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What Is Gender-Affirming Hormone Therapy?

• How to Get Started
• Masculinizing Therapy
• Feminizing Therapy
• What to Expect
• Access to Treatment

Gender-affirming hormone therapy helps transgender and other gender-nonconforming people align their bodies with their gender identity . Not all transgender (trans) people are interested in hormone therapy. However, many transgender people, particularly binary transgender people, turn to hormones to affirm their gender.

Gender-affirming hormone therapy is comprised of masculizing hormone therapy used in trans men and feminizing hormone therapy used in trans women.

This article describes the goals of gender-affirming hormone therapy, how the treatment is administered, and the different types of hormones used. It also explains what to expect when undergoing gender-affirming hormone therapy and the possible risks.

Verywell / Brianna Gilmartin

Definitions

The term "gender affirmation" is preferred over "gender confirmation" because a transgender person does not need to confirm their gender to anyone. The word "confirm" suggests proof, while "affirm" means to assert strongly.

Who Is Gender-Affirming Hormone Therapy For?

Gender-affirming hormone therapy is the primary medical treatment sought by transgender people. It allows their secondary sex characteristics to be more aligned with their individual gender identity.

Gender-affirming hormone therapy comes in two types:

• Masculinizing hormone therapy used to develop typically male sex characteristics
• Feminizing hormone therapy used to develop typically female sex characteristics

Hormone therapy can be used on its own for people who have no interest in pursuing gender-affirming surgery . It can also be used in advance of surgery (usually for six months to one year) to improve the outcomes of surgery, such as breast augmentation.

According to the National Transgender Discrimination Survey, 95% of transgender people and 49% of non-binary people were interested in hormone therapy.

Hormone Therapy vs. Puberty Blockers

Puberty blockers are used to delay the onset of puberty in young, gender-diverse people prior to the start of hormone therapy. They are considered to be a distinct but complementary component of gender-affirmation therapy.

How to Get Started 

Gender affirmation is a process in which hormones only play a part. It typically starts with social gender affirmation in which you alter your appearance, wardrobe, and manner of grooming while updating your name, pronouns, and legal documentation.

Medical gender affirmation is typically the next step in which you work with a healthcare provider to identify your personal goals and which type of types of treatments are needed to achieve those goals.

Hormone therapy is typically overseen by a specialist in the endocrine (hormonal) system called an endocrinologist . Other healthcare providers trained in gender-affirming medical care may be equally qualified to administer treatment.

Depending on state law and other factors, healthcare providers may be able to dispense treatment on the same day. No letter from a mental health provider may be needed. Call Planned Parenthood or your local LGBTI organization to learn about the laws in your state.

To receive authorization for insurance coverage, many insurers require a diagnosis of gender dysphoria . To do so, a therapist or mental health professional must confirm that there is a mismatch between a person's expressed or experienced gender and the gender they were assigned at birth for a period of at least six months.

How to Choose the Right Provider

Not every endocrinologist is equally well-suited to administer gender-affirming hormone therapy. Those who have undergone a comprehensive, multidisciplinary gender-affirmation training program are generally preferred.

Do not hesitate to ask about a healthcare provider's experience and qualifications in administering gender-affirming care.

Masculinizing Hormone Therapy

Masculinizing hormone therapy uses various types of testosterone to promote masculinizing changes in both binary and non-binary individuals. Testosterone is most often given as an injection, but other formations are available, including pills and creams.

There has been growing interest in the use of subcutaneous pellets for testosterone treatment, as they only need to be inserted two to four times a year. However, they are not always available or covered by insurance.

Changes that can be induced by masculinizing hormone therapy include:

• Facial and body hair growth
• Increased muscle mass
• Lowering of the pitch of the voice
• Increased sex drive
• Growth of the glans clitoris
• Interruption of menstruation
• Vaginal dryness
• Facial and body fat redistribution
• Sweat- and odor-pattern changes
• Hairline recession; possibly male pattern baldness
• Possible changes in emotions or interests

Masculinizing hormone therapy cannot reverse all of the changes associated with female puberty. If transmasculine individuals have experienced breast growth that makes them uncomfortable, they may need to address that with binding or top surgery .

Testosterone will also not significantly increase height unless it is started reasonably early. Finally, testosterone should not be considered an effective form of contraception, even if menses have stopped.

Feminizing Hormone Therapy

Feminizing hormone therapy uses a combination of estrogen and a testosterone blocker. The testosterone blocker is needed because testosterone has stronger effects on the body than estrogen.

The blocker most commonly used in the United States is spironolactone , a medication also used for heart disease. The medication used as a puberty blocker, called Supprelin LA (histerline), can also be used to block testosterone.

Various forms of estrogen can be used for feminizing hormone therapy. In general, injectable or topical forms are preferred as they tend to have fewer side effects than oral estrogens. However, some trans women prefer oral estrogens.

Changes that can be induced by feminizing hormone therapy include:

• Breast growth
• Softening of the skin
• Fat redistribution
• Reduction in face and body hair (but not elimination)
• Reduced hair loss/balding
• Muscle-mass reduction
• Decrease in erectile function
• Testicular size reduction

Estrogen cannot reverse all changes associated with having undergone testosterone-driven puberty. It cannot eliminate facial or body hair or reverse shoulder width, jaw size, vocal pitch, or facial structure. Many of these can be addressed with aesthetic or surgical treatments.

What to Expect During Treatment

Some hormones used for gender-affirming hormone therapy are self-administered or given by someone you know. Others need to be administered by a healthcare provider.

Thereafter, regular follow-ups are needed to evaluate the effects of treatment and possible side effects. Most healthcare providers recommend visiting every 3 months for the first year and every 6 to 12 months thereafter.

Effects of Therapy

It can take three to five years for your body to show the full effects of gender-affirming hormone therapy. Some changes can occur within the first six months, such as the development of larger breasts. Others, like changes in facial structure, can take years.

In addition to physical changes, hormone therapy can cause emotional changes. If you are sexually active, it may improve sexual satisfaction as well as your overall sense of well-being. Hormone therapy can also help to ease the stress associated with gender dysphoria.

If you discontinue therapy, some changes may be reversible. Others like changes in bone structure may be permanent.

Possible Risks

As beneficial as gender-affirming hormone therapy can be, it also carries certain risks depending on which hormone you are taking.

Possible risks of feminizing hormone therapy include:

• High blood pressure
• Blood clots
• Heart disease
• Type 2 diabetes
• Weight gain
• Infertility
• Breast and prostate cancer

Risks of masculinizing hormone therapy:

• Male pattern baldness
• High cholesterol
• Pelvic pain
• Sleep apnea
• Interfertility

Access to Gender-Affirming Hormone Therapy

Until relatively recently, access to gender-affirming hormone therapy was largely managed through gatekeeping models that required gender-diverse people to undergo a psychological assessment before they could access hormone treatment.

However, there has been a growing movement toward the use of an informed consent model to better reflect access to other types of medical care. This change has been reflected in the standards of care for transgender health produced by the World Professional Association of Transgender Health (WPATH).

Gender-affirming hormone therapy is considered to be a medically necessary treatment for gender dysphoria. It should be covered by most insurers in the United States after legal changes that occurred as part of the passage of the Affordable Care Act.

However, state laws vary substantially in terms of transgender protections, and some states do allow policies to exclude various aspects of transgender health care, including gender-affirming hormone therapy.

Access to hormone therapy can be prohibitively expensive for many people if they need to pay out of pocket, which may lead some people to try to get these medications from friends or other unlicensed sources.

In addition, individuals who are involved with carceral systems such as immigrant detention may be denied access to hormones. This can have significant negative physical and psychological effects.

Gender-affirming hormone therapy is the primary form of treatment for transgender people. Masculizing hormone therapy involving testosterone is used to develop secondary male sex characteristics like larger muscles. Feminizing hormone therapy involving estrogen and a testosterone blocker is used to develop secondary female sex characteristics like breasts.

Some masculinizing and feminizing effects can occur within months, while others may take years. If you stop treatment, many of the effects will reverse while some will be permanent. Regular follow-up care is needed to avoid potential side effects and long-term complications.

Gardner I, Safer JD. Progress on the road to better medical care for transgender patients . Curr Opin Endocrinol Diabetes Obesity . 2013 20(6):553-8. doi:10.1097/01.med.0000436188.95351.4d

James SE, Herman JL, Rankin S, Keisling M, Mottet M, Anafi M. The Report of the 2015 U.S. Transgender Survey . Washington, DC: National Center for Transgender Equality. 2016.

Planned Parenthood. Gender-affirming hormone therapy: what to expect on your first visit and beyond .

Boskey ER, Taghinia AH, Ganor O. Association of surgical risk with exogenous hormone use in transgender patients: A systematic review . JAMA Surg . 2019;154(2):159-169. doi:10.1001/jamasurg.2018.4598

Almazan AN, Benson TA, Boskey ER, Ganor O. Associations between transgender exclusion prohibitions and insurance coverage of gender-affirming surgery. LGBT Health . 2020;7(5). doi:10.1089/lgbt.2019.0212

White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals . Transgender Health . 2016;1(1),21–31. doi:10.1089/trgh.2015.0008

Cavanaugh T, Hopwood R, Lambert C. Informed consent in the medical care of transgender and gender-nonconforming patients . AMA Journal of Ethics . 2016;18(11),1147–1155. doi:10.1001/journalofethics.2016.18.11.sect1-161

World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (7th Version) . WPATH. 2011.

By Elizabeth Boskey, PhD Elizabeth Boskey, PhD, MPH, CHES, is a social worker, adjunct lecturer, and expert writer in the field of sexually transmitted diseases.

Appointments at Mayo Clinic

• Puberty blockers for transgender and gender-diverse youth

Puberty blockers can be used to delay the changes of puberty in transgender and gender-diverse youth who have started puberty. The medicines most often used for this purpose are called gonadotropin-releasing hormone (GnRH) analogues. Here's a summary of their possible benefits, side effects and long-term effects.

What do puberty blockers do?

When taken regularly, GnRH analogues stop the body from making sex hormones. That includes testosterone and estrogen.

Sex hormones affect:

• Primary sex characteristics. These are the sexual organs present at birth. They include the penis, scrotum and testicles, and the uterus, ovaries and vagina.
• Secondary sex characteristics. These are the physical changes in the body that appear during puberty. Examples include breast development and growth of facial hair.

In people assigned male at birth, GnRH analogues slow the growth of facial and body hair, prevent voice deepening, and limit the growth of the penis, scrotum and testicles.

In people assigned female at birth, this treatment limits or stops breast development and stops menstruation.

What are the possible benefits of puberty blockers?

Gender identity is the internal sense of being male, female, neither or some combination of both. Gender dysphoria is a feeling of distress that can happen when gender identity differs from a person's sex assigned at birth or from sex-related physical characteristics. Some transgender and gender-diverse people experience gender dysphoria. Others do not.

For transgender and gender-diverse youth who have gender dysphoria, delaying puberty might:

• Improve mental well-being.
• Ease depression and anxiety.
• Improve social interactions with others.
• Lower the need for future surgeries.
• Ease thoughts or actions of self-harm.

Taking puberty blockers alone, however, without other medical or behavioral treatment, might not be enough to ease gender dysphoria.

What are the criteria for use of puberty blockers?

In most cases, to begin using puberty blockers, an individual needs to:

• Show a lasting pattern of gender nonconformity or gender dysphoria.
• Have gender dysphoria that began or worsened at the start of puberty.
• Address any psychological, medical or social problems that could interfere with the treatment.
• Be able to understand the treatment and agree to have it. This is called informed consent.

Puberty blockers are not recommended for children who have not started puberty.

In most cases, youth aren't old enough to get medical treatment without a parent, guardian or other caregiver's permission. This is called medical consent. For those who haven't reached the age of medical consent, a parent, guardian or caregiver often needs to agree to the use of puberty blockers. Parent and family support and encouragement also has been shown to be an important part of boosting mental health and well-being throughout this treatment.

Are the changes permanent?

GnRH analogues don't cause permanent physical changes. Instead, they pause puberty. That offers a chance to explore gender identity. It also gives youth and their families time to plan for the psychological, medical, developmental, social and legal issues that may lie ahead..

When a person stops taking GnRH analogues, puberty starts again.

When does treatment usually start and end?

In general, puberty begins around age 10 or 11, though it may start earlier or later. The effect of puberty blockers depends on when a person begins to take the medicine. GnRH analogue treatment can begin at the start of puberty to delay the development of secondary sex characteristics. In slightly later stages of puberty, the treatment could be used to stop menstruation or erections. It also may prevent further development of secondary sex characteristics.

While many people take the medicine for a few years, everyone is different. After delaying puberty for several years, some teens might decide to stop taking puberty-blocking medicine. Or they may start taking hormones that match their gender identity. This is called gender-affirming hormone therapy.

How is the medication given?

GnRH analogue medicine is prescribed, given and monitored by a health care professional who has expertise in this group of medicines. The medicine typically is given as a shot either monthly, every three months or every six months. Or it may be given as an implant placed under the skin of the upper arm. The implant usually needs to be replaced every 12 months.

While taking puberty blockers, regular blood tests are needed to check the medicine's effectiveness. Regular appointments with the health care team to check for side effects also are important.

What are the possible side effects and complications?

Possible side effects of GnRH analogue treatment include:

• Swelling at the site of the shot.
• Weight gain.
• Hot flashes.
• Mood changes.

Use of GnRH analogues also might have long-term effects on:

• Growth spurts.
• Bone growth.
• Bone density.
• Fertility, depending on when the medicine is started.

If individuals assigned male at birth begin using GnRH analogues early in puberty, they might not develop enough skin on the penis and scrotum to be able to have some types of gender-affirming surgeries later in life. But other surgery approaches usually are available.

Those who take GnRH analogues typically have their height checked every few months. Yearly bone density and bone age tests may be advised. To support bone health, youth taking puberty blockers may need to take calcium and vitamin D supplements.

It's important to stay on schedule with all medical appointments. Between appointments, contact a member of the health care team if any changes cause concern.

What other treatments are needed?

Assessment and counseling by a behavioral health care professional can help youth and their families as they move through the decision-making process about puberty blockers. Behavioral health care also is an important source of support while taking puberty blockers. Talking about an individual's gender identity with teachers, school staff, and staff in other organizations in which the youth is involved also may help ease social adjustment during this time.

After a time of adjusting to puberty blockers and confirming gender identity, gender-affirming hormone therapy might be an option. This can develop masculine or feminine secondary sex characteristics to help better align the body with an individual's gender identity. Some of the changes triggered by gender-affirming hormone therapy cannot be reversed. Others may require surgery to reverse.

GnRH analogues are the most common medicines used to delay puberty. But they are not the only medicines that can be used. Talk to a member of the health care team for information about other treatment choices.

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• AskMayoExpert. Gender diversity in childhood and adolescence. Mayo Clinic; 2023.
• Coleman E, et al. Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People. 8th version. World Professional Association for Transgender Health; 2022. https://www.wpath.org/publications/soc. Accessed March 22, 2023.
• Olson-Kennedy J, et al. Management of transgender and gender-diverse children and adolescents. https://www.uptodate.com/contents/search. Accessed March 23, 2023.
• Health Education & Content Services. Puberty blockers for transgender and gender non-conforming youth. Mayo Clinic; 2022.

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Trans-led healthcare

From gender-affirming hormone therapy and transition support to medications for anxiety and depression, it can be hard to find one clinic or doctor who understands how to care for you. That’s why we founded Plume, a virtual home for transgender, nonbinary, and gender non-conforming people.

We offer a range of healthcare services, including prescriptions for estrogen or testosterone. At Plume, you can be your authentic self and get the gender-affirming care you need. You don’t have to teach your doctor how to care for you—instead, you can let your Care Team support you with a unique care plan that is customized to your transition goals.

We’ll always respect your gender identity, pronouns, name, and gender expression, and we’ll always put your wellness first. We’re here for you when you’re ready.

Appointments In Days, Not Months

Plume doesn’t impose arbitrary gatekeeping like therapists letters or barriers to life-saving care. Membership with Plume provides everything you need to start, continue, and maintain your gender-affirming hormone treatment. We know everyone has different goals for their transition, and we’re here to help you navigate your journey.

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You must be 18 years old or older to access Plume services. Some states have additional restrictions on age or services available.

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Support groups are included in every membership, offering a space to talk through your transition, make new connections, and deepen your understanding of your identity. No matter how you identify, support groups allow you to meet others on a similar journey and explore together . Each group is guided by a trans or nonbinary facilitator from our community who is trained by our licensed therapist. Plume members can join any time and explore different topics that are relevant to you, no matter where you are in your gender journey.

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Medications for Gender Affirming Hormone Therapy

Other names: GAHT

Gender-affirming hormone therapy (GAHT) is used to change secondary sex characteristics to align with gender identity, this can be feminizing or masculinizing hormone therapy.  Hormone therapies are prescription medications that are taken by mouth, patch, gel, or injection.

Drugs used for Gender Affirming Hormone Therapy

The following list of medications are in some way related to or used in the treatment of this condition.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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