"Gender-affirming care is essential and life-saving for many trans, intersex, gender non-conforming and gender-diverse individuals. At Equal Health, we understand the necessity for gender-affirming care and ensure a safe and inclusive health care experience to everyone we serve." - Dr. Avantika Varma
One of the main services Equal Health offers is Gender-Affirming Hormone Therapy. Equal Health’s Estrogen or Testosterone Memberships gives the trans, non-binary and gender-diverse community the option to pursue Hormone Replacement Therapy (HRT) conveniently from the privacy and safety of their own homes. For clarity and specification, this post will focus on Estrogen, along with the expectations and changes through treatment. In April, we will discuss Testosterone.
Much in the way we create goals for our financial or creative futures, envisioning one’s own gender-affirming healthcare journey can be an incredible guide. Having focused goals is helpful to communicate hopes with a healthcare professional and provides information to move forward with an individual plan. Awareness around the changes caused by HRT can empower and help prepare for the journey ahead. There are a few categories in which changes occur with HRT: physical, reproductive, sexual and emotional.
First and foremost, it’s important to note that HRT is never a one-size-fits-all. Just as the puberty experienced in teen adolescence happens over years, the body’s journey with HRT will develop over time. Though it typically takes around 3 years to see the fuller fruition of HRT, gender-affirming hormone therapy has no exact timeline. As it is akin to secondary puberty, with the patient’s current age and genetics considered, timelines will be individual dependent. Dosage is tailored to each patient and may change according to a healthcare provider’s observational analysis, noting the body’s response with lab tests. However, higher doses do not produce desired results more quickly; in fact, too much too soon can be harmful. In addition to Estrogen HRT, anti-androgens will help block the production of and action of testosterone, allowing Estrogen to work more effectively at a steady pace.
Initial changes with Estrogen are thinner skin and less oil production. After 2 years or more, facial fat shifts and skin becomes smoother, especially around the eyes and cheeks. Though bone structure will not change, weight will redistribute throughout the body around the hips and thighs while the muscles on the arms and legs will be less defined and more smooth. Facial and body hair additionally becomes thinner and will grow at a slower pace. “Buds” will develop under the nipples and can initially be painful as breasts begin to further develop. All of these changes can take a year or more and any breast augmentation or facial surgeries or further treatments like electrolysis are recommended after a year or two of regular treatment.
Sexual changes are another aspect that will be noticeable during Estrogen treatment. It is common for erections to decrease and the testicles to shrink to about half of their previous size, especially as the body begins to feel the effects of HRT. A short-term decrease in sexual desire may occur; alternatively, a more euphoric “whole body” orgasmic experience has been widely reported! While changes in sexual desire are temporary, many individuals feel a revived and renewed relationship with their bodies after stabilization within their transition journey.
Because feminizing hormone therapy can reduce sperm count, the risks regarding infertility increase. Seeking sperm preservation may be a discussion wanted with a healthcare provider. However, there is no clear evidence that HRT will cause an irreversible loss of ability to create sperm, as many people maintain some sperm count while on an HRT plan. In this era of medical advancement, the risks of HRT have proven to be minimal but can include blood clots, heart problems, diabetes, and stroke. Co-existing health issues should be reviewed for safety, especially regarding any hormone-sensitive cancers, in a professional and reasonable manner.
Another aspect that is often overlooked and little discussed is the emotional changes of the HRT journey. Though the physical, reproductive and sexual effects of an Estrogen-based healthcare plan have been monitored by supportive healthcare providers and gender-diverse clients, with much to report on the variations and timelines of transition, the often unspoken shift of an individual’s emotion is important to note. While an array of emotions may become more noticeable during HRT, reduced gender dysphoria and increased relief will likely align with the emotional aspects of Estrogen.
“HRT such as Estrogen (Estradiol) is pivotal for some Transgender identified women or Trans Femme individuals. As we celebrate Women’s History Month let’s remember to support and celebrate every woman’s medical journey their way.” - Mallery Jenna Robinson
As discussed in the previous post, Equal Health covers a range of services with or without insurance. Though insurance can be applied towards labs and prescriptions, insurance is not necessary to receive health care through one or more of Equal Health’s Memberships, safety and with comfort always in mind. The HRT Memberships also include letter(s) for name and gender marker change and to approve gender-affirming surgery.
"Information on Estrogen Hormone Therapy", University of California
"Feminizing Hormone Therapy", Mayo Clinic