Transgender Hormone Therapy

As a trans woman, trans man, or nonbinary person, you may want your body to look and feel differently. You may hope to look as female or male as possible. Or you might just want less obvious sex characteristics. Whatever your goal, we’ll work with you to find the right transgender hormone therapy for you.

Ready to begin hormones? Unsure? Either way, we’re here to help. You don’t need a referral to see us.

What Does Transgender Hormone Therapy Do?

Starting hormone therapy is like going through a second puberty. You’ll experience changes that are:

  • Physical
  • Emotional
  • Sexual
  • Reproductive

Transgender Hormone Therapy at UVA

If you have gender dysphoria, you may want more obvious or less obvious sex characteristics. At UVA, we work to find you the right transgender hormone therapy. Christine Eagleson, MD, walks us through the process. View hormone therapy transcript.

Physical Effects 

Sex hormones create physical changes in your body. The speed and amount of the changes will vary from person to person.

MTF Hormone Changes

Physically, if you’re taking female hormones, you can expect to:

  • Grow breasts
  • Sweat less
  • Lose muscle tone
  • Have the hair on your face and chest thin
  • Experience fewer and smaller erections
  • Have your testicles shrink
  • Possibly stop creating sperm
  • Have fat move to your face and thicken around your hips and thighs

FTM Hormone Changes

If you’re taking testosterone, you can expect:

  • Your skin to become thicker and more oily
  • To sweat more
  • Development or worsening of acne
  • Fat moving away from hips and thighs
  • More muscle definition in your arms and legs
  • A more angular look to your face
  • Voice changes
  • Thicker and fast-growing hair in different places
  • Libido and sexuality changes
  • Shorter periods that eventually stop

How Long Will These Changes Take?

The effects of hormone therapy vary from person to person. How quickly the changes happen will depend on a range of factors. Some new body features may affect you almost right away. Others may take from two to five years to develop.

You might want to wait for a while after starting hormones before surgery. You won't know what procedures you want or need until you know what effects hormones will have.

Emotional Changes

Everyone going through hormone therapy should prepare to have emotional shifts. Your feelings, interests, and sexuality could all fluctuate. It can feel like a rollercoaster.

If you can, get a support system in place as you start this journey. Having a therapist, friends, or family who knows what you’re going through can really help.

If you’re overwhelmed by changes in your mood, like feeling depression or anxiety, let us know. We’ll work with you on finding ways to address problems. Finding someone to talk to or tweaking your dose could make you feel better.

Fertility & Birth Control

You may think that you’ve stopped making sperm or eggs. But you may still have the ability to get pregnant or get someone else pregnant. Depending on the type of sex you have, you may still need to use birth control to prevent pregnancy.

Taking transgender hormones can change your reproductive system and make it hard to have your own baby. We can work with you on your options for saving your sperm or eggs.

Getting Started with Hormones

Many people ask: How soon can I start hormones?

We know the urgency you can feel. But we also want to make sure to keep you healthy and safe.

Creating Your Hormone Therapy Plan

We’ll need to look at several factors, including:

  • Your goals – how much you hope to change
  • Your age and medical history

A blood test happens first. This will give us a baseline to compare against after you start hormones.

Analyzing your blood also helps us see if taking hormones could cause side effects. And we’ll continue to monitor your blood levels during therapy to make sure you’re OK.

We usually get lab results back in a couple of days. If we don’t see any issues, usually then your transgender hormone therapy can start.

Pills, Gels, Patches, or Shots

You have options with how to take your hormones. Typically, gender hormones include:

  • Testosterone comes as a gel, patch, or injection.
  • Estrogen, and sometimes progesterone, come as a pill, patch, or injection.
  • Spironolactone, which blocks testosterone, is taken as a pill.

Your insurer may cover certain types of hormones and not others.

Hormones at home? Yes, we can teach you how to give yourself a hormone injection at home. 

Hormone Therapy Risks & Side Effects 

Any kind of hormone treatment can cause mood changes. You’ll also want to watch for other symptoms, depending on what you’re taking. We will talk about a lot of possible side effects at your appointment, but here are some of the more serious ones.

Testosterone Side Effects

In addition to worsening any acne, if you’re taking testosterone, we’ll need to watch your red blood cell count. Testosterone can cause your body to make more red blood cells than you need. Other conditions can also cause this increase. So we’ll figure out the cause and what we can do to even things out.

Estrogen & Spironolactone Risks

If you’re taking estrogen, you’ll need to watch for signs of:

  • Blood clots
  • Stroke

These risks are more serious if you smoke. So tend to want a plan to help you quit tobacco before you start estrogen.

Spironolactone can put you at risk for:

  • Dehydration
  • High potassium
  • Needing to pee more than normal

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