Considering hormone therapy

Many trans people are comfortable with their bodies without hormone therapy. Others seek hormone therapy to bring their bodies into alignment with their gender. You are the best judge of what is right for you. 

Note

If you choose to begin hormone therapy, your primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. or specialist can provide detailed information that is specific to you. The information on this page, although reviewed by medical professionals, is not intended to replace consultation with your medical team.

What is hormone therapy?

Hormone therapy (sometimes referred to as HRT) is the use of sex hormones Hormones, such as estrogen and testosterone, that affect sexual and reproductive development or function. (such as estrogen and testosterone) to alter secondary sex characteristics Physical traits that develop after sexual maturity (puberty), such as facial hair growth, deepening of the voice or breast development. . Hormone therapy can be used to promote physical characteristics reflective of one’s gender and relieve dysphoria. 

To help meet their gender-affirming goals, an individual may take:

• Estrogen — Often used in combination with a testosterone-blocking medication, estrogen reduces testosterone-related features and induces estrogen-related features such as softer skin, thinner body hair and reduced muscle mass.
• Testosterone — Testosterone reduces estrogen-related features and induces testosterone-related features such as deeper voice, increased muscle mass and facial hair growth. 
• Puberty blockers A group of medications for youth that temporarily suppress or inhibit puberty by suppressing the production of sex hormones and preventing development of secondary sex characteristics. — Puberty blockers are medications that suppress the sex hormones that are produced by the body. These medications can be started soon after puberty begins.

Why might someone want hormone therapy?

If you experience discomfort or distress because your gender and the sex you were assigned at birth are different, hormone therapy may provide significant comfort.

Hormone therapy may help you to feel more at ease in your body, which can have positive effects on your emotional wellbeing. It may also improve your ability to be read by others as your affirmed gender.

Some people  choose to continue hormone therapy for the rest of their lives. Others may want to bring about changes (such as a deepened voice with testosterone or breast growth with estrogen) and then discontinue hormone therapy. And finally, there are some who may want more subtle or a slower onset of effects. For people with these kinds of goals, hormones can be used in lower doses or for a short amount of time.

How to decide if hormone therapy is right for you?

The decision to start hormone therapy is yours. Your health care provider’s role is to encourage, guide and assist you in making fully informed decisions and becoming adequately prepared.

The best way to approach the decision is to gather information by speaking with your health care provider. You can ask them about: 

• The effects you can expect
• The timing of changes to your body
• The ongoing monitoring that is needed 
• Any risks associated with hormone therapy
• Other medical considerations related to your health

You can also speak with a counsellor about social and emotional changes that come with hormone therapy.

Finally, peer support is a good way to connect with others who may have similar questions and experiences. 

How will hormone therapy change your body?

Hormone therapy produces a variety of changes to one’s body — not dissimilar to puberty. The goal is to bring about changes to a person’s secondary sex characteristics (such as beard or breast growth). For a detailed list of these changes, visit the links below:

• Effects of estrogen-based therapy
• Effect of testosterone-based therapy
• Effects of puberty blockers

Is there financial assistance for hormone therapy?

Medications, including hormone therapy are not covered by MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. (provincial health funding). However, there are a number of ways to get hormone therapy covered or partially covered such as:

• Extended benefit plan — Some employer, income assistance or disability assistance plans cover the cost of hormone therapy medications.
• Fair PharmaCare Provides eligible BC residents with coverage for some prescription drugs and medical supplies. program — Depending on your income, many medications used in hormone therapy will be covered.
• Special Authority A BC government system for obtaining coverage for prescription medications not covered by PharmaCare. — Your health care provider can apply to have your hormone therapy covered if it is not covered by Fair PharmaCare or your benefit program.
• Benefits for Indigenous individuals — The cost of hormone therapy may be covered through a benefits plan at First Nations Health Authority, Non-Insured Health Benefits, or your band. As benefits and eligibility may change over time, consider reaching out to the organizations listed below for confirmation of current details.

If you are not covered by a benefit plan or social program, you will need to pay out of pocket for your hormone therapy.

For cost estimates related to specific medications, visit the links below:

• Costs of estrogen-based therapy
• Costs of testosterone-based therapy
• Costs of puberty blockers

You can also talk to your health provider about low-cost options. 

Monitoring hormone therapy

If you choose hormone therapy or puberty blockers, you will need to have regular follow-up appointments. Typically people will have this follow-up with whoever prescribes their hormones, such as their nurse practitioner, family physician, pediatrician or endocrinologist A doctor specially trained in the study of hormones and their actions and disorders in the body. . Sometimes more than one health care provider is involved in monitoring hormone therapy, for example a pediatric endocrinologist and a nurse practitioner. 

The frequency of your follow-up appointments will differ depending on your health needs and the providers involved in your care. You can expect to have more frequent follow-up appointments when you first start treatment. These will usually become less frequent once you are on a stable dose. 

Your prescribing provider may order blood work at some of your follow-up appointments. Bloodwork is needed more often early on in treatment or when doses are being adjusted, and then less over time once a stable dose has been achieved.