Female-to-male (FTM) hormone replacement therapy is a transition process for transgender men who are born females but want to be identified as males. This process is also known as masculinizing hormone therapy, and it is used to replace the secondary sexual characteristics of transgender men from feminine to masculine.
Successful hormone treatment will result in deepening of your voice, building muscles around the thighs, arms and buttocks, masculine facial alignment, and in some cases even male balding pattern depending on your genes.
Hormone replacement therapy cannot guarantee a change in all characteristics that are caused due to natural puberty, which is why certain surgeries and treatments are needed for full reassignment of the male gender properties.
Four Aspects that you Should Expect to Change
- Physical: As the therapy begins, you will notice changes like thicker and oilier skin, larger pores, and skin that is more prone to acne. You will start to sweat more, and your touch sense may feel different.If this therapy is done before you hit female puberty, the development of breasts can be stopped. Otherwise, there will be only a marginal change in your breast reduction unless you go for chest surgery.The hair on your body will get thicker, darker and grow faster too; basically, you will start noticing the pattern of hair growth. Appearance of beard will depend on your genetics.
- Emotional: Similar to natural puberty you will go through the ups and downs of emotions as you pass through this therapy. The range of your emotions and feelings will become narrower; experiencing a different interest and taste, and your attitude towards maintaining a positive relationship will change as well. During the treatment, some people are believed to get help from psychotherapy.
- Sexual: When it comes to your libido, you will start feeling different about your preferences and orgasms too. Your whole sex orientation will go through a confusing stage, and it is normal so try to explore your sexuality through different means.
- Reproductive system: As you start transitioning through the hormone therapy, your periods will start diminishing in shorter duration each time. Your chance of getting pregnant will be significantly reduced, though total elimination of conceiving will not happen. If you get pregnant during the therapy, it is strongly advised to stop the testosterone treatment and wait for your doctor’s consent to resume the therapy.
Route of Administration of HRT
Hormones are the chemical regulators telling our body to function in specific ways. The functions involve growth, digestion, fat distribution, metabolism, sex drive, and reproduction. Testosterone is the male hormone that develops the masculine traits in a FTM hormone replacement therapy. These hormones work on your body tissues directly and suppress estrogens (female hormones) indirectly. There are three approaches to take testosterone to your body:
- Intramuscular Administration (Injection): Depo-Provera is a type of progestogen (the hormone to prevent pregnancy) which is injected for the hormone therapy to work.
Right after injecting you will feel the testosterone at its peak, and your aggression level is likely to increase. And at the end of your injection cycle, the testosterone level will lower making you feel irritable and fatigued. Side effects usually follow the peaking and dipping reaction; to reduce the impact you can shift to oral or transdermal application.
- Transdermal Administration (Skin patch or cream): This application takes a long time to show results compared to testosterone injection, though the degree of masculinization is the same. Areas like your stomach, upper arms or thighs are usually the spots you can apply these patches, make sure the area is free from oil and hair.
Your doctor may regulate the dosage of testosterone on the patch as you progress during the treatment. A daily dosage of transdermal therapy will steady the blood level of testosterone in your body.
- Oral Administration (Pills): Oral testosterone is usually not as effective as transdermal or intramuscular application which is why this route of administration is the least used approach for FTM HRT.
If you have AIS (Androgen Insensitivity Syndrome), taking testosterone may not be effective as your body’s receptors will not respond to testosterone. In this case, you can opt for chest surgery, speech therapy, and genital surgery.
Possible Risks Involved in Hormone Replacement Therapy
- Inducing testosterone in your system can thicken your blood increasing your hematocrit count; this may lead to stroke and other fatal conditions. If you are taking doses that are more than what your metabolism can take, your cholesterol will rise.
- In any case of ovaries been removed, stay on a low dosage of male hormones post-op, especially until you reach 50 years – this is to prevent bone weakening (osteoporosis).
- Testosterone can worsen migraines and headaches. On the frequent occurrence of pain, you should see your doctor.
- There is a possibility of increased risk in some types of cancer. If you are above 50, overweight or have a history of estrogen-dependent cancer, you might be vulnerable to estrogen-related cancer.
- Your mental health may receive adverse effects. Some typical results of deteriorating mental health are heightened aggression, irritability, frustration, and even schizophrenia and bipolar disorder. This problem can be reduced by shifting the applications of the procedure.
Preparation to therapy
Your doctor will study your health to rule out any possibilities of conditions that may not be compatible with the treatment. A list of evaluations will be as follows:
- An assessment of you and your family medical history.
- A physical test on external reproductive organs.
- A review on your immunization, blood sugar, blood count, electrolytes, lipids, and a pregnancy test.
- Medical screening to see appropriation on your age and sex.
- Identifying any sexually transmitted diseases, alcohol abuse or drug abuse.
- Mental health evaluation is also necessary to overcome any stress that you will face during and after the transformation. Other concerns are emotions, sexual health, and behavioural changes.
Follow-Up after starting HRT
- Following your hormone replacement therapy, you will be required to visit your doctor regularly for documenting any physical changes in your body.
- Go for breast cancer and cervical screening. There will be appropriate examinations based on various ages.
- Evaluate your sleep apnea.
Starting a hormone replacement therapy is like going through second puberty. Natural puberty takes years to finish its course; likewise, masculinizing therapy will be a slow and lengthy process. Patience will get you to your desired results. Be mentally prepared to face and overcome any stress that our society might cause, and lastly, make an informed decision.