Hormone replacement therapy (HRT) changes the body’s hormone balance to bring a series of changes, similar to going through puberty for the first time and may be used by people who wish to change their physical appearance. Testosterone blockers and estrogen are used to provide effects that include breast growth, fat redistribution, and skin and hair softening, and are often used by transfeminine people. Testosterone provides effects that include voice deepening, increased facial and body hair, fat redistribution, and an increase in muscle mass, and are often used by transmasculine people. Hormone therapy is a choice and can be adjusted to meet individual needs. Several internet sites expand on typical changes people experience. However, everyone’s experience is different based on factors such as genetics and age, since HRT releases effects that are already coded in DNA.
There are sometimes negative health effects or health risks associated with HRT (e.g., increased risk of stroke or blood clots). HRT should always take place under a doctor’s supervision, and a caution is provided regarding the use of non-prescribed hormones or hormone substitutes (e.g., plant-based or bovine-based products). Though going through proper channels can be exasperating and discouraging, or simply very time consuming, it is important to follow accepted medical procedures. Hormones, like any medical treatment, are safest when they are used in the way they are supposed to be used, with the proper background information based on your particular physiology and health status. There is a real danger in buying hormones and taking them without the guidance of professionals and the medical testing that can help these professionals find the safest dosage for you. As much as there needs to be improvements in the systems that trans people often rely on for help, these systems are necessary and mitigate dangers which are very preventable. This is why this resource guide cannot condone the use of unsupervised hormone usage.
In Alberta, it is not required to go through a psychologist or psychiatrist to obtain an assessment in order to access HRT. A family doctor has the ability to assess a patient for readiness for HRT. That said, most family doctors are not familiar with hormone treatment for trans patients, and prefer that an endocrinologist initiate hormone treatment via a referral from a gender psychiatrist.
Hormones sometimes accessed by transfeminine spectrum people:
- Testosterone blockers – Spironolactone or Cyproterone Acetate, Finasteride.
- Estrogen – comes in the form of an intramuscular injection, cream, gel, patch, or pill. Pill and patch are the most common.
For more information on hormones and transitioning, click here.
Hormones sometimes accessed by transmasculine spectrum people:
- Testosterone – comes as an intramuscular injection, skin patch, cream/gel, or pill.
For more information, click here.
- Persistent, well-documented gender dysphoria;
- Capacity to make a fully informed decision and to consent for treatment;
- Age 18+ (if younger, doctors follow the Standards of Care for children and adolescents);
- If significant medical or mental health concerns are present, they must be reasonably well-controlled.
- Usually, clients need to present one referral from a therapist / psychologist / psychiatrist.
Psychotherapy is not an absolute requirement prior to initiation of HRT.
Many people may choose to go on a lower dose of hormones for slower changes or to stop hormone treatments once they’ve reached certain desired effects. Unfortunately there is little research or best practices for this, but doctor supervision can still be important to monitor hormone changes, particularly after a hysterectomy or GAS.