Feminizing Hormones

Your Primary Care Provider will want to ensure you have a thorough understanding of the medication, anticipated changes, irreversible changes, risks and benefits, and fertility preservation options. You will be required to provide informed consent and review consent documents with your provider. 

It’s important to understand that even though you may be coming to your provider with a vast understanding of Medical Transitioning, you will still be required to go through all of the consent documents before beginning. To help prepare you for this appointment example consent forms are linked below: 

• Example of Estrogen/Testosterone Blocker Consent Form
• Example of Progesterone Consent Form

Hormones affect everyone differently and the rate/degree in which your body changes will vary. It is important to note that some changes caused by hormone therapy are irreversible, while others may be reversible over time.

Although hormones can lead to many desired changes and outcomes, there are some gender-affirming features that are not obtainable through hormone therapy. Information about hormone effects is summarized in the chart below:

There are many different estrogen options available. Your Primary Care Provider will discuss these options with you to determine which is the best fit for you. As with all medications, it is important to follow the prescribed dosing and administration schedule. It is also important to note that the starting doses of hormones will vary from one individual to the next based on health history, bloodwork results and desire for physical changes. The options are outlined in this section.

Anti-Androgen & Progestin Therapy

It is common to see a type of medication called an “anti-androgen” combined with feminizing hormones when starting or maintaining a feminizing medication regimen. Anti-androgens act to block the effects of naturally-occurring testosterone (masculinizing hormone found in all bodies), which helps promote feminizing changes. There are a couple different anti-androgen options available in Canada that your primary care provider can discuss with you.

Spironolactone is a very commonly used anti-androgen in Canada and around the world. The cost of this medication varies depending on the dose that works for you. Pricing in Alberta can range from $20 – $50 / month without any kind of drug coverage/insurance.

Progestins are another drug therapy that helps reduce naturally-occurring testosterone levels and may be considered in a feminizing therapy regimen. The use of this type of medication varies depending on the desired outcomes, patient risk factors, and prescriber comfort level. If used, it is often initiated with the intention of being a short-term medication (maximum 2 years)

Estrogen Preparations and Starting Doses

There are many  different estrogen options available. Your Primary Care Provider will discuss these options with you to determine which is the best fit for you. As with all medications, it is important to take your medication as prescribed.

It is also important to note that the starting doses of hormones will vary from one individual to the next based on health history, bloodwork results and desire for physical changes. The options are outlined below:

Monitoring and Bloodwork

Bloodwork will be required more frequently during the first year of therapy than it will be afterwards. It is very important to complete routine bloodwork to ensure the selected therapies are safe as well as effective for you:

• Baseline: this will be required before starting any medication so that your Primary Care Provider can get a good sense of your current hormone levels.
• Bloodwork will also be required at 1 month, 3 months, 6 months and 1 year after hormones have been initiated to ensure the medications are safe and effective. 
• You may also be asked to do additional bloodwork if you notice any adverse side effects or outcomes from starting hormones (more information on this will be provided below)

Contraindications & Adverse Event Monitoring

Contraindications are symptoms or conditions that may prevent you from accessing certain medical treatments to avoid adverse effects or harm. Your Primary Care Provider will need to determine if there are any health considerations which may delay a start to hormone therapy. If you experience any of these items, it is important to be transparent so that you can be referred appropriately.

• Cardiac Disease
• Active Breast or Pituitary Cancer
• Previous Venous Thromboembolism (VTE): condition in which a blood clot forms in the deep veins of the leg, groin or arm (can also be known as a DVT- Deep Vein Thrombosis)
• Current Smoker

You may also experience some adverse side effects after starting hormone therapy. These side effects may vary depending on the medication you are taking. For more information contact your Primary Care Provider. Some adverse side effects may include

• Thrombosis (VTE, DVT)
• Menopause
• Erectile Dysfunction
• Migraines

Hormones will impact you in many ways. This section will explore considerations for contraception, surgery, and for non-binary individuals.

Contraception

Spironolactone & Estradiol: Are NOT sufficient to bring sperm count to zero. Discuss partner contraception and condom options with your Primary Care Provider. It is also important to remember to continue routine testing and follow appropriate STI prevention methods. 

Take this opportunity to discuss PrEP with your provider!

Surgery

Pre-operative hormone management is surgeon dependent. Discuss this with your surgeon during the pre-operative consultation. Most commonly, hormones will be stopped 2-3 weeks prior to a major surgery and restarted 1-2 weeks after surgery

Depending on the type of surgery, Anti-Androgen medications may be stopped and Estrogen doses may be decreased. Discuss these changes with your Primary Care Provider

For Non-Binary Individuals

As a non-binary person beginning hormones, your Primary Care Provider should have a conversation about what transitioning means to you and how they can facilitate that.

It is important to note that some irreversible changes will happen with hormone therapy and your provider will want to ensure you are aware and accepting of all possible changes/effects.