HRT Therapy, How it Affects Your Emotions
If you are beginning your transition, one of the first things you consider is gender-affirming hormone therapy, GAHT for short.
There are many reasons GAHT is an initial step. For example, FFS Specialists suggest that it is beneficial to first see the effects of hormone replacement therapy (HRT) on your facial features before deciding on what might become unnecessary procedures.
Yet before embarking on your transition journey, you’ll want to be informed about how gender-affirming HRT may affect your emotions.
Why do Trans People start with HRT?
Many transgender men and women begin hormone therapy as part of their transition. It is understandable to have the need to address your hormones to the gender you identify with. It helps to reduce gender dysphoria, and psychological or emotional distress as to improve social functioning.
Transgender individuals are known to experience unreasonable rates of depression and anxiety compared to cisgender populations. They may present concurrent mood disorders or low self-esteem due to issues with gender dysphoria. However, persistent transphobia, systemic discrimination, social isolation and constant fear of violence are detrimental to mental health.
Therefore, although there is some conflicting information, GAHT seems to have an overwhelming positive psychological effect in transgender and non-binary people. It is shown to reduce symptoms related to depression, anxiety, social distress, and it improves quality of life and self-esteem.
Do I need psychosocial assessment before GAHT?
With an increasing number of transgender and gender non-binary people presenting for care, it is necessary to explain the mental health and cognitive outcomes that come from gender affirming hormone therapy.
In most countries, professionals consider mental health the first step. In this aspect, there are controversial opinions: On one side, those who consider a psychological evaluation does not help them in any way and they are fit for GAHT, and those who accept that mental health is an important requirement in the transition.
A psychosocial assessment before starting GAHT is now considered medically necessary to inform you of the benefits and risks and to make sure you have a very clear idea of your responsibilities and what is typically expected.
The role of the mental health professional is to guide the patient through their emotions during the decision-making process, which will therefore reduce the risk of planning errors or having second thoughts in time.
HRT for MtF patients
When we talk about hormones that transgender women take, we’re speaking of exogenous estrogen and anti-androgens, which help to feminize the facial features and suppress those masculinizing features.
In those benefits and risks, we can also include the changes they will start to experience, such as breast growth, increased body fat, slowed growth of the body and facial hair, decreased testicular size and erectile function. But not only do patients experience physical changes, but also emotional ones.
Everyone has different experiences, but we’ve seen that many of our patients consider that thanks to HRT it is much easier to understand what they’re feeling. Hormone therapy helps to feel and express those emotions and stop suppressing them as they did in the past. Some have even started to feel more positive emotions than before, feeling happier and more emotional.
Though it is also true that these sudden emotions, if you’re not used to them, can be a bit overwhelming at first. Controlling your feelings requires training, and doing so can take its time.
So if you’re just starting on HRT, you’re planning to, or you’re already on them, take your time to get used to those changes. It can always be helpful to get professional help to manage your emotions and thoughts.
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- Nguyen, H.B., Chavez, A.M., Lipner, E. et al. Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Curr Psychiatry Rep 20, 110 (2018).
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Frequently Asked Questions on HRT
If you are currently taking HRT medication, it doesn’t need to be suspended before or after surgery, as we will administer an antithrombotic agent to counteract the clotting effects of hormones.
This isn’t true. It aims to create hormonal balance much in the same way that birth control does, which stabilizes the menstrual cycle and related symptoms. Yet this may not happen overnight. GAHT helps people see progress in their physical transition so they feel better about their body in the long term.
Some report more drastic emotional fluctuations and others the opposite.
More scientific investigation is needed to understand how GAHT affects the emotional and physical state of the person in transition.
It does not affect your surgery but it is true that it can affect or intervene in the way you cope through the recovery. There are many emotions involved in a surgery, as well as with HRT. This is why it’s recommended to have emotional and mental stability before going into FFS. Waiting for the changes from HRT, letting it settle down and having good coping skills can for sure help through the post-operative journey.
It is not required but you should’ve been for at least a year on HRT to have been able to see the physical changes. With that done, you can go on to choose the surgical procedures that most suit you and you’re happy with. But it is recommended to wait for those changes that hormones do before having FFS.