The decision to start hormone replacement therapy (HRT) can be an exciting one. For many people, hormone therapy is the first step towards the physical transition to a female body. First you need to find a doctor who can prescribe female hormones, which you will take via patches, pills or injections. As your body begins to change, you will need to manage side effects and reduce unwanted ones. After a few years of therapy you will be able to consider the option of surgery.
Steps
Part 1 of 4: Receiving Medical Treatments
Step 1. Find an endocrinologist or other local doctor
Ask your GP if he can prescribe HRT for you. Some are able to do this, but in most cases you will be recommended the name of an endocrinologist (a hormone specialist). If you don't have a family doctor, search the internet.
- Consult with local LGBT agencies and ask for recommendations on the best doctors.
- If you live in the United States, some Planned Parenthood centers offer HRT.
Step 2. Provide informed consent on the transition process
Your doctor will explain the changes, side effects and the process you will have to undergo during HRT; can also deliver brochures and materials to you. Read them carefully. Once you are sure you are continuing, sign a release for the doctor to proceed.
- Most doctors prescribe HRT only for patients of age. Adolescents close to the age of majority can support therapy with the authorization of their parents or guardian. Talk to your doctor for more information.
- HRT increases the risk of blood clots, cancer and heart attack.
- After a couple of months of therapy you will become permanently sterile. If you wish to store sperm so as not to preclude the possibility of having a baby someday, talk to your doctor about your options for this.
Step 3. Show that you are able and willing to take HRT
Some doctors require "proof" that you are comfortable living as a woman and that you are able to make the decision to start therapy. To do this, you may need to prove that you have lived for 12 months as a woman. If you have a psychologist who follows you, you can ask him to write you a recommendation.
- Some doctors require a psychological evaluation done by a therapist. They can recommend a professional to you or you can choose one yourself.
- Not all doctors require this step. That said, many will try to make sure you have thought through your decision.
Step 4. Talk to your doctor about your health history
Hormone therapy increases the risk of some medical problems and can interfere with certain medications. Tell your doctor your entire medical history, including previous hormone treatments and drug therapies you are currently following.
- Tell your doctor about any history of cardiovascular problems (such as heart disease, high blood pressure, or heart attacks), deep vein thrombosis, blood clots, or liver disease. Hormone therapy increases the risk of these conditions.
- Be sure to tell your doctor about your mental health as well, mentioning any history of depression, bipolar disorder, or psychosis.
Step 5. Get blood tests to determine your health status
These tests help your doctor choose the medications and dosages that are best for you. Plus, you can be sure that you are healthy enough to take hormone therapy. Your blood will be scanned for this information or disease:
- Blood cell counts, glucose and lipid levels in the blood.
- Liver function.
- Diabetes.
- Testosterone Levels.
Step 6. Get a prescription for female hormones and antiandrogens
You will be prescribed a form of estrogen to introduce female hormones into your body, as well as an antiandrogen to act as a male hormone antagonist. In rare cases, you will also be given progesterone.
- Estrogens include estradiol, estriol and estrone (this is the "female" hormone, available in pills, patches or syringes).
- Antiandrogens reduce the effects of testosterone (the "male" hormone) in your body. The most common form is spironolactone, which is available in pills.
- In some cases, progesterone can be used if estrogen isn't working for you. That said, it is usually not prescribed due to the high risk of side effects.
Step 7. Save for the treatment
HRT can cost up to € 1,500 per year. Some drugs may be passed by the ASL, others not. Find out about the costs involved in your specific therapy and, if necessary, start saving.
Almost all people follow HRT throughout their life. Include hormone expenses in your budget
Part 2 of 4: Taking the Medications
Step 1. Apply the estrogen patches directly to the skin
This hormone can be administered through the skin. Follow the instructions on the package insert to apply the patch. In almost all cases, you will need to do this twice a week on clean, dry skin.
The patches are best suited for women over 40, smokers, and those at high risk of developing blood clots
Step 2. Take a pill according to your doctor's instructions
In some cases, estrogen is prescribed in pills. In addition, antiandrogens are also often in pills. Read carefully the instructions contained in the package. Some pills are taken every day, others every 48 hours.
- The pills carry various levels of risk and effectiveness.
- Never exceed the prescribed dose of hormones. Taking higher dosages does not accelerate the transition, it only increases the risk of complications.
Step 3. Inject estrogen into the buttocks or thigh once a week
Ask your doctor to show you the correct procedure. Before injecting, clean the syringe and skin with alcohol wipes. Insert the tip into the medicine bottle and hold it upside down to fill it. To do this, pull the plunger. Make sure you squeeze the syringe and push the plunger to push out any air bubbles before injecting.
Injections administer high doses of estrogen, but greatly increase the risk of blood clots
Step 4. Watch out for side effects when starting therapy
Each person reacts differently to HRT. Some take longer than others to develop feminine characteristics. It's important to keep an eye on your health and recognize any side effects right away. Call your doctor if you notice:
- Abdominal pain.
- Nausea or vomiting.
- Headaches or migraines.
- Skin irritations.
Step 5. Go back to the doctor every 3 months for the first year
It will check your hormone levels and for side effects, such as diabetes or kidney and liver problems. He may also decide to increase the dosage of estrogen or antiandrogen. After the first year, you will need to be checked every 6-12 months.
Part 3 of 4: Managing Physical Change
Step 1. Stop smoking
Smoking can reduce the effects of estrogen and increase the risk of complications. If you smoke, ask your doctor to help you quit.
Step 2. Pay attention to decreased libido
HRT can reduce your sex drive. If you are currently in a romantic relationship, talk to your partner about your needs and desires. Make sure she understands that your libido may be decreasing. If necessary, you can participate in couple therapy sessions together to overcome the problem.
For some people, the reduction in libido continues for the duration of therapy
Step 3. Exercise to maintain muscle tone
Estrogen changes how the body distributes fat and muscle. On average, women have less muscle than men. That said, muscle tone is important for overall health. Keep exercising to stay fit.
Step 4. Undergo laser or electrolysis treatments to remove unwanted hair
Estrogen makes hair on the back, face and arms thinner, but it will usually not get rid of it completely. To remove hair from those areas, make an appointment with a dermatologist or plastic surgeon for laser or electrolysis hair removal treatment. It can take several sessions to get rid of the hair completely.
- The average cost of laser hair removal is around € 200 per session.
- The average cost of electrolysis is € 50-100 per hour.
Step 5. Create a good support group
HRT can help you feel at peace with your sexual identity. That said, you may be suffering from mood swings or other side effects. Tell friends and family what to expect as you go through therapy. Ask them to support you in these difficult times.
- If you are not already in group therapy, you can find a psychologist who can assist you with therapy.
- Many LGBT centers offer support groups for people who are currently facing or considering HRT.
Part 4 of 4: Taking the Next Step
Step 1. Wait 2 years before considering plastic surgery
It can take up to 2 years for the hormone to complete its action on the body. Breasts, hips, and face may not assume feminine characteristics before that time, and it can also take time for fat to redistribute within your body.
Step 2. Start having breast cancer follow-up visits 2-3 years after starting therapy
Even if your risk of breast cancer is still lower than that of a non-trans woman, your risk will still increase. After a few years of taking hormones, schedule annual checkups to prevent breast cancer.
Step 3. Talk to your doctor if you wish to have surgery
Not all people undergoing HRT decide to go through the gender reassignment operation, but if this is your preferred option, talk to your doctor to determine the best step for you. The operation consists in the removal of the male genitalia and the formation of the female ones.
- Removal of the testicles is a procedure called an orchiectomy. After that, you can start taking lower doses of estrogen.
- Other interventions you can consider include cosmetic surgery to make the face more feminine and breast augmentation.
Step 4. Save for the surgery
In some cases, the reassignment surgery will be passed by the ASL, but other cosmetic surgery operations such as breast augmentation will rarely be, which can be very expensive.
- The price of a reassignment intervention starts from € 30,000.
- The feminization of the face starts at € 5,000 and goes up to € 20,000.
- The cost of breast augmentation varies a lot, but can usually go up to € 4,000.
Step 5. Ask your doctor if you need to stop hormone therapy before surgery
Since hormones can increase the risk of clots, your doctor may advise you to stop taking them for 4-6 weeks before the operation. You will have to wait a couple of weeks after getting under the knife before resuming therapy.
Warnings
- HRT can increase the risk of heart attacks, breast cancer, and blood clots.
- You can suffer from mood swings during therapy.
- Taking hormones without a doctor's supervision or prescription can be extremely dangerous.
