Transsexuality is a phenomenon involving a mismatch between the gender assigned at birth and the gender experienced. For example, when a person assigned male at birth identifies as female.

Transsexuality is often discussed in a social context because transgender individuals are frequently stigmatized and excluded due to their differences. Fortunately, the societal approach to transgender individuals is gradually changing, partly because there is increased discussion on this topic.

The Role of Hormones in Transition

The topic of transsexuality is incredibly interesting from an endocrinological perspective as well because transgender individuals <strong,> undergoing transition, or gender correction typically aim for hormonal therapy. Transition also includes surgeries on the genitalia and legal procedures to align personal data in court.

In the case of hormonal therapy, there are several changes in external appearance.

Some time ago, on our Lumedic platform, Dr. Luiza Napiórkowska hosted a Live session on transsexuality from an endocrinologist’s perspective. Dr. Luiza invited Dr. Anna Kępczyńska-Nyk, an endocrinologist and sexologist, an expert in the field of transsexuality, to lead this Live session.

This article is a summary of the most important information from that conversation and was created to provide insight into transsexuality from an endocrinological perspective.

What criteria must be met to start hormonal therapy?

Hormonal therapy is initiated when specific criteria are met, with the most important being a diagnosis of gender dysphoria, a mismatch with one’s biological sex. Such a diagnosis is made by a mental health specialist – it could be a sex psychologist or a sex psychiatrist.

The transgender person must display clear and long-standing signs of dissatisfaction with their body and the gender assigned at birth. Discovering this truth about oneself often takes years, and making the diagnosis can be challenging.

Before starting treatment, collaboration between an endocrinologist and specialists in psychology, sexology, and psychiatry is necessary, especially when there are additional mental health issues. It’s crucial to administer hormones only to individuals whose identification with a gender other than their birth sex is persistent.

To begin hormonal therapy, achieving an appropriate age is also necessary. Sex hormones should not be administered to patients before reaching the final stages of sexual maturation or before 16 years old (unless there are additional factors).

In Western countries, such treatment can begin at 16 years old, assuming that at this age, the person is aware of the consequences of their actions. In Poland, there are no clear guidelines in this regard, but they are being formulated.

Starting hormonal therapy is preceded by a physical and subjective examination and laboratory tests and, in selected cases, imaging studies. A person wishing to undergo gender correction must primarily familiarize themselves with the medical procedure.

Only after meeting diagnostic criteria can hormonal treatment begin.

What does hormonal treatment involve?

Hormonal therapy for transgender men and transgender women differs.

For transgender men, testosterone preparations are used in the form of a gel for daily application to the skin or intramuscular injections.

However, for transgender women, treatment is more complicated as it involves anti-androgenic drugs that inhibit the secretion and action of testosterone and estrogen preparations. Estradiol – the female hormone – can be used in the form of patches, tablets, injections, or skin gel or spray.

Fun fact – hormones in gel work the same way as hormones in injections or tablets.

Hormones are administered chronically, aiming to achieve reference ranges of hormone concentrations for a specific gender.

There is no need to remove gonads before or during hormonal treatment unless the patient wishes. In Poland, without formal agreement in court, such procedures (impairing fertility) are possible.

For transgender women, after removing testicles, anti-androgens can be stopped. Most patients of Dr. Anna Kępczyńska-Nyk do not have removed gonads.

Hormonal therapy is a chronic treatment, so the patient takes sex hormones essentially for life.

Can complications arise after hormonal therapy?

A well-implemented therapy conducted according to guidelines is safe for patients. It’s essential to remember that the higher the hormone concentration, the greater the risk of complications, so treatment should be conducted exclusively under a specialist’s supervision.

However, individuals opting for gender correction must bear in mind that certain treatment effects are irreversible, hence the diagnostic procedure preceding hormonal therapy is crucial.

One of the irreversible changes caused by testosterone intake is a deepened voice in transgender men. In the case of transgender women, it’s breast gland growth.

The extent of changes achievable through hormonal treatment depends on the genetic predispositions of the patient.