Transgender hormone therapy

Transgender hormone therapy is a medical process that involves ingesting the hormones typically associated with a particular gender expression. This causes physical changes in the body, usually helping to change a transgender person’s body in a way that more closely resembles their personal gender identity. Individuals taking testosterone will experience increased muscle mass, a lower voice, thicker hair, and sharper facial features. Individuals taking estrogen will grow breast tissue, experience thinner hair, and find it more difficult to build muscle mass. Additionally, people undergoing transgender hormone therapy will experience emotional changes, including mood swings, changes in libido, and changes in life interests. Transgender youth may also take puberty blockers, or medicine that can be used to delay the changes of puberty by stopping the body from making testosterone and estrogen.

Transgender hormone therapy is commonly used as a treatment for gender dysphoria. When individuals experiencing gender dysphoria lack access to the quality medical care necessary to secure transgender hormone therapy, many resort to black-market treatments, which are usually more dangerous than those prescribed by a licensed medical professional. During the 2020s, many states passed anti-trans bills that made it increasingly difficult for transgender people to access hormone therapy and other forms of gender-affirming care.

Background

The term transgender refers to people whose gender identity differs from the gender they were assigned at birth. Gender identity refers to someone’s internal knowledge of their gender.

Transgender individuals differ from cisgender individuals because the latter’s gender identity matches what they were assigned at birth. Cisgender people rarely, if ever, question their gender. Their body matches the person they view as themselves.

Gender expression refers to the outward characteristics that are traditionally associated with a specific gender. For example, gender expression might include style of dress, manner of speaking, hairstyle, chosen name and pronoun, as well as many other methods of expression. Some of these signifiers are cultural and may vary between regions and social groups.

When someone’s gender expression does not match their gender identity, they may experience gender dysphoria, which is a sense of psychological distress that comes from a lack of gender affirmation, meaning that someone does not feel their outward appearance or presentation matches how they view themselves. Some transgender people avoid expressing their gender identity to avoid social condemnation, discrimination, harassment, or other negative consequences. Others choose to transition their gender expression to match their gender identity.

Gender transition refers to the process by which a person begins to live according to their gender identity rather than their assigned gender. This typically involves changing gender expression attributes, including names and pronouns. It may also include surgical procedures intended to make someone’s body appear more like their gender identity. Many transgender people may also seek legal affirmation of their gender identity, changing their gender on medical paperwork and government identification. These changes may alleviate the psychological distress caused by gender dysphoria.

Overview

Many transgender people choose to undergo specialized hormonal therapies to treat their gender dysphoria. This involves ingesting the sex hormones typically associated with a particular gender to cause certain changes in the body. Transgender individuals seeking to transition from male to female usually take estrogen, while transgender individuals seeking to transition from female to male usually take testosterone. Transgender youth who have begun puberty may take puberty blockers to delay the changes of puberty. In people assigned male at birth, such changes can include voice deepening and the growth of the penis. In people assigned female at birth, puberty blockers can limit breast development and stop menstruation.

Individuals who regularly take estrogen will experience several physical changes. They will grow breasts, even if little breast tissue existed before they began ingesting estrogen. They will lose muscle tone and find it more difficult to build muscle from strenuous activity. Hair present on the face and chest will become thinner. The body’s fat deposits may grow on the face, hips, and thighs. If they have testicles, they will shrink. They will struggle to get erections and stop creating sperm.

Individuals who regularly take testosterone will develop thicker, oilier skin. Their face may become more angular, and muscle definition may increase throughout their body. They may sweat more easily and develop acne. Many people ingesting testosterone experience vocal changes, particularly a deepening of their voice. They may also experience sudden changes in libido.

Some changes in the bodies of those undergoing transgender hormonal therapy occur quickly, and they soon develop noticeable physical features that are traditionally associated with their gender identity. Other changes may take place over long periods of time, with some people continuing to undergo significant changes for up to five years. Most physicians recommend that transgender individuals avoid having plastic surgery to change their appearance until they have spent a significant amount of time undergoing hormone therapy to ensure that their body is finished adjusting to its new hormonal balance.

Because the body’s hormones play a key role in regulating emotional health, people undergoing transgender hormone therapy often undergo significant emotional changes. They may experience sudden changes in mood, including feelings of both depression and euphoria. Their interests and sexuality may drastically change. To best cope with these shifts in feelings, doctors recommend that transgender individuals develop a strong support network before undergoing transgender hormone therapy.

Transgender hormone therapy can be carried out in several ways. Some prescriptions involve taking hormones orally, typically in pill form, according to a specific schedule. Others involve wearing a patch that slowly passes the hormones through the skin. Still others involve periodically injecting hormones directly into the bloodstream.

In some cases, it is difficult for transgender individuals seeking to undergo a gender transition to gain access to hormone therapy. They may find it difficult to find a physician willing to prescribe the necessary hormones or have adequate health care to pay for costs. When faced with a lack of gender-affirming health care, some transgender individuals use black-market hormones to carry out their own transition. Many procure such hormones through illegal online markets. These hormonal treatments may be more expensive than securing treatments with insurance through proper medical facilities. They may also be more dangerous, as it can be difficult to verify the integrity of illegally purchased hormones. For these reasons, many medical experts recommend widespread legislative change to make it easier for transgender individuals to safely secure desired medical treatments.

However, during the 2020s, many state legislations caused the opposite to happen as states passed new laws banning gender-affirming care for transgender minors, including access to hormones. In 2023, at least five states passed anti-trans health care bills, most of which specifically banned minors from receiving gender-affirming care. In response, the American Medical Association (AMA), the American Academy of Pediatrics, and other groups publicly endorsed gender-affirming care, calling on governors in states considering anti-trans legislation to oppose such measures and pointing to numerous studies that show the positive effects of gender-affirming care on youth. Despite such opposition, Republican-led states continued to fast-track anti-trans bills at increasingly alarming rates, with more than one hundred pieces of legislation under consideration in 2023 alone. Additionally, some proposed bills had more far-reaching consequences, extending bans on transition-related care to trans adults as well children.

In some states, federal courts sought to block anti-trans legislation, deeming the laws unconstitutional. In Tennessee and Kentucky, for example, federal judges temporarily blocked certain provisions of those states' bans on gender-affirming care for minors in June 2023, allowing trans youth to retain access to puberty blockers and other hormones. However, the situation worsened in 2025, when Donald Trump entered his second term as president. Shortly after his inauguration, Trump signed an executive order directing federally managed insurance programs such as Medicaid to exclude coverage for gender-affirming care, including puberty-blocking drugs and hormone therapy, for individuals under nineteen. In response, many hospitals across the country paused their gender-affirming care centers. By that time, twenty-six states had passed laws prohibiting or limiting gender-affirming care for transgender minors.

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