Gender-affirming hormone therapy
Gender identity
Gender identity refers to how a person feels and their sense of belonging to a gender category: man, woman, both, neither, or elsewhere on or off the gender spectrum. A person can identify within the gender binary (man or woman) or outside of it, and therefore, as nonbinary.
Gender is often confused with gender expression, which refers to how a person expresses their gender through behaviours, clothing, hairstyles, and other visible signs. A person may want to express themselves in a feminine way, in a masculine way, somewhere in-between or outside of the gender binary.
As they say: the clothes don’t make the identity
Gender also differs from sex, which refers to biological, physiological, genetic, or physical sex characteristics that society classifies into binary categories: male and female. These characteristics include primary (external genitalia) and secondary (changes that appear at puberty) sex characteristics. Sex is assigned to us at birth: the social and medical system classifies us either as a man (male) if we have a penis or as a woman (female) if we have a vulva. However, this does not take into account how we feel nor people whose sex characteristics do not fit this binary categorization system, such as intersex people.
It is essential to respect everyone’s gender identity and expression. We all have the right to define our own gender identity and express ourselves in a way that feels authentic to us. No one should be the victim of discrimination, harassment, or violence.
What about the term “trans” in all this?
The term “trans” is an umbrella term that covers a range of identities and lived realities. Broadly, the term “trans” is used to refer to people whose gender identity does not match the sex they were assigned at birth.
By contrast, cisgender people are people whose gender matches the sex they were assigned at birth. The term trans designates a state or a journey, but not a gender. A trans person can identify within the gender binary (male/female) or not, and not all nonbinary people identify as trans.
Gender transition can take many forms depending on each person’s journey. A trans person’s identity is valid regardless of the steps they have taken. Being trans starts with one’s inner feelings and identifying as trans is personal and cannot be imposed. There are three types of gender transition:
Gender-affirming hormone therapy
Many people, especially trans and nonbinary people, choose to undergo hormone therapy, which involves taking sex hormones to masculinize or feminize the body. It can also help achieve a more androgynous appearance.
How much does hormone therapy cost?
Although hormones are covered by private insurance plans and RAMQ, you will probably have to pay a certain amount depending on your insurance plan. The price may also vary depending on the chosen method of administration.
How can I access it?
If you want to start hormone therapy, you will first need to get a prescription from a family doctor or doctor specializing in endocrinology or trans health.
The access criteria are not yet standardized in Quebec, so depending on your doctor, you may have to provide a letter of reference from a mental health professional who attests to your need for treatment.
Other physicians advocate for an informed consent approach. This generally includes a meeting and the signing of a form attesting to the assessment of the need for hormone therapy and the understanding of the expected effects and possible risks.
Medical follow-up should be maintained throughout hormone therapy to monitor the development of long-term side effects related to hormone intake, particularly regarding bone health.
The effects of hormones can be permanent, partially reversible, or reversible. Hormones work throughout the body to effect change. Depending on the hormone(s) you take, according to your situation and the changes you want to experience, the process can permanently affect your body. Contact us or your healthcare professional for more information.
Masculinizing hormone therapy
Masculinizing hormone therapies have the effect of helping a trans person develop male secondary sex characteristics, including:
How does it work?
The doctor usually prescribes testosterone. The dose will be determined based on an evaluation of the level of sex hormones in the person’s bloodstream. Medical follow-ups help to ensure that the person’s body is adapting well to the hormone-induced changes and
inform modifications of the dose, if necessary. Testosterone, or “T,” is available as an injection, topical gel, or oral tablets.
How fast does it work?
It may take several months for the first changes to appear. The full effects of testosterone can take 2 to 5 years. You should also know that the effects vary greatly from person to person.
Observed change | Time of appearance | Maximum effect |
Acne and oilier skin | 1 to 6 months | 1 to 2 years |
Cessation of menstruation | 2 to 6 months | N/A |
Increased body and facial hair | 3 to 6 months | 3 to 5 years |
Redistribution of body fat | 3 to 6 months | 2 to 5 years |
Voice change | 3 to 12 months | 1 to 2 years |
Vaginal atrophy and clitoral growth | 3 to 6 months | 1 to 2 years |
Increased muscle mass | 6 to 12 months | 2 to 5 years |
Hair loss (in some people) | 12 months + | Variable |
What are the side effects of taking testosterone?
Although gender-affirming hormone therapy can be a validating and ultimately positive experience, “negative” or unwanted effects are common.
Feminizing hormone therapy
Feminizing hormone therapies support many trans people in their transition journey. These treatments aim to reduce or block the effects of testosterone and induce the appearance of female secondary sex characteristics.
How does it work?
Feminizing hormone therapies generally combine two types of hormones, estrogens and testosterone blockers (also called antiandrogens).
1. Estrogens
By acting on estrogen receptors in the body, estrogens help induce bodily changes. Well tolerated and less expensive than other options, estradiol is often the first drug prescribed. There are other types of estrogen, available either in the form of tablets, patches, or injections. Not all options are covered by drug insurance plans. Contact us to find out more.
2. Testosterone blockers
Testosterone blockers, as their name suggests, lower testosterone levels in the body to negate its effects. Spironolactone (Aldactone) or cyproterone (Androcur) will often be prescribed.
A follow-up with your doctor is necessary because these drugs can sometimes cause fatigue, a drop in blood pressure, potassium imbalances, and a drop in one’s overall mood. For these reasons, they are often prescribed at low doses, and increases are made gradually according to their effectiveness and the person’s tolerance.
The choice to take estrogen alone or in combination with testosterone blockers, as well as the respective doses, depends on the person but also on price and accessibility. Contact us or your physician for more information.
How fast does it work?
It may take several months for the first changes to appear, and up to 2 to 5 years to see the full effects of the therapy. The effects can vary greatly from person to person. Your doctor will be able to monitor the observed changes with you and adjust the dose of the medications if necessary.
Observed changes | Time of appearance | Maximum effect |
Decreased sexual desire | 1 to 3 months | 1 to 2 years |
Decreased frequency of spontaneous (morning) erections | 1 to 3 months | 3 to 6 months |
Slowing or cessation of hair loss | 1 to 3 months | 1 to 2 years |
Decreased testes size | 3 to 6 months | 2 to 3 years |
Redistribution of body fat (mainly around the hips) | 3 to 6 months | 2 to 5 years |
Decreased muscle mass | 3 to 6 months | 1 to 2 years |
Softening of the skin, decreased oil on skin | 3 to 6 months | Variable |
Increased breast size | 3 to 6 months | 2 to 3 years |
Decreased body and facial hair | 6 to 12 months | Variable, more than 3 years |
What are the side effects of taking estrogen and testosterone blockers?
Gender-affirming hormone therapy for nonbinary people
A nonbinary person might desire a more gender-neutral appearance. It is possible to achieve this by taking masculinizing or feminizing hormones in lower doses, called microdoses. It is possible to slow the onset of effects, but it is impossible to predict what effects will occur and when. It is therefore important to have regular follow-ups with your doctor to monitor both the desirable and undesirable effects of the therapy.
Gender-affirming hormone therapy for minors
It is possible for a person under the age of 18 to start gender-affirming hormone therapy. A person between the ages of 14 and 18 can, depending on their needs and transition intentions, take hormone blockers, feminizing hormones, or masculinizing hormones. A person under the age of 14 can take hormone blockers to interrupt puberty and delay the onset of secondary sex characteristics that do not correspond to their gender.
Hormone blockers can:
The information on this website is presented for general information purposes only and is not intended to provide complete information on the subjects covered or to replace the advice of a healthcare professional. This information does not constitute medical consultations, diagnoses, or opinions, and should therefore not be interpreted as such. Please consult your healthcare professional if you have any questions about your medical condition, medications, or treatment.
