Hormone therapy

Feminizing hormone therapy also called cross-sex hormone therapy, is used to induce physical changes in your body caused due to female hormones during puberty. It helps harmonize your gender identity and your body (called gender congruence). If feminizing hormone therapy is commenced before the changes of male puberty starts, male secondary sex characteristics, including changes in voice pitch and increased body hair, can be prevented.

During this therapy, you will be provided with medication to inhibit the action of the testosterone hormone. You will also be provided with the estrogen hormone to minimize testosterone production and persuade feminine sex characteristics. The changes caused due to these medications can be temporary or permanent. Alo, feminizing hormone therapy can be done along with feminizing surgery in some cases.

Remember, feminizing hormone therapy isn’t appropriate for all trans women. It can affect your fertility and sexual functioning and bring about other health issues. Ask your doctor to help you weigh the benefits and risks of the therapy in your case.

Hormone therapy

Why Is Feminizing Hormone Therapy Done?

It is used to make changes in your hormone levels to match your gender identity. Generally, people who look for feminizing hormone therapy experience stress or torment due to a disparity between experienced or expressed gender and sex assigned at birth (a condition termed as gender dysphoria). The primary goal of the treatment is to keep hormone levels in the standard range for the target gender.

Feminizing hormone therapy is done for various reasons, including:

  • Reduce emotional and psychological; stress.
  • Decrease the severity of gender dysphoria
  • Improve the quality of life
  • Improve sexual satisfaction
  • Improve psychological and social functioning

Presently, the FDA (Food and Drug Administration) doesn’t approve the use of hormone therapy for the treatment of gender dysphoria. However, research says that it can be safe and effective. 

If used in adolescence, hormone therapy usually starts at the age of 16 years. Typically, the treatment should start before developing secondary sex characteristics, thus allowing teens to undergo puberty as their identified gender. Hormone therapy is generally not recommended in children. 

As we have already discussed, feminizing hormone therapy isn’t appropriate for all transgender women. Your healthcare provider may its use if you:

  • Have or had hormone-sensitive cancer, like prostate cancer
  • Have uncontrolled serious mental health issues
  • Have a thromboembolic disease, for example, when a blood clot develops in one or more of the deep veins of your body (called deep vein thrombosis) or a blockage in one of the pulmonary arteries in your lungs (called pulmonary embolism)

Are There Any Risks?

Talk to your healthcare provider regarding the changes in your body and any issues you might have. Complications of feminizing hormone therapy may include the following:

  • A blood clot in a lung (pulmonary embolism) or in a deep vein (deep vein thrombosis)
  • Weight gain
  • High triglycerides, a fat (lipid) in your blood
  • Elevated liver function tests
  • Gallstones
  • Infertility
  • Erectile dysfunction
  • Decreased libido
  • Type 2 diabetes
  • High blood pressure (hypertension)
  • Cardiovascular disease, when at least two other cardiovascular risk factors are present
  • High potassium (hyperkalemia)
  • Unreasonably high prolactin in your blood (hyperprolactinemia) or a condition in which a noncancerous tumor (adenoma) of the pituitary gland in your brain produces an excessively high amount of hormone prolactin (prolactinoma)

The latest research reveals that feminizing hormone therapy does not increase the risk of breast cancer.

Also Read: Functioning Of Important Hormones In Human Body 

Feminizing Hormone Therapy and Fertility

As feminizing hormone therapy may reduce fertility, you’ll need to plan for the future before getting started with the treatment. The odds of permanent infertility elevates with long-term use of the hormone, specifically when hormone therapy has started before puberty. In this case, you may not recover your testicular function completely to ensure conception even after discontinuing the treatment.

If you want to have biological children in the future, discuss with your doctor about freezing your sperm before starting feminizing hormone therapy. 

Some other side effects of estrogen use in transgender women include low sexual desire, erectile dysfunction, and ejaculation. You may recover your erectile function by taking oral medications such as sildenafil or tadalafil. 

How To Prepare For The Treatment?

Before initiating feminizing hormone therapy, your healthcare provider will assess your health to address or rule out any health condition that can impact or contraindicate treatment. The assessment might include the following:

  • A physical exam, such as an evaluation of your external reproductive organs
  • An assessment of your personal and family medical history
  • Age- and sex-appropriate screenings
  • Lab tests evaluating your blood sugar, lipids, blood count, liver enzymes, electrolytes, and the hormone prolactin
  • An assessment of your immunizations
  • Discussion about sperm freezing (sperm cryopreservation)
  • Discussion about the use of potentially unsafe treatment approaches, like unprescribed hormones, industrial-strength silicone injections or self-castration
  • Detection and management of tobacco use, alcohol abuse, drug abuse, HIV, and other sexually transmitted diseases

You may also require a mental health assessment by a provider with proficiency in transgender health. The assessment might review:

  • Your gender identity and dysphoria
  • The effect of your gender identity at home, school, work, and social environments, including concerns associated with relationship abuse, discrimination, and minority stress
  • Sexual health concerns
  • Mood or other mental health issues
  • Risk-taking behaviors, such as substance use and use of non-medical-grade silicone injections or illegal hormone therapy or supplements
  • Protective factors including social support from family, friends, and peers
  • Your objectives, risks, and anticipations from treatment and your the plans for your care

How Might Your Body Change With Feminizing Hormone Therapy?

First of all, hormone therapy is not quick to act. It is a process that can take a few years to complete. So, what can you expect from the treatment? How might your body change? Consider the following points and comprehend how the body changes from feminizing hormone therapy:

  • Body Fat Redistribution: Body fat shifts towards the legs, hips, cheeks, and face to create a more feminine fullness. Arms and leg muscles will appear less defined, and more fat accumulates under the skin. 
  • Breast growth: Fat will also show up on the breasts, and you could perhaps develop an "A" cup or a small "B" cup, though outcomes are quite variable and can vary for everyone. You will also form mammary and ductal tissue, which is significant to note because you will need breast cancer screenings in the future. 
  • Hair and Skin Differences: Your facial and body hair will become thinner. Any receding hairlines or bald spots on top of the head will cease. Your skin will turn softer and less oily.
  • Reduced Sperm Count: Estrogen drugs and spironolactone can reduce sperm count, making it more challenging to produce biological children on the basis of a study.

To develop an appropriate individualized treatment plan, you should discuss with your doctor what you would like to obtain from feminizing hormone therapy and your favored schedule, as you can modify your dosage accordingly.

Let us now discuss the timeline when can you expect the changes after the treatment:

  • Decreased libido: This will start1 - 3 months after initiating treatment. The peak effect will occur within 1 - 2 years.
  • Decreased spontaneous erections: This will start 1 -3 months after treatment. The peak effect will occur within 3 - 6 months.
  • Deceleration of scalp hair loss: This will start 1 - 3 months after treatment. The peak effect will occur within 1 - 2 years.
  • Softer, less oily skin: This will start 3 - 6 months after treatment.
  • Testicular atrophy: This will start 3 - 6 months after treatment. The peak effect will occur within 2 - 3 years.
  • Breast growth: This will start 3 - 6 months after treatment. The peak effect will occur within 2 - 3 years.
  • Redistribution of body fat: This will start 3 - 6 months after treatment. The peak effect will occur within 2 - 5 years.
  • Decreased muscle mass: This will start 3 - 6 months after treatment. The peak effect will occur within 1 - 2 years.
  • Reduced facial and body hair growth: This will start 6 - 12 months after treatment. The peak effect will occur within three years.

Results Of Feminizing Hormone Therapy

During the first year after the treatment, you will need to see your healthcare provider every three months for checkups. Also, whenever you make changes in your hormone regimen, kindly consult your doctor. Your doctor will:

  • Record your physical changes
  • Check your hormone levels, and prescribe the lowest dosage necessary to attaining desired physical effects.
  • Check your mental health stability.
  • Review changes in your fasting blood sugar, lipids, blood count, liver enzymes, and electrolytes that might be caused by hormone therapy

After undergoing feminizing hormone therapy, you will also require routine preventive care, including:

  • Breast Cancer Screening: It includes monthly breast self-exams and age-appropriate mammography screening after 5 - 10 years of estrogen therapy.
  • Prostate Cancer Screening: It should be done according to age-appropriate guidance. With estrogen treatment, your prostate-specific antigen (PSA) is expected to reduce by about 50%.
  • Supplementation: It includes standard calcium and vitamin D supplementation, along with bone density assessment based on the female age-appropriate recommendations.



Sources:

https://www.mayoclinic.org/

https://www.businessinsider.in/

https://www.hormone.org/

https://www.healthline.com/