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. 

References

1. Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L. C., Deutsch, M. B., … & Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health.

2. Colizzi M, Costa R, Pace V, et al. Hormonal treatment reduces psychobiological distress in gender identity disorder, independently of the attachment style. J Sex Med 2013;10:3049-58. 10.1111/jsm.12155

3. Gorin-Lazard, A., Baumstarck, K., Boyer, L., Pringuey, D., Albarel, F., Morange, I., … & Bonierbale, M. (2011). Is Hormonal Therapy Associated with Better Quality of Life in Transsexuals? A Cross-Sectional Studyjsm_2564.

4. Mawri, S. (23 de Agosto de 2022). Beware High Levels of Cortisol, the Stress Hormone. Premier Health. 

5. Morrison, S. D., Capitán-Cañadas, F., Sánchez-García, A., Ludwig, D. C., Massie, J. P., Nolan, I. T., … & Satterwhite, T. (2020). Prospective quality-of-life outcomes after facial feminization surgery: an international multicenter study. Plastic and Reconstructive Surgery, 145(6), 1499-1509.

6. 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).

7. Randall, J., McCaskill, M., & Hinson, H. (2020). Interactions of Mood Disorders and Episodic Event Frequency in Transgender Patients – 2052.

8. Unger, C. A. (2016). Hormone therapy for transgender patients. Translational andrology and urology, 5(6), 877-884. doi: 10.21037