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For many trans and non-binary folks the use of hormones can be the difference between gender dysphoria and gender euphoria. Here are some commonly asked questions and answers about the process of starting HRT.
1.“Does HRT mess you up on the inside?”
No, it does not. Hormone Replacement Therapy like many treatments has short and long term effects.
The purpose of Hormone Replacement Therapy, (often referred to as ‘HRT’ for short) is to increase the presence of the desired secondary sex conditions and decrease the presence of the undesired secondary sex conditions to alleviate gender dysphoria. This is done through the administration of hormones which can be issued through pills, gel form, patches, injection, and in the case of testosterone, pellets that can be inserted under the skin as well. It is important to note that the method in which you take hormones does impact the potential side effects. Both the process of HRT for the purpose of transfeminization and transmasculinization increase chances of infertility.(Puberty Blockers are not linked with infertility however.) Transfeminine women on HRT and cisgender women alike have higher risks of breast cancer. Transfeminine women over the age of 40 are recommended non-oral treatment to reduce the risks of blood clots. There is no evidence to support the notion that taking hormones or puberty blockers will have a negative impact on your ability to perform cognitively, or regulate emotionally.
2. “Can it be ‘too late’ to start HRT?”
According to researcher Meredith B. Deutsch (2016), hormone therapy can be viewed as a second puberty. In puberty sex hormone exposure generally happens over a span of some years, conversely with HRT and adults higher doses are administered and effects are seen much quicker.
It will never be too late to do something that will allow you to feel more authentically yourself. Additionally HRT is not the ‘end all be all’ of your transition, should you choose to pursue it.
3. “Will I have to take HRT forever?”
Very few effects from Hormone Replacement Therapy are considered to be permanent. Breast development for transfeminine women is permanent, lowering of the voice, and facial hair growth for transmasculine men are permanent. Generally speaking all other effects of HRT may reverse if HRT treatment discontinues.
4. “I’m gaining weight, is this normal?”
The redistribution of weight is expected to occur. For transmasculine men you may see a thinning of the fat underneath the skin, less fat on the hips and thighs, more muscle on arms and legs, more visible veins, rougher skin, and weight around the midsection is possible as well.
For transfeminine women it is the opposite, an increase in weight distribution in the hips, decreased muscle mass, breast development, softening of the skin.
5. “Do you have to be a binary trans person to do hormones?”
No you do not! Speak to your affirming doctor about options that will best suit you. Often a lower dose of HRT can help dissolve some of the gender dysphoria you experience as a nonbinary person. Places to consider hormone replacement therapy are online services such as plume, and folx as well as your local planned parenthood.
6. “When can a child that is trans start HRT?”
Puberty blockers are a great option for trans children showing signs of beginning puberty. Research shows that puberty blockers are linked to lower rates of suicidality in trans youth. Research does not support claims that gender dysphoric children will “grow out of it” or experience regret and generally continue their transition after childhood.
7. “Will I Pass?”
The idea of needing to “Pass” is harmful and invalidating, even when you are inflicting this notion on yourself. No matter what type of treatment you are able to pursue your identity is valid. HRT has been shown to help with dysphoria in a way that has a positive effect on self-esteem and outlook. Transfeminine women may choose to pursue voice training, while transmasculine men can generally expect a deepening in their voice. Laser hair removal and electrolysis can be great for facial hair that is not expected to be impacted by HRT. There are gender affirming surgeries that you can choose to do if you are financially able.
We are not in a place currently where access is equitable, but any steps you take should be right for you- not to make you palatable to others.
8. “Am I still valid as a trans person if I do not include HRT in my transition?”
YES!
D, M. B., (2016) Overview of Masculinizing Hormone Therapy. Transcare.UCSF.edu
D, M. B., (2020) Information on Testosterone Hormone Therapy. Transcare.UCSF.edu
M.,(2022) Puberty Blockers: A Review of GnRH Analogues in Transgender Youth. Transfemscience.org.
W, A. (2018). An Introduction to Hormone Therapy for Transfeminine People. Transfemscience.org.
