What medical interventions are involved in physical transitions?
There are two basic classes of treatment that are available:
1. hormonal transition
2. gender-affirming surgery with different specialists in each area.
What sorts of hormone treatments do people undergo?
This depends on whether the person is transitioning Male-to-Female or Female-to-Male, as well as whether they have already gone through puberty.
Male-to-Female Hormone Replacement Therapy (MtF HRT)
The first step in hormone therapy for transwomen is blocking the production or action of male hormones, or androgens. The second step is the administration of estrogen, the principal feminizing hormone. Different caregivers may prescribe varying combinations of androgen suppressants or testosterone blocking agents. Estrogen is often taken in pill form, but may be administered by a skin patch or via injection. Transwomen generally continue to take estrogen throughout their life.
Female-to-Male Hormone Replacement Therapy (FtM HRT)
Transmen do not need to take anything to suppress estrogen. Hormone treatment for FtM transition generally means administering the male hormone testosterone, often just referred to as T. Unlike estrogen, testosterone is not usually taken orally because it has adverse effects on the liver. It is most common for testosterone to be given via intramuscular injection into the thigh or hip. Testosterone is not stored in the body, so injections must be done every one to three weeks. Testosterone treatment for transmen is a long-term (often life-long) commitment.
What effects do these hormone treatments have on a person?
Again, this is different for MtF and FtM transitions. In both cases, however, a person’s body is being exposed to a surge in a hormone (estrogen or testosterone) that it has not experienced before, so the transition has some similarities to puberty. As with puberty, full change does not occur overnight, and the effects noted below will usually take several years of treatment to develop fully. Also as with puberty, there is a great deal of individual variability in the timing and degree of any change. I’ve only listed physical results, as emotional effects differ widely from person to person, and it is extremely difficult to tease out what is due to hormones directly, and what is due to life changes.
What sorts of surgery do people have?
Many transgender individuals do not get any type of gender-affirming surgery. Remember that not all trans* individuals are interested in appearing as conventionally male or female. For those who are and who consider surgical intervention, in addition to the hurdles of time, discomfort and recovery that any surgery entails, most do not cover gender-affirming surgery, and straight-up costs can be prohibitive. Furthermore, not all states, like Alaska, have surgeons who possess the skills or willingness to work with trans* individuals. This can compound time away from a job by adding in travel, as well as increasing expenses stratospherically. Learn more about gender-affirming surgery options.
Is medical transition the same for youth and adults?
No, there are some significant differences. Some individuals realize that their identity and their sex assigned at birth do not match before they go through puberty, although many do not. For those who do know before the secondary sex characteristics (e.g. breast growth, facial hair, voice change) develop it is easier to start to live as their actual sex, providing they have the support of family and institutions.
Additionally, trans* children can take puberty-inhibiting medication, or blockers, which will, as the name implies, put the development of secondary sex characteristics on hold. Although this is considered elective by most insurance, and can be incredibly expensive, it is also vitally important. Many people feel alienated from their bodies during puberty under the best of circumstances, and for children who are trans* and aware of their sex incongruence, being forced to undergo puberty and have their bodies change into the wrong sex is devastating. It also means that they will need more invasive and risky intervention in adulthood.
Puberty-inhibiting medication can be continued for several years while the young trans* person, their family, and their medical team plot a workable course of future treatment. Once the child is ready to go through puberty, they can be given the appropriate hormone for their sex (i.e. transmen will receive T, and transwomen estrogen). They will then develop the secondary sex characteristics of their identified sex, although genitalia and internal organs will remain those of their natal sex. Decisions about genital surgery are not usually made until the trans* person is at least eighteen years of age.