionally, you may request a baseline Estradiol, Testosterone (Free & Total), LH, and FSH count.
Before your provider issues any referrals for insurance, they should also discuss the effects on your fertility. Namely, within the first three weeks, hormone therapy sterilizes most patients.
Finally, your provider should issue you a referral to a psychologist, gender therapist, or mental health provider.
In order to begin most treatments for Gender Dysphoria, you should have at least two psychological evaluations. Depending on whether or not you already have a mental health provider, you may have to undergo several sessions. These include establishing rapport, confirming your diagnosis, treating other conflicting conditions, and managing your expectations.
These sessions can take anywhere from a few weeks, to several years depending on your personal readiness. I suggest reading through the Psychology posts to help prepare you for these evaluations.
Your second provider can, based on your readiness, probably provide your second evaluation within one three hour session. The primary mental health provider can usually facilitate that by providing a letter in advance to the second evaluator, detailing your history with them.
With both letters of recommendation from your mental health providers, your primary provider can write you a referral to an endocrinologist. Of note, do not settle for an internal medicine provider. While they specialize in many disciplines and can treat most illnesses, they do not usually appreciate the nuances of endocrinology.
First, your Endocrinologist will review the labs that you did initially, and if needed get your baseline hormones. Then, they should start you on the lowest dosage based on your initial results. After your first three months, your endocrinologist should order a second set of labs similar to the first. Depending on those results, they may or may not adjust your dosage. At this stage, you want to track your weight, moods, libido, hydration, blood pressure, exercise, and eating habits. While that seems like a lot, if you experience any problems, it allows the endocrinologist to pinpoint the issue much quicker.
Barring any complications within you first six to nine months, prepare to see some steady changes.
Types of Hormone Therapies Used
As of 2021, the medical community commonly uses seven different methods of hormone delivery for trans-women. The following table can help understand the differences.
|Intramuscular Injection||Using a longer needle to inject the medication deep into the muscles to deliver it straight to the bloodstream.|
|Orally||Swallowing the pill whole and letting it start to work from your stomach.|
|Subcutaneous Implant||Implanting a pellet directly between the muscle and skin using an injector or surgery to give a constant dose over a long period of time.|
|Subcutaneous Injection||Injecting with a shorter needle into the tissue layer between the skin and the muscle to deliver the medication slower.|
|Sublingual Delivery||Dissolving the pill underneath your tongue to allow the mucus there to activate it.|
|Transdermal Gel||Massaging a gel onto a specific area to absorb the medication through your skin.|
|Transdermal Patch||Putting on a sticky thing that feels like a Band-Aid, and allows the medication to absorb directly through the skin into the bloodstream.|
Maintaining Realistic Expectations
First off, hormones can make gender dysphoria less severe. They reduce distress, improve psycho-social function, increase sexual satisfaction, and generally benefit your quality of life. However, you cannot classify hormones as a magical solution. The risk of blood clots, cardiovascular disease, high blood pressure, and diabetes should give you pause. Your medical team should eliminate those in the comprehensive evaluation beforehand. They should also help you decide which delivery method might work best for you depending on your tolerance, lifestyle, and medical conditions.
Hormones and Limitations
The male skeletal structure remains completely unaltered. You will not get shorter, your feet will not shrink, and your pelvis will not widen. While some trans-women report a shift in their sizes, this happens because of ligaments and muscles in your feet and spinal column.
Hormone therapy cannot reverse male pattern baldness, nor can it stop facial hair altogether. It will make the hair softer, making various forms of hair removal easier. To learn more about growing hair, check here.
Your voice pitch, tone, and volume remains unaffected. In order to effectively feminize your voice, speech therapy, YouTube videos, and some apps provide a solid guide. It does take lots of practice, with the shortest being around six weeks, and most programs averaging about three to four months.
Women’s Health Issues Caused by Hormones
Due to the unique nature of trans-women, a combination of health-related issues come up. Understanding the dynamics of those can help prevent serious problems later.
Many medical professions disagree on the timing merits of mammograms for trans-women. My Endocrinologist recommended one for me after my first year of Hormone Therapy. Internal medicine and my Primary Care Manager (PCM) both said they wouldn’t refer me. A few months later, while conducting a regular self-check, I found a lump on my left breast. Both of my providers dismissed it, but my PCM referred me to an ultrasound to try and stop my constant concern. The ultrasound tech found the lump, but because of its size, dismissed it as nothing.
At that point, I met with my Endocrinologist, and she conducted a quick check. She immediately contacted my PCM, and I received a mammogram a couple of days later, confirming that there was an issue (link to full story).
Sharing this story, I cannot stress enough the importance of regular self-checks and trusting your instincts.
While not unique to trans-women, vitamin deficiencies can cause a ton of avoidable problems. Taking a multi-vitamin formulated for women of your age group will lower your risk of bone density issues, and avoidable immune deficiencies.
Prostate Health on Hormones
Despite a nearly 50% shrinkage, trans-women still require regular prostate screenings. Your medical provider should track them ordinarily, but never take that for granted. Ask, and if necessary, keep a record for yourself.
- Coleman, Eli, et al. “Standards of Care for the Health of Transsexual, Transgender, and GenderNonconforming People.” World Professional Association for Transgender Health (WPATH), World Professional Association for Transgender Health (WPATH), 2012, https://www.wpath.org/publications/soc.
- Deutsch, Maddie. “Information on Estrogen Hormone Therapy | Transgender Care.” UCSF Transgender Care, The Regents of the University of California, July 2020, https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy.