Hormone therapy is one of the main stages in the process of gender transition (or gender confirmation). This method helps individuals acquire physical and psychological characteristics that align with their gender identity without the need for difficult surgical procedures. Different medications are used depending on the type of transition—Male-to-Female (MTF) or the reverse. This method requires psychiatrist approval and legal endorsements, and must be performed by specialist and experienced medical staff in this field. This procedure can significantly improve quality of life, mental health, and individuals' satisfaction with themselves and their lives. Stay with us to fully familiarize yourself with this treatment method.

What is Gender-Affirming Hormone Therapy?

Gender Affirming Hormone Therapy (GAHT) is one of the main stages in gender confirmation. In this method, the individual takes specific hormonal medications to change their secondary sexual characteristics, allowing the person to experience the appearance and psychological features that match their gender identity. Depending on the type of transition (MTF or FTM), different hormonal drugs such as testosterone, estrogen, or androgen blockers will be used. Hormone therapy leads to changes in mood, sexual desire, body shape, and facial and body hair.

The Difference Between Hormone Replacement Therapy (HRT) and Gender Affirming Therapy (GAT)

In both methods, hormone injection is used for specific purposes, but the type of treatment, timing, and goal are completely different. Hormone Replacement Therapy (HRT) is used for those who do not need to change their gender identity but whose natural hormones have decreased for various reasons. For example, women use this method during menopause to increase female hormones. In Gender Affirming Therapy (GAT), the goal is generally to change the outward gender from male-to-female or vice-versa. In fact, in HRT, hormones corresponding to the physical body are injected, while in gender confirmation hormone therapy, hormones different from the physical body are used. Also, the type of treatment, duration, dosage, and combination of medications differ between these two methods.

Who Can Undergo Hormone Therapy?

The most important factor for using hormone therapy is the diagnosis and confirmation of gender incongruence by a specialist psychiatrist. In fact, before hormone therapy, individuals must undergo specialized counseling sessions with a doctor so that the psychiatrist can confirm that the person truly has an identity mismatch with their body and needs a change. If the psychiatrist approves, the individual must meet the following conditions: no uncontrolled heart or liver disease, full awareness of the treatment results and side effects, and the ability to follow regular check-ups. Also, in many countries like Iran, the legal age for this treatment method is 18 years old.

What Hormones are Used During Hormone Therapy?

Hormone treatments vary depending on the type of transition. For trans men (FTM) who want to transition from female-to-male, testosterone is usually used. For trans women (MTF) who want to transition towards female characteristics, estrogen is typically used along with an androgen blocker. The important issue is the dose and amount of medication. The doctor must start the treatment with a low dose to give the body a chance to adapt, minimizing side effects.

Testosterone for Trans Men

Testosterone is the primary male hormone. Its use in trans men leads to an increase in facial and body hair, increased muscle mass, reduced subcutaneous fat, the cessation of menstruation, and an increase in sexual desire. To use this hormone, various methods such as injection, gel, or skin patch can be used as prescribed by a doctor. Injection is usually faster-acting, but its level in the blood must be precisely monitored and measured.

Estrogen + Anti-Androgens for Trans Women

In feminizing treatment, estrogen is used to create female characteristics such as softening of the skin, fat distribution in a feminine body shape, breast development, and a slight change in voice pitch. Anti-androgens such as spironolactone are also used to reduce the amount of testosterone in the body. Anti-androgens help estrogen take effect faster and more easily.

Starting Gender Confirmation Hormone Therapy

As mentioned earlier, starting gender confirmation hormone therapy requires specialized counseling sessions and psychiatrist confirmation. After that, blood tests, checking liver function, measuring fat levels, blood sugar, blood pressure, and hormone levels in the body must be accurately performed. The doctor determines the type of medication and its appropriate dose based on the person's physical condition, treatment goal, age, and lifestyle.

Pills, Gel, Patch, or Injection: Which is Better?

The choice of drug administration method depends on the treatment goal, the type of transition, the medical condition, and the individual's lifestyle. For example, injection is used for faster changes. Gel and patch are considered suitable options for individuals with hormonal fluctuations or liver problems due to their smooth and uniform absorption. Each method has its own specific features and must be chosen and performed under the supervision of a specialist doctor. The following table will help you compare the methods better.

What to Expect When Starting Hormone Therapy?

You should not expect many changes in the beginning of the treatment, or in the first three weeks. During this time, mild changes such as mood changes, increased energy, breast tenderness, or changes in the menstrual cycle may occur. Changes such as breast growth in trans women and voice change will occur in later months. The doctor usually arranges more follow-up sessions in the first three months to fully monitor the person's hormone levels and general health.

Physical Changes of Hormone Therapy

Hormone therapy in trans men leads to muscle strengthening, increased body and facial hair, reduced fat in the thighs and buttocks, and the cessation of menstruation. In trans women, this treatment method brings about changes such as breast growth, fat tissue development in the buttocks and thighs, and skin softening.

Voice, Skin, and Hair Changes

Hormone therapy in trans men leads to an increase in body and facial hair and the thickening and oiliness of the skin. In trans women, hormone therapy results in changes such as skin softening. The main difference is in voice change. Testosterone causes vocal cords to thicken and the voice to change permanently, but hormone therapy in trans women does not affect the vocal cords. Therefore, trans women rely on voice therapy to achieve a higher-pitched voice.

Growth or Reduction of Breast Tissue

In trans men, hormone therapy causes breasts to shrink but does not eliminate them completely. Mastectomy surgery is usually used for a completely masculine appearance. In trans women, breast growth begins around the third month, but full development usually requires two to three years.

Changes in Sexual Desire and Mood

One of the main effects of hormone therapy is mood changes. These changes are completely normal at the beginning of treatment and subside gradually as the medication dose is adjusted. Testosterone usually leads to an increase in sexual desire and energy. Estrogen may reduce sexual desire but usually helps reduce anxiety.

How Long Does it Take for Hormonal Changes to Take Effect?

Generally, small and minor changes begin around the second and third month depending on the type of transition and the dosage used, but the final result requires two to five years. Therefore, you must be patient during the treatment process.

Hormone Therapy for Trans Men (FTM)

In FTM treatment, testosterone enanthate or cypionate is usually used via injection weekly or every two weeks. As prescribed and deemed appropriate by the doctor, the testosterone level is usually 400 to . The dose used starts low and is gradually increased.

Short-term and Long-term Effects

Masculinizing hormone therapy in the short term leads to increased energy, improved mood, and the cessation of menstruation. In the long term, as mentioned above, it causes changes in facial and body shape, voice change, increased muscle mass, and the growth of facial and body hair.

Feminizing Hormone Therapy (Male-to-Female)

In this method, estrogen and anti-androgens are also used. Hormone injection is performed every two or four weeks, about 5 to 20 mg. The exact dose and method of consumption must be adjusted based on blood tests and the body's response so that the hormone level remains within the normal female range. Excessive and unprincipled doses can lead to problems such as blood clots, liver problems, or severe mood swings.

Hormone Injection for MTF Transition

In MTF transition (or male-to-female), various methods such as injection, medication, or patch can be used. However, injection has its specific advantages:

• Injection will have a faster and more stable effect.
• It is a better choice for individuals with liver or heart problems.
• It is usually performed every two or four weeks and requires precise control.

Potential Complications and Risks of Gender Confirmation Hormone Therapy

If non-medical and arbitrary doses are consumed, hormone therapy can lead to complications and problems such as blood clots, increased blood lipids, liver problems, increased blood pressure, and acne/pimples. In very rare cases, there are risks such as stroke, permanent infertility, and heart problems. For this reason, doctors start the treatment with a low dose initially.

The Effect of Feminizing Hormone Therapy on Fertility

Feminizing hormone therapy usually leads to a reduction in sperm, a decrease in its quality, and sometimes a complete stop in production. These changes may be reversible or permanent. If fertility is important to individuals, sperm can be frozen before starting hormone therapy.

Are the Changes from Hormone Therapy Permanent?

Some changes, such as the voice change in trans men, breast growth in trans women, or body fat distribution, are largely permanent. Some changes, such as a decrease or increase in sexual desire, skin quality, or mood changes, are temporary and will subside after a while.

Does Hormone Therapy Affect Surgery?

Yes, hormone therapy changes the tissues and improves the conditions for surgery. For example, masculinizing hormone therapy causes the clitoris to enlarge and firm up. In one type of surgery, the clitoris is converted into a small male penis. Testosterone also helps with muscle building and wound healing. Estrogen also makes the skin softer and more amenable to surgery. Sometimes, hormone regulation before surgery is mandatory and is instructed by the specialist doctor.

Post-Hormone Therapy Care for Gender Confirmation

After gender confirmation hormone therapy, the person must be regularly visited by a doctor. Monitoring blood pressure, checking hormone levels in the blood with tests, and examining the liver and lipid profile are essential. The frequency of doctor visits is higher in the first three months and usually increases to every three to six months thereafter. Also, individuals in the post-hormone therapy period must fully adhere to care practices such as drinking sufficient water, refraining from consuming tobacco and alcohol, regular exercise, and taking medication exactly as prescribed by the doctor.

Conclusion

Hormone therapy is a crucial stage in gender transition. In this stage, individuals take specific hormones that cause gradual changes in their appearance, voice, mood, and secondary sexual characteristics. This stage is carried out using various methods such as oral medication, gel, patch, or injection. The selection of the type of treatment and its dosage must be performed by a specialist doctor to largely prevent subsequent complications. Hormone therapy is highly helpful in improving the quality of life, increasing self-confidence, and promoting the sexual health of these individuals.

Frequently Asked Questions

How long does it take for hormones to affect the body of trans individuals?

The first changes start around the third month, and the final result will be clear after two to five years.

Is it possible to smoke or vape during hormone therapy?

Smoking and vaping, especially in trans women, increase the risk of problems such as blood clots. Therefore, it is best to refrain from consumption.

What happens if we stop taking hormones?

Some changes return to their initial state, but others, such as the voice change in FTM or breast growth in MTF, remain largely permanent.

How often should check-ups be done?

In the beginning of the treatment, usually once a month for the first three months, and then every three to six months.

Can gender identity disorder be treated with hormone therapy?

No, hormone therapy only harmonizes the body with the gender identity.

Is FTM hormone therapy safe?

If this method is performed by a specialist doctor and regularly monitored, it is usually safe and without serious complications.

What hormones are used for female-to-male gender confirmation?

The main hormone is testosterone.

Does progesterone feminize men?

Not at medical doses, but in feminizing treatment, it may help with breast growth.