Male to female hormone replacement therapy (M2F HRT) is a medical way of dealing with one’s gender dysphoria. Its main goal is to successively alter the patient’s physical appearance, so it matches her gender identity. The most visible effects of HRT concern changing the features that appear during puberty (these are called secondary sex characteristics), such as breast development and widening and rounding of the pelvis (if HRT is started early). These changes are irreversible, even if hormone therapy is terminated. Others, such as feminine fat and muscle distribution, thinning of body hair, cessation of testosterone-triggered hair loss (and in some cases even regrowth of lost hair) as well as softening of skin are reversible and need constant hormone therapy to take effects.
The point of no return is the sex reassignment surgery (SRS), as, without testicles, a trans woman’s body no longer produces testosterone hormones (so she needs to replace and supplement them with artificial estrogen and has to take medications until the very end of her life). Till that time, besides estrogen and progesterone, a transgender MTF patient usually receives antiandrogens (also called testosterone blockers), which prevents male hormones from working. It’s not the most healthy medication but is considered a necessary evil, so to speak.
There are of course things that cannot be changed or altered through medications and require practices (like voice) and optional surgical and cosmetic and procedures (like breast and buttock augmentation, facial feminization surgery, called FFS for short, chondrolaryngoplasty, called tracheal shave, which in other words is like filing the Adam’s apple, hair removal ) that intend to improve the patient’s self-acceptance. There is no one set way to undertake – some transwomen decide to go all in, while others don’t undergo SRS or even don’t or can’t seek HRT in the first place (for example due to health: more below). It’s important to underline that they are all women, even if some people don’t see them that way.
For those who receive HRT, there are possible adverse effects – as with any medications – that can cause or increase the risk of many harms, including the ones that can be life-threatening, like blood clotting, gallbladder disease, prolactinoma etc. These risks are however considered lesser than the expected outcome of HRT. There are also some conditions that are absolute contraindications: those include breast cancer, thrombosis, embolism or macroprolactinoma.
Fortunately, we know more and more about HRT and how patients react to it. Unfortunately, it’s still a mystery in many ways, as the medications’ aim wasn’t originally intended to treat transgender women, but menopausal cis women. There are still many things to learn, and because everybody reacts differently, it is very important for a trans woman to monitor her blood work on a regular basis (especially at the beginning).
Because of received hormones many transgender women also experience different processing of feelings, emotions and overall perception of basic senses and erogenous stimula. Everything changes, not only on the physical level. They often feel lonely, misunderstood and victimized. It’s therefore highly recommended to seek psychotherapy and find as much support as possible. I’ll cover the reasons why it’s not easy in one of the articles to come.
(Of course, this article doesn’t cover all information regarding HRT. It’s just a basic introduction for people that don’t know much or anything about this topic.)