Transgender individuals are a part of society. Unfortunately, there is still a lack of acceptance and willingness to understand their needs, which often leads to feelings of exclusion, stigmatization, and minority stress. Thankfully, by discussing transgender issues across various platforms, awareness of this phenomenon is growing, attitudes toward gender diversity are changing, and transgender people are increasingly able to receive understanding and support.
Transgender identity can be described as the incongruence between the gender assigned at birth and the gender that a person feels. For example, someone assigned female at birth may identify as male or as another gender. Over time, the increasing experience of gender dysphoria—discomfort or distress due to the lack of acceptance of one’s body—may lead individuals to begin hormone therapy or undergo surgeries to align their bodies with their gender identity.
How does hormone therapy work?
The requirement to begin hormone therapy is a psychological and sexological evaluation. During meetings with a psychologist, it is determined whether the individual meets the criteria for gender incongruence, does not present mental health issues that could impede making an informed decision, and has sufficient knowledge about the transition process. The decision to start hormone therapy must be made with careful consideration, as some changes caused by the medications are irreversible and may occur even in the early stages of therapy.
For transgender men, testosterone preparations are administered. In Poland, the available options include:
- Intramuscular injections
- Testosterone gel
These preparations vary in terms of duration, method of administration, and cost, but the effects they produce are similar.
For transgender women, therapy is more complex. Estrogen preparations are administered alongside anti-androgens because estrogen alone will not suppress the endogenous testosterone produced by the gonads, making it difficult to achieve satisfactory feminizing effects.
Estrogen preparations available in Poland include:
- Oral preparations (tablets)
- Gel preparations
- Patches
Some individuals also use intramuscular preparations, although these are not available in Poland.
Anti-androgens available in Poland, used orally, include:
- Cyproterone acetate
- Spironolactone
In Poland, hormone therapy is reimbursed only for transgender women (covering most preparations containing estradiol and cyproterone acetate).
What Are the Effects of Hormone Therapy?
- The effects of hormone therapy for transgender women may include breast growth, redistribution of body fat, smoother and softer skin, and the reduction of hair growth in androgen-dependent areas.
- For transgender men, effects may include a deeper voice, increased muscle mass, the appearance of hair in androgen-dependent areas, and clitoral enlargement.
However, the results of therapy may not always meet expectations. It is important to inform individuals beginning gender-affirming hormone therapy that the belief that “higher hormone levels lead to better results” is a myth. There is no simple relationship between hormone concentrations in the blood and clinical effects, e.g., higher estrogen levels do not necessarily result in larger breasts. Much depends on a person’s genetic factors. In reality, higher levels of sex hormones carry increased risks and side effects.
Hormone therapy does not change the shape of bones, such as the forehead, jaw, or other facial features. Therefore, some transgender women may choose facial feminization surgeries. Similarly, transgender women may opt for vocal cord surgery, as the tone of the voice does not change as a result of feminizing hormone therapy.
Regarding non-binary individuals who do not fully identify with either gender and have specific needs, hormone therapy can be challenging. Sometimes, only part of their needs can be met.
Side Effects of Hormone Therapy
Before starting hormone therapy, individuals should be informed about all possible side effects.
Transgender Women:
- Venous thromboembolism (only with oral estrogen preparations)
- Prolactinomas
- Breast cancer (not clinically significant)
- Gallstones
- Elevated blood triglycerides (oral preparations)
Transgender Men:
- Polycythemia (increased red blood cell count—hematocrit)
- Liver function disorders (not clinically significant)
- Hypertension
- Hypercholesterolemia (elevated LDL and non-HDL cholesterol)
Are There Contraindications to Hormone Therapy?
Hormone treatment is safe if conducted according to a doctor’s guidelines and when regular lab tests (including hormone levels and other parameters affected by hormones) are carried out.
How to Prepare for a Specialist Appointment?
For transgender women, an endocrinologist appointment requires a psychological and sexological evaluation confirming the criteria for gender incongruence, along with a certificate from a psychiatrist stating no contraindications to undergoing therapy. Laboratory tests are also necessary.
Transgender men should prepare an ultrasound of the breasts and results from a gynecological consultation, including an ultrasound of the reproductive organs.
Laboratory tests are needed for all individuals.
Dr. Anna Kępczyńska-Nyk, MD, PhD
Endocrinologist and Sexologist