Understanding the Approach to Using Gender-Affirming Hormones to Boost Confidence and Enhance Quality of Life
Having a gender identity different from the sex assigned at birth, or feeling that one’s physical characteristics do not align with their inner feelings, is an experience many people face in life. This includes those with diverse gender identities (Gender Diverse), transgender individuals, or those who feel their gender characteristics do not match their true self.
Hormone therapy to align with gender identity, known as Gender-Affirming Hormone Therapy (GAHT), is a medically recognized and internationally proven option. This therapy helps recipients develop physical traits consistent with their gender identity, reduce psychological distress, and improve quality of life.
For those interested or considering hormone therapy, we provide accurate, safe hormone use information and essential knowledge to help make confident decisions when consulting with specialists.
What is Hormone Therapy?
Hormone therapy to align with gender identity involves using hormones to change secondary sex characteristics to match an individual’s gender identity, whether feminizing hormone therapy or masculinizing hormone therapy.
This therapy is not limited to transgender people but also includes those with diverse gender identities, such as non-binary individuals or those who want to adjust some physical traits to align with their inner feelings.
Types of Hormone Treatments
Hormone treatments are divided into two main types, depending on the desired direction of change.
- Feminizing Hormone Therapy (Feminizing Hormone Therapy)
Suitable for those who want to develop physical traits toward the female direction, primarily using estrogen along with anti-androgens to reduce testosterone effects. The treatment effects are gradual, including breast growth, softer skin, changes in fat distribution, reduced body hair, and decreased muscle mass.
- Masculinizing Hormone Therapy (Masculinizing Hormone Therapy)
Suitable for those who want to develop physical traits toward the male direction, using testosterone. Treatment effects include voice deepening, growth of facial and body hair, increased muscle strength, changes in fat distribution, and cessation of menstruation.
There is also low-dose hormone therapy suitable for those who want mild changes or have gender identities outside the binary framework. Doctors will adjust dosages to fit individual goals.
Guidelines for Considering Hormone Therapy
Those who should consider hormone therapy are individuals experiencing persistent psychological distress from incongruence between sex assigned at birth and gender identity (Gender Dysphoria) and have a clear understanding of the treatment’s effects, including benefits, complications, and irreversible outcomes after starting hormone therapy. Therefore, consultation and evaluation by specialists are required before treatment.
Why is Gender-Affirming Hormone Therapy Important?
The benefits of hormone use to align with gender identity significantly impact mental health, social aspects, and overall quality of life.
- Mental Health and Emotional Well-being
Hormone therapy helps reduce depression and psychological distress, alleviating stress caused by the mismatch between identity and body.
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- Reduces suicidal thoughts
- Decreases depression symptoms
- Increases positive mood and life satisfaction
- Body Satisfaction
Therapy enhances body satisfaction and creates alignment between external appearance and gender identity, boosting self-confidence, improving life satisfaction, and increasing motivation in daily life.
- Quality of Life and Social Integration
Treatment improves social functioning, reduces feelings of alienation from one’s body, and recipients gain confidence in communication, work, and starting relationships without feeling the need to hide themselves.
How to Start Hormone Therapy (Taking Hormones)?
Starting hormone therapy requires a comprehensive and safe evaluation process by a team of specialists as follows:
- Initial Consultation
Interested individuals should begin by scheduling an appointment with a gender identity specialist to discuss personal history, feelings about gender identity, therapy goals, and expectations. The doctor will explain treatment details, expected outcomes, duration, and potential risks.
- Mental Health Assessment
In some cases, the doctor may recommend seeing a psychiatrist or psychologist specializing in gender identity to assess mental readiness and provide appropriate support.
- Physical Examination and Blood Tests
Before starting therapy, the doctor will perform a general physical exam, including blood pressure, weight, height, and blood tests to evaluate hormone levels, liver and kidney function, blood sugar and lipid levels, and overall health. These tests help the doctor create the safest and most suitable treatment plan for each individual.
- Treatment Planning
After evaluation, the doctor will plan hormone therapy with the patient, including medication type, dosage, administration form (e.g., pills, injections, patches, or gels), and follow-up schedules. Patient involvement in decision-making is crucial to ensure the plan fits their needs and lifestyle.
Expected Treatment Effects and Timeline
Changes from hormone therapy occur gradually and vary among individuals. Understanding realistic effects and timelines helps set appropriate expectations.
Feminizing Hormone Therapy
Initial changes are usually seen within 1-3 months:
- Softer skin
- Beginning breast growth
- Reduced ability to achieve genital erection
Breast growth continues gradually over 2-3 years. Fat distribution shifts slowly to hips, thighs, and buttocks, taking about 2-5 years for full effect. Facial and body hair thins and grows more slowly but may not disappear completely. Hair loss on the scalp may not regrow but will help prevent further loss.
Masculinizing Hormone Therapy
Some changes occur relatively quickly, such as:
- Voice deepening begins within 3-6 months and becomes permanent within 1-2 years
- Menstruation usually stops within 2-12 months
- Growth of facial hair and body hair starts within 3-6 months and thickens over 3-5 years
- Muscle strength and mass increase within 6-12 months
- Fat distribution gradually shifts to the abdomen over 2-5 years
- Skin may become oilier and acne may develop within the first 1-6 months
It is important to note that some changes are permanent (e.g., voice deepening, beard growth), while others may reverse if treatment stops (e.g., muscle mass, fat distribution).
However, individual results vary depending on factors such as genetics, age at treatment start, dosage, and individual body response.
Risks and Side Effects to Know Before Taking Hormones
Hormone therapy, like all medical treatments, carries risks and potential side effects. The risks and side effects to be aware of and monitor include:
Risks from Feminizing Hormone Therapy
Risk of blood clots (Thromboembolism), especially in those with other risk factors such as smoking, older age, or family history; increased blood lipid levels; long-term cardiovascular disease risk; and possibly increased breast cancer risk.
Although evidence is not definitive, other possible side effects include mood swings, weight gain, infertility or reduced fertility, and changes in genital function.
Risks from Masculinizing Hormone Therapy
- Increased red blood cell count (Polycythemia), which may raise blood clot risk
- Changes in blood lipid levels, especially decreased good cholesterol (HDL) and increased bad cholesterol (LDL)
- Risk of cardiovascular disease
- Liver changes, including hepatitis or liver abnormalities
- Risk of vaginal atrophy, causing dryness, burning, and itching in the vaginal area
- Acne, hair loss, weight gain, mood swings, and reduced or lost fertility
Note that absence of menstruation after testosterone therapy does not mean pregnancy is impossible.
Therefore, those having vaginal intercourse with cisgender men who do not wish to become pregnant should use contraception. Additionally, if future fertility is desired, consult a doctor about options for preserving reproductive cells before starting treatment.
Regular monitoring and health check-ups help doctors detect and manage problems early. Most risks can be reduced by choosing appropriate medications, monitoring, and adopting a healthy lifestyle.
How Long Does Hormone Therapy Take?
Hormone therapy is a long-term treatment requiring ongoing monitoring and adjustment to achieve the best and safest results.
- Initial Monitoring
During the first 3-6 months, doctors will schedule close follow-ups, usually every 1-3 months, to check physical health, blood pressure, and blood tests for hormone levels, liver and kidney function, and other relevant parameters. Dosages may be adjusted to achieve optimal hormone levels and minimize side effects.
- Long-term Monitoring
Once hormone levels stabilize within the desired range, follow-ups are spaced out, typically every 3-6 months. Blood tests remain important to ensure hormone levels are appropriate. Liver, kidney, and lipid profiles should be regularly checked. For testosterone users, red blood cell counts must be monitored to watch for polycythemia.
- Age-appropriate Health Screenings
Recipients should undergo age-appropriate health screenings and organ-specific checks, such as breast cancer screening, bone density tests, or other relevant cancer screenings, even while on hormone therapy.
- Treatment Plan Adjustments
Throughout therapy, individual needs and goals may change. The medical team is ready to discuss and adjust treatment plans accordingly, including dosage changes or medication forms. Treatment success is measured by patient satisfaction and quality of life, not just physical changes.
FAQ: Common Questions and Misunderstandings About Hormone Use
Many people interested in hormone therapy have questions and concerns. Correct understanding helps make better decisions.
Q: Is surgery required before starting hormone therapy?
Hormone therapy to align with gender identity does not require prior surgery. Many people choose hormone treatment alone without surgery. Decisions about surgery are personal and separate from hormone therapy.
Q: Do I have to take hormones for life?
In most cases, hormone therapy is long-term because the body needs sex hormones for proper function, especially if hormone-producing reproductive organs have been removed. However, each person’s situation is different, and you should consult your doctor about your long-term treatment plan.
Q: Will hormone therapy change my personality?
Hormones may affect mood and some feelings but do not change the core identity or personality of the person receiving treatment. Many report feeling happier and more themselves after starting therapy because their physical traits align better with their identity.
Q: Is it too late to start hormone therapy if I am older?
There is no upper age limit for hormone therapy. Although effects may vary with age, many start treatment in middle or older age and gain significant benefits. Doctors will assess overall health and individual risks case by case.
Q: Once I start hormone therapy, can I stop anytime?
Generally, you can decide to stop therapy, but it should be done under medical supervision. Some changes will reverse after stopping hormones (e.g., fat distribution, muscle mass), while others are permanent (e.g., voice deepening, beard growth, baldness, breast growth). Doctors will help plan a safe and appropriate discontinuation.
Where is the Best Place for Gender-Affirming Hormone Therapy?
The most effective and safest hormone treatment should be under the care of specialists who understand and respect each individual’s identity.
Sexual Health Center, Phyathai 3 Hospital (Love Life Center Sexual Health and Sexual Wellness) provides care by specialists from multiple fields. Sexual medicine doctors, family medicine, or internal medicine specialists experienced in transgender and gender-diverse health coordinate the treatment.
Additionally, psychiatrists or psychologists provide mental health support, especially during transition periods, along with other specialists such as endocrinologists for complex health conditions.
Gender-Affirming Hormone Therapy
Gender-affirming hormone therapy is a recognized and effective medical option for those experiencing distress from incongruence between sex assigned at birth and gender identity.
This treatment approach is not limited to any single group but is suitable for anyone wishing to adjust physical traits to align with their inner feelings.
If you are considering hormone therapy or have questions about gender identity, it is recommended to consult a specialist. The doctor will provide comprehensive information, assess your health, and collaboratively plan the most appropriate treatment for you.
Dr. Amornthis Chaimongkolpipop
Specialist in Obstetrics and Gynecology
Board Certified in Obstetrics and Gynecology
Subspecialist in Sexual Medicine
