Transgender Hormone Therapy: What to Expect

At Fiamo Aesthetics in Yakima, Washington, Nawo K. Fiamo, ARNP, and our expert team are proud to offer a full scope of aesthetic medicine, anti-aging, and wellness services that fit the needs of our diverse community. 

This includes providing gender-affirming care in the form of custom, bioidentical hormone therapy. 

Whether you’re transgender or nonbinary and you’re just starting to consider your treatment options for gender dysmorphia, or you’ve already reached a decision and you’re about to embark on gender-affirming hormone therapy, you may be wondering what to expect along the way. 

Here’s what you should know.  

Gender-affirming care treatment components

Gender dysmorphia, or the distress of living with a gender identity that doesn’t match the sex you were assigned at birth, can make it very difficult to live your fullest, most authentic life. 

This is true whether you’re transgender (your gender identity is different than what your birth certificate states) or you’re nonbinary (your gender identity doesn’t fit within traditional female or male categories). 

In either case, gender affirmation steps and medical treatment can help you transition into your true gender identity. 

Depending on your age and preferences, your gender-affirming medical plan may include: 

• Puberty blockers
• Hormone therapy
• Voice therapy
• Transgender surgery  

To transition socially to your self-identified gender, you may also adopt a new name, choose different pronouns, change your hairstyle, or wear different clothing.   

Feminizing vs. masculinizing hormone therapy 

Gender-affirming hormone therapy involves taking a supplement of sex-specific reproductive hormones to increase masculine or feminine characteristics as desired. Some people use it as a stand-alone treatment, while others combine it with gender affirmation surgery. Let’s take a closer look at each type. 

Feminizing hormone therapy

This form of hormone therapy helps male-to-female transgender people (transwomen) attain a more feminine appearance. This typically means starting with anti-androgen therapy to block the production of the main male sex hormone, testosterone. Changes at this stage include:

• Decreased muscle mass
• Thinning facial and body hair
• Smaller testicles, fewer erections

The next phase of feminizing hormone therapy uses estrogen supplementation to promote feminine physical changes, such as softer skin, fuller breasts, and more fat on the face, hips, and buttocks. 

Masculinizing hormone therapy

This hormone therapy protocol helps female-to-male transgender people (transmen) realize a more masculine appearance. It uses testosterone therapy to suppress female secondary sex traits like breasts and full hips, and induce male secondary sex characteristics.  

Changes prompted by masculinizing hormone therapy include menstrual period cessation, a deeper voice, increased facial and body hair, greater muscle mass and strength, diminished breast size, and less fat on the hips and buttocks. 

What to expect during each step of the process

Gender-affirming hormone therapy and its associated medical care happens over the course of three general stages. Here’s what you can expect during each stage: 

Before hormone therapy

Whether you’re considering feminizing or masculinizing hormone therapy, it’s essential to prepare yourself for the process. This includes having:

• A comprehensive evaluation to make a gender dysphoria diagnosis  
• A complete medical history review to check for potential health risks
• A physical exam to ensure it’s safe for you to start hormone therapy
• Lab work (blood, urine, and liver function testing; a pregnancy test) 

 Most importantly, you can expect to have a detailed discussion of your treatment expectations that includes exploring the risks and benefits associated with your specific hormone protocol. 

During hormone therapy 

No matter what the details of your personal hormone therapy protocol happen to be, you can expect to start your treatment at a low dose to reduce the chances of complications and side effects. 

You can receive feminizing and masculinizing hormones in the form of injectables, pills, pellets, patches, or gels. We recommend the hormone delivery type, dose, and frequency that’s best for your treatment needs. 

In your first year of treatment, you meet with our team every three months so we can track your response and check for side effects or complications. As your body gets used to the hormones, we gradually increase your dosage. 

Once you attain the full effects of hormone therapy — which takes 18-24 months for most people — we taper you back down to a lower, lifelong maintenance dose.  

Long-term follow-up care

After your first year of gender-affirming hormone therapy, you continue meeting with our team once every 6-12 months. During these visits, we assess the effectiveness of care, check for unwanted side effects, and make any adjustments as needed. 

Do you have questions about hormone therapy?

If you have questions about gender-affirming hormone therapy, we have answers. Call or click online to schedule a consultation at Fiamo Aesthetics in Yakima, Washington, today.