Hormones & Endocrinology

The following is a good description of the varied parameters for individuals regarding hormones and endocrinology.


     Given the spectrum of gender identity and the variation in each person’s expression, there is no single pathway for a trans person to follow in order to actualize the presentation of their authentic self. Non-binary patients may also seek hormone therapy to modify their secondary sex characteristics. When hormones are chosen as part of transition, some patients may seek maximum feminization/masculinization, while others may seek a more androgynous appearance.

     The decision to initiate hormone therapy is a collaborative patient-centered process that focuses on both psychosocial preparation and informed consent. The PCP (with or without the support of a multi-disciplinary team) can facilitate a decision-making process that informs, educates and supports patients. For each patient seeking hormone therapy, it is important to not only consider the possible risks of treatment but to consider the often substantial risks of withholding treatment."

   

    ---  excerpt from "Quick Reference Guide for Primary Care Providers" authored by Dr. Amy Bourns and produced by Rainbow Health Ontario, a program of Sherbourne Health, to accompany the "Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients, 4th edition". Ontario.

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CANADIAN SOURCES

Child & youth

“A supportive environment is important for gender creative, trans or questioning children and youth”

By Trans Care BC.

Home page for many resources.

Do I have to use hormones?

Frequently asked questions. Gender Creative Kids. Montreal, QC.

​Q. Do I have to use hormones?
A. Not at all, it’s important to remember that medical transition is in no way necessary! There are lots of reasons why certain trans youth might not use hormones. While some trans people just aren’t interested in taking hormones, others simply don’t have access to them. This could be due to a lack of parental support, the high costs associated with the medication, or because of a shortage of gender-affirming medical care in the area. Your trans/non-binary identity is valid with or without the use of hormones!

Estrogen-Based Hormone Therapy

By Trans Care BC, Provincial Health Services Authority.   (BC)

"Some trans and gender diverse people benefit from gender-affirming hormone therapy to promote physical characteristics reflective of one’s gender identity or gender expression.

    Estrogen, often in combination with a testosterone blocking medication, is used to reduce testosterone-related features, induce estrogen-related features and relieve distress related to gender. This page sets out the advantages and disadvantages, expected effects, and potential risks of common estrogen, testosterone blocker and progesterone therapies. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you."

Feminizing hormone therapy: Quick reference guide for feminizing hormone therapy

(FOR DOCTORS)
By Shelbourne Health / Rainbow Health Ontario. 2020
“The goal of hormone therapy in transfeminine patients is to reduce the endogenous effects of testosterone such as a coarse body hair and facial hair; and to induce feminine secondary sex characteristics such as breast and hip development, in keeping with the patient’s individual goals. Physiologically, this requires a suppression of endogenous androgens and the addition of estrogen.”
Download English PDF.

Download French PDF.

 

Feminizing hormones

Trans Wellness Initiative.      (Alberta)

"The main goal of hormone treatments is to facilitate physical changes to 'better match' your gender identity. There is no one way to transition and not everyone who transitions uses hormones.

   If you choose to take hormones this document section outlines different options including medication, short/long term monitoring, costs, side effects, and contraindications (otherwise known as symptoms or conditions that may cause harm to you if certain medical treatments are undertaken)

   Not everyone requires a referral to a specialist to begin a medical transition hormone treatment. Your and your Primary Care Provider would be a great place to is a great person to speak with to get started and discuss your goals."

Guidelines for gender-affirming primary care with trans and non-binary patients: A quick reference guide for primary care providers (PCPs)        (FOR DOCTORS)
By Shelbourne Health / Rainbow Health Ontario. 2020
“This quick reference guide was derived from Sherbourne’s Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients and is designed to be used in conjunction with the full Guidelines.
Key messages: Prescribing hormone therapy for trans patients is well-situated in primary care. // The risks of witholding hormone therapy are often more substantial than the risks of treatment.”

(Health care) resources

By Skipping Stone Foundation. Calgary.

Have posters on testosterone injections, HRT at a glance for folks AFAB, and HRT at a glance for folks AMAB.

“In keeping with our mission to provide low barrier access to supports & services, all our resources are available to all to download, use & share. We ask that you include appropriate credit when using our materials. We always love to hear about who and how people are using these resources and it helps us be able to produce even more.”

Hormone effects
By Trans Wellness Initiative (Alberta).
“Hormones affect everyone differently and the rate/degree in which your body changes will vary. It is important to note that some changes caused by hormone therapy are irreversible, while others may be reversible over time.Although hormones can lead to many desired changes and outcomes, there are some gender-affirming features that are not obtainable through hormone therapy. Information about hormone effects is summarized in the chart (in the link).”

 

​Hormone readiness assessment
By Trans Care BC, Provincial Health Services Authority
“A hormone readiness assessment is an evaluation conducted by a healthcare professional to determine if a patient is ready to begin hormone therapy.”

 

Hormone therapy considerations
By Trans Care BC, Provincial Health Services Authority
“Many trans and gender diverse people are happy with their bodies, or find comfort with their bodies without hormone therapy. Only you can decide whether hormone therapy is right for you.”

 

Hormones
By Trans Care BC, Provincial Health Services Authority
“Hormone therapy is the use of sex hormones to alter secondary sex characteristics.” See articles on hormone therapy, hormone readiness, feminizing hormones, masculinizing hormones and how to inject hormones.”

Hormones: A guide for FTMs     (Female to Male)

NOTE:  2006 publication.

By Olivia Ashbee and Joshua Mira Goldberg as part of the Trans Care Project, a joint effort of Transcend Transgender Support & Education Society and Vancouver Coastal Health’s Transgender Health Program. Vancouver, BC.  2006. Booklet/PDF   (Canada/BC)

“While there are some health risks involved with hormone therapy, it can have positive and important effects on trans people's quality of life. Knowing what you can expect will help you work with your health care providers to maximize the benefits and minimize the risks.

The purpose of this booklet is to:

• explain how hormones work

• describe the changes to expect from testosterone

• outline possible risks and side effects of testosterone

• give you information about how to maximize the benefits and minimize the risks

   This booklet is written specifically for people in the FTM spectrum who are considering taking testosterone. It may also be a helpful resource for partners, family, and friends who are wondering how testosterone works and what it does.”

How to self-inject testosterone

Skipping Stone. YouTube video. May 2021. (Calgary)

Physician Ted Jablonski explains. "Many of our clients and folks in the trans and gender diverse community inject testosterone as part of affirming their gender identity... But, once you have your prescription, what do you do next? How do you get your injection on a regular basis? Many folks will schedule appointments with their clinic to receive their injections but for others, this simply isn't practical. That's why we're created this video to help you build the knowledge and confidence to do your injections yourself. This video covers both Intramuscular and Sub-Cutaneous injection methods."

HRT: For people assigned female at birth
By Skipping Stone Foundation. Calgary. Graphic/poster.

HRT: For folks assigned male at birth
By Skipping Stone Foundation. Calgary. Graphic/poster.

Intramuscular injections pamphlet – a guide to giving yourself intramuscular hormone injections
By Trans Care BC and BCCDC Harm Reduction Services.

Pamphlet with diagrams.

Masculinizing hormone therapy     (FOR DOCTORS)
By Shelbourne Health & Rainbow Health Ontario. 2020.
Quick reference guide for masculinizing hormone therapy.

"The cornerstone of hormone therapy for trans masculine patients is testosterone. The goal of treatment is virilization – the development of masculine secondary sexual characteristics."
Download English PDF.

Download French PDF

Medical affirmation & transition

Information on gender-affirming medical care for children and youth in BC

Trans Care BC Provincial Health Services Authority.    (BC)

"Gender-affirming medical care is necessary for some trans and gender diverse people. If your young person is feeling distressed about their body or anxious about the changes that will come with puberty (e.g., breast growth, menses, voice change, facial hair), it is important to know what medical care options are available.

Starting puberty blockers or hormone therapy, or having gender-affirming surgery are big decisions, and support from family and health care providers is important. Assessment and care planning may be provided by a number of professionals who have received advanced practice training in this area of care. These may include a pediatrician, family doctor, psychologist, psychiatrist, social worker or nurse practitioner."

 

Medical care
Trans Wellness Initiative website.  (Alberta)
“This section offers information about health and medical support for trans folks”..   (feminizing hormones; masculinizing hormones; surgery navigation; PrEP; pelvic health; sexual health)

 

My guide to caring for trans and gender-diverse patients   

(FOR DOCTORS)
By Rainbow Health Ontario. Trans Primary Care. 2020
Guide for medical personnel caring for gender-diverse patients. “The content of this illustrated guide is based on Sherbourne’s Guidelines for gender-affirming primary care with trans and non-binary patients authored by Dr. Amy Bourns, a family physician on Sherbourne’s LGBT2SQ Health Team.”

Puberty blockers for youth

Information on puberty blocker medication used to delay the onset of puberty

Trans Care BC Provincial Health Services Authority.    (BC)

"The changes to your body that happen during puberty can be distressing if they are not in line with your gender. Puberty blockers can help relieve this distress. Delaying puberty gives you more time to explore your gender identity, before changes happen to your body that can’t be reversed. Also discusses:  Effects of puberty blockers /Risks of taking puberty blockers / Risks of withholding puberty blockers."

Sherbourne’s “Guidelines for gender-affirming primary care with trans and non-binary patients”: 4th edition
Authored by Dr. Amy Bourns, a family physician on Sherbourne’s LGBT2SQ Health Team. 2019.  Ontario
“In addition to incorporating recently available evidence in both general primary care and trans health, the 2019 edition features revisions and expansions in several areas, including: expanded discussion of considerations for non-binary patients; unique considerations for older trans patients; subtle language changes that reflect the rapid pace of cultural change; an expanded discussion of fertility considerations for trans people; discussion of alternate routes of hormone administration; an overview of the role of PCPs in supporting patients with transition-related surgeries; and The Trans Primary Care Guide, the online interactive tool based on the Guidelines, has also been updated… You may also want to access the Quick Reference Guide that was created to accompany the full Guidelines.”

 

Subcutaneous injections pamphlet – a guide to giving yourself subcutaneous hormone injections
By Trans Care BC and BCCDC Harm Reduction Services (pamphlet with diagrams)

Testosterone-based hormone therapy

Trans Care BC Provincial Health Services Authority.    (BC)

"Some trans and gender diverse people benefit from gender-affirming hormone therapy to promote physical characteristics reflective of one’s gender identity or gender expression.

    Testosterone is used to reduce estrogen-related features, induce testosterone-related features and relieve gender-related distress. This page sets out the advantages and disadvantages, expected effects, and potential risks associated with testosterone-based hormone therapy. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you."

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AMERICAN & INTERNATIONAL SOURCES

 

Changes from 5 years on testosterone / transition update

By Jackson Bird. YouTube video. Apr 2020

“In this five years on testosterone update video as an FTM trans man, I discuss my experiences with using finasteride to treat hair loss, get real about how I often felt behind other people’s physical transitions, question what changes are caused by being on testosterone for this length of time versus being on testosterone at this age, and I share some things I’ve never mentioned publicly before.”

Endocrine care of transgender children and adolescents

By Daniel Evan Shumer and Adrian Araya. YouTube video/talk June 22, 2018
“What we know about caring for gender non-conforming and transgender youth is changing rapidly. Learn the latest best practices in caring for transgender and gender non-conforming children and adolescents. Daniel Shumer, MD, MPH, pediatric endocrinologist, and Ellen Selkie, MD, MPH, adolescent medicine physician, discuss best practices in the care of gender non-conforming and transgender youth. Topics covered include defining gender dysphoria, approaches to caring for children and adolescents with gender dysphoria, pharmacologic therapies used in transgender medicine, barriers to care and future directions for the delivery of care for this important patient population.”

Endocrine treatment of gender-dysphoric/gender-incongruent persons: An endocrine society clinical practice guideline

By Wylie C Hembree, Peggy T Cohen-Kettenis, Louis Gooren, Sabine E Hannema, Walter J Meyer, M Hassan Murad, Stephen M Rosenthal, Joshua D Safer, Vin Tangpricha, Guy G T’Sjoen .

The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017, Pages 3869–3903. Published: 13 September 2017

​Correction published: https://academic.oup.com/jcem/article/103/7/2758/5036711

 

Gender nonconformity in children and adolescents
Endocrine Society / Hormone Health Network.
Discusses terminology, hormones, gender dysphoria, etc.

“How do I talk about periods with my non-binary kid?”

Blog post. (US)

How I help transgender teens become who they want to be
By Dr Norman Spack, Endocrinologist Boston’s Children’s Hospital. Ted Talk video..
“Puberty is an awkward time for just about everybody, but for transgender teens it can be a nightmare, as they grow overnight into bodies they aren’t comfortable with. In a heartfelt talk, Norman Spack tells a personal story of how he became one of the few doctors in the US to treat minors with hormone replacement therapy. By staving off the effects of puberty, Spack gives trans teens the time they need.”

How will estrogen hormone therapy affect the body?

By Veronica Zambon. Medically reviewed by Emelia Arquilla, DO. April 2021  (US)

“This article looks at what changes a person can expect and how long these changes take when undergoing estrogen hormone therapy.”

 

Hudson’s FTM resource guide
By Hudson. (US)
Supportive website for FTM (Female to Male = Trans Male) individuals. “This Guide is intended to provide information on topics of interest to female-to-male (FTM, F2M) trans men, and their friends and loved ones. Non-trans men have also found the pages on men’s grooming and clothing to be helpful. Transgender, cisgender, intersex, non-binary, genderqueer, questioning, and “just plain folks” are all welcome. Tons of information regarding FTM (female-to-male) trans men, including medical info, presenting.

[Hudson is a trans man who resides in the US. “I wanted to gather information on many topics of concern to trans men and their loved ones, so that a reader could get a solid, detailed introduction to any topic listed here, as well as find links to where they could learn more. I wanted the tone to be accessible and welcoming, so that no matter what the identity of the reader, their stage in transition, or their knowledge of FTM issues, they would be able to walk away with useful, non-judgmental information.]

I’m a pediatrician who cares for transgender kids – here’s what you need to know about social support, puberty blockers and other medical options that improve lives of transgender youth

By Mandy Coles. Apr 2021.  (US)

“I am a pediatrician and adolescent medicine specialist who has been caring for transgender youth for over a decade using what is called a gender-affirmative approach.  In this type of care, medical and mental health providers work side by side to provide education to the patient and family, guide people to social support, address mental health issues and discuss medical interventions.”

Information on testosterone hormone therapy
Overview of masculinizing hormone therapy
By Dr Maddie Deutsch.  UCSF Transgender Care, UCSF Health System. (Univ of California – San Francisco). July 2020.

Good overview of what to expect on testosterone, and what to consider when making decisions.

"Hi, I'm Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California – San Francisco (UCSF), and Medical Director for UCSF Transgender Care. In this document I will provide an overview of gender affirming masculinizing hormone therapy, including choices, risks, and unknowns associated with testosterone therapy."

Medically transitioning is not a walk in the park

"Sometimes, it actually sucks"

By Sam Dylan Finch. Let's Queer Things up! blog post. 2016.

"This contradiction – that these hormones can be both life-giving and life-threatening – is impossibly hard to negotiate and is a testimony to just how complex this intersection of transness and mental illness can really be."

Musician Freddie Lewis on dealing with periods as a trans man

BBC. Article. Jan 2022.   (UK)

"Freddie Lewis is a pop musician and poet from Bristol.  He shares his life as a transgender man in his art and on social media, bringing positivity and pride to the trans narrative.

   At just 21, Freddie has learned to love and accept his body, including the fact that he occasionally has periods.  In his own words while in conversation with BBC reporter Harriet Robinson, Freddie details his experiences of bleeding, how he found self-acceptance and what changes he wants to see from society.

​   I would also love to see trans people being more proud and not resenting their own bodies.  You can just love yourself and if others don't understand they're allowed to be wrong about you and your body.  I wish I could go back and tell that to 16-year-old Freddie. You don't have to pander to that, you can be proud of everything your body does."

 

Puberty blockers

Children’s Hospital, St Louis. (US)

“Puberty can be confusing or difficult for a child who is transgender, genderqueer, nonbinary or questioning their gender. 

   Puberty blockers, also called hormone blockers, help delay unwanted physical changes that don’t match someone’s gender identity. Delaying these changes can be an important step in a young person’s transition. It can also give your child more time to explore their options before deciding whether or how to transition. Puberty blockers, also called hormone blockers, help delay unwanted physical changes that don’t match someone’s gender identity. Delaying these changes can be an important step in a young person's transition. It can also give your child more time to explore their options before deciding whether or how to transition. “

Puberty suppression in transgender children and adolescents
Published online in
The Lancet, Diabetes & Endocrinology. May 22, 2017

By Simone Mahfouda, BA; Julia K Moore, FRANZCP; Aris Siafarikas, MD; Prof Florian D Zepf, MD † Ashleigh Lin, PhD †.
“The World Professional Association for Transgender Health’s standards of care recommend suspending puberty, preferably with the use of gonadotropin-releasing hormone agonists, in certain gender non-conforming minors (aged under 18 years) who have undergone a psychiatric assessment and have reached at least Tanner stage II of puberty. This approach seeks to lessen the discordance between assigned natal sex and gender identity by temporarily halting the development of secondary sexual characteristics, essentially widening the temporal window for gender clarification. Despite promising preliminary evidence on the clinical utility of this approach, there is a dearth of research to inform evidence-based practice. In view of these challenges, we review the available empirical evidence on the cognitive, physical, and surgical implications of puberty suppression in gender-incongruent children and adolescents. We also explore the historical underpinnings and clinical impetus for suspending puberty in this population, and propose key research priorities.”

 

Puberty suppression linked to improved well-being in transgender youth
By Cordelia Ross, MD, MS and Leah H. Carr, MD.  2014

"Study Rundown: Transgender adolescents may experience significant distress, meeting criteria for GD, upon the development of secondary sex characteristics during puberty. Management of these patients includes a gonadotropin-releasing hormone analog (GnRHa) used to suppress puberty, added to a treatment protocol with cross-sex hormones (CSH) and gender reassignment surgery (GRS). However, the evidence is scant about its effectiveness in relieving distress and improving quality of life in transgender youth. This study evaluated Dutch youth with GD before, during, and after treatment with GnRHa, CSH, and GRS, and assessed changes in body image satisfaction, psychological functioning, and overall well-being. Participants reported significant improvements in GD and body image difficulties, as well as improved global psychological functioning and well-being. This study is limited by its small size, the use of self-report measures, and lack of control group. Nonetheless, findings highlight the importance of early medical intervention and a multidisciplinary approach to improving quality of life in gender dysphoric youth."


Scared of needles: Tips on T-shots - FTM life

By Aydian Dowling. Video. 018.

Posted on Be Healthy While Trans blog site.

Transgender health: Injection guide
Fenway Health. (US)
“A step-by-step guide for intramuscular (IM) and subcutaneous (SubQ) injections.”

 

Transgender health: A practitioner’s guide to binary and non-binary trans patient care
by Benjamin Vincent. Book. 2018.    (UK)
“The number of people coming out as transgender continues to rise, and this book shows healthcare and medical practitioners how to deliver excellent primary and secondary care to gender diverse patients. This guide provides accessible and practical advice on tailoring the social and ethical aspects of practice to the needs of each individual. Beyond setting out how clinical procedures should work for gender reassignment, it explains how to use language and pronouns in a respectful way, provides information on transgender services and resources, and offers insights into the challenges commonly faced by transgender people in both medical and social contexts. Based on cutting edge research and the lived experience of the author as a non-binary person, this is essential reading for all those working to meet the needs of transgender people in healthcare settings.”

 

Transgender Hormone Replacement Therapy – HRT Guide 101 (Oestrogen & Testosterone)
By Transgender Hub. June 2017.

Tiopics covered: What are hormones? What effects do naturally produced hormones have?  What is the aim of hormone therapy for trans people? What physical effects will hormone treatment have on me? You can stop taking hormones at any time. Teenage trans people. Will I always have to take hormones? What are the risks of hormone treatment? The most serious risks when taking oestrogens are (___). The most serious risk when taking testosterone is (___). Why do I need to be monitored? will I need to stop taking hormones before surgery?   (etc)

Where’s my book? A guide for transgender and gender non-conforming youth, their parents, & everyone else
By Linda Gromko, MD. 2015.
“Linda Gromko, MD is a Board Certified Family Physician who has worked with the transgender community for nearly eighteen years. She explains the basics of gender identity, sexual orientation, puberty, puberty blockers, hormone treatments, and gender affirming surgeries. She shares years of her patients’ wisdom and practical information on getting through every day in the best way possible—from coming out to parents, to school issues, to coping with depression, to love and sex. Why is this book important? We know that transgender kids and their families need specialized information. Alarmingly, the suicide attempt rate among trans youth is close to half! This book is intended to give gender non-conforming kids some of the information they need to grow to be happy, productive, loving and loved. It’s intended to provide the information we need as parents, educators, and health care providers to do better with and for our kids.“

Click to see Kindle edn.

 

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ZINNIA JONES - Gender Analysis Web Series              (US)

"My new series, Gender Analysis, takes a deeper look at the intricacies of living as a trans person"

 

Gender Analysis

By Zinnia Jones. Gender Analysis web series. (US)

“I’m Zinnia Jones, a trans woman activist and writer on YouTube. I've been transitioning for the past eight years, which has required me to learn a lot about a variety of transgender-related subjects. In that time, I've found that most mainstream coverage of trans topics is largely inadequate – presenting only shallow oversimplifications, produced by cis (non-trans) people, for cis people. I think we can do better, and that’s the aim of Gender Analysis.

    Gender Analysis is a web series launched in 2014 exploring transgender science and life experiences in depth, and revealing the many insights to be found at their intersection. We take a closer look at fields such as sociology, public health, psychiatry and more, weaving these diverse perspectives into a deeper understanding of gender-related phenomena. Gender Analysis goes beyond the 101s to educate both trans and cis viewers on some of the most fascinating dimensions of our lives – and the pressing issues we face in society.”

Click to go to Facebook site.

“Conveyer belt” fallacy against youth transition is missing a crucial piece: all the off-ramps before transitioning

By Zinnia Jones. Gender Analysis web series. Jul 1, 2021.   (US)

Do all trans youth on puberty blockers go on to transition?

By Zinnia Jones. Gender Analysis web series. Aug 31, 2017.   (US)

Early use of masculinizing steroid oxandrolone in trans boys can add 2 more inches of height compared to testosterone

By Zinnia Jones. Gender Analysis web series. May 31, 2021.   (US)

Gender basics:  How sex hormones work, and their use by trans people

By Zinnia Jones. Gender Analysis web series. Article and podcast. 2016. 

"Over the past several years, I’ve heard countless comments which reveal a surprising unawareness of some basic facts of the human endocrine system. In particular, it’s clear that many people don’t entirely understand what estrogen and testosterone actually are, how they work, and their effects on trans people. Not all trans people take hormones, and it’s always a personal choice based on individual needs and preferences. That said, most of us do. Trans people likely already know everything that’ll be covered here, so you can go ahead and skip this episode if you want. Cis people: this one’s for you."

Learning to love and accept your body: Testosterone helps adolescent trans boys do that

By Zinnia Jones. Gender Analysis web series. Sep 1, 2021.   (US)

Starting puberty blockers at the onset of puberty is standard care for trans youth. Starting HRT could be, too.

By Zinnia Jones. Gender Analysis web series. Aug 31, 2021.

“If a transgender or gender-questioning youth is experiencing the distress of gender dysphoria about changes to their growing body, when – if at all – should they be treated with puberty blockers to pause any progression of their puberty?”

 

Transmasculine adolescent fertility breakthrough: Successful egg retrieval following puberty blockers since Tanner 2 and direct continuation to testosterone

By Zinnia Jones. Gender Analysis web series. May 31, 2021.

 

Why gender-questioning youth continue or discontinue puberty blockers

By Zinnia Jones. Gender Analysis web series. Mar 31, 2020.   (US)

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