For almost every transgender patient, endocrinology treatment marks the beginning of the physical transition to one’s experienced gender. Endocrinology refers to the field of medicine that cares for patients with hormonal conditions. Quality transgender care is comprehensive, typically including holistic therapy, surgery, and endocrinology/hormones. However, without hormone replacement therapy (HRT), a true medical/physical transition is not possible thus, this is a vital aspect of transgender care.
HRT entails treatment with sex hormones that match the patient’s identified gender, such as estrogen for transwomen and testosterone for transmen. These sex hormones are responsible for the physical characteristics that we typically think of as feminine or masculine (breast development in women and facial hair in men, for example).
Two medical organizations have established guidelines that address the appropriate use of HRT in transgender patients. These include The Endocrine Society and The World Professional Association for Transgender Health (WPATH). At the International Center for Transgender Care, our expert endocrinologists follow these guidelines when providing care for transgender patients. Typically, patients will first meet with a holistic therapist for evaluation and counseling. From there, your therapist can provide a referral to one of our endocrinologists.
While being transgender is a natural aspect of human diversity and is not considered a disease, many transgender patients are diagnosed with a condition called gender dysphoria. Gender dysphoria refers to the distress and discomfort associated with being transgender. Symptoms can include depression, anxiety, and social isolation. Fortunately, HRT can be an effective treatment option for gender dysphoria. In fact, gender dysphoria typically decreases (or even disappears altogether) when patients begin HRT.
For transwomen, the standard HRT protocol includes combined treatment with both an estrogen and an anti-androgen medication. Anti-androgen medications are given to reduce the levels of testosterone in the body and allow the estrogen to have its fullest effect. Estrogen may be prescribed in several forms, including an oral pill, a topical gel or patch, or as an injection. This medication should be taken daily for best results. Physical changes that can be expected from this HRT regimen include breast development, decreased facial and body hair, shrinking of the external sexual organs, and increased fat deposits on the lower body for a more traditionally feminine shape. Side effects of estrogen can include mood changes, loss of libido, an increased risk for blood clots, liver disorders, and high blood pressure, as well as a risk of breast cancer that is similar to that of cis-female.
The standard HRT protocol for transmen includes treatment with testosterone. Testosterone is usually prescribed as injection. Physical changes that can be expected with this HRT regimen include increased muscle mass and decreased fat mass for a more traditionally masculine body shape, increased facial and body hair, a deepening of the voice, cessation of menstrual periods, increased libido, and enlargement of the clitoris. Side effects that can be associated with testosterone use include acne, weight gain, increased red blood cell count, and mood changes. Your endocrinologist can help you to manage any undesirable side effects that may occur with HRT.
Unlike their adult counterparts, younger children (pre-puberty) who identify as transgender do not typically require hormones or other medications. At this age, treatment is usually limited to support and education for the patient and his or her family. However, it is a good idea for transgender children to be examined by a physician. The treatment team at ICTC can assist children and families in developing coping skills, managing the symptoms of gender dysphoria, providing education on the condition, and helping to navigate the social transition process.
Once a transgender child enters puberty, guidelines suggest that he or she begin taking a medication called a GnRH agonist, or “puberty blocker”. Puberty can be a challenging time for transgender children, as undesired physical characteristics begin to develop, and gender dysphoria symptoms can increase. Puberty blocking medications can prevent the physical signs of puberty from occurring, and can decrease gender dysphoria symptoms. During this time, the effects of these medications are completely reversible. Puberty blockers can buy the patient a little more time to sort through their feelings about being transgender and undergoing the physical transition process.
Once an adolescent patient has reached a certain level of emotional and intellectual maturity, he or she can decide whether to begin HRT. While every patient is different, typically this occurs around the age of 16. HRT regimens for adolescents are similar to those prescribed for older transgender patients.
HRT is a vital component of the gender transition process, offering many physical and psychological benefits. Because HRT is such an important treatment, it is paramount to work with only the most expert endocrinologists. At the International Center for Transgender Care, we can provide you with referrals to our large network of board-certified endocrinologists who are knowledgeable and experienced in caring for transgender patients. We look forward to assisting you in achieving the very best possible results from your hormone replacement therapy. Contact us today to schedule a consultation at (972) 543-2477.