Gender-Affirming Hormone Therapy: What to Expect

March 24, 2021

Gender-affirming hormone therapy is a key treatment for many transgender people. Under the guidance of a healthcare provider, specially trained to administer hormone therapy, either estrogen- or testosterone-based medicines are given. They cause a wide range of changes that align people with their desired gender characteristics.

Jefferson Health – New Jersey’s Dr. Bradley Johnson and Marina Khazan, APN – of Haddonfield Primary & Specialty Care, an LGBTQ+ Affirming Practice – are just two providers with expertise in hormone therapy and helping transgender people thrive throughout their transition journey.

Starting hormone therapy isn’t a simple decision; it’s a life-changing one – in a good way, of course, says Dr. Johnson. Unfortunately, accessibility and affordability of hormone therapy are two common hurdles that people face, as many offices don’t offer it (forcing people to commute further away for care) and some insurers don’t cover it.

Plus, there are evolving protocols on what clearances are needed before you “qualify,” explains Khazan. Currently, most healthcare institutions require a general physical with bloodwork and mental health screening. These are necessary to uncover any underlying conditions – be it heart disease, high cholesterol, or depression – that can worsen from excess hormones.

“This doesn’t mean that if you have these conditions you can never undergo hormone therapy, it just means we have to ensure they’re under control first,” said Khazan.

So, how does hormone therapy work?

Testosterone, or masculinizing therapy, is administered via injection into a large muscle – typically in the thigh. Estrogen, or feminizing therapy, is administered via a skin patch – typically on the lower stomach.

Doses and frequency vary depending on your individual preference and goals, emphasizes Johnson. It’s important to know that developing feminizing features can sometimes be more challenging, and, in some cases, additional medications are used to help.

The most immediate changes are physical and occur within three to six months. It’s similar to going through puberty, says Khazan. If you’re transitioning to male, you can expect:

  • your skin to become oilier and rougher,
  • hair to become coarser (and grow on more areas of the body, particularly the face),
  • body fat to redistribute from the thighs and buttocks, to the abdomen,
  • muscle mass to increase,
  • voice to deepen (sometimes),
  • and menstrual cycle to stop.

For those transitioning to female, it’s nearly the exact opposite:

  • your skin becomes softer, less oily,
  • hair thins,
  • body fat shifts down from the abdomen, to the buttocks and thighs,
  • muscle mass decreases,
  • voice becomes higher (sometimes),
  • and breasts start to form.

The longer you’re on hormone therapy, the more prominent (and somewhat permanent) these characteristics become.

Additionally, emotional changes – primarily minor mood swings – are common at first, adds Khazan. “We can talk through these with you, and if we feel it would be beneficial, we can refer you to one of our therapists.”

More often than not, we see a positive emotional shift and an increase in confidence and self-esteem, says Dr. Johnson. “Hormone therapy is affirming; it allows people to finally express who they are.”

How often is follow-up needed?

In the beginning, follow-up is encouraged every three months, says Dr. Johnson. This is followed by every 6 months and, eventually, once a year. “The goal is to create a steady hormone routine for patients to adhere to for the rest of their life.”

Can you ever “speed up the process?”

Your provider may decide that slightly higher doses are appropriate, but super high doses can actually be harmful, explains Dr. Johnson. Too much testosterone and/or estrogen can increase the risk of blood clots, heart disease, stroke, and some types of cancer.

Can you ever stop hormone therapy once you start?

Yes. However, there are risks involved. Some changes, regarding body fat distribution and the menstrual cycle, are reversable. Others, such as voice and facial hair, aren’t.

Your provider will review these risks with you in-depth before you start therapy, notes Johnson. One of the biggest impacts to fully understand is for males transitioning to females. “Over time, you become functionally sterile. If you stop estrogen, your reproductive potential may not return. Because of this, we will discuss sperm banking prior to starting estrogen, in case you’re planning to have biological children.”

Do you have to go through hormone therapy?

No! It can be beneficial, but your transition journey is unique and entirely up to you, says Khazan. Some people choose to transition with only hormone therapy. Some undergo sexual reassignment surgery as well. But many people choose to transition solely through social aspects – such as behaviors and interests – and that is okay.

“If you’re nervous, be sure to do as much research as you can. There are many blogs and videos online of peoples’ transitions,” continues Khazan. “We are here to help guide you through this process – only when you are ready.”

Hormone therapy is meant to be affirming, reminds Dr. Johnson. It’s incredibly personalized, so you can and should do what you’re comfortable and content with.

For more information on Haddonfield Primary & Specialty Care, an LGBTQ+ Affirming Practice, click HERE