The Guide to Hormones: Their tie to the trans experience, the complications, and the exceptions

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For many trans individuals, hormone replacement therapy is the epitome of healing options for treating gender dysphoria.

There are countless effects of hormones; for trans women who take estrogen, they can experience a softening of features, new curves, decrease of muscle mass, less body hair, and even development of breasts, to name a few. Trans men who take testosterone experience a voice drop, hardened features, an evolved sex drive and even facial hair (not to mention some extra hair everywhere else).

Ultimately, hormones are responsible for secondary sex characteristics, meaning anything typically developed during puberty.

For the trans person who may have been suffering since childhood, these changes can be a powerful relief.

On the flip-side, they cannot undo characteristics that developed during the ‘first round’ of puberty. That may be where different surgeries come in, although that is ultimately up to the individual to decide.

Yet physical changes aren’t the only thing that hormones affect. Energy level, mood, and even overall brain function can be affected by hormones.

As an example, many trans men including myself recall estrogen-driven anger as hysteric and even sad. Yet on testosterone, anger becomes more of a power-driven state that is far more physical.

Hormone therapy may also result in unintended side effects. There is a small chance that one may suffer an allergic reaction to the oil used to preserve hormones prior to injection. A rare but much greater concern is the possible development of venous thromboembolism, yet according to Henk Asscheman, MD, PhD, who spoke on the results of the 2014 study, “When using the guidelines from the Endocrine Society [Endocrine Treatment of Transsexual Persons], you are not going to see a lot of comorbidities with cross-sex hormone treatment." Asscheman’s study followed over 2000 trans patients over the course of a year and found that less than one percent suffered from venous thromboembolism.

For this reason, it is still highly recommended that hormone therapy patients continue permanent ongoing checkups with a health provider to screen for any negative symptoms. Contrary to popular belief, hormones are not temporary; once therapy begins, it is a lifelong process that will likely only be discontinued if a doctor sees it as detrimental to one’s health.

Many of the changes and risks may not be seen as a benefit, occasionally leading an individual to pause or cease hormone therapy altogether. Nonetheless, the changes that hormones offer is generally seen as enough of a benefit to pursue treatment.

For those who are able to use hormones in their transition, it is a necessity that comes with additional hurdles — the complication of insurance, receiving a therapist’s approval, and finding a trans-friendly doctor.

Fortunately for those in South Florida, there are many options, depending on location.

Yet even for the trans person who decides against or is unable to complete hormone therapy, it is crucial to understand that their decision should not reflect on their authenticity. The trans community always has and will continue to have those who choose not to conform to certain standards. Hormone therapy, surgery, and even what clothes are worn are ultimately their decision.

They say every journey is different. But if the shoe fits, wear it.

If you are considering hormone therapy, do not rely on this guide alone. Visit WPATH.org or reach out to SunServe or Care Resource to find a doctor or therapist to speak about treatment options.

 


 

The steps to begin

Regardless of where you go or what your treatment options would involve for hormone therapy, there are generally a number of steps one can expect from hormone therapy.

 

1. Visit a therapist

In order to begin hormones, it’s a requirement in Florida to receive a letter of approval from a certified therapist. This may seem unnecessary, especially for a trans person who is well aware of their identity. Nonetheless, speaking to a therapist may still provide an important outlet for preparing oneself for the changes ahead. 

 

2. Find a certified endocrinologist

While endocrinology is widespread for diabetic patients, it is much harder to find a doctor who is willing to treat transgender patients. Once a doctor is located, they will require the therapist letter in order to begin treatment.

 

3. Beginning treatment

Early on, one can expect that the doctors will insist on administering the hormones during visits. This may also be a requirement based on insurance or the practice itself. There are a variety of options, including topical gels, intramuscular injections, and even some oral prescriptions.

 

4. Self-treatment

If self-administering hormones eventually becomes an option, blood work will still be required on a fairly regular basis. Regardless of treatment, it is crucial to maintain treatment; too little or even too much in one dose may result in a body’s overcompensation, resulting in detransition.

 

5. Monitoring progress

The first few months may see changes, or they may not. It is important to be patient, and take pride in every road mark. Many trans individuals monitor their progress with selfies, videos or blogs.


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