Table of ContentsView AllTable of ContentsWhat It IsHow to Get StartedMasculinizing TherapyFeminizing TherapyWhat to ExpectAccess to Treatment
Table of ContentsView All
View All
Table of Contents
What It Is
How to Get Started
Masculinizing Therapy
Feminizing Therapy
What to Expect
Access to Treatment
Gender-affirming hormone therapy helpstransgenderand othergender-nonconformingpeople align their bodies with theirgender identity. Not all transgender (trans) people are interested in hormone therapy. However, many transgender people, particularly binary transgender people, turn to hormones to affirm their gender.
Gender-affirming hormone therapy is comprised of masculizing hormone therapy used in trans men and feminizing hormone therapy used in trans women.
This article describes the goals of gender-affirming hormone therapy, how the treatment is administered, and the different types of hormones used. It also explains what to expect when undergoing gender-affirming hormone therapy and the possible risks.
Verywell / Brianna Gilmartin
DefinitionsThe term “gender affirmation” is preferred over “gender confirmation” because a transgender person does not need toconfirmtheir gender to anyone. The word “confirm” suggests proof, while “affirm” means to assert strongly.
Definitions
The term “gender affirmation” is preferred over “gender confirmation” because a transgender person does not need toconfirmtheir gender to anyone. The word “confirm” suggests proof, while “affirm” means to assert strongly.
Who Is Gender-Affirming Hormone Therapy For?
Gender-affirming hormone therapy comes in two types:
Hormone therapy can be used on its own for people who have no interest in pursuinggender-affirming surgery. It can also be used in advance of surgery (usually for six months to one year) to improve the outcomes of surgery, such as breast augmentation.
According to the National Transgender Discrimination Survey, 95% of transgender people and 49% ofnon-binarypeople were interested in hormone therapy.
Hormone Therapy vs. Puberty BlockersPuberty blockersare used to delay the onset of puberty in young, gender-diverse people prior to the start of hormone therapy. They are considered to be a distinct but complementary component of gender-affirmation therapy.
Hormone Therapy vs. Puberty Blockers
Puberty blockersare used to delay the onset of puberty in young, gender-diverse people prior to the start of hormone therapy. They are considered to be a distinct but complementary component of gender-affirmation therapy.
Gender affirmation is a process in which hormones only play a part. It typically starts with social gender affirmation in which you alter your appearance, wardrobe, and manner of grooming while updating your name, pronouns, and legal documentation.
Medical gender affirmation is typically the next step in which you work with a healthcare provider to identify your personal goals and which type of types of treatments are needed to achieve those goals.
Depending on state law and other factors, healthcare providers may be able to dispense treatment on the same day. No letter from a mental health provider may be needed. Call Planned Parenthood or your local LGBTI organization to learn about the laws in your state.
To receive authorization for insurance coverage, many insurers require a diagnosis ofgender dysphoria. To do so, a therapist or mental health professional must confirm that there is amismatch between a person’s expressed or experienced gender and the gender they were assigned at birth for a period of at least six months.
How to Choose the Right ProviderNot every endocrinologist is equally well-suited to administer gender-affirming hormone therapy. Those who have undergone a comprehensive, multidisciplinary gender-affirmation training program are generally preferred.Do not hesitate to ask about a healthcare provider’s experience and qualifications in administering gender-affirming care.
How to Choose the Right Provider
Not every endocrinologist is equally well-suited to administer gender-affirming hormone therapy. Those who have undergone a comprehensive, multidisciplinary gender-affirmation training program are generally preferred.Do not hesitate to ask about a healthcare provider’s experience and qualifications in administering gender-affirming care.
Not every endocrinologist is equally well-suited to administer gender-affirming hormone therapy. Those who have undergone a comprehensive, multidisciplinary gender-affirmation training program are generally preferred.
Do not hesitate to ask about a healthcare provider’s experience and qualifications in administering gender-affirming care.
Masculinizing Hormone Therapy
Masculinizing hormone therapyuses various types oftestosteroneto promote masculinizing changes in both binary and non-binary individuals. Testosterone is most often given as an injection, but other formations are available, including pills and creams.
Masculinizing hormone therapy cannot reverse all of the changes associated with female puberty. If transmasculine individuals have experienced breast growth that makes them uncomfortable, they may need to address that with binding ortop surgery.
Testosterone will also not significantly increase height unless it is started reasonably early. Finally, testosterone should not be considered an effective form of contraception, even if menses have stopped.
Feminizing Hormone Therapy
Feminizing hormone therapy uses a combination ofestrogenand atestosterone blocker. The testosterone blocker is needed because testosterone has stronger effects on the body than estrogen.
The blocker most commonly used in the United States isspironolactone, a medication also used for heart disease. The medication used as a puberty blocker, called Supprelin LA (histrelin), can also be used to block testosterone.
Various forms of estrogen can be used for feminizing hormone therapy. In general, injectable or topical forms are preferred as they tend to have fewer side effects than oral estrogens.However, some trans women prefer oral estrogens.
Estrogen cannot reverse all changes associated with having undergone testosterone-driven puberty. It cannot eliminate facial or body hair or reverse shoulder width, jaw size, vocal pitch, or facial structure. Many of these can be addressed with aesthetic or surgical treatments.
What to Expect During Treatment
Thereafter, regular follow-ups are needed to evaluate the effects of treatment and possible side effects. Most healthcare providers recommend visiting every 3 months for the first year and every 6 to 12 months thereafter.
Effects of Therapy
It can take three to five years for your body to show the full effects of gender-affirming hormone therapy. Some changes can occur within the first six months, such as the development of larger breasts. Others, like changes in facial structure, can take years.
In addition to physical changes, hormone therapy can cause emotional changes. If you are sexually active, it may improve sexual satisfaction as well as your overall sense of well-being. Hormone therapy can also help to ease the stress associated with gender dysphoria.
If you discontinue therapy, some changes may be reversible. Others, like changes in bone structure, may be permanent.
Possible Risks
As beneficial as gender-affirming hormone therapy can be, it also carries certain risks depending on which hormone you are taking.
Possible risks of feminizing hormone therapy include:
Risks of masculinizing hormone therapy:
Access to Gender-Affirming Hormone Therapy
Until relatively recently, access to gender-affirming hormone therapy was largely managed through gatekeeping models that required gender-diverse people to undergo a psychological assessment before they could access hormone treatment.
However, state laws vary substantially in terms of transgender protections, and some states do allow policies to exclude various aspects of transgender health care, including gender-affirming hormone therapy.
Access to hormone therapy can be prohibitively expensive for many people if they need to pay out of pocket, which may lead some people to try to get these medications from friends or other unlicensed sources.
In addition, individuals who are involved with carceral systems, such as immigrant detention, may be denied access to hormones.This can have significant negative physical and psychological effects.
Summary
Gender-affirming hormone therapy is the primary form of treatment for transgender people. Masculizing hormone therapy involving testosterone is used to develop secondary male sex characteristics like larger muscles. Feminizing hormone therapy involving estrogen and a testosterone blocker is used to develop secondary female sex characteristics like breasts.
Some masculinizing and feminizing effects can occur within months, while others may take years. If you stop treatment, many of the effects will reverse, while some will be permanent. Regular follow-up care is needed to avoid potential side effects and long-term complications.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gardner IH, Safer JD.Progress on the road to better medical care for transgender patients.Curr Opin Endocrinol Diabetes Obes. 2013;20(6):553-558. doi:10.1097/01.med.0000436188.95351.4dJames SE, Herman JL, Rankin S, Keisling M, Mottet M, Anafi M.The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. 2016.Planned Parenthood.Gender-affirming hormone therapy: what to expect on your first visit and beyond.Boskey ER, Taghinia AH, Ganor O.Association of surgical risk with exogenous hormone use in transgender patients: a systematic review.JAMA Surg. 2019;154(2):159-169. doi:10.1001/jamasurg.2018.4598Almazan AN, Benson TA, Boskey ER, Ganor O.Associations between transgender exclusion prohibitions and insurance coverage of gender-affirming surgery.LGBT Health. 2020;7(5):254-263. doi:10.1089/lgbt.2019.0212White Hughto JM, Reisner SL.A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals.Transgend Health. 2016;1(1):21–31. doi:10.1089/trgh.2015.0008Cavanaugh T, Hopwood R, Lambert C.Informed consent in the medical care of transgender and gender-nonconforming patients.AMA Journal of Ethics. 2016;18(11),1147–1155. doi:10.1001/journalofethics.2016.18.11.sect1-161Coleman E, Radix AE, Bouman WP, et al.Standards of care for the health of transgender and gender diverse people, version 8.Int J Transgend Health. 2022;23(Suppl 1):S1-S259. doi:10.1080/26895269.2022.2100644
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gardner IH, Safer JD.Progress on the road to better medical care for transgender patients.Curr Opin Endocrinol Diabetes Obes. 2013;20(6):553-558. doi:10.1097/01.med.0000436188.95351.4dJames SE, Herman JL, Rankin S, Keisling M, Mottet M, Anafi M.The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. 2016.Planned Parenthood.Gender-affirming hormone therapy: what to expect on your first visit and beyond.Boskey ER, Taghinia AH, Ganor O.Association of surgical risk with exogenous hormone use in transgender patients: a systematic review.JAMA Surg. 2019;154(2):159-169. doi:10.1001/jamasurg.2018.4598Almazan AN, Benson TA, Boskey ER, Ganor O.Associations between transgender exclusion prohibitions and insurance coverage of gender-affirming surgery.LGBT Health. 2020;7(5):254-263. doi:10.1089/lgbt.2019.0212White Hughto JM, Reisner SL.A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals.Transgend Health. 2016;1(1):21–31. doi:10.1089/trgh.2015.0008Cavanaugh T, Hopwood R, Lambert C.Informed consent in the medical care of transgender and gender-nonconforming patients.AMA Journal of Ethics. 2016;18(11),1147–1155. doi:10.1001/journalofethics.2016.18.11.sect1-161Coleman E, Radix AE, Bouman WP, et al.Standards of care for the health of transgender and gender diverse people, version 8.Int J Transgend Health. 2022;23(Suppl 1):S1-S259. doi:10.1080/26895269.2022.2100644
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gardner IH, Safer JD.Progress on the road to better medical care for transgender patients.Curr Opin Endocrinol Diabetes Obes. 2013;20(6):553-558. doi:10.1097/01.med.0000436188.95351.4dJames SE, Herman JL, Rankin S, Keisling M, Mottet M, Anafi M.The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. 2016.Planned Parenthood.Gender-affirming hormone therapy: what to expect on your first visit and beyond.Boskey ER, Taghinia AH, Ganor O.Association of surgical risk with exogenous hormone use in transgender patients: a systematic review.JAMA Surg. 2019;154(2):159-169. doi:10.1001/jamasurg.2018.4598Almazan AN, Benson TA, Boskey ER, Ganor O.Associations between transgender exclusion prohibitions and insurance coverage of gender-affirming surgery.LGBT Health. 2020;7(5):254-263. doi:10.1089/lgbt.2019.0212White Hughto JM, Reisner SL.A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals.Transgend Health. 2016;1(1):21–31. doi:10.1089/trgh.2015.0008Cavanaugh T, Hopwood R, Lambert C.Informed consent in the medical care of transgender and gender-nonconforming patients.AMA Journal of Ethics. 2016;18(11),1147–1155. doi:10.1001/journalofethics.2016.18.11.sect1-161Coleman E, Radix AE, Bouman WP, et al.Standards of care for the health of transgender and gender diverse people, version 8.Int J Transgend Health. 2022;23(Suppl 1):S1-S259. doi:10.1080/26895269.2022.2100644
Gardner IH, Safer JD.Progress on the road to better medical care for transgender patients.Curr Opin Endocrinol Diabetes Obes. 2013;20(6):553-558. doi:10.1097/01.med.0000436188.95351.4d
James SE, Herman JL, Rankin S, Keisling M, Mottet M, Anafi M.The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality. 2016.
Planned Parenthood.Gender-affirming hormone therapy: what to expect on your first visit and beyond.
Boskey ER, Taghinia AH, Ganor O.Association of surgical risk with exogenous hormone use in transgender patients: a systematic review.JAMA Surg. 2019;154(2):159-169. doi:10.1001/jamasurg.2018.4598
Almazan AN, Benson TA, Boskey ER, Ganor O.Associations between transgender exclusion prohibitions and insurance coverage of gender-affirming surgery.LGBT Health. 2020;7(5):254-263. doi:10.1089/lgbt.2019.0212
White Hughto JM, Reisner SL.A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals.Transgend Health. 2016;1(1):21–31. doi:10.1089/trgh.2015.0008
Cavanaugh T, Hopwood R, Lambert C.Informed consent in the medical care of transgender and gender-nonconforming patients.AMA Journal of Ethics. 2016;18(11),1147–1155. doi:10.1001/journalofethics.2016.18.11.sect1-161
Coleman E, Radix AE, Bouman WP, et al.Standards of care for the health of transgender and gender diverse people, version 8.Int J Transgend Health. 2022;23(Suppl 1):S1-S259. doi:10.1080/26895269.2022.2100644
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