trans healthINFORMATION ON
TRANSITIONING
& TRANS HEALTH

To be transgender or transsexual means that one identifies with a gender other than one’s biological or assigned gender. Transitioning refers to any physical, mental, or emotional change that a person makes in order to better reflect their gender identity. The information below is intended for people living on the FTM or MTF spectrum who are seeking information on transitioning. We use FTM to refer to anyone who was assigned female at birth but who identifies as masculine, male, or a man some or all of the time. We use MTF to refer to anyone who was assigned male at birth but who identifies as feminine, female, or woman some or all of the time.

The information has been generously shared with us by two amazing organizations in Montreal: ASTT(e)Q and Project 10.

As trans people, we make many choices about transitioning, and continue making choices over our lifetimes. Some of us choose: voice therapy, top surgery, gaffing, make-up, vaginoplasty, tattoos, hair replacement, binding, name change, phalloplasty, hormones, breast implants, piercing, metoidioplasty, prosthetic breasts, pronoun change, artificial facial hair, psychotherapy, change of sex designation, hair removal, gendered dress, sideburns, or hairspray…Of course, this is a partial list! Our choices are often difficult to make, and once we decide, we still have to come up with the money, or the psychiatric evaluation, or the courage, or the legal precedent, or the family and community support. No two trans people are alike. We make different changes in different orders and in different ways. Trans people who seek a change of name or change of designation of sex may find that it’s a complicated, frustrating and drawn-out process. If you need to strategize, vent, or share ideas as you work your way through the system, consider calling a trans support organization.

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trans mens symbolFTM
HORMONE
THERAPY

HOW DO HORMONES WORK?
Hormones are chemical messengers produced by the glands. They are released into the bloodstream, where they direct the activities and development of other cells. Hormones affect the appearance and growth of body fat, breasts, hair, reproductive organs and skin.

WHICH HORMONES?
Hormone therapy for FTMs increases testosterone levels while lowering estrogen levels into a typical “male” range.

HOW IS TESTOSTERONE ADMINISTERED?
The three main ways of administering testosterone are by injection, by skin patch or gel, and by pill.

INJECTIONS:Testosterone is injected into the buttocks or thigh, one to four times per month, depending on dosage. Of all the methods, this one is the least expensive, and in many cases offers the quickest results. Some people who use this method experience fatigue or irritability towards the end of the injection cycle, when testosterone levels are at their lowest.

SKIN PATCH OR GEL: Both gel and patch, applied daily, are efficient ways to keep testosterone levels stable. When using this method, instructions must be followed carefully to avoid transferring testosterone through physical contact with children or with intimate partners. This method is among the most expensive options.

PILL: Rarely prescribed because it is the least effective in stopping menstrual periods.

WHERE CAN I GET HORMONES?
Hormones are medications that can be prescribed by general practitioners, endocrinologists and gynecologists. Like all drugs, they should be taken with care, as they can cause temporary and/or permanent side effects.

WHAT EFFECTS WILL HORMONES HAVE ON MY BODY?
The effects of testosterone are completed over several years, and many factors can influence the degree of change you experience, including the number of hormone receptors in your body, your age, and your dose. Testosterone affects the entire body; it is not possible to pick some changes and not others.

VOICE: Your voice may deepen. In most people, some change is noticeable after 3 months, and there is no further change after 1 year. This change is permanent. Another way to change your voice is through voice therapy.

BODY FAT / MUSCLES: Body fat will be redistributed from the more typically “female” pattern (under the skin, including on arms, legs, and hips) to a more typically “male” pattern (surrounding internal organs, and in the abdomen). Your muscular mass may increase. Changes will be gradual, possibly beginning around 3 months. If you stop taking testosterone, fat may redistribute towards its original pattern, and muscle mass may gradually decrease.

BODY HAIR / FACIAL HAIR: A beard may grow, and you may develop more body hair. This could include hair on your eyebrows, chest, stomach, back, neck, pubic area, arms, and/or legs, as well as in your ears and nose. Existing hair may become more coarse. Changes may be noticeable between one month and one year, and will not be completed for many years. This change is permanent; if you stop taking hormones the hair won’t disappear, although it may become less coarse.

HAIR: Testosterone can lead to hair loss and perhaps baldness. For some, this is a desired effect. If this is not your case, you may consider a range of options such as medication to prevent hair loss such as Finasteride, implants or wigs.

SKIN: Testosterone changes the skin, making it thicker, and sometimes a little oilier. This may result in acne. For persistent acne, consider talking to your doctor. Together, you may consider lowering your dosage of testosterone, prescribing medication, or experimenting with different washing regimes.

FEELINGS / MOOD: Changes in hormonal levels can affect your moods and feelings both positively and negatively. However, during hormonal therapy, it is difficult to tell which mood variations are due to chemical change, and which are due to other factors. For example happiness could result from bringing the body more in line with the mind.

BONE SIZE: After puberty, the skeleton is fixed in shape and size. Although bone density may increase, hormones will not enlarge your bones, and the size of the bones in your feet and hands will remain the same.

MENSTRUATION/LIBIDO AND FERTILITY: Menstruation should cease after 1 to 6 months on testosterone. If it does not, consult with your doctor. You may experience an increase in libido and sexual appetite. It is still possible to get pregnant while taking testosterone, however testosterone is toxic for a fetus and you can’t take testosterone while pregnant. Depending on how you have sex, you may need to use birth control. There is a possibility that you will become permanently sterile as the long term effects of hormone therapy on fertility are not fully understood.

GENITALS: Testosterone affects the clitoris, which may become more sensitive and somewhat larger (average size between 1 and 3 cm). The vagina may become dryer and more fragile, so if you have vaginal sex, consider adding extra lubricant. Testosterone does not protect you from sexually transmitted infections, Hep C, or HIV. As always, consider using a latex barrier such as a glove, a dental dam, or a condom.

BREASTS: Hormones will not make your breasts disappear, although they may become less firm as body fat shifts to a more typically “male” pattern.

WILL HORMONES MAKE ME A MAN?
Although hormones are a part of a transition process for some, they are not miracle drugs that will turn you into a man or woman.

WHAT RISKS ARE INVOLVED WITH HORMONE THERAPY?
Many of the risks associated with taking hormones can be reduced by having periodic blood tests to monitor liver health. Medications taken in hormone therapy are processed by the liver, and there is a possibility that long term hormone therapy can put strain on your liver, or cause liver disease. Buying hormones from unreliable sources or on the “underground market” should be avoided, because you can’t always be certain of what you’re buying. You may expose yourself to unnecessary health risks, thereby slowing down your hormone therapy. Long term medication can have serious side effects and risks. Visiting your doctor regularly in order to monitor your overall health and well-being is an important and necessary part of any medical treatment. While it is inconvenient and difficult at times, it is important to be proactive with your health during hormone therapy.

WILL I HAVE TO CONTINUE WITH HORMONE THERAPY ALL MY LIFE?
If you decide to stop taking hormones, you may require medical monitoring to ensure that your hormonal levels do not put you at increased risk for osteoporosis, or other health concerns. This is particularly true for FTMs who have undergone an oophectomy (removal of the ovaries).

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trans womens symbol

MTF
HORMONE
THERAPY

HOW DO HORMONES WORK?
Hormones are chemical messengers produced by the glands. They are released into the bloodstream, where they direct the activities and development of other cells. Hormones affect the appearance and growth of body fat, breasts, hair, reproductive organs and skin, and help regulate blood sugar, cholesterol levels, and metabolism.

WHICH HORMONES FEMINIZE THE BODY?
Hormone therapy for MTFs increases estrogen levels while lowering testosterone levels into a typical “female” range, resulting in internal as well as visible changes to the body. A third hormone, progesterone, is linked directly to the reproductive cycle in a “female” and is not produced in a “male”. It is not necessarily prescribed as part of a hormone therapy for MTFs.


ESTROGEN, ANTI ANDROGEN, PROGESTERONE, WHAT SHOULD I TAKE?

ESTROGEN: Estrogen is the main feminizing hormone. It is the principle hormone responsible for the development of secondary sex characteristics in the body (breast development, change in the distribution of body fat to hips, arms, abdomen etc.)

ANTI-ANDROGEN: This hormone is used to lower the level of testosterone produced by the body. With time, anti-androgens can decrease the level of testosterone to levels that correspond to those found in most women. This allows MTFs to take a lower dose of hormones, helping to lower the risks associated with hormone therapy such as blood clots and liver damage.

PROGESTERONE: A lack of studies in the area leave room for discussion, however progesterone is not often prescribed to MTFs.

WHERE CAN I GET HORMONES?
Hormones are medications that can be prescribed by general practitioners, endocrinologists and gynecologists. Like all drugs, hormones should be taken with care as they can sometimes cause temporary and/or permanent side effects.

WHAT EFFECTS WILL HORMONES HAVE ON MY BODY?
Hormones will have a different effect on different people, depending on dosage, body type and age and will take a couple of years to fully take effect. Hormones affect the entire body. It is not possible to choose some changes and not others.

VOICE: Hormones won’t have an effect on your voice. If you’re looking for a change, keep in mind that through practice, you can train your vocal cords to produce a sound more to your liking.

BREASTS: Hormones encourage breast development in MTFs. As is the case with all women, MTF transsexuals dissatisfied with their breast size after they cease to grow, can use both non-surgical and surgical methods to obtain their desired breast size. These effects are gradual and might lessen if you stop take hormones.

BODY FAT: Taking estrogen will cause a redistribution of body fat in a pattern generally found in biological women (around the abdomen, buttocks, hips, thighs upper arms etc.). These effects are gradual and might lessen if you stop taking hormones.

BODY HAIR: Anti-androgens sometimes cause body hair to become more fine. Beards are minimally affected by hormone therapy. To completely eliminate facial hair, there are two proven methods: electrolysis or laser hair removal.

HAIR: Hormone therapy can reinvigorate your hair, but won’t stimulate new hair growth.

SKIN: Facial skin pores will reduce in size, and the skin becomes more sensitive and soft. You will begin to see changes between 1 and 3 months.

MUSCLES: A loss of muscle mass is to be expected in the long term. These effects are gradual.

FEELINGS / MOOD: Changes in hormonal levels can affect your moods and feelings both positively and negatively. However, during hormonal therapy, it is difficult to tell which mood variations are due to chemical changes and which are due to other factors. For example, happiness could result from bringing the body more in line with the mind.

ERECTIONS, EJACULATIONS, LIBIDO AND FERTILITY: There is often a noticeable change in the frequency of erections and a reduction in their duration and firmness. Since the quantity of semen decreases, there is a possibility of short or long term infertility. You will begin to see changes between 1 and 3 months.

WILL I HAVE TO CONTINUE TAKING HORMONES ALL MY LIFE?
If you decide to stop taking hormones, you may require medical monitoring to ensure that your hormonal levels do not put you at increased risk for osteoporosis, or other health concerns. This is particularly true for MTFs who have undergone a vaginoplasty.

WILL HORMONES MAKE ME A WOMAN?
Although hormones are a part of a transition process for some, they are not miracle drugs that will turn you into a man or woman.

WHAT KINDS OF RISKS ARE INVOLVED WITH HORMONE THERAPY?
Many of the risks associated with taking hormones can be reduced by having periodic blood tests to monitor liver health. Medications taken in hormone therapy are processed by the liver, and there is a possibility that long term hormone therapy can put strain on your liver, or cause liver disease. Buying hormones from unreliable sources or on the “underground market” should be avoided, because you can’t always be certain of what you’re buying. You may expose yourself to unnecessary health risks, thereby slowing down your hormone therapy. Long term medication can have serious side effects and risks. Visiting your doctor regularly in order to monitor your overall health and well-being is an important and necessary part of any medical treatment. While it is inconvenient and difficult at times, it is important to be proactive with your health during hormone therapy.

Thank you again, to Project 10 and ASTT(e)Q for allowing us to republish this information.

PROJECT 10: A resource for LGBTQ communities and our allies, providing information and support for youth and adults 14-24 who identify as lesbian, gay, bisexual, transgender, transsexual or queer as well as those that are questioning their sexual orientation or gender identity. Services are free of charge, confidential and anonymous, and are offered in English and French.

ASTTEQ: Action Santé Travesti(e)s et Transsexuel(le)s du Québec works to encourage the health and well-being of trans people through access to resources and support. We aim to develop and strengthen trans people’s social and medical support networks. We also work to educate health and social service workers regarding transsexuality. We provide information about the medical, social and legal aspects of transitioning and work to prevent HIV/AIDS, Hepatitis and STIs. We offer weekly drop-ins for trans people, safer sex materials, a needle exchange, and we outreach to trans communities to give information and referrals to trans-friendly resources.