Hormone Replacement Therapy (HRT) for male-to-female (MTF) transgender individuals involves taking medications to induce physical changes that align the body more closely with female gender characteristics. Here’s a basic overview of HRT for MTF individuals:

  1. Estrogen:
    • This is the primary feminizing hormone.
    • It promotes the development of secondary female characteristics such as breast growth, fat distribution around the hips and thighs, and a reduction in muscle mass.
    • Estrogen can be taken in various forms: pills, patches, gels, or injections.
  2. Anti-androgens / Testosterone Blockers:
    • These medications reduce the levels or effects of testosterone in the body.
    • Spironolactone: Commonly used in the U.S., it’s a diuretic that also has anti-androgenic effects.
    • Cyproterone acetate: Used in Europe and other parts of the world, this is a progestin with anti-androgenic properties. It’s not approved for use in the U.S.
    • GnRH agonists: These are sometimes used to suppress testosterone, especially in adolescents or those who cannot take other testosterone blockers due to side effects.
  3. Progestogens:
    • Progesterone and related compounds can be added to the HRT regimen, although their benefit is still a topic of debate among professionals. Some believe they may help with breast development or mood.
  4. Effects of HRT:
    • Physical Changes: Softening of the skin, reduced body hair growth, breast development, changes in fat and muscle distribution, reduced erections and testicular size, and thinning and lightening of body hair.
    • Emotional Changes: Some individuals report mood changes, which could be due to the hormones themselves or other factors, like the psychological effects of undergoing a gender transition.
    • Sexual Changes: Reduced libido, reduced sperm production (which can lead to sterility), and reduced frequency of erections.
  5. Risks and Monitoring:
    • Like all medical treatments, HRT has risks. These can include blood clots, elevated liver enzymes, high potassium levels (with spironolactone), weight gain, and high blood pressure.
    • Regular medical monitoring is crucial while on HRT. This typically involves periodic blood tests to check hormone levels, liver function, and other vital parameters.
    • If one has not had gender-affirming bottom surgery, it’s also essential to continue routine medical screenings appropriate for one’s assigned sex at birth, such as prostate exams.
  6. Infertility: It’s essential to note that while HRT reduces fertility, it doesn’t eliminate the risk of pregnancy entirely. If one is engaging in sexual activity that could lead to pregnancy, some form of contraception should be used. For those wishing to have biological children in the future, sperm banking before starting HRT is an option.
  7. Duration: Once started, HRT is typically a lifelong treatment, especially if the testicles have been removed. Some effects of HRT, like breast development, are permanent, while others, like fat distribution, can reverse if HRT is stopped.

Starting HRT is a significant decision and should be made in consultation with knowledgeable medical professionals. Before beginning HRT, it’s typical to have assessments from mental health professionals, not to pathologize transgender identity, but to ensure the individual is making an informed and considered decision.