What is Transgender Hormone Replacement Therapy?

Amanda Valentine Dela Cruz May 15, 2020

This post was last updated on August 1, 2023.

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Trans women go through a lot because of gender identity. Some of us, even go further and reach the stage of transition called transgender hormone replacement therapy.

Today, I’m going to discuss the:

effects
costs
and dangers

of transgender hormone therapy. Please know that what I’m going to be writing here is from my personal experience as a trans woman. This should not be taken as a replacement for proper transgender care information from a specialist.

Why some of us undergo Transgender Hormone Therapy

Hormone replacement therapy (HRT) is a choice. It’s not imposed and neither necessary to survive. However, the lines are blurred in terms of the word survival when it comes to well-being.

Technically, as trans women, we may live a long life without medical intervention. However, to a huge number of us, what kind of quality would such a long life offer? The saying “You only live once” isn’t popular for no reason. I personally believe that we were not born in this world simply to exist.

Mental Help

Gender dysphoria is a real thing and it can be eased by the use of hormone replacement therapy.

When I’m not on hormones, I feel like a man and I can’t seem to function correctly. My confidence goes downhill and I feel like there’s something incorrect in regards to every fiber of my body.

Just the thought that I have ample estrogen inside me already makes me feel less anxious and calms my mental health. There’s something so comforting about knowing that my hormone levels align with the gender that I identify with.

However, please do not think that hormone levels are what define one’s gender. This notion is incorrect as some transgender people are perfectly fine and are functioning well as the gender they are living with; without the need of taking this type of therapy.

Physical Help

Added to that, one of the most welcome effects of hormone therapy for transgender women is the physical changes that we get to receive when we’re undergoing it.

Estrogen helps in distributing fat to have a more “womanly” shape.

It also:

reduces and slows down the growth of body hair
lessens muscle buildup
provides suppler skin
and overall gives a more feminine glow

Moreover, it also deals with pheromones and makes our sweat smell less “masculine”.

I know how confusing this can be right now and there’s really no scientific way to tell the difference between a masculine and feminine scent. However, it’s how I find the smell of human excretions easier to describe in colloquial terms.

Feminizing Hormone Therapy for Trans Women

There are 2 main types of medication that trans women use when they’re under hormone replacement therapy. Some doctors would prescribe both while others would advise just to use only one kind; depending on the patient’s starting hormone levels.

Estrogen

This is what dreams are made of (quoting Hilary Duff) lol. Estrogen is the more dominant hormone in most cisgender women. As I’ve explained in the former section, it deals a lot in terms of feminization.

This can be taken alone because some studies show that having a high amount of this can already suffice in suppressing testosterone A.K.A male hormones. It’s mainly used for:

alleviating Gender Dysphoria
reducing distress both emotionally and psychologically
improvement of social and psychological function
quality of life improvement
s*xual satisfaction improvement

Albeit the FDA’s lack of approval for estrogen’s treatment of gender dysphoria, there’s a lot of research saying that it’s safe and very effective. If you have reached this part of the guide and you’re still mystified by gender dysphoria, let me explain it in laymen’s terms.

Gender Dysphoria = a condition of feeling that one’s psychological and emotional identity is opposite to his or her biological s*x.

Anti Androgen AKA Testosterone Blockers

This can be considered as the saving grace for most transgender women who have not undergone hormone replacement therapy at an early age. Hormone replacement therapy is typically recommended to start at the age of 16 to get the maximum effect of feminization, most especially if the individual is planning to undergo a s*x reassignment surgery.

The earlier you suppress your testosterone levels, the more feminine you’ll look after you get past puberty. I know, it’s kind of surprising because, at this age, most of us are still wondering how we’d copy our best friend’s book report without it looking like an exact clone.

To be honest, I started HRT when I was 16 because in my country, the Philippines, it’s very easy to buy birth control pills. The reason why I knew about it is that I had a trans mentor who guided me through every step of the way. However, please know that birth control pills are not proper HRT medication. Most doctors don’t advise for it to be used as a method for HRT.

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Transgender Hormone Therapy Side Effects

How hormone treatment works for transgender women is not as easy as 1-2-3. Some of us are not even eligible to go through it. The main reason all boils down to one’s health condition and medical history. In this section, I will share with you the common side effects and why some of us should not take this type of approach when it comes to transitioning.

Common Trans Hormone Therapy Side Effects

Please know that our bodies and health conditions are different. These may or may be applicable to you. I’m not a fear-mongering witch and I don’t want to discourage your dreams in life.

PROS:

less Gender Dysphoria
reduced Anxiety
reduced Depression
less Perceived Stress
increased Breast Tissue
improved Quality of Life
less Sebum and Acne
softer Skin
reduced Male Pattern Baldness
less Facial and Body Hair
decreased follicle stimulation
reduced Prostate Size

CONS:

Lower Sperm Count and Quality (If you’re planning to have biological children)
Decreased S*xual Desire
Reduced Physical Strength
Increased Mood Swings
Intensified Food Cravings
Increased Visceral Fat
Higher Fat Mass
Decreased Lean Mass

Neither PRO nor CON (depending on your needs in terms of Health and More)

higher risk of Impotence
decreased Systolic Blood Pressure
decreased Haemoglobin and Haematocrit
increased LDL cholesterol
elevated Triglycerides
increased S*x hormone-binding Globulin
elevated Prolactin
decreased Luteinising Hormone

Dangers of Transgender Hormone Replacement Therapy

Let me reiterate this, I, for one am under gender-affirming hormone therapy or hormone replacement therapy. I did not create this guide to scare you off from doing the same treatment. However, I feel that every individual has the right to know all of the information in regards to a certain type of medication. Especially if it can prove fatal to them.

Transgender women undergoing HRT may be at a higher risk for cardiovascular problems like:

stroke
heart attack
and blood clots

This is based on the largest study of the health of transgender individuals done by Dr. Darios Getahun.

Added to that, this study has found that transgender women taking HRT medications are twice as likely to experience venous thromboembolism (blood clot) compared to people who are not taking the same type of medication. We are also 90% more likely to have a heart attack or a stroke.

These are not the types of risks that one would voluntarily take. But then again, it all boils down to how you want to live your life and the diagnosis of your physician. If you already have underlying health conditions, it’s best to avoid hormone replacement therapy altogether.

Cost of Hormone Replacement Therapy for Transgender Women

The cost of this type of treatment mainly depends on the country that you live in. However, if you’re lucky enough to be living in Canada, medication and gender reassignment surgery can be offered to you for free; granted that you have passed the qualifications and psychological evaluations.

If you’re in the US, you could also seek help from UCSF Transgender Care.

For the rest of the world, it can be quite pricey, and in some cases, downright unreachable.

Doctors

If you’re planning to undergo hormone replacement therapy the proper way, visits to the doctors are going to cost you. Apart from seeking an endocrinologist, transgender patients have to go and get several lab tests. In some countries, a psychological evaluation is a must as well.

Here in the Philippines, we only have one clinic that’s dedicated to transgender health so if you’re living in the same country, feel free to check Victoria by Love Your Self out and please be very honest with your medical history.

Medication

This is where you’re going to have to be truly prepared for. In my country, the average salary of an office worker per month is only around $300. HRT medications can cost from around $50 and more per month (depending on the type of medication that you’re going to take).

If you’re not financially ready, hormone replacement is not for you. It’s not something that you just take on and off. This kind of therapy requires maintenance.

Should you do HRT as a Trans Woman?

I’m not here to encourage nor discourage you to undergo this type of treatment. I’ve written this for the sole purpose of sharing my experiences on what transgender hormone therapy is.

No matter how your gender transition may be, always remember that you are a woman from the inside first. Remind yourself of this fact on a daily basis and your femininity will eventually shine through; with or without medication.