For the transwoman or transman undergoing a physical transition, hormone replacement therapy (HRT) is vital. An endocrinologist is a doctor that specializes in hormone imbalances and the treatment of these conditions. This includes the administration of cross-sex hormones which is important in the treatment protocol for the transman or transwoman.
For transwomen, HRT includes estrogen with an anti-androgen. Anti-androgens are medications that block the body’s natural production of testosterone which allows the estrogen to achieve maximum effect. HRT for the transwoman results in the development of female secondary sex characteristics such as breast development, decreased facial and body hair and fat redistribution to the buttocks, thighs and hips. The testes may also shrink due to a decrease in the production of testosterone and there may be a decreased sex drive.
For transmen, HRT includes testosterone which results in the development of male secondary sex characteristics such as cessation of menstrual periods, facial hair and increased body hair, enlargement of the clitoris and increase muscle mass. Transmen also experience a reduction of body fat or they may experience body fat redistribution to the abdomen. Transmen typically experience a dramatic increase in sex drive as well.
The administration of cross-sex hormones varies depending on individual conditions. Patches, injections and pills are the most commonly prescribed medications. Your endocrinologist will help you decide which is the best protocol for you.
There are always side effects with medication and HRT is no exception. However, an experienced endocrinologist will work with you to help mitigate and manage these side effects. Some common side effects of estrogen include bone loss and increased risk for blood clots. Common side effects for testosterone can include weight gain, insulin sensitivity and increased aggression.
While there is no universal age to begin HRT, there is a general consensus among the medical community that transgender adolescents be only presecribed “puberty blockers” which will temporarily stop the physical effects of the body’s puberty. This allows the adolescent to continue therapy to determine if a full transition is the best approach or if a partial transition will suffice. Transgender endocrinologists are typically comfortable prescribing HRT to adolescents around the age of 16.
There have been great advances in recent years in research and understanding of the causes and treatment of transgender individuals. Along the way, we have learned that gender is a spectrum and that some transgender individuals choose a partial or no medical transition while others choose a full transition. There is no single approach to all.
Two professional organizations, the Endocrine Society and WPATH, have established guidelines for HRT treatment in patients that identify as transgender. Endocrinologists at the Trans Center follow these guidelines when prescribing HRT. Generally, this means that patients will begin their transition with supportive counseling, then receive a referral for endocrinology treatment.
At the International Center for Transgender Care, we look forward to assisting you in achieving the very best possible results from your HRT. Contact us today to schedule a consultation at (972) 543-2477. We can provide you with a referral to an experienced, board-certified transgender endocrinologist.
