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Importance of Feminizing Hormonal Therapy

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Feminizing hormone therapy helps trans women achieve a more feminine appearance. Read the article below.

Written by

Dr. Dheeksha. R

Medically reviewed by

Dr. Raveendran S R

Published At June 2, 2023
Reviewed AtMarch 11, 2024

Introduction

Feminizing hormonal therapy helps male-to-female transgender, usually known as transwomen, attain a more feminine appearance. This therapy uses anti-androgen hormones to block male hormones. Intake of estrogen and progesterone hormones helps develop breasts, softer skin, rounded hips, etc.

What Is Feminizing Hormone Therapy?

Feminizing hormonal therapy is usually used by transwomen or nonbinary people to bring physical changes in the body caused by female hormones during puberty; those changes are called secondary sex characteristics. It helps to align the body better with gender identity; hence is called gender-affirming hormone therapy.

This therapy involves the blockage of male hormones like testosterone through medications. It also involves the intake of the female hormone estrogen. Estrogen helps to reduce the production of testosterone and enhances the female secondary sexual characteristics. Feminizing hormone therapy can be done alone or with feminizing surgery, which can affect fertility and sexual function and may result in health issues.

Who Does Feminizing Hormonal Therapy?

Trans women do feminizing hormone therapy; they are male at birth but are identified as women. It is a common treatment for gender dystrophy (a condition where there is a difference between physical appearance and assigned gender). Nonbinary and intersex people also undergo feminization therapy. Nonbinary people have gender identities that do not fit within the male or female category. Intersex people are born with sexual characteristics that do not fit perceptions of male and female bodies. They may have conditions affecting the gonads, external genitals, or chromosome patterns. This therapy is for anyone who feels that their external appearance mismatches their gender and self.

Why Is It Done?

Feminizing hormone therapy alters hormonal levels, stimulating the physical changes that better align with the body and gender identity. This therapy helps to improve the following:

  1. Enhance psychological and social well-being.

  2. Smooths the psychological and emotional stress related to gender.

  3. Enhance satisfaction with sex.

  4. Enhance the quality of life.

Feminizing Hormonal Therapy Can Cause Certain Problems If:

  1. A person is affected by hormone-sensitive prostate cancer.
  2. A person has issues with blood clots, such as deep vein thrombosis, a condition where clots form in the deep vein, or pulmonary embolism, where there is a blockage in the pulmonary arteries of the lung.

  3. A person has a medical condition that has not been addressed.

  4. A person with a behavioral health condition.

  5. A person with a condition that limits the ability to give informed concern.

What Are the Changes Caused by Feminizing Hormonal Therapy?

People assigned as male at birth produce a low level of the female hormone estrogen. Feminizing hormonal therapy enhances physical and emotional changes that are very consistent with feminine anatomy and behavior. With this therapy, a person will get hormones and other substances, which include anti-androgen medicines, estrogen, and progesterone. The male sex hormone testosterone is blocked through anti-androgen therapy. The changes caused are:

  1. Reduced muscle mass.

  2. Decreased erection.

  3. Alterations in sex drive.

  4. Smaller testicles.

  5. Thinning facial and body hair.

Estrogen and progesterone enhance physical changes that show more female appearance. These changes are:

  1. Soft skin.

  2. More fat in the hip, buttocks, and face.

  3. Full breast.

  4. Mood swings, anxiety, and depression.

When Is the Therapy Done?

It is the choice of a person to take up feminizing hormone therapy. Some people change their gender initially by changing their names and dressing. Feminizing hormone therapy can be done at the age of 16; starting at a young age helps to block the effects of puberty on their assigned birth gender.

How Does a Person Prepare for Feminizing Hormonal Therapy?

  • Patient Education:

It educates the person about how the treatment works and what to expect from the outcome. It also explains the risks and benefits.

  • Medical History:

A check for estrogen-dependent conditions, such as breast cancer and endometriosis.

  • Physical Examination:

To ensure the person is healthy enough to start with feminizing hormone therapy.

  • Lab Test:

These tests include blood panel, urinalysis, and liver function test.

  • Mental Health Evaluation:

It helps to make a gender dysphoria diagnosis.

How Does This Therapy Work?

Initially, anti-androgen medication is taken to stop testosterone production, followed by estrogen after a few weeks. These hormones are available in many forms, such as

  1. Pills.

  2. Injections.

  3. Cream.

  4. Patches.

People undergoing feminizing hormonal therapy are initially prescribed with a low estrogen level; these levels differ for each person. The doctor determines the dosage that is appropriate for each person. Starting with a low dosage helps to reduce the complications and side effects. Once the body gets used to the medications, then the dosage is increased. After achieving the desired result, the medications can be taken in low doses throughout life.

What Are the Side Effects and Risk Factors of Feminizing Hormonal Therapy?

The complications include:

  • Deep vein thrombosis (DVT).

  • Electrolyte imbalance.

  • Hyperglycemia (elevated blood sugar).

  • High blood pressure.

  • Hyperkalemia (high level of potassium).

  • Low blood pressure.

  • Osteoporosis.

  • Water retention.

  • Blood clots in deep veins.

  • Heart problems.

  • High levels of triglycerides.

  • Nipple discharge.

  • High level of prolactin hormone.

  • Infertility.

  • Type 2 diabetes.

  • Stroke.

  • Weight gain.

  • Increased chances of breast cancer.

To minimize the risk and complications, the people taking feminizing hormone therapy should maintain a hormone level in the range similar to cisgender women.

How Does Feminizing Hormonal Therapy Affect Fertility?

Feminizing hormone therapy usually limits fertility; deciding about fertility before starting the therapy is best. With the long-term use of hormones increases the risk of permanent infertility. It causes a high risk for people who start the therapy before puberty. Even after stopping the hormonal therapy, the testicles may not recover to ensure conception without infertility treatment. If a person plans to have biological children, they can discuss it with the doctor to freeze the sperm before starting the hormonal therapy; this is called sperm cryopreservation.

What Are the Other Methods Available for Transwomen?

Feminizing hormone therapy is usually the first step in gender affirmation, while some trans women also prefer surgery. For those for whom surgery is not required, there are other options, such as:

  • Facial Feminization:

This procedure causes changes in the face, such as shortening of the forehead or softening of the angles of the jaw.

  • Vaginoplasty:

It includes the removal of the penis, testicles, and scrotum, and the remaining tissue is used to create a functioning vagina.

  • Voice Feminizing Surgery:

The surgeon alters the vocal cords, which helps achieve a high-pitched and more feminine-sounding voice.

Conclusion

Feminizing hormone therapy is used by trans women to achieve a better feminine appearance. These are done by changing the hormonal levels. Anti-androgen medications are prescribed, which reduce the production of testosterone hormone, and certain estrogen hormones are provided that enhance female sexual characteristics. These may include many side effects and may lead to infertility, which needs to be discussed with the doctor before initiating feminizing hormone therapy.

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Dr. Raveendran S R
Dr. Raveendran S R

Sexology

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