Being transgender means that someone doesn’t identify the gender they were assigned at birth. Transgender people can choose to transition in a variety of ways, whether it be socially, hormonally, surgically or all of the above.
Transgender men and women can go through hormone replacement therapy using androgens for trans men and estrogen for trans women. This changes a person’s secondary sexual characteristics to match with their gender identity.
Hormones can be administered in many different forms. Testosterone can be injected, come as a transdermal patch or gel, orally or as small pellets placed under the skin, Cosmopolitan reports. For trans women, HRT can begin with an antiandrogen, commonly called a T-Blocker or testosterone blocker. Estrogen and progesterone may be administered and come in pill form, as skin patches and as creams, gels and sprays.
But what’s going on to the body of someone who is transitioning?
While HRT is different for everyone, transitioning with hormones can be seen as a second puberty.
For males transitioning to female, hormones typically change everything, from skin to fat. Over time, body hair will diminish, sometimes disappearing completely from the arms, chest, legs and shoulders. However, hair in the pubic region and armpits does not diminish as significantly as other body hair, and facial hair at the start of HRT will remain. Skin will also change, becoming softer and more translucent during treatment. More long term, over one to two years, subcutaneous fat will redistribute and muscle mass will decrease, with most fat being localized in the thighs, buttock and hips.
The more expected changes caused by HRT affects the genitals and prostate as well as fertility. Testes and the prostate will diminish in size and testosterone production will be reduced. Continued use of estrogen will most likely result in infertility. One thing unchanged by hormone therapy, however, is voice. HRT will not change the pitch or inflection of someone transitioning.
HRT for individuals transitioning to male also has varying affects. For trans men, HRT will change their voice, causing it to become deeper. Facial and body hair will also begin to grow thicker and in more areas. Some individuals may also experience male-pattern baldness.
Due to a redistribution of fat, breast tissue will also shrink and muscles will see further development, especially in the upper body. Veins will become more prominent and skin will coarsen and acne — mainly during the first few years of transitioning — will occur more often.
As expected, ovulation and menstruation will cease, but red blood cell count will also increase as therapy continues. Some may also experience a growth spurt during the course of treatment.
While physical changes that occur because of HRT are noticeable, psychological changes that come with the therapy are often harder to observe and define. After starting HRT, many trans men reporting feeling more energetic and confident with an increased sex drive. Increased aggression, while often associated with high levels of testosterone, is not noticeable in most trans men who are taking testosterone as part of HRT.
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