To alleviate symptoms associated with menopause, conventional hormone replacement therapy includes an estrogen and progesterone component to mimic the hormones created by the human ovary. Hormone replacement therapy is a medication that contains female hormones. The medication is taken to replace the estrogen that the body stops producing during menopause.
Hormone therapy
is most commonly used to treat common menopausal symptoms, such as hot flashes and vaginal discomfort.There are many different types of progestins (synthetic progesterone) available to women. If you still have a womb (uterus), it's important to be prescribed a progestogen along with estrogen for HRT. When you take estrogen, the lining of the uterus can build up, which can increase the risk of cancer. However, taking progestogen or progesterone prevents this build-up, meaning there's no increased risk of cancer when taking hormone replacement therapy.
There isn't much scientific evidence about cancer risks in transgender women. We think the risk of prostate cancer will decrease, but we're not sure. The risk of breast cancer may increase slightly, but it will still be a lower risk than that of a non-transgender woman. Since there isn't much research on the use of estrogen for feminization treatment, there may be other unknown risks, especially for people who have used estrogen for many years.
In particular, for trans women over 50, it may be appropriate to use testosterone blockers alone or with a lower dose of estrogen. Since most non-transgender women go through menopause with a decline in estrogen levels at age 50, this approach is similar to the natural cycle of female life and can be especially useful for those who pose other health risks. Modern, healthy approaches to estrogen therapy have no risk of causing liver damage. However, in some cases, the flow of bile from the liver through the gallbladder may decrease, which may increase the risk of gallstones.
The degree of this increased risk is small. Estrogen is the main “female hormone”. It is involved in many of the physical and emotional changes that occur during the transition. Estrogen can be administered in pill form, by injection, or through various skin preparations, such as a gel, spray, or patch. Many trans women are interested in injectable estrogen.
Estrogen injections tend to cause very high and fluctuating estrogen levels, which can lead to mood changes, weight gain, hot flashes, anxiety, or migraines. In addition, little is known about the long-term effects of these high levels. If injections are used, they should be administered in low doses and taking into account that uncomfortable side effects can occur and that stopping injecting to replace them with other forms may cause mood changes or hot flashes. Some trans women have struggled to get a consistent supply of injected estrogen because of ongoing problems with the provider.
Realistically, there is no evidence that injections lead to faster feminization or a greater degree of feminization. In my practice, I generally avoid prescribing injections unless it's under very specific circumstances. In general, you can gain or lose weight once you start hormone therapy, depending on your diet, lifestyle, genetics and muscle mass. It is best to store sperm before starting treatment, to avoid any risk of reduced sperm count due to hormone therapy that could affect your ability to conceive a child.
If your testicles are removed by orchiectomy or vaginoplasty, you can stop taking testosterone blockers and take a lower dose of hormones, but you should continue to take at least a minimum dose of hormones until you are at least 50 years old. Hormone therapy has also been shown to prevent bone loss and reduce fractures in postmenopausal women. On the other hand, hormone replacement therapy (HRT) generally means that hormones are replacing natural hormones that the body no longer produces, especially in people in their 30s and 40 years old. Women often realize that only when they are given the right hormonal balance, their symptoms begin to truly improve.
If you have experienced any baldness on your scalp, hormone therapy usually stops it; however, the degree to which it will grow back varies. Since these changes can take two or more years to fully develop, it's a good idea to postpone the decision to undergo facial feminization surgery until you've been on hormone treatment for at least a year. Some people may maintain a sperm count during hormone therapy or may recover their sperm count after stopping it, but it's best to assume that won't be the case for you. On the other hand, since feminizing hormone therapy doesn't always lower your sperm count, if you're sexually active with someone who can become pregnant, you should always keep using birth control to avoid an unwanted pregnancy.
Because early estrogen loss increases the risk of many conditions, including cardiovascular disease, people who lose estrogen before age 40 are at risk of heart disease if they don't use hormone replacement therapy (HRT). Hormone therapy (HT) is a broader term, meaning that it can be applied to any type of treatment that involves hormones. Ask your medical provider if you have more questions about risks, health management needs, and other long-term considerations when taking hormone therapy. This activity describes the indications for hormone replacement therapy and highlights the role of the interprofessional team in the treatment of patients with postmenopausal symptoms.
You and your doctor must consider all of these risks when deciding if hormone therapy could be a option for you.
