Hormone treatment for transgender women

Hormone treatment for transgender women

Prof. Dr. Luc Van Gaal – Professor in Endocrinology, Diabetic and Metabolic Diseases at the UZA (University Hospital Antwerp)

For many, hormone treatment is one of the first steps in the transition. If the patient is a trans-gender woman, she is given female hormones while at the same time reducing the production of male hormones. For trans-gender men, it is exactly the opposite. It is possible to start with hormone treatment via 2pass Clinic.

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Who should receive hormone treatment?

Hormone treatment is a major therapy. Before the endocrinologist (hormone specialist) prescribes hormones, it is first determined whether genetic dysfunction actually occurs. In addition, you have to answer some questions about your health and you may have to undergo a short medical examination.

Hormone treatment is not recommended for  transgender women with untreated high blood pressure, who have a thrombosis (blood clot) or cerebral hemorrhage, or who are known to be at risk of thrombosis, and transgender women with severe liver disease.

In addition, you must be at least 16 years old. People below 16 years of age cannot get puberty inhibitors. These inhibit the development of gender characteristics. There are conditions attached to this.

Unfortunately, in Belgium, it is still common practice that a transwoman is asked for an “approval” by a psychologist of psychiatrist that she was diagnosed with gender dysphoria before she can start with hormone treatment. Here you can read more about counseling for transgender patients.

Are you considering gender-change surgery (sexual reassignment surgery)? During the operation, the testicles are removed. This eliminates the source of testosterone production. After surgery, only estrogens are necessary.

Types of hormones  

For hormone treatment of transgender women, two types are used:

  • Natural hormones, such as estradiol.  
  • Synthetic hormones, for example ethinyl estradiol.

The main difference between these species is that synthetic hormones are much stronger. They give faster results, but also have more side effects.

It is possible to buy hormone preparations for trans women via the Internet. We do not recommend that. Self-medication increases the risk of health damage, side effects and other unwanted effects. In addition, the quality of products sold through the Internet is not guaranteed.

What does a hormone treatment do? 


Hormone treatment inhibits the production of the male hormone testosterone in transgender women. This is achieved with anti-androgens such as cyproterone acetate. To this is added estrogens, which are provided both in tablet form and in patches. A number of male gender characteristics gradually disappear into the background.

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Effects of anti-androgens:

  • Decline of libido
  • Reduction of testicles
  • Reduction of body hair  
  • The normal process of hair loss in men is stopped   
  • Weakening of muscles  
  • Possible side effects include fatigue, lethargy and long-term infertility.  

Effects of estrogens:

  • Breast growth
  • Fat is distributed differently across the body (more around the hips)
  • Skin becomes softer  
  • Increasing emotionality  
  • Increased risk of thrombosis (especially in smokers).

People respond differently to hormone treatment. In some people, the effects are more pronounced or may present quicker than in others. This is normal.



What does hormone treatment not do?

Treatment with hormones ensures that you feminize sooner. However, there are cases where hormones have little or no effect.

  • Although body hair will slowly decrease, male beard growth is not affected at all, or is only slightly affected. People who need to get rid of beard growth will therefore need laser treatment or electrolysis.
  • Also, the voice does not change through hormone treatment. You can only feminize your voice through speech therapy and in some cases by surgery.
  • Breast forming is stimulated by female hormones. This requires patience. It may take up to two years to reach the final size. Many transgender women are not fully satisfied with the result obtained after two years of treatment. In such cases, breast enlargement can be chosen.
  • The skeleton and the body length are not changed by hormone treatment. Male features of the facial bones (strong jaw and chin, forehead bossing) can be altered by facial feminization surgery.

Hormone treatment and fertility  

Hormones affect your fertility. If you are treated with hormones for a long time, there is a strong possibility you will not be able to produce any more children. Do you nevertheless want a child in the future? Trans-gender women can freeze seed cells before hormone treatment. The endocrinologist can tell you more about this.

Follow-up

In the first year there are quarterly controls by the endocrinologist;  in the second year of hormone treatment, semi-annually. After gender-adjusting operations, follow-ups are often done annually.

Re-reimbursement

In most cases, your health insurance will reimburse you for hormone preparations. This usually happens after approval by the physician and after submitting a statement from the psychologist and endocrinologist. 

If you want to know more about the statement from a psychologist, you can take a look at counseling for transgender patients.

 

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FAQ

How long will it be until I see the development of my breasts?

In general, you will start to notice breast development between three and six months after starting with HRT. After two years they will have reached their maximum natural size. However, in some people there may not be any growth at all. Read more about the effects of HRT on the MtF body.

Should I wait with FFS until I have taken hormones long enough?

The hormones will have their effect on the soft tissues of your face: the fat will redistribute and the muscles will atrophy a bit. Also the facial hair will diminish and hair to the scalp will become denser and thicker. All this will make your face look softer and more feminine.
Dr van de Ven will try to make your face as feminine as possible and there is no negative effect to your face becoming even more feminine after your FFS due to the hormones. Those last changes will be very subtle. Therefore Dr van de Ven does not see a reason to postpone FFS if you have only started taking hormones recently.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.