New data show importance of gender-affirming hormone therapy

• Gender-affirming hormone therapy resolves conflicts between gender identity and secondary sexual characteristics in transgender people.
• A new cross-sectional study emphasizes that people who have been receiving this therapy report its positive effect on their lives.
• The 142 Portuguese participants in the study had all been receiving hormone therapy for at least a year.

Dr. Miguel Saraiva, endocrinologist at Centro Hospitalar Universitário do Porto – Hospital de Santo António, Portugal, told Medical News Today: “We have to understand that being transgender is not an illness. As cisgender people do, transgender people also know who they are. It is their identity and one can not change that.”

“We have to start listening to these patients and educate ourselves about their health needs and about gender-affirming medical interventions,” he stressed.

In late May 2022, Dr. Saraiva presented his research at the European Congress of Endocrinology in Milan, Italy regarding the value of gene-affirming hormone therapy.

An increasing number of transgender and nonbinary people, according to Dr. Saraiva, have been seeking treatment to resolve conflicts between their gender identity and the sex assigned to them at birth.

The Portuguese researchers found that people who had undergone gene-affirming hormone therapy reported high levels of satisfaction with the psychological and physiological results.

Dr. Saraiva noted that “[t]his therapy seems to significantly enhance self-esteem, body well-being, and social/ familial relations and to reduce suicidal ideation, having an overall great impact on the quality of life.”

Gender dysphoria

The National Health Service in the United Kingdom describes gender dysphoria as the “sense of unease that a person may have because of a mismatch between their biological sex and their gender identity.”

Gender dysphoria is increasingly common among adolescents. And according to one 2019 study, “[g]ender dysphoric patients are at significant risk for psychiatric comorbidities and suicidal ideation and attempts.”

“It is crucial that primary care providers be aware of and diligently evaluate these risks, regardless of treatment status. A collaborative, multidisciplinary approach can help care for this vulnerable population and avoid tragic outcomes,” the study emphasizes.

Dr. Saraiva recalled his first transgender pediatric patient: “I will never forget the look of relief on the eyes of that patient when I said we were going to stop their puberty.“

“It is important,” Dr. Saraiva underscored, “that these adolescents have regular psychology/ pedopsychiatry appointments with experienced professionals in this field.”

Gender-affirming hormone therapy

The acronym for gender-affirming hormone therapy is “GAHT.”

GAHT provides an individual with hormones that allow some of their secondary sexual characteristics to align with their gender identity.

Feminizing hormones may increase breast development, promote softer skin, reduce testicle size, and feminize the distribution of body fat.

Masculinizing hormones block menstruation, promote body and facial hair, increase muscle mass, deepen the voice, and redistribute body fat to match male patterns.

Dr. Saraiva explained: “Both masculinizing and feminizing gender-affirming hormone therapy are effective, if prescribed correctly by an experienced physician. However, I would say that feminizing regimens are generally more challenging and complicated, since most of the time we have to use more than one drug to induce a satisfying feminization — we generally use two types of drugs simultaneously — feminine hormones and a blocker for masculine hormones.”

High level of satisfaction

The cross-sectional study took place in March 2021. The 142 Portuguese participants had all been receiving GAHT for at least a year. Their median age was 25.

Participants reported a high level of satisfaction with the results of GAHT, giving it an average score of five points out of a possible six.

They rated GAHT according to several criteria: self-esteem, body well-being, suicidal ideation, and social/ familial relations.

“Our study,” said Dr. Saraiva, “reinforces that transgender people report high grades of satisfaction with both the psychological and physical effects of gender-affirming hormone treatment.”

The difference that GAHT can make

Dr. Saraiva recalled: “Fortunately, I have been able to witness many memorable results in the transgender people that I follow as a clinician. It is a gradual process — it is like starting a second puberty — and the gains are progressive and do not come all at once.”

“I would say,” he added, “that one of the things that impact me the most is witnessing my patients’ comfort and confidence in themselves increasing appointment by appointment. Many times, in the first consultation trans and non-binary people are quite depressive and unhappy.”

“As hormones start changing their bodies to an image that matches the gender that they have, their posture changes completely,” Dr. Saraiva noted. “They come to the consultation clearly more happy and more at peace, smiling and saying that the gender-affirming hormone treatment has completely changed their lives for the better.”

For people with severe dysphoria, suicidal thoughts are a concern. This is perhaps, according to Dr. Saraiva, the most striking benefit of GAHT.

“More than life-changing, I have no doubt that this gender-affirming hormone therapy is life-saving. It is important to realize that transgender people are not sick, they just sometimes need our help to stop struggling with a body that does not reflect who they really are.”

– Dr. Miguel Saraiva

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