Transsexual Hormone Support

Overview

If you are born biologically male or female but identify yourself as the opposite sex, you may chose to change your physical appearance to match your gender identity. To accomplish this goal, you will need psychological support and a medical evaluation. Many people who find it is appropriate for them, choose to use long-term hormone support under medical supervision. In addition to hormones, some people choose to have elective surgery to alter or remove their reproductive organs.

Hormones are often prescribed to initiate and maintain the physical changes from female-to-male (FTM) or male-to-female (MTF). If needed, medications to prevent your body from producing male or female hormones are sometimes prescribed. The amount and type of hormones prescribed are based on your individual needs.

Hormone support therapy is an important part of treatment before and after sex reassignment surgery. However, we also need to monitor for possible side effects that hormone support can produce, such as an increased risk for high blood pressure, diabetes, or sleep apnea, as well as changes in cholesterol, hemoglobin, or prolactin levels.

Gender identity disorder

Gender identity disorder (GID) occurs when you identify yourself as a gender other than the gender assigned to you based on your biologic characteristics at birth (genes and anatomy). When you have GID, the quality of your life may be significantly reduced and you may have difficulty functioning in society, work, or school.

When gender issues cause great anxiety or depression, or if they interfere with your daily living, you may decide to present as another gender and transform your body to improve the quality of your life. Hormone support plays a significant role in maintaining this transformation.

Phases of Care

Before you receive hormone support, you must go through several phases of treatment and observation. Once you are diagnosed with GID, you will undergo psychotherapy to help you sort out your goals for transformation and to help you to identify a solid support system.

Prior to being considered for hormone support, you will be asked to dress and experience life as the opposite sex, along with continuing with psychotherapy for at least 3 months. You may then be considered for hormone support so that your physical traits are more closely aligned with your gender identity. After at least a year of hormone treatment and with the support of your health care team, you may then consider undergoing sex reassignment surgery to better match your body to your gender identity.

Not every person decides to have sex reassignment surgery. Some people choose to receive only hormone support to enhance feminine or masculine physical traits. Some people find that hormone support provides enough of a physical change to live comfortably.

If you undergo sex reassignment surgery, you usually need to continue hormone support to maintain female or male characteristics.

Criteria

To receive transsexual hormone support, you must be at least an adolescent starting to show signs of puberty and understand the risks, benefits, and limitations of hormone support. You must also show that you will only take the hormones as prescribed. Taking too much of the prescribed hormones can cause serious complications, such as a blood clot in the lungs or a liver tumor.

Medications

We will prescribe hormones to support your transformation. It may take several months and up to 2 years to determine the appropriate doses for each hormone prescribed.

Male-to-female (biological male)

We generally prescribe 3 types of hormones to sustain your MTF physical changes: estrogen and testosterone-blocking agents.

These hormones trigger female secondary sex characteristics, most notably breast enlargement, body fat redistribution, decreased body and facial hair and decreased testicle size.

Female-to-male (biological female)

Testosterone is the hormone used to sustain your FTM physical characteristics.

Testosterone produces male secondary sex characteristics, most notably a deepening of the voice, an increase in muscularity, body fat redistribution, and increased facial and body hair. Scalp hair may thin. Menses usually stops and the clitoris enlarges.

Hormone Effects

You must commit to taking your hormones exactly as prescribed so that we can determine the proper doses and avoid harmful side effects.

Similar to the physical changes experienced during puberty, it takes 3 to 5 years to experience the full physical effects of hormone support. Each individual responds differently to hormone support. You cannot increase the physical changes simply by increasing the hormone dosage. In fact, you can trigger harmful, severe side effects by doing so.

Desired Effects

As a biological male (MTF), you can expect to see breast development, softer skin, less body hair, except the hair on your scalp. Scalp hair generally stops thinning or get thicker. You can also expect to notice that the fat in your body moves to other places, such as to your hips. If you have not had sex reassignment surgery, you may also notice that your testicles shrink and you have less firm erections. Most of these changes are reversed if you stop taking hormone support.

As a biological female (FTM), you can expect increased facial and body hair as well as a deeper voice. You should also notice weight gain and muscle development, especially in your upper body. Your hips should become narrower as the fat on your hips moves to your upper body. The hair on your scalp may thin. You may easily become sexually aroused. If you have not had sex reassignment surgery, you may also notice that your breasts shrink and your clitoris becomes larger.

Complications

If you have heart disease or a family history of heart disease, your risk for developing serious or even fatal results from hormone support increases. You are also at greatly increased risk for heart disease or stroke if you smoke, have high blood pressure, a tendency for forming blood clots, or if you have diabetes. In addition, risks increase as you age, if you are obese, or if you are not physically active. Female hormones can increase the risk of developing breast cancer. Male hormones can increase the risk of developing sleep apnea.

Biological male (MTF). Hormone support increases your risk of developing blood clots, a benign tumor in your pituitary gland, liver disease, and gallstones. You might also gain weight, develop high blood pressure and/or diabetes. You might experience unpleasant mood shifts. If you have not had sex reassignment surgery, you might have difficulties getting an erection (impotence).

Biological female (FTM). Hormone support may change your cholesterol levels, putting you at greater risk for developing heart disease, liver tumors (both cancerous and non-cancerous), and liver disease. You might develop acne and experience frequent and unpleasant mood shifts. If you have not had sex reassignment surgery, you may not be able to get pregnant (infertile).

Follow Up Care

During an initial examination, we will review your mental health care – including whether there is a formal diagnosis of GID and what mental health counseling and support you have received. We will assess your risks for side effects from hormone support. We will get baseline laboratory and other appropriate tests. Once an initial evaluation has been completed, then we may prescribe hormone support. It is important that you continue to receive follow-up care, including blood tests and office visits to ensure your body is responding appropriately to the hormone support.

We will likely adjust your hormones depending on lab work and your own response to the treatment. We will work closely together to assess any possible side effects. Once we determine the ideal  hormone support doses, we may only need to check hormone levels once a year.

It is important that you only take hormones that are prescribed specifically for you. The risk of severe and even fatal side effects of hormone support is serious.

In addition, psychological support is an important aspect of continued treatment. You need a solid support system as you transition. You will experience significant changes in your body and you will need to be able to cope with the mental and social challenges that come with this change. We offer qualified counseling to help you cope with the challenges you will face.


If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following:
(1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.