Transitioning from one sex to the other has never been easy for people who identify as transgender. The problems begin as soon as you experience body dysphoria, which is categorised as distress experienced because of your birth sex and / or gender. This shouldn’t, however, be confused with mental illness.

The challenges may persist after the transition, but are usually a result of societal outlooks. Biologically speaking, transgender people’s hormones have been such a contentious topic. The lack of understanding has resulted in many being shunned by society, and not receiving the appropriate care before and after they choose to transition.

Before transitioning

Much has been said about transgender people, with very little understanding being put into the biological factors that contribute to gender dysphoria. Until recently, there was a preconceived notion that gender dysphoria could be the result of hormonal imbalances.

The contentious correlation between gender dysphoria and hormonal imbalances has resulted in many parents and loved ones seeking medical help in order to “cure” the condition. While body dysphoria can result in depression and an increase in the likelihood of suicide, research shows that identifying as transgender in itself is not a disease, thereby can't be cured. Yet, this is the widespread way of thinking, with hormonal medication being used to "treat" the imbalance so that it is in line with the physical traits a transgender is born with.

However, a study by the Center for Transyouth Health at Children’s Hospital Los Angeles concluded that hormonal imbalances weren’t in fact responsible for gender dysphoria. The study helps to paint a clearer picture into what transgender people experience before and even after they choose to transition. This, in turn, may help in how those experiencing dysphoria receive attention both in terms of the emotional support from loved ones and the medical support from health providers. 

During and after the transition

While hormones arguably don’t have an impact before the transition, they do play an integral role during and after. The desire for you to reflect your true identity can help you make a choice to transition. This might require surgical and medical treatments, which is where hormones come into the picture.

Hormones basically help with the development of cells. They affect the appearance of many parts of the body, including breasts and reproductive organs. Hormones are also responsible for the production of fat and hair, and how we speak.  So if you’re looking to physically transition you may require therapy, either known as FTM (female to male) hormone therapy, or MTF (male to female) hormone therapy.

With FTM therapy, the objective is to stimulate your testosterone production and reduce oestrogen levels to what a typical male may have. It’s either administered through injections, skin patch or gel medications, or pills. It can take several years to see the effects, which impact the entire body. As a result, your voice can deepen, fat may be redistributed and muscular mass may increase. Some may experience beard growth. After six months, menstruation should stop and, if not, you should seek medical help.

MTF therapy, on the other hand, does the exact opposite of FTM. Usually, you would need to take estrogen, anti-androgen and progesterone. As a result, you might experience breast development, redistribution of fat to reflect that of women, a change in skin texture, loss in muscle mass, and hair reinvigoration (but not growth). Unlike FTM, however, the voice does not change and the beard is minimally affected. Most who are looking to have a more feminine voice can train themselves to strain it, while choosing to regularly remove their facial hair through shaving or hair removal products, or undergo laser hair removal.

The complications

Complications don’t really arise from taking hormones to help with the transition. In fact, the only known change that might complicate the transition is your mood and feelings, which can be minimised if you’re receiving the appropriate psychological treatment.

The complication for most, however, is actually acquiring the hormones they need to transition. Transgender people are known to receive the poorest forms of medical help around. If it’s not due to discrimination, the cost of acquiring hormones may act as an impediment. This is because many are required to undergo psychological evaluation for months before they can receive treatment, while the hormone therapy itself is so costly. What’s more, most health insurance companies (despite there being evidence that treatments are safe and essential) don’t cover the vital costs of the transition.

The sad reality is that some then resort to dangerous alternatives such as administering silicone injections, which aren’t regulated. To make matters worse, the lack of medical assistance also increases the chances of suicide attempts, with 54% of people who identify as transgender having tried to do so, while 21% have resorted to self-mutilation.

Understanding how hormones affect transgender people is essential to changing how we choose to administer medical assistance and see people who identify as such. It only forms a small part of the problem most face when transitioning, but creating an environment where it’s easy for transgender people to acquire the most basic forms of treatment, which include hormones, can make transitioning less complicated and safe.

Sources:

Advocate, http://www.advocate.com/transgender/2015/07/22/study-transgender-youth-do-not-have-hormonal-imbalance

American Foundation for Suicide Prevention, http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf

PubMed, http://www.ncbi.nlm.nih.gov/pubmed/23398495

Revel and Riot, http://www.revelandriot.com/resources/trans-health/

The American College of Obstetricians and Gynaecologists, http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Transgender-Individuals