Transgender Health Initiative Learning Center
EDUCATE: HORMONE THERAPY - TGHI Learning Center
Hormone therapy for the transgendered is most often termed cross-gender hormone therapy or hormone replacement therapy (CGHT or HRT, respectively) within the community and by health professionals experienced in this area. Whatever you chose to call it, there is no question hormone therapy is the most prevalent form of medical intervention for transgender people. Its purpose is to aid in the development of the secondary sex characteristics of an individual's chosen gender.
Physical Changes
CGHT in transgender women (transitioning male-to-female) adults does appear to redistribute fat in proportions similar to that found in natal females. Body hair may appear finer, and the skin may feel softer. Spontaneous erections diminish or cease. Muscle mass tends to decrease over time, but bone structure remains largely the same.
CGHT is subject to many false expectations from the transgender community and general public. It usually takes only a short time for transgender people on CGHT to realize the development of secondary sex characteristics in an adult, especially a MTF adult, is limited. For example, in transgender women, CGHT does not change the voice. It does not have a great impact on beard growth in natal males, and hair removal methods (electrolysis, laser, etc.) are necessary. Breast growth is minimal in most cases, with development rarely over a B cup. For more information on expected results, see Transgendercare's Medical Feminizing Program.
CGHT in transgender men (transitioning female-male) adults has more obvious physiological changes. There is usually an increase growth and density of facial and body hair, deepening of the voice, cessation of menstruation and an increase in muscle mass. Many also report the enlargement of the clitoris and increased libido. For more information on expected physical changes resulting from the FTM hormone regimen, as well overall information on hormone therapy and regimens in transgender individuals, see Dr. Anne Lawrence's concise 1 page hand out Suggested Hormone Regimens and the more extensive Tom Waddell Health Center Transgender Team's Hormone Protocols Guide.
Many of CGHT's effects on secondary sex characteristics are permanent, especially in transgender men. Activated hair follicles in natal male adults and transgender men can not be deactivated, so hormonal facial hair (the thick, prickly kind) has to be removed by other means such as those mentioned above. While voice changes in natal males are not effected by CGHT, it has a permanent effect on transgender men. Long term breast growth in transgender women, even if minimal, is usually not effected the cessation of CGHT if necessary. Clitoral enlargement in transgender men is permanent, but impotence in transgender women is variable, depending on the duration and dose of administered estrogens.
Emotional Changes
The most apparent, and more difficult to quantify, are emotional changes. On a completely anecdotal note, having worked with dozens of transgender people in the last decade, these affects are the most striking to me. In transgender women (MTF adults), sexual libido decreases while, in transgender men, it increases. Mood swings may be more obvious. There also seems to be an increase in aggression in transgender men. There is some evidence HRT in menopausal women increases serotonin binding in the prefrontal cortex, so it might be enlightening to investigate how CGHT effects levels of serotonin in the transgendered as well.
Transgender Children
Unfortunately, there is not a wealth of information on CGHT for transgender children. Physiological changes in secondary sex characteristics are usually more dramatic due to the lesser degree of masculinization or feminization in the individual's phenotypic sex. There is support where transgender children are concerned regarding the delay of puberty through the use of LHRH, progestins and antiandrogens. For more information, see HBIGDA's SOC for the Assessment of and Treatment of Children and Adolescents.
Summary
A significant amount of information on CGHT can be found in the History and Physical Section of this TGHI website. This History and Physical Section on CGHT covers effects, risks, precautions, contraindications and much more. Please see that page for more details on CGHT for transgender men and women.