Hormone replacement therapy (HRT) is now more commonly referred to as gender-affirming hormone therapy or GAHT. This change in terminology reflects an understanding that transgender, nonbinary, and gender diverse people undergo hormone therapy not merely to "replace" hormones associated with their sex assigned at birth, but rather to bring their physical characteristics and hormone levels into better alignment with their gender identity.
Some key points about gender-affirming hormone therapy:
- GAHT involves administering estrogen, testosterone, or other hormones to match a person's gender identity rather than their sex assigned at birth
- It is one treatment option available to transgender and gender diverse people wishing to undergo gender transition or affirmation
- GAHT can provide physical changes in fat distribution, development of sex characteristics, stop menstruation, facilitate erections, etc. aligned with the patient’s gender identity
Goals of Gender-Affirming Hormone Therapy:
- Induce feminizing or masculinizing changes — development of breast tissue, decreased testicular size, masculine fat redistribution patterns, etc.
- Halt bodily processes that do not align with gender identity — stopping menses for trans masculine patients or inhibiting erections for trans feminine patients
- Improve mental health and quality of life by aligning external physical characteristics and internal hormone levels with gender identity
Types of Gender-Affirming Hormones:
For transgender women and others wishing to develop feminine secondary sex characteristics:
- Estrogen — usually 17β-estradiol, estradiol valerate, or estradiol cypionate
- Progestogens — often micronized progesterone or medroxyprogesterone acetate
- Anti-androgens — spironolactone, finasteride, GnRH analogues
For transgender men and others aiming to masculinize features:
Expected Timeline for Gender-Affirming Hormone Effects:
Feminizing Hormone Therapy
- 1-3 months: Breast growth begins, skin softens, body fat shifts
- 3-6 months: Decreased muscle mass, slowed facial hair growth, emotional changes
- 1-2 years: Continued breast growth reaching Tanner Stage 4 or 5, nearly complete suppression of erectile function
Masculinizing Hormone Therapy
- 1-3 months: Menstruation ends, increased muscle mass and strength
- 3-12 months: Facial and body hair growth begins, voice pitch drops
- 1-2 years: Continued voice changes, atrophy of breast tissue, masculine fat redistribution
Of course, changes vary from person to person based on factors like dosage, genetics, lifestyle choices (diet, exercise), so it’s important to work with your GAHT provider to set reasonable expectations.
Risks and Side Effects
While GAHT allows many transgender people to feel more at home in their bodies, there are some risks to be aware of:
- Blood clots
- High potassium levels (hyperkalemia)
- Liver issues
- Increased blood pressure
This makes following your hormone provider’s lab testing and monitoring guidelines extremely important for minimizing risks on GAHT.
Always immediately report new symptoms like chest pain, leg pain/swelling, sudden vision issues, etc. to your GAHT physician.
| Feminizing HRT | Masculinizing HRT |
|-|-|
| Breast tenderness | Acne, oily skin |
| Headaches | Sleep apnea |
| Nausea | Anger, aggression |
|
Low libido | Vaginal atrophy |
The decision to start or continue GAHT involves carefully weighing potential benefits against possible side effects. This is why it's so important to work with a provider experienced in transgender healthcare when considering gender-affirming hormones.
In summary,
gender-affirming hormone therapy (GAHT) has largely replaced the term "hormone replacement therapy" when referring to feminizing or masculinizing hormones for transgender patients. This change emphasizes treating hormone levels according to one's gender identity rather than sex assigned at birth. By better understanding the nuanced goals, effects, risks, and options for GAHT, transgender individuals can make informed decisions on pursuing hormones as part of their transition.