Hrt

HRT, Hormone Replacement therapy is the process of taking hormones. You do not have to take HRT to be trans, and not all trans men/women take HRT. It is very important to figure out who you are and what your transition goals are before considering HRT as some the effects of HRT are permeant.

Do consider the following before starting HRT:

  • Do you like your sexual function as it is now?
  • How would starting HRT would affect your relationships, especially if you are married or have children?
  • Do you wish to live full time as your chosen gender?
  • If your sexuality changed due to HRT would you feel comfortable with that?
  • If HRT gives you visible changes i.e. breast development, or a beard, would you feel comfortable going to the shops/work etc?
  • Is it safe to transition? Is your family and home life situation safe?
  • Have you done your research?

It is important to remember that:

  • HRT can change your sexuality
  • HRT will make you infertile (trans-women) (trans-men will remain somewhat fertile)
  • The effects of HRT can be permanent
  • The effects of HRT cannot really be hidden for long.
  • HRT can change your height and shoesize a very small amount, this is due to muscle loss/gain and is usually only about 1 inch.
  • HRT does NOT solve all of your problems, or change how you think. It can help slightly, but it doesn't solve any any of your issues, for that you will need to work through your problems yourself with or without the assistance of a therapist.
  • HRT is not instant, it can take years and years to see results.

HRT for Trans-Women

HRT will have the following effects:

  • Breast growth (This is permanent and does not go away if you stop HRT)
  • Infertility (This can take a while and can happen anywhere from 3 months to several years after starting) It is somewhat reversable in the first 2 years or so, but your mileage may vary.
  • Fat redistribution, you may notice that your bum gets slightly bigger, as fat distribution does happen. Over several years this will give you a more female body shape.
  • Muscle loss, dependant upon your testosterone levels, you will lose muscle mass. I would estimate that the average trans-woman loses 50-70% of their body strength after a while.
  • Reduction in sex drive, your sex drive can plummet.
  • Reduction in erections and penis size. You won't get as many erections and over time you may find that the size of your penis may reduce by upto 40%. After a while you may also not be able to maintain an erection for penetrative sex.

HRT does not:

  • Stop the growth of facial hair, your facial hair will continue to grow although slightly slower, you will need to look at one of the many hair removal options.
  • Change your voice, your voice will not change, in order to change your voice to be more feminine you will need to do voice therapy, and spend time re-training your voice.

HRT for Trans-Men

HRT will have the following effects:

  • You will develop facial hair
  • Your voice will change and become lower (This is in contrast to trans-women where hrt does not affect the voice)
  • You may become bald or have thinner hair (This is a long-term thing and is generally related to your genetics and family)
  • You will find gaining muscle mass becomes a lot easier
  • You may find your sex-drive becomes a tad-excessive
  • Generally most trans-men become unable to pass as a woman within 6 months of starting HRT

HRT does not:

  • Stop your periods, it can reduce them and may stop your periods in some cases, but in general they do continue.
  • Make you infertile, as a trans-man it is still possible for you to become pregnant. If you take birth-control it is important that you use hormone-free contraceptives.
  • Reduce your breast size, you generally will need surgery to remove your breast tissue.

Is it right for you?

Saying all of the above, if HRT is right for you, then go for it. Its a fun & interesting ride, although one that you can never be fully prepared for.

NHS GICs & CMagic

So the GIC and CMagic, both require a diagnosis of gender incongruence prior to starting you on hrt. In order to get a diagnosis you will be required to have two nhs psychologists sign you off as having gender incongruence. Getting two psychologists to officially sign you off can take between 3 months and several years depending on your case. On top of this there is also a waiting list to be seen by the GICs and CMagic

Once you have got a diagnosis, both the GICS and CMagic will refer you to an endocrinologist to start you on hrt.

It is always worth applying to the GIC/CMagic regardless of wether you choose to go private or DIY, as once you have a formal diagnosis your hrt prescriptions fall under the NHS and it somewhat guarantees you access to hrt for life.

Do be aware that there can be very large waiting lists to be seen by the GICS, and CMagic. Generally you will be seen by CMagic quicker than the GICs, but you can be waiting 1-6 years after applying before you manage to get hrt.

Bridging Hormones

Bridging hormones are when a gp provides hrt as part of a harm reduction method. Bridging hormones are for those people who are currently taking DIY hormones or at imminent risk of starting DIY hormones.

When approaching your gp for bridging hormones it is important to stress that you are either currently taking hrt sourced by yourself or at imminent risk of starting diy hrt. A gp can not initiate hormone therapy, it has to be provided as part of a harm reduction strategy. I must really stress this as without saying the magical words implying you are currently taking hrt or about to start can put a doctors career at risk and make them liable for any consequences of you starting hrt.

It is always worth asking your gp if they will provide bridging hrt prior to looking into a private hormone provider, many gps in Liverpool for instance would rather do bridging hormones than work with gendergp for example.

Bridging hormones bypass any safety checks, you wont have any therapy or confirmation of being trans prior to starting hrt, as its done under the understanding you are or are about to start hrt yourself via diy or sketchy private routes.

Private Hormone Providers

With large waiting lists many people look towards private hrt providers. A private hrt provider generally will assess you in the same way the GIC would, but their process is a lot more lax and less strict. You are essentially paying for a diagnosis. The private providers will have an ongoing costs, but you can be looking at between £300-£600 initially and a possible monthly monitoring cost dependant on provider

GenderCare

GenderCare are a private hrt provider based in london. One of their main psychologists also works for charring cross, so if you get your diagnosis from them, you may only need 1 diagnosis at the GICs rather than two diagnosis's thus speeding things up somewhat

Costs

Initial Cost: 2 x sessions at £250-£300 each Yearly follow-up at £150. No ongoing prescription costs Most practices will do shared care, so you pay the nhs prescription charge for medication.

GenderGP

GenderGP are a private hrt provider based in spain. There is a lot of bad press over genderGP as they were providing hrt for under 18s. Most gp practices in the Liverpool region have also been advised to not provide shared care with them, i.e. prescriptions become more expensive

Costs

Initial Cost: 1 x gp sessions at £200 and 1 x therapy session at £60 Monthly monitoring charge of £30 Prescriptions are private or if your gp agrees to shared care, the nhs prescription charge.

DIY Hormones

DIY hormones are when you source the hormones yourself, usually from hongkong or india and self medicate without the supervision of a endocrinologist. DIY can be dangerous as you don't get any monitoring and hrt can aggravate certain medical conditions.

DIY is strongly discouraged!

But

If you do choose to DIY, it is generally advised to keep it simple and stick to minimum dosages and avoid a blocker. Blockers generally add extra possible contraindications and can have some serious side effects, also if your blood levels are wrong they can cause you to essentially go through menopause. They can make you transition slightly faster, but if you are DIYing it is better to avoid blockers in order to reduce your risk. Oestrogen wise, its generally advised to stick to the minimum dosage, i.e something like 2mg progynova.

Birth control is very different to HRT used by trans women, birth control pills should be avoided as it can cause quite a few health problems for trans women.

Remember its not a race, safety always comes first!

Task Runner