“What does transgender mean?”
These were the unexpected words I heard from my father while sitting on the beach recently. He had been reading a newspaper article about a family who has supported their transgender child transition from female to male.
My dad was in awe of these parents’ actions, admitting this would be a real challenge for many families. He was still a little confused though, about what the terms ‘transgender’ and ‘transitioning’ actually meant.
The following information answers his question. It also describes some of the types of hormone therapy that can be used, thanks to advice provided by Dr Ingrid Bretherton, an expert in transgender health.
Gender refers to your own sense of self. Everyone has a gender identity.
For some people, their gender is the same as the sex they were labeled at birth. That is, they were born female and identify as female, or were born male and identify as male.
Other people, however, do not feel that the sex they were assigned at birth matches their true sense of self. This is referred to as being transgender, trans, or gender diverse. These people can identify as male, female, or may not fit into either a male or female category (commonly referred to as non-binary).
Importantly, being transgender or gender diverse is viewed as part of the natural spectrum of being human.1
Around 1 in 100 Australians (1.2%) identify as transgender or gender diverse.2
Being transgender does not mean someone is taking hormone therapy, or has had gender-affirming surgery.
There are many ways to make your appearance align more with your gender identity. This can be through choice of clothing, hairstyle, chest binding or their body language.
Many transgender or gender diverse people do not choose to take hormones or have surgery.
For some, however, having a physical body that does not match their gender identity can be extremely distressing, resulting in severe anxiety and depression.
Medical interventions, such as hormone therapy or surgery, can help align physical characteristics with gender identity. Research shows having strong social support and affirmative care (including medical interventions) leads to improvements in quality of life, and reduced distress, anxiety and depression.3, 4
What is masculinising hormone therapy?
Masculinising hormone therapy generally refers to testosterone. This is used by those whose sex was assigned female at birth who identify as more masculine.5
Testosterone can only initially be prescribed by a doctor, who specialises in endocrinology, paediatrics, urology or sexual health. Ongoing prescriptions can then be provided by a GP.
Before taking testosterone, it is important to talk to your doctor to understand the effects completely. This is because some body parts will change with treatment while others won’t be affected. It can also take a while for some of the effects to happen.
For example, periods will likely stop within the first 6 months of taking testosterone. Changes to body shape, fat and muscles may occur within months but take years to reach maximal effect.
Breasts will decrease in volume with testosterone therapy, but won’t disappear completely without surgery.
Some of the effects of testosterone therapy are also irreversible. This includes the increase in facial and body hair growth, deepening of voice and enlargement of the clitoris.6
What is feminising hormone therapy?
Feminising hormone therapy generally refers to estradiol – a form of estrogen. This is used by those whose sex was assigned male at birth who identify as more feminine. Anti-androgen therapy may also be required to reduce the effects of natural testosterone.5
Before taking estradiol, it is important to talk to your doctor, so you know what to expect and how long it takes for the changes to occur.
For example, estradiol will cause changes to facial and body hair, body fat distribution, and muscle mass and strength. In some cases, this can take up to 5 years to reach maximal effect.5
Estradiol also causes changes to the reproductive organs and function. This includes decreasing sperm production and reducing the volume of the testes. It will also reduce sex drive and the frequency of spontaneous erections.5
Seeing your doctor after starting hormone therapy
After starting hormone therapy, it is important to see your doctor routinely. This is to ensure that your goals are being met, and so your doctor can make sure you are taking the dose that is right for you.5 This involves discussing the effects of the hormone on your body and your overall health.
Genital examinations are rarely required and not considered routine5, 6.
An appointment to check how things are going will normally be scheduled every 3 months in the first year and then 1-2 times per year after that.
Some tests can also be done to monitor the effects of hormone therapy on other body systems. This can include blood tests to measure your glucose levels, haemoglobin and blood lipid profiles. Depending on your age and circumstances, you may also need bone health tests, or breast and cervical cancer screening tests.5
More information
For more information on masculinising therapy, see our masculinising hormone therapy information.
More information on feminising therapy coming very soon!
Medical review
Dr Ingrid Bretherton
The clinical information in this article has been reviewed by Dr Ingrid Bretherton, who is a Consultant Endocrinologist at Austin Health and Western Health and works in private practice. She has an interest in all aspects of general endocrinology and diabetes and has a special interest in transgender medicine. Dr Bretherton is also a medical researcher at The University of Melbourne (Department of Medicine, Austin Health).
References
- Saraswat A, Weinand JD, Safer JD. Evidence supporting the biologic nature of gender identity. Endocr Pract. 2015;21(2):199-204.
- Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E. Size and Distribution of Transgender and Gender Nonconforming Populations: A Narrative Review. Endocrinol Metab Clin North Am. 2019;48(2):303-321.
- Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2017;5(4):301-311.
- Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol. 2017;5(4):291-300.
- Cheung AS, Wynne K, Erasmus J, Murray S, Zajac JD. Position statement on the hormonal management of adult transgender and gender diverse individuals. Med J Aust. 2019;211(3):127-133.
- Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903.
