Hormone replacement therapy (HRT) for transgender and transsexual people replaces the hormones naturally occurring in their bodies with those of the other sex. Its purpose is to cause the development of the secondary sex characteristics of the desired gender. It can not undo the changes produced by the first natural occurring puberty of transgender people, this is done by sexual reassignment surgery and for transwomen by epilation. Some intersex people also receive HRT, either starting in childhood to confirm the gender they were assigned, or later, if this assigment has proven to be incorrect.
While some argue that hormonal therapy does not truly masculinize or feminize, the question is one of definitions. If by masculinize and feminize one means to completely reproduce the male or female biological state, that cannot be done with current medical or surgical therapy. However, the goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their true psychological gender identity. It should be noted that the effects of hormonal therapy are often much more satisfying to transgender males than transgender females. It is easier to produce secondary male sexual characteristics with androgens than it is to rid transgender women of those established characteristics.
Formal requirements for HRT
The requirements for hormone replacement therapy vary very much, often at least a certain time of psychological counselling is required, and so is a time of living in the desired gender role, if that is at all possible, in order to assure that they can psychologically function in that gender role. This period is sometimes called the Real Life Test (RLT). See also Standards of Care for Gender Identity Disorders.
Some individuals choose to self-administer their medication (“do-it-yourself”), often because available doctors have too little experience in this matter, or no doctor is available in the first place. Sometimes, trans persons choose to self-administer because their doctor will not prescribe hormones without a letter from the patient’s therapist stating that the patient meets the diagnostic criteria for GID and is making an informed decision to transition. Many therapists require at least 3 months of continuous psychotherapy and/or a real life test in order to write such a letter as is suggested in the HBIGDA Standards of Care. In these circumstances, the individual may self-administer until they can get these authorizations, feeling that they shouldn’t have to wait for a medical professional to be convinced of their situation. In addition, as many individuals must pay for evaluation and care out of pocket, expense can also be prohibitive to pursuing such therapy.
However, self-administration of hormones is potentially dangerous. Individuals seeking physicians who are knowledgeable and willing to treat transgender patients may wish to consult the Gay and Lesbian Medical Association’s referral service. GLMA.org.
- Tom Waddell Clinic Transgender Protocol – MTF and FTM clinical protocols aimed at providers
- Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects – Review Article on the treatment of transgender patients (MTF and FTM) from The Journal of Clinical Endocrinology & Metabolism – full text free online. This is a great article along with the Tom Waddell protocols to give to a medical provider new to treating trans patients.