What Is Gender-Affirming Hormone Therapy (GAHT)?

Many people experience a gender identity different from their birth sex or feel that their physical characteristics do not align with their inner sense of self. This includes individuals who are gender diverse, transgender, or feel their physical sex characteristics do not reflect their true identity. This article introduces hormone therapy as a way to affirm identity, boost confidence, and improve quality of life.

What is hormone therapy?

Gender-Affirming Hormone Therapy (GAHT) is a medically recognized and globally validated treatment option that helps individuals develop physical traits consistent with their gender identity. It alleviates psychological distress and improves quality of life by using hormones to modify secondary sexual characteristics, whether through feminizing hormone therapy or masculinizing hormone therapy.

This therapy is not limited to transgender individuals but also includes people with diverse gender identities, such as non-binary persons or those seeking partial physical changes to better align with their internal gender experience.

Types of hormone therapy

Hormone therapy is mainly categorized based on the desired direction of physical change.

1. Feminizing hormone therapy Feminizing hormone therapy is suited for those wishing to develop physical traits aligned with female characteristics. It primarily involves estrogen combined with anti-androgens to reduce testosterone effects. Changes occur gradually and include breast development, softer skin, altered fat distribution, reduced body hair, and decreased muscle mass.

2. Masculinizing hormone therapy Masculinizing hormone therapy is intended for individuals aiming to develop male physical traits by using testosterone. Effects include voice deepening, growth of facial and body hair, increased muscle strength, altered fat distribution, and cessation of menstruation.

There is also low-dose hormone therapy for those seeking less intense changes or who identify outside the binary gender framework. Doctors adjust dosages to match each individual's goals.

How to start hormone therapy (taking hormones)?

Getting startedHormone therapyrequires a comprehensive and safe evaluation process by a specialized medical team.

• Initial medical consultation Interested individuals should begin by consulting a gender identity specialist to discuss personal history, feelings about gender identity, treatment goals, and expectations. The physician will explain the treatment details, expected outcomes, timeline, and potential risks.
• Mental health assessment In some cases, referral to a psychiatrist or psychologist specializing in gender identity may be recommended to assess psychological readiness and provide appropriate support.
• Physical examination and blood tests Before starting therapy, a general physical exam—measuring blood pressure, weight, height—and blood tests to evaluate hormone levels, liver function, blood sugar, cholesterol, and overall health are conducted. These help the doctor designa safe and suitable treatment plantailored to the individual.
• Planning treatment After evaluation, the doctor collaborates with the patient to plan hormone therapy, including medication type, dosage, delivery method (such as pills, injections, patches, or gels), and scheduling follow-up appointments. Patient involvement is vital to ensure the plan aligns with their needs and lifestyle.

Expected treatment effects and timeline

Hormonal changes happen gradually and differ among individuals. Understanding realistic outcomes and timelines helps set proper expectations.

• Feminizing hormone therapy effects Initial changes appear within 1-3 months, such as softer skin and decreased genital erectile function. Breast growth continues progressively over 2-3 years. Fat redistributes to hips, thighs, and buttocks. Facial and body hair thins and grows more slowly but may not disappear completely. Hair loss on the scalp may not reverse but is slowed.
• Masculinizing hormone therapy effects Some changes occur quickly: voice deepens within 3-6 months and stabilizes permanently within 1-2 years. Menstruation usually stops. Facial and body hair grows and thickens. Muscle strength and mass increase. Fat shifts toward the abdomen and skin may become oilier.

However, individual results vary due to factors like genetics, age at treatment start, dosage, and personal body response.

Risks and side effects to be aware of before hormone therapy

Hormone therapy like any medical treatment, carries risks and potential side effects. Key concerns to monitor include:

1. Risks from feminizing hormone therapy

There is a risk of blood clots (thromboembolism), especially in people with other risk factors such as smoking, older age, or family history. Increases in blood lipid levels, potential long-term cardiovascular risks, and possibly increased breast cancer risk are also concerns, though evidence is limited. Other side effects may include mood swings, weight gain, infertility or reduced fertility, and changes in genital function.

2. Risks from masculinizing hormone therapy

Risks include increased red blood cell count (polycythemia), which may raise clotting risk, changes in blood lipids—particularly decreased HDL (good cholesterol) and increased LDL (bad cholesterol)—potential heart disease risk, liver changes including inflammation or abnormalities, vaginal atrophy causing dryness, burning, or itching, as well as acne, hair loss, weight gain, mood changes, and decreased or lost fertility.Especially low HDL cholesterolis noted as a cardiovascular risk factor.

Notably, absence of menstruation after testosterone therapy does not guarantee infertility. Therefore, individuals having vaginal intercourse with cisgender men who do not wish to conceiveshould use contraception concurrently.Those desiring future fertility should consult a physician about options for preserving reproductive cells before starting therapy.Importance of regular monitoringand health check-ups enables early detection and management of issues. Most risks can be minimized by using appropriate medications, regular follow-ups, and healthy lifestyle adjustments.

How long does hormone therapy take?

Hormone therapy is a long-term treatment requiring ongoing follow-up and plan adjustments to achieve safe and optimal results. During the first 3-6 months, doctors conduct close monitoring, adjusting dosages to maintain appropriate hormone levels and minimize side effects. Once stable, monitoring intervals lengthen to ensure hormone levels remain suitable. For testosterone users, red blood cell counts are monitored to watch for polycythemia. Treatment plans evolve with the patient's changing goals. Success is measured by patient satisfaction and quality of life rather than physical changes alone.

Anyone considering hormone therapy or with questions about gender identity is advised to consult a specialist physician. They can provide comprehensive information, assess health, and collaboratively develop the most appropriate treatment plan.

Information provided by :Dr. Amornthis Chaimongkolpipop, a specialist in obstetrics and gynecology,certified in obstetrics and gynecology,with a subspecialty in sexual medicine, at Phyathai 3 Hospital.