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Transgender Care & Gender-Affirming Hormones: A Holistic Approach



Gender transition is a very private, personal, and individualized process. Our clinic is unique in that we provide gender-affirming care in the context of integrative & holistic medicine. Most clinics that provide transgender services do so following a conventional-only medical model: here's your script, best of luck.


Our clinic, on the other hand, recognizes the interconnectedness of mental health, physical health, sexual health, nutrition, sleep, well-being, nutrition, community, social health, spirituality, lifestyle, and behavioral health. We treat our patients holistically, meaning, taking into account and supporting all these various aspects of "whole health." Thus, we don't merely care for the transgender needs of our patients--we care for all aspects of our patient's needs, including full primary care for needs above and beyond transgender care. We also strive to provide the safest routes and forms of hormones possible, including bioidentical hormones and compounded medications.


Many transgender and gender non-binary people have questions about approaches to or components of gender transition.


At Hearthside Medicine, our providers use professional guidelines established by UCSF, WPATH, TransLine, and the Endocrine Society to support your in your gender-affirming care. We individualize your care based on YOUR desires (and obviously while practicing safe, data-driven medicine).


Identifying as transgender (or trans) means knowing that your gender identity is different than the sex assigned to you at birth. For example, it could mean that you were assigned male at birth but you know that your gender identity is female. It could also mean that you were assigned male or female at birth, but understand that your gender identity is neither one or the other. In that case, your gender identity might be best described as non-binary.

Many people know that they’re trans from a very young age — even as young as age 3. For others, it may not be something they fully understand about themselves until later in life. It’s OK not to know, or to be questioning your gender identity. No matter what, your gender identity is valid.


The purpose of this blog is to run through some common, basic transitioning questions (changing from assigned gender at birth to gender identified with). For more detailed blogs on male to female (MtF) transitioning and female to male (FtM) transitioning, please scroll to the bottom of this blog for additional links.


I'm thinking of starting transgender medications and transitioning. What physical effects will hormone treatment have on me?


Hormones are helpful in making your appearance more masculine or feminine. Beginning gender affirming hormone therapy has many similarities to going through puberty. Although hormones taken in adulthood can help to keep your bones healthy, they can't alter your skeletal shape or your height.


What are the benefits of hormone therapy?


Hormone therapy can make you feel more at ease with yourself, both emotionally and physically. You may be experiencing discomfort because you are not happy with your appearance, or in your gender role. Perhaps your appearance and your gender role are in conflict with your inner sense of gender identity. If this is how you are feeling, hormone treatment may help you to overcome your distress.


What is transitioning?


Transitioning, or a gender transition, is the process some people may go through to live as the gender with which they identify, rather than the sex assigned to them at birth. Transitioning can involve medical treatment, medications, and hormones, changing name and pronouns, altering appearance and dress, or coming out to your friends and family. Not all transgender people transition. Gender affirming hormone therapy is an essential part of transition for many transgender people.





What medications does one take to transition?


Transitioning with medications often involves using sex hormones testosterone or estradiol (estrogen) and sometimes progesterone. It also may involve medications to suppress or bock hormones.


Will I always have to take hormones/medications?


You'll need to take hormones for the rest of your life if you want to maintain the effects of hormone therapy.


How much does it cost?


We're in-network for most insurance plans and also have a cash plan for those without insurance. It's a good idea to contact your health insurance company directly before your visit to find out if this service is covered. They can tell you if you'll need to pay for anything out-of-pocket.

If you don't have insurance, our expert staff can help you figure out cost and payments. We encourage you to discuss your options before your visit.


How old do I have to be to start medications for transitioning?


If you are post-puberty and a minor, you’ll need to bring a parent or guardian to your first hormone therapy visit so they can sign some paperwork. For younger children, we refer our patients local pediatric teams specializing pre-puberty therapy.





What are the effects of estrogen?


  • Fat may be distributed on the hips.

  • The size of the penis and testicles may be slightly reduced.

  • Erections and orgasms may be harder to achieve.

  • Muscle bulk and strength may be reduced.

  • Breasts may feel tender and lumpy and may sometimes increase modestly in size.

  • The growth of facial and body hair may slow.

  • Androgenetic alopecia (baldness) may be slowed or stopped

What are the effects of testosterone?


  • Beard and body hair growth will be promoted.

  • Androgenetic alopecia (baldness) may develop.

  • The clitoris increases slightly in size.

  • Libido may be heightened.

  • Muscle bulk increases.

  • The voices deepens.

  • Periods will stop, although there may be some breakthrough bleeding.

  • Some individuals develop acne.

Social Transition


Presenting in public part- or full-time in your identified gender, may include:

  • Changing your wardrobe or hair style

  • Packing (using a penile prosthesis to give a masculine genital contour)

  • Tucking (placing the testes into the inguinal canal, held in place with tight underwear or a garment called a gaff, to give a feminine genital contour)

  • Binding (using a tight chest garment to flatten breasts and give a masculine chest contour)

  • Breast, hip, or buttock prostheses (inserts into clothing or bra to augment breast, hip, or buttock size)

  • Coming out to spouse, partner(s), children, friends, family, classmates, coworkers, community members

  • Changing your legal documents to reflect your chosen name, gender identity, and pronoun used

Medical/Surgical Transition

  • Hormone therapy

  • Hair removal (face, body, in some cases genital hair removal if preparing for surgery)

  • Speech therapy

  • Fertility preservation (sperm/egg storage)



As you consider your options and starting treatment, it is helpful for you and for your medical team to know what your goals are.


Do you want to get started quickly and aggressively or begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking moderate effects and would like to remain on a low dose for the long term.

Many folx are eager for changes to take place rapidly but it is important to remember that changes depend on many factors, such as genetics and the age at which you start hormones. Consider starting hormones as a second puberty--puberty normally takes years for the full effects to be seen. 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, reminds us that "taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health. And because everyone is different, your medicines or dosages may vary widely from those of your friends, or what you may have seen on YouTube, or read in books or in online forums. Use caution when reading about hormone regimens that promise specific, rapid, or drastic effects. "


How can I get care for myself or my transgender family member or friend?


Patients can be seen at Hearthside Medicine Family Care for only for hormone therapy and consultation, or, in conjunction with receiving primary care. In many cases, visits can be conducted using video visits / telemedicine. Our providers are licensed in California and Oregon, meaning anyone residing outside of these states cannot qualify for care.


We accept most insurances and also offer a discount cash pay option. To schedule, please visit our website at www.hearthsidemedicine.com under "book an appointment" or call 541-316-5693 to schedule.


For more information on hormones, safety, options and side effects of hormones, check out our blogs (please note that some of these blogs are geared toward cisgender women in perimenopause wanting to start hormone replacement therapy but the actual content and information regarding hormones can be applied to many audiences):


https://www.hearthsidemedicine.com/post/estrogen-progesterone-testosterone-side-effects-safety


https://www.hearthsidemedicine.com/post/the-ups-downs-of-bioidentical-hormones-everything-you-should-know


https://www.hearthsidemedicine.com/post/an-in-depth-look-at-your-hormone-options

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