Effects of Hormonal Therapies

Hormonal therapy is a crucial part of the gender alignment process for transgender individuals and causes various physical, emotional, and sexual changes in the body.

These therapies are divided into two main groups: feminizing hormone therapy for trans women (male-to-female, MTF) and masculinizing hormone therapy for trans men (female-to-male, FTM). The aim of both treatments is to align a person’s body characteristics with their gender identity. The short and long-term effects of hormonal therapies are as follows:

Effects of Hormonal Therapy in Trans Women (MTF)

Hormonal therapy for trans women generally includes estrogen and anti-androgens. Estrogen promotes the development of feminine features while anti-androgens suppress the effects of testosterone.

• Physical Changes
  • Breast Development: Long-term use of estrogen results in breast growth, typically starting within 3 to 6 months and becoming noticeable in 2-3 years. However, growth usually does not reach the size seen in cisgender women and results can vary from person to person.
  • Skin and Hair: Skin becomes thinner, softer, and smoother. Body hair decreases, but facial hair might not completely disappear, requiring additional procedures such as electrolysis or laser hair removal.
  • Body Fat Distribution: Fat tissue increases in the hips, thighs, and waist, leading to a more feminine body shape.
  • Muscle Mass: Decreased testosterone levels lead to a reduction in muscle mass and strength, resulting in a softer and less muscular body structure.
  • Changes in Sexual Organs: Suppressed testosterone levels can cause the penis and testicles to shrink. Sperm production and fertility significantly decrease, potentially leading to permanent infertility.
• Emotional and Sexual Changes
  • Libido: Estrogen therapy can decrease libido, which may alter sexual desires and fantasies.
  • Sexual Function: Frequency and firmness of erections decrease. While the ability to orgasm continues, the sensation and duration of orgasm can change.
  • Emotional State: Estrogen and low testosterone levels can lead to emotional changes. Some individuals report increased emotional sensitivity, reduced aggression, and enhanced emotional expression due to hormonal therapy. However, these changes may not always be positive, and conditions such as depression or anxiety can also be triggered by hormonal changes.

Effects of Hormonal Therapy in Trans Men (FTM)

Hormonal therapy for trans men primarily involves testosterone. Testosterone promotes the development of masculine features.

• Physical Changes
  • Virilization: Testosterone therapy initiates signs of virilization, such as voice deepening, increased body and facial hair, clitoral enlargement (clitoromegaly), and oily skin. These effects usually appear a few months after starting the treatment.
  • Muscle Mass: Testosterone causes an increase in muscle mass and strength, leading to a more masculine body structure.
  • Body Fat Distribution: Fat shifts from the hips and buttocks to the abdominal area, creating more masculine body contours.
  • Cessation of Menstrual Periods: Testosterone generally stops menstrual cycles within a few months, which can significantly relieve gender dysphoria for some trans men.
  • Changes in Sexual Organs: The clitoris enlarges and sexual excitability may increase. Prolonged use of testosterone can negatively affect fertility and lead to permanent infertility.
• Emotional and Sexual Changes
  • Libido: Testosterone therapy often leads to an increase in libido, resulting in heightened sexual desires and altered sexual behaviors.
  • Emotional State: Some trans men report that testosterone provides them with more energy and emotional stability. Conversely, increased anger, aggression, or emotional variability can also occur during testosterone use.

Health and Risks

While there are benefits to hormonal therapy, there are also some risks. Therefore, hormone therapy should be supervised by a doctor and monitored through regular blood tests:

• Cardiovascular Health: Especially in trans women, estrogen therapy can affect heart health. Estrogen increases the risk of blood clotting, which can lead to vascular blockages.
• Bone Health: Long-term testosterone therapy can increase bone density, while a lack of estrogen can decrease it, raising the risk of osteoporosis.
• Liver Function: Both estrogen and testosterone therapies can affect liver functions over the long term. Regular monitoring and tests are crucial for maintaining liver health.

Personal and Individual Variations

Each individual’s response to hormonal therapy can differ. Factors such as genetics, initial hormone levels, age, and overall health condition determine the effects and outcomes of the treatment. Therefore, hormone therapy should be personalized.

Long-Term Effects

More research is needed to understand the long-term effects of hormonal therapies. Current studies emphasize the positive correlation between hormone therapy and gender alignment, but regular follow-up and assessment of long-term health outcomes are necessary.

In conclusion, hormonal therapy helps transgender individuals achieve a body experience aligned with their gender identity. However, the effects, benefits, and risks of this therapy should be thoroughly discussed with health professionals and tailored to individual needs.