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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.