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Hormone Replacement Therapy: The Basics

Disclaimer: The information found throughout this document has been provided by the NHS. If you wish to find more information on Hormone Replacement Therapy, please visit the NHS website.

Hormone Replacement Therapy (or HRT) is the process of a transgender person starting to take the appropriate hormones to start the physical process of becoming their desired gender. Here is your basic guide to what you should know before starting HRT

What are hormones?

Hormones are naturally produced in the body from glands. These hormones are released into the bloodstream so that they can be carried around the body. Amongst many others, the body produced sex hormones: Testosterone produced by the testes and Oestrogen by the ovaries. 

What effects do naturally produced hormones have?

Overall, Testosterone produces masculinising effects and Oestrogen produces feminizing. In-hand with genetic factors, sex hormones impact your reproductive system, your brain, and physical characteristics like height and build. 

Then, during puberty, more changes occur as a result of sex hormones. For instance, in women breast development and periods will occur and in men, facial and body hair will begin to grow, along with height, muscle bulk and penis growth. 

What do trans people aim to achieve with HRT?

The overall aim of HRT in transgender people is to allow the body to produce the hormone linked to your desired gender. This causes physical and psychological changes so that you can appear and feel as the gender you wish to be. 

For trans people, starting HRT and seeing and feeling the physical changes in your body to become who you really wish, it is a huge deal. Starting HRT is a start to your transition and begins the process of changing your body to look and feel more feminine or masculine. Blockers may be needed in cases where the hormones in which your body naturally produce must be blocked in order for HRT to work.

HRT is often the first stage for transgender people, following surgery if wanted or needed. 

What physical effects does HRT have on transgender people?

Trans Women:

  • Fat may be distributed to the hips
  • Slight reduction in the size of penis/testicles
  • Erections and orgasms may be harder to achieve
  • Muscle bulk and power might be reduced
  • Breasts may feel tender and lumpy and may increase in size
  • Facial and body hair production becomes weaker. This can be helpful in the hair removal process

Trans Men:

  • Promotion of facial and body hair growth
  • Male pattern baldness may occur
  • Clitoris increases slightly in size
  • Sex drive may be heightened
  • Increased muscle bulk
  • Deepening of the voice, but may not be to the pitch of other men
  • Periods will stop occurring
  • Acne may develop

Once start HRT, you will have to stay on the medication in order for your body to keep producing the new hormone.

There are no large risks to taking hormones, and they are considered ‘remarkably safe’ according to the NHS. 

The most serious risks when taking Oestrogen are:

  • Deep vein thrombosis (DVT)
  • Stroke
  • Pulmonary embolism (block in a blood vessel in the lungs)
  • Altered liver function

The most serious risks when taking Testosterone are:

  • Polycythemia (over-production of red blood cells)

Although these risks are extremely rare, if you start seeing signs of the above, or have side effects following the start of HRT, make sure you inform you GP immediately. 

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