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Hormone Replacement Therapy: HRT 101

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Hormone Replacement Therapy: HRT 101

Hormones are things like estrogen and testosterone. They can help people change the shape of their body or grow breasts or facial hair. As part of transitioning, some people who are transgender, non-binary, or both choose to get hormone replacement therapy, or HRT. Some intersex people also take prescribed hormones to develop a body that feels right for them. Some people also stop or slow down puberty with puberty blockers.

Hormones replacement therapy can help with gender dysphoria, which means feeling uncomfortable with your sex assigned at birth. HRT can help people feel more comfortable with their bodies and the way people see them.

Whether someone takes hormones and how much they take are personal medical decisions. A lot of trans and non-binary people choose not to take HRT. That doesn’t make them any “more” or “less” trans or non-binary!

Some people want the most change that HRT can give them. Others explore microdosing, or getting a a lower dose of hormones to change in ways that feel best for them.

Puberty blockers 

Puberty blockers are also called “blockers” or GnRH agonists. They do what the name says: they “block” the body from making the hormones that cause puberty. Taking puberty blockers can stop or slow down changes like getting taller or growing facial hair. People can take blockers as injections or implants.

Blockers can be useful for some young trans and non-binary people! Taking blockers or hormones early can help with dysphoria and stigma. It can also make it so people don’t need things like top surgery or hair removal later on.

Puberty blockers are medically safe. Blockers have been used and studied for a long time in people who start puberty early. Most research says that risks are low for things like reduced bone density. People can also weigh any risks with the chances for depression and anxiety

Estrogen

Estrogen softens the skin. It also causes breast growth, fat redistribution and some other changes. It’s available as a pill, patch, injection, or topical cream.

A lot of doctors prescribe estrogen with anti-androgens like spironolactone. These stop bodies from making as much testosterone. They also reduce some of its effects. These changes let people take smaller doses of estrogen. As a result, people avoid some risks that larger amounts can have. 

Estrogen and anti-androgens raise people’s risks for liver damage and blood clots. But their doctor can tell them if they’re at risk for these. They can also talk about ways lower any risk! 

Testosterone

Testosterone, or T, causes changes like facial hair growth and fat redistribution. It can also make someone’s voice lower and their skin rougher. It’s rare, but some people take testosterone with estrogen blockers. People can take testosterone as a pill, patch, injection or cream.

Testosterone can cause high cholesterol and increase someone’s risk for type 2 diabetes. Someone who takes testosterone can talk to a doctor about lowering their risk for these things.

How can I get HRT in Montreal?

There are clear HRT guidelines for doctors in Quebec. That means family doctors and doctors who give more general care are allowed to prescribe HRT and puberty blockers. But many may not feel comfortable doing that, especially if they don’t have training in trans healthcare. Fortunately, there are also doctors who have training and want to help!

Some clinics like Head and Hands and the Meraki Health Center have HRT programs for trans and non-binary youth. There are also doctors who have experience treating trans and non-binary Montrealers. Some have long waiting lists. But organizations like ASTT(e)Q or Project 10 can help people find the care they need.

Doctors can help people take safe, pharmaceutical HRT that doesn’t have unexpected risks. They can also monitor hormone levels and side-effects. This helps you find the right dose to stay healthy and change in the ways you’d like. 

Some people get hormones in other ways. Some of these have large and unexpected health risks.

Hormone replacement therapy and sex

HRT causes some changes that can affect your sex life. Some of this changes your sexual health risks. Hormones can also make bodies feel and work differently. But you can experiment to find what’s pleasurable for you!

HRT can change someone’s sex drive, also called their libido. These changes can vary a lot! Most often, sex drives get lower with estrogen and higher with testosterone.

There are medications and other things that might help with any changes you don’t like. Working with a doctor can help you find what works for you!

More info

Hormones – Trans Health BC

This page by BC’s public health authority talks about the essentials of hormones and HRT for trans and non-binary people.

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