What is gender affirming hormone therapy?

Gender affirming hormone therapy is an umbrella term for when someone takes hormones and/or other medication to help decrease gender dysphoria. The most commonly used hormones are estrogen and testosterone, which achieve feminizing and masculinizing effects respectively. Each of these effects exists on a spectrum, and while some people may desire full effects, others may only wish to have mild effects. It is best to discuss your goals with your provider to best individualize hormone therapy to your desires. For those desiring feminizing effects, some people choose to use medications which decrease testosterone, minimize head hair loss, or increase sex drive. People assigned-female-at-birth who use testosterone long term may experience vaginal discomfort or dryness and may opt to use medications which decrease this side effect.

While most people who use these medications identify as transgender or gender diverse, not everyone with these gender identities chooses to use hormone therapy. Gender identity and expression are very individual and there is no one-size-fits-all choice. In fact, not everyone who identifies as transgender or gender diverse experiences gender dysphoria. Apart from hormone therapy, some people may also choose hair removal or restoration, voice therapy, and/or surgery on the face, vocal cords, chest, or genitals in order to achieve their goals.

Can I start and stop?

All hormone therapy medications are relatively safe and may be stopped and restarted when desired. Some people opt to stay on hormone therapy for the foreseeable future. However, others may choose to stop after certain effects are achieved. Still others may find the best option for them is to stop and restart periodically. All of these options are safe and valid. 

One item of note, however, if you have had surgery to remove your ovaries or testicles, you should review bone health with your provider. If you have had these surgeries and are taking hormone therapy, the hormones can help protect your bones. However, if you decide to stop hormone therapy after these surgeries, you could be at a significant risk for osteoporosis. Taking calcium and vitamin D supplements can help mitigate this risk, but you may need additional medication to prevent bone loss as well as periodic bone scans to screen for any loss.

What age can I start hormone therapy?

In Massachusetts, hormone therapy can be started in people who are 16 years and older. Minors (those ages 16-17) need a parent or legal guardian present at their appointment to start hormone therapy. According to the 2022 National Survey on LGBTQ Mental Health nearly 1 in 5 transgender and gender diverse youth attempted suicide in the past year. However, the rate of suicide of transgender and gender diverse youth who report high acceptance and support from their family is less than half the suicide attempt rate of those who reported low to moderate familial support. Supporting your child through their teenage years and the challenging process of gender discovery can be a matter of life and death for a minor. If you are a parent of a child who does not identify with their sex-assigned-at-birth, I encourage you to keep your mind, heart, and ears open for your children.

While most patients will have a prescription for hormone therapy at the end of their initial visit, these visits can also be used as a discussion for both minors and their parents or legal guardians to learn more about hormone therapy. I welcome families at all stages of decision-making to schedule an appointment.

Here are some other ways you can support trans and gender diverse people in your life:

• Use their name and pronouns correctly

• Support their gender identity and expression

• Welcome their LGBTQ friends and partners

• Educate yourself about LGBTQ people and issues