Feminizing hormone therapy, also known as transfeminine hormone therapy, is a gender-affirming treatment to alter secondary sex characteristics from masculine to feminine.
It is used by transgender women, non-binary transfeminine individuals, and sometimes intersex and non-transgender people.
The therapy cannot reverse changes from previous puberty, often requiring additional interventions like surgery.
Purpose
Develops feminine secondary sex characteristics: breasts, feminine hair patterns, and body fat/muscle distribution.
Reduces distress and discomfort associated with gender dysphoria.
Medications Used
Estrogens: Induces feminization and suppresses testosterone.
Antiandrogens: Oppose testosterone effects.
Progestogens: Offer various possible benefits.
GnRH Modulators: Used to suppress testosterone further.
Requirements for Therapy
Many providers follow the WPATH Standards of Care, requiring psychotherapy and a letter of recommendation.
Some use an informed consent model without such requirements.
DIY hormone therapy is sought due to long waiting lists and high costs.
Medications and Administration
Estrogens can be administered orally, sublingually, transdermally, rectally, or by injection/implant.
Antiandrogens include spironolactone, cyproterone acetate, and GnRH analogs.
5-Reductase inhibitors like finasteride may be used but have limited efficacy.
Effects of Therapy
Physical Changes: Breast development, decreased body hair, redistribution of body fat, and decreased muscle mass.
Psychological Changes: Improved mood and quality of life.
Potential Side Effects: Include cardiovascular risks, liver issues, and changes in libido.
Monitoring
Regular blood tests to monitor hormone levels, liver function, and more.
Recommended hormone level ranges vary by health organization.
Risks and Considerations
Increased risk of venous thromboembolism, cardiovascular events, and certain cancers.
Long-term effects on fertility and bone health.
History
Hormone therapy for transgender women started in the mid-20th century.
Originally used high-dose estrogens; newer treatments involve lower doses with antiandrogens.
Key Takeaways
Feminizing hormone therapy is a critical component of gender transition for many transfeminine individuals.
Therapy requires careful supervision due to potential health risks.
Access to care varies significantly worldwide, leading some to self-medicate.