What is HRT?
HRT involves taking hormones to develop the secondary sex characteristics of one's affirmed gender. For trans feminine individuals, this typically means taking estrogen and often an anti-androgen. For trans masculine individuals, it involves taking testosterone. This process is not about changing one's primary sex characteristics (genitals) but about altering the body's hormonal balance to influence features like body shape, voice depth, and facial hair.
Feminizing Hormones: Estrogens
Estradiol is the primary form of estrogen used in feminizing HRT. It is responsible for most of the desired changes, including breast development, redistribution of body fat to the hips and thighs, and softening of the skin. It works by activating estrogen receptors throughout the body. The dosage and method of administration are tailored to the individual to achieve target hormone levels safely.
Suppressing Testosterone: Anti-Androgens
For feminizing HRT to be most effective, the body's production of testosterone must be suppressed. Anti-androgens, or testosterone blockers, achieve this. Spironolactone is a commonly used anti-androgen in the United States, while others like Cyproterone Acetate are common elsewhere. These medications block the effects of testosterone, allowing estrogen to work more efficiently and preventing further masculinization.
Masculinizing Hormones: Testosterone
Testosterone is the primary hormone used in masculinizing HRT. It is responsible for changes such as the deepening of the voice, cessation of menstruation, growth of facial and body hair, and redistribution of body fat away from the hips and towards the abdomen. It also leads to increased muscle mass and skin oiliness.
Methods of Administration
Hormones can be administered in several ways. Estrogen can be taken as pills, through transdermal patches, or via injections. Testosterone is most commonly administered via intramuscular or subcutaneous injections, or as a transdermal gel. Each method has its own pros and cons regarding convenience, cost, and how the body processes the hormone. The choice of method is a personal decision made in consultation with a doctor.
Effects and Timeline
The effects of HRT occur gradually over months and years. Some changes, like skin softening or changes in libido, can occur within the first few months. Others, such as breast growth or full facial hair development, can take two to five years to reach their maximum effect. It is a marathon, not a sprint, and patience is essential.
Risks and Medical Monitoring
Like any medical treatment, HRT carries risks. For feminizing HRT, risks include an increased chance of blood clots (thromboembolism), particularly with oral estrogens. For masculinizing HRT, risks can include polycythemia (an excess of red blood cells). Because of these risks, regular monitoring by a healthcare professional is crucial. This involves periodic blood tests to check hormone levels, liver function, and other health markers to ensure the regimen is both effective and safe.
The Informed Consent Model
Many healthcare providers now use an informed consent model for starting HRT. This model centers the patient's autonomy. Instead of requiring letters from therapists or a lengthy psychological evaluation, the provider ensures the patient fully understands the effects, timelines, risks, and irreversible nature of some changes. Once the patient can give their informed consent, the treatment can begin. This approach reduces barriers to care while ensuring the individual is making a well-informed decision about their body.