5 Things You Need to Know About Hormone Therapy From an Lgbtq+ Nurse Practitioner

When I started medical transition at 20 years old, it was very difficult to get the care I needed for hormone replacement therapy because there are very few providers trained in starting hormones for trans people, even though it’s very similar to the hormones that we prescribe to women in menopause or cisgender men with low testosterone.

I hope more providers get trained in LGBTQ+ healthcare, so they can support patients along their individual gender journey, and provide the info needed to make informed decisions about their body. I’ve personally seen my trans patients find hope and experience a better quality of life through hormone replacement therapy.

If you don’t have a primary care physician who specializes in LGBTQ+ care in your community, you may need to educate yourself (and your provider). But, before you seek such therapy, here are five things you should know!

1. Monitor closely. At Spectrum Medical Care Center, we screen patients for certain risks before starting anyone on hormones. We frequently monitor patients in the first year to ensure there are no adverse reactions and lab results are within safe ranges. Follow-up care is also important to assess your comfort with the transition as well as the social impact and social support you’re experiencing.
2. Some changes are permanent, some temporary. For transmasculine individuals going on testosterone, they’ll experience these permanent changes: deepened voice, clitoral enlargement (also known as bottom growth), more body, facial hair, and male pattern baldness. Reversible changes include cessation of menses, increased muscle mass and strength, body fat redistribution, and skin oiliness or acne. For those going on estrogen therapy, the most permanent change is breast growth. Feminizing hormone therapy can also cause atrophy (shrinkage) of the genitals and loss of erectile function that may not be reversible. Estrogen will thin body hair, soften the skin, can increase scalp hair, and decrease muscle mass and strength, all of which are reversible.
3. You can’t pick and choose results. Unfortunately, you can’t pick and choose the physical changes you want, which may feel challenging. Some of my patients will say, ‘Okay, ‘I’ve seen the permanent changes I want, and I don’t want it to go any further,’ and so at that point, we stop therapy. Low-dose hormone therapy can slow down the rate of changes, allowing for a more gradual physical transition. We counsel patients in advance about the common changes, and it’s up to the individual as to when they’d like to scale back and determine whether some benefits are worth the potential risks.
4. Be aware of risks. Like any medical treatment, there are potential risks involved. Some risks with testosterone therapy include increased red blood cell mass, acne, hypertension, sleep apnea, weight gain, and dyslipidemia (increases the chance of clogged arteries). Cardiovascular disease is likely increased with additional risk factors for testosterone and estrogen therapy. Transfeminine patients going on estrogen therapy may experience weight gain, thromboembolic disease (when a blood clot breaks off and blocks another blood vessel), and a high level of triglycerides in the blood.