At a Glance
Before starting gender-affirming hormone therapy, it is important to understand your transition goals, current health, fertility considerations, expected physical and emotional changes, potential risks and the need for ongoing monitoring. Choosing an experienced healthcare provider with structured follow-up and comprehensive support helps ensure treatment is safe, informed and tailored to your individual needs.
Considering Gender-Affirming Hormone Therapy?
Starting the journey of gender-affirming hormone therapy (GAHT) is akin to beginning a personal journey to align your physical traits with your gender identity. Undoubtedly, it’s a significant and empowering step for many transgender people and comes with many positive effects.
You may have read about GAHT, have decided that it’s right for you and are eager to start the process. But GAHT may introduce changes that greatly affect many aspects of your life. This treatment’s outcomes vary from person to person and may involve hormones like testosterone or estrogen at different stages of care.
Before you dive into gender-affirming hormone treatment, this article will help you carefully consider some important factors.
1. Your Personal Goals
Before you begin, you must be clear about what you wish to achieve from transgender HRT. Everyone has different transition goals, and there is no single right outcome.
GAHT introduces a wide range of changes, but it’s important that you clearly understand which are possible and which aren’t. For instance, using oestrogen for transgender HRT or feminisation may bring about many physical, sexual, emotional and reproductive changes. It’s important to know which of these changes are permanent and which can be reversed.
Everyone’s transition goals are different. During GAHT, you may expect the transition to happen sooner, but the changes don’t follow strict timelines. Some changes may happen earlier than others. That is why, along with setting your transition goals, it’s equally important to set realistic expectations for the outcomes.
2. Your Existing Health
Having certain medical conditions doesn’t automatically mean HRT won’t be successful, but it may require close monitoring or adjustments. Before starting transgender HRT, you’ll need to work with a healthcare professional like your general physician (GP). They may discuss your heart health, blood pressure, diabetes, liver function, smoking, blood clots and family medical history.
Regardless of whether you have any medical conditions, you may still be advised to conduct baseline blood tests. These tests are important as they establish current hormone levels, check general health markers and provide a safe starting point for treatment.
3. Fertility Preservation
Once on GAHT, the changing hormones can affect your fertility, and the effects may not always be reversible. As a result, if you want biological children in the future, you may want to discuss fertility preservation options with your healthcare professional before you start hormone therapy. Common fertility preservation options include egg freezing, sperm freezing and embryo freezing.
4. Changes to Expect
Depending on your goals, as you start taking gender-affirming hormones such as oestrogen and testosterone, you can expect many physical and emotional changes to occur.
Physical Changes
These may include changes in the distribution of body fat, your skin texture and the development of secondary sexual characteristics. You may experience breast development if you’re undergoing feminisation with oestrogen and testosterone blockers. While testosterone in masculinisation therapy can lead to voice deepening and increased muscle mass.
Emotional Changes
Emotional changes are common along with physical changes. You may experience mood swings similar to those you may have experienced during puberty. You may also experience better mental well-being as you become more aligned with your gender identity. From mood swings to anxiety, these emotional changes are common to the transgender HRT journey and usually settle down over time.
Throughout these changes, it’s important to work with a gender care provider and monitor hormone levels through regular blood tests, interpretation and review.
5. Benefits to Consider
GAHT has numerous benefits, including increased self-esteem, confidence and sexual satisfaction, though individual experiences and outcomes vary. When done right and under the guidance of clinicians, hormone therapy can considerably reduce gender dysphoria and improve your mental health, well-being and overall quality of life.
5. Possible Risks to Expect
Along with the benefits, you also need to consider the potential risks involved in transgender HRT.
Potential risks vary depending on the hormone you have been prescribed and your health. For example, oestrogen therapy may increase the risk of blood clots in some people, while testosterone therapy may lead to polycythemia or thickening of the blood. Your clinician will discuss this with you based on your health history.
However, many find that the benefits of hormone therapy outweigh the potential risks.
6. Follow-Up and Monitoring
For GAHT to succeed, you must place equal emphasis on consistent monitoring and follow-up, in addition to hormone intake. To ensure that your treatment is both safe and effective and in line with your transition goals, you’ll need to attend regular follow-ups.
In the initial year or so, expect these follow-ups and reviews to be more frequent, about every 3 months. Once the hormones and their effects stabilise, follow-up appointments are often less frequent and may shift every six to twelve months, depending on your progress. Regular review sessions allow healthcare professionals to adjust hormone dosages based on your individual response and changes in health.
Blood tests play an important role in monitoring your progress. Your healthcare provider will check the hormonal levels of testosterone and estradiol, along with other markers that may flag potential complications, such as high potassium levels or liver function issues.
7. Choosing the Right Healthcare Provider
Selecting the right healthcare provider is just as important as deciding to start HRT. Before you begin GAHT, you may want to consider your care goals.
Some questions worth asking before you decide on a provider:
- How do you carry out assessments?
- How often are follow-up appointments?
- How do you arrange for blood tests?
- Are prescriptions included?
- Do you offer additional services such as GRC reports and surgery referrals?
8. Care After GAHT
After starting GAHT, you’ll still need to care for your body.
Preventative care and regular screenings are just as important before you transition. The screenings you need depend on your anatomy, age, medical history and treatment. These can include mammograms, prostate screenings, pap smears and DEXA tests (for bone density). Your clinician can advise which routine screenings are appropriate for you.
In Summary
Feeling excited, nervous and uncertain before starting gender-affirming hormone therapy is absolutely normal. What’s important is to be sure about transitioning, fully understand the commitment involved and choose a provider who can offer all-round care to begin transgender hormone therapy with renewed confidence.
Additionally, surrounding yourself with a supportive community or network can help you navigate any challenges smoothly. Besides this, taking the time to prepare mentally, emotionally and physically will pave the way for a more positive and fulfilling experience.
