Gender Affirming Hormone Therapy

• Testosterone therapy: This type of therapy involves taking testosterone to develop masculine physical characteristics. Some of these changes include a deeper voice, facial hair growth, and increased muscle mass
• Estradiol therapy: This therapy uses estrogen, specifically estradiol, to induce feminine physical traits. These may include breast development, fat redistribution, and softening of skin.
• Feminising hormone therapy: Your guide to hormonal transition leaflet
• Masculinising hormone therapy: Your guide to hormonal transition leaflet

Hormone therapy can be administered in various ways, each with its own benefits and risks. The most common methods include:

• Injections: Hormones are injected directly into the muscle. This method typically delivers a high dose of hormones at once, resulting in noticeable fluctuations in hormone levels between injections
• Transdermal (skin-applied) methods: Transdermal methods include gels and patches. The hormones are absorbed through the skin, offering a more gradual and consistent release into the bloodstream. This approach often results in fewer side effects and a more stable hormonal profile.
• Oral medication: Some hormones can be taken orally and processed safely by the liver. However, this option is generally limited to trans women under the age of 40 with no additional health factors, as these can increase the risk of liver complications.

While hormone therapy can be beneficial for transgender and non-binary individuals, it's crucial to understand the potential risks and side effects. Some common risks include:

Testosterone therapy:

• Lipid profile changes: Testosterone therapy can negatively impact cholesterol levels, potentially increasing the risk of heart disease. These changes may not always present with noticeable symptoms but can be monitored through routine blood tests
• Insulin resistance: Testosterone can impact insulin effectiveness, leading to elevated blood sugar levels and an increased risk of type 2 diabetes. Symptoms of insulin resistance can include increased thirst, frequent urination, unexplained fatigue, and slow healing of cuts or wounds.

Estradiol therapy:

• Blood clots (venous thromboembolism): Estradiol can increase the risk of blood clots, potentially leading to serious complications like deep vein thrombosis or pulmonary embolism
• Elevated blood pressure: Estradiol therapy can raise blood pressure, potentially leading to hypertension and an increased risk of cardiovascular problems like heart disease, stroke, or kidney damage
• Liver function impact: While transdermal estradiol is considered safer than oral estradiol, both forms can potentially affect liver function. Regular blood tests are necessary to monitor liver enzyme levels
• Lipid profile changes: Estradiol therapy can influence lipid levels, potentially leading to increased triglycerides. Though this therapy can also decrease LDL (bad cholesterol) and increase HDL (good cholesterol), high triglycerides may still pose cardiovascular risks.

Regular monitoring and management are essential for minimising the risks and side effects of hormone therapy.

• Routine blood tests and health assessments: These are crucial for identifying any potential issues early on
• Lifestyle modifications: A balanced diet, regular exercise, and avoiding smoking can help manage risks like cholesterol changes and insulin resistance
• Medication: In some cases, medications may be prescribed to address specific side effects, like high blood pressure or cholesterol
• Electronic prescribing: Since our service began, we have used the same electronic prescribing system as general practitioners, allowing medication to begin as soon as the assessment process is complete.

• Blood tests: Blood tests may be requested from your general practitioner or ordered directly from a laboratory, depending on your circumstances. Initially, blood tests are required every 12 weeks until stability is achieved.

• Endocrinology support: Our service includes access to a consultant endocrinologist who can provide expert advice for more complex hormone management cases.

• Ongoing care: We are happy to prescribe hormone therapy for the first 12 months before arranging a transfer of care to your general practitioner.