Gender-Affirming Hormone Therapy

What do hormones do when taken for gender transition?

Testosterone

Testosterone is typically given to people assigned female at birth who are seeking to develop stereotypical male characteristics. Taking this hormone typically results in:

• Deepening of the voice (starts within one month)
• Development of more body hair (starts within six months)*
• Development of more muscle mass (starts around six months)
• Decreasing the size of the vagina (starts around six months and can be ongoing)
• Increasing oily skin/acne (starts around one month)
• Enlarging the size of the clitoris (starts around three months)*
• Ending of menses or menstruation cycles (starts at three or four months, is often dose dependent)
• Redistribution of body fat (starts around six months)
• Variable infertility so pregnancy is possible while taking testosterone

*These changes are understood to be irreversible

Estrogen and anti-androgen

Estrogen and anti-androgen medications are often taken together by people assigned male at birth but identifying as female and seeking stereotypical female characteristics. Taking these hormones typically results in:

• Decreased libido/erections (start within one to three months)
• Decreased growth and thinning of facial/body hair (starts around three to six months)
• Softening of skin/decreased oiliness (starts around three to six months)
• Decreasing the size of male genital (starts around 12 months)
• Decreasing muscle mass (starts around three to six months)
• Developing breasts (starts around three to six months)*
• Variable infertility that is unique to each person so it is difficult to predict when someone will stop producing sperm*

*These changes are understood to be irreversible

What hormones do not change

Hormone therapy does not change a person’s:

• Height
• Bone structure
• Voice (for those who have undergone natal male puberty)
• Adam’s Apple appearance

How are hormones taken?

Testosterone can be taken in any of these methods:

• As a gel or cream applied daily to the skin
• As a subcutaneous (or intramuscular) weekly injection
• As a tablet two times a day

Anti-androgen medications are typically taken via pill one to two times daily to suppress testosterone levels.

Estrogen can be taken in any of these formats:

• As a tablet you swallow (or dissolve under your tongue) one to three times daily
• As a subcutaneous (or intramuscular) injection weekly
• As a patch applied to the skin one to three times a week

There are other medications commonly used as adjuvants to GAHT for masculinization and feminization. Your clinician will talk to you about them and how they might be included in your transition.

What are the risks associated with GAHT?

Generally, the risks of GAHT are quite low.

Testosterone risks

• Polycythemia (the body’s production of too many red blood cells) is seen commonly in tobacco users. It is not life threatening, and your clinician will talk with you about your red blood cell levels monitored by blood work.
• Issues with conceiving a baby. Testosterone cannot be taken if you are trying to become pregnant or could become pregnant.

Estrogen risks

• Increased risk of blood clots. Blood clots can be life threatening and require emergency treatment. The risk of developing a blood clot is much higher in those with a personal history of blood clots, family history of blood clots or those using products containing nicotine (even occasionally). This risk also varies depending on the type and delivery method of estrogen used. Your clinician will talk to you about what method of taking estrogen makes sense for you.
• Loss of erectile function associated with testosterone suppression.
• Permanent sterilization/infertility may be likely, even if hormones and blockers are stopped. Your clinician will talk to you about options to preserve your fertility and family planning.

How often will I have to get blood work?

This will vary but you can expect to have labs done every three to six months after starting GAHT for approximately one year. It will be annually once you are on a consistent dose and have consistently had normal lab results.

Can I get gender-affirming hormone therapy near me?

GAHT is provided by specially trained experts from the Main Line Health Gender Care Program at Bryn Mawr Hospital in Bryn Mawr, PA and at Riddle Hospital in Media, PA.

How do I take the next steps to get gender-affirming hormone therapy?

Your care may vary depending on your provider. Typically, you’ll start with an initial visit to discuss a personalized plan. Follow-up appointments help monitor your health and treatment progress.

To learn more about the Main Line Health Gender Care Program or to schedule an appointment with a gender care specialist, please review our LGBTQ+ Inclusive Care services.