Medical Transition

Please note that some of the language used on this page may cause gender dysphoria, as anatomical terms are used.

Hormone Therapy

Gender-Affirming Hormone Therapy

For many trans people, gender-affirming hormone therapy (masculinising or feminising), is a very important step during their transition. Gender-affirming hormone therapy is different for everybody, so it is important to go through the right avenues to obtain and use hormone therapy.

Where to find a doctor:

Australia-wide Australian Professional Association of Trans Health member providers

Victorian Trans and Gender Diverse Health Community Health Services - complete a quick online form and a trained peer navigator will help you coordinate healthcare.

In Victoria (where we are based), Northside Clinic, Prahran Market Clinic, Equinox Gender Diverse Health Centre, Eleanor Clinic, Ballarat Community Health, Your Community Health (based at PANCH with Austin Health) and Monash Gender Clinic are specialised clinics designed to help trans, gender diverse and non-binary people seek hormone therapy.

Traditional Pathway to Accessing Hormones:

This pathway to hormones involves obtaining an approval letter to start hormones after a detailed assessment and support (usually 3–6 appointments) with a specialised mental health professional experienced in gender transition. Whilst there is criticism that this process is ‘gate-keeping’, many find this process beneficial and valuable to support them through gender transition, and prepare them for starting hormones.

Informed Consent Pathway:

Under an ‘Informed Consent’ model of care, General Practitionersperform the initial assessment, play a key role in mental health and risk assessments for trans clients, and organise referral for secondary consultation where required. This process was designed to reduce unnecessary barriers.

Hormone therapies can make trans people infertile. Feminising hormones with oestrogen can block sperm production, and if biological children are desired in the future, sperm storage is recommended before starting hormones. This can be done at some hospital andrology clinics and some specialised pathology clinics (ask your GP) and there is a cost involved (usually a few hundred dollars) for collection and then annual storage costs (a few hundred dollars).

Feminising Hormones

Treatments for Trans Women and AMAB Non-Binary People

Feminising hormone therapy, for transgender people who are assigned male at birth, typically increases the feminising hormone estradiol, and lowers the masculinising hormone testosterone. Estradiol is the mainstay, but often testosterone blockers are needed too.

Estradiol

Estradiol in Australia is available on the PBS which comes in three different forms: oral tablets, patches and gels. Tablets are taken everyday and patches are changed twice weekly or weekly depending on the brand. Gels are applied to the skin daily. Medications covered by the PBS cost a maximum $40.30 per month or $6.50/month for health care card holders. There are no Therapeutic Goods Administration (TGA)-approved or PBS implants or injections available in Australia (speak to your doctor about compounded medications).

Side-Effects

There are side-effects of estradiol including reduced fertility, a raised risk of blood clots and probable increased risk of heart disease and stroke. Some others include mood swings (more with cyproterone), passing too much urine (spironolactone) and nausea. There are uncertain effects on breast cancer and other cancers. More research is needed, but potential risks include:

Thromboembolic disease
Hypertriglyceridaemia
Prolactin elevation
Gall bladder disease
Cardiovascular disease
Breast cancer
Safety

Testosterone Blockers (Anti-Androgens)

There are several types of anti-androgens (all are daily tablets) with the most common types being cyproterone acetate (not available in the US), spironolactone and micronized progesterone.

Health Behaviours

There are certain things to consider which help reduce the side effects of feminizing hormone therapy. Look after your mental health and get as much support as possible.

Exercise regularly
Minimise weight gain
Eat healthily
Reduce/stop smoking
During long flights to keep active and well hydrated to reduce
risk of blood clots
Have regular monitoring with your doctor, particularly as new information comes out all the time.

Effects of Feminizing Hormone Therapy

Like puberty, physical changes occur gradually over 2-3 years and sometimes continue to occur thereafter. Early effects include skin softening, breast growth, loss of muscle mass, redistribution of body fat to hips, thighs and buttocks, a reduction of facial and body hair, reduced sex drive, reduced fertility, and shrinkage of the penis and testicles. Feminizing hormone therapy won’t change your voice pitch or bone structure.There is much more research needed to determine the best hormone regimen, so don’t be surprised to hear varying responses online and varying recommendations. Always discuss your individual needs and responses with your doctor.

There is much more research needed to determine the best hormone regimen, so don’t be surprised to hear varying responses online and varying recommendations. Always discuss your individual needs with your doctor.

Experiences Throughout HRT

Masculinising Hormones

Treatments for Trans Men and AFAB Non-Binary People

Masculinising hormone therapy consists of a testosterone formulation which increases a person’s blood testosterone concentrations, typically to the male reference range. Some people, particularly non-binary people, may choose to use a lower dose of testosterone to achieve partial masculinisation.

Types of Testosterone

3 monthly injections (Reandron)

2 – 3 weekly injections (Primoteston)
Daily testosterone gel in a pump pack (Testogel). The pump pack makes it easy to provide low doses which often suits people wanting partial or slow masculinisation.
Daily testosterone cream (Androforte)

Possible Side Effects

There are also uncertain long-term effects on cancer, bone health, immune function and cardiovascular risk. More research is needed, but possible risks include:

Polycythaemia
Acne
Sleep apnoea
Male pattern baldness
Dyslipidaemia (increased triglyceride and LDL levels; decreased HDL levels)

Changes

Voice lowering (irreversible)
Increase in muscle and decrease in fat
Redistribution of fat to masculine pattern
Facial hair and body hair growth.
Clitoral growth.
Change in libido
Change in appetite
Stopping of menstruation.
Testosterone doesn’t change bone structure, presence of chest tissue (many use chest binders), or reproductive organs.

Health Behaviours

There are certain things to consider which help reduce the side effects of masculinising hormone therapy:

Look after your mental health and get as much support as possible
Exercise regularly
Minimise weight gain
Eat healthily
Reduce/stop smoking
During long flights to keep active and well hydrated to reduce risk of blood clots
Have regular monitoring with your doctor, particularly as new information comes out all the time

Side Effects

Acne
Oily skin
Mood changes
Thick blood (polycythemia)
Increased risk of blood clots
Potential increase in heart attack risk
Fertility is often affected, but typically menstruation returns when T is stopped
There is thinning and dryness of the vagina, and sometimes pelvic pain can occur

Experiences Throughout HRT

Surgery

For many trans people, surgery is an important step. Many do not have surgery. Our research has found that many more desire surgery than have had surgery. Cost is the biggest barrier as surgery in Australia is only performed in the private sector. There are many different types of surgeries available. You can find a list of Australian Professional Association of Trans Health member surgeons here.

Feminising Surgery Includes:

Facial Feminisation Surgery

FFS is a combination of facial reconstructive procedures thats aim is to change the effects testosterone has had on the person’s face and to create a more typically feminine face.

Bottom Surgery/Gender Confirmation Surgery

Bottom surgery for trans feminine people is when a surgeon surgically constructs a vagina from the existing genitals they were born with at birth.

Voice Surgery

The effects testosterone has on someone’s voice permanently deepens their voice and for some voice training (more information in Social Transitioning) isn’t enough to help feminise the voice so voice surgery can help raise the pitch of your voice and create a more feminine sounding voice.

Laryngeal Shave

This reduces the appearance of the Adam's apple in the neck.

Masculinising Surgery Includes:

Chest Reconstructive Surgery

Chest reconstructive surgery or top surgery removes breast tissue to create a more flat, masculine chest. There are many methods to do this but some of the popular methods include keyhole surgery and the inverted “T” method.

Reproductive Surgery

Reproductive surgery involves removing the reproductive system including the uterus and fallopian tube with either a hysterectomy and or bilateral oophorectomy.

Bottom Surgery/Gender Confirmation Surgery:

For trans masculine people there are multiple options for having bottom surgery. The most common types include metoidioplasty and phalloplasty, and are usually done over multiple stages.

Videos About Surgery

Here are some videos, featuring trans people reflecting on their experiences with surgery, and surgeons talking about their professional involvement with trans communities.