Estradiol (E2)
Estradiol is the strongest and most active of the three primary estrogens and may have a role in supporting menstrual, bone, cardiovascular, and overall cellular health.
Gender-affirming hormone therapy (GAHT) may be a form of medical change a transgender person can initiate to feel more aligned with their gender identity. For transgender persons, the sex they are assigned at birth does not match their gender identity — whether that’s male/female/both/neither. For example, a person born male may feel authentically female and want to take steps to support that identity.
Gender-affirming hormone therapy looks different for everyone, depending on their individual needs and health. Feminizing hormone therapy may help transgender female patients achieve therapeutic effects like breast tissue growth, decreasing muscle mass, and other body composition changes. Masculinizing hormone therapy may help transgender male patients achieve therapeutic effects such as stopping menstruation or other body composition changes like increasing muscle mass.
Belmar Pharmacy compounds estradiol and testosterone as bioidentical hormones that are identical to the chemical and molecular structure of the body’s naturally produced hormones. These can be instrumental in assisting individuals desiring gender-affirming hormone therapy.
Gender-Affirming Hormone Therapies from Belmar Pharmacy
Testosterone Cypionate / DHEA Grapeseed Oil
A testosterone cypionate/DHEA grapeseed oil injection combines long‑acting testosterone with DHEA, a hormone that the body can naturally convert into other hormones.
Testosterone
Testosterone is a sex hormone that plays a number of important roles in reproductive health and general wellness in both women and men.
About Gender-Affirming Hormone Therapy
Overview
Gender-affirming hormone therapy (GAHT) uses hormones to help a patient align their gender identity to their physical characteristics. Feminizing or masculinizing hormone therapy are medications that may help patients transition medically to the gender they identify with. Hormones for gender transition can work in multiple ways. The hormones prescribed may work to suppress some of a patient’s existing physical characteristics while also encouraging the development of the traits the patient wants.
For males transitioning to females, feminizing therapy may involve a combination of androgen blockers and estrogen hormones to help reduce body hair and muscle mass, and develop breasts. For females transitioning to males, gender-affirming hormone therapy is a masculinizing therapeutic method. This typically involves testosterone hormones to help lower voice, increase body and facial hair, increase muscle mass, and stop monthly periods.
Patient-specific therapy plans target individual goals and responses to medication. It’s important to note that not all transgender patients take these steps to align their appearance with their gender identity.
Transgender patients can be at risk for many health-related complications, in part because of trouble accessing care. Their unique needs highlight the importance of preventive health condition screenings and regular health visits. For example, feminizing and masculinizing hormones can impact a person’s mood. Mental health discussions with a licensed healthcare provider can provide necessary support during this significant transition.
GAHT
Gender-affirming hormone therapy (GAHT) can use feminizing hormones or masculinizing hormones.
Feminizing hormone therapy may help transgender female patients (assigned male at birth, identifying as female) achieve therapeutic effects like breast growth, decreased muscle mass, and other body composition changes. These therapies typically involve estrogen and may help individuals reach physiologic ranges expected in menstruating populations. Patients transitioning from male to female may also need additional support to suppress testosterone, a masculinizing hormone. Anti-androgen therapy such as spironolactone or finasteride can be prescribed to decrease testosterone levels. Both methods can be encouraged, depending on the patient’s therapeutic goals.
Masculinizing hormone therapy may help transgender male patients (assigned female at birth, identifying as male) achieve therapeutic effects like stopping menstruation, increased muscle mass, and other body composition changes. These therapies typically involve reaching male physiologic ranges of testosterone. Patients transitioning from female to male may also want additional support suppressing estrogen levels, a feminizing hormone. Therapeutic strategy will depend on the patient’s goals.
Even with continued hormonal support, feminizing changes generally take 3-12 months to initiate effect and may take over 2 years to reach their maximum potential. Masculinizing changes generally take 1-6 months to initiate effect and may take over 4 years to reach their maximum potential. Establishing individualized goals for GAHT involves a trusted prescriber who can help set healthy expectations and reasonable timelines.
Many patients seek BHRT to address gender dysphoria. Untreated gender dysphoria can lead to depression and anxiety for some people. Gender dysphoria means the person experiences immense, clinical distress because the gender they were assigned at birth does not match the way they feel about or want to express themselves. People with gender dysphoria may see gender-affirming hormone therapy as an option for addressing these feelings of distress.
Therapies
Belmar Pharmacy compounds estradiol and testosterone as bioidentical hormones that can be used in gender-affirming hormone therapies (GAHT). These bioidentical hormones are produced from plant-based sources and have the exact chemical and molecular structure and function as the estradiol and testosterone produced by the human body.
Estradiol and testosterone are available in a variety of dosage forms to suit different conditions and patient preferences, including oral and sublingual tablets, topical creams, and injectables. A visit with an experienced hormonal healthcare provider, specifically one who understands gender-affirming hormone therapies, can help patients get the personalized support they need to successfully transition.
Hormone therapy in transgender patients may limit fertility. It is unknown if fertility impact is reversible, which is why it’s important to discuss implications to reproductive health with a healthcare professional before starting any form of hormone replacement. There are ways to ensure options are available to transgender patients if or when the time is right to expand their families.
Gender-affirming hormone therapy may be part of a comprehensive plan for an individual to transition from male to female, or female to male, along with some combination of psychotherapy, hormone therapy, or other medical interventions that help support gender transitioning.
Commonly Asked Questions About Gender-Affirming Hormone Therapy
Gender dysphoria often occurs in adolescents and adults who do not identify with their assigned gender. To be diagnosed with gender dysphoria, it needs to last a minimum of 6 months, and manifests with two or more of the following characteristics/experiences:
- Strong desire to be rid of sex characteristics assigned at birth
- Incongruence with expression of gender and those assigned at birth
- Strong desire to possess sex characteristics of a different gender (often opposite of physical characteristics they were born with)
- Strong desire to be treated as a different gender than what was assigned at birth
- Having feelings, emotions, reactions that align with a gender other than their own
For a gender dysphoria diagnosis, these signs are associated with distress in social settings, at work, or in life in general.
Based on individual symptoms and/or diagnosis of gender dysphoria, gender-affirming hormonal therapy may be an appropriate option, along with psychotherapy, and a personalized treatment plan with an experienced healthcare provider.
Feminizing hormone therapy may help transgender female patients (assigned male at birth, identifying as female) achieve therapeutic effects like breast growth, decreased muscle mass, and other body composition changes. These therapies typically involve estrogen and may help individuals reach physiologic ranges expected in menstruating populations. Patients transitioning from male to female may also need additional support to suppress testosterone, a masculinizing hormone. It can take up to 2 years for feminizing gender-affirming hormone therapy to reach maximum potential for gender reassignment and therapeutic strategy will depend on the patient’s goals. Some GAHT effects are permanent or irreversible, including breast growth, and may also impact fertility with feminizing therapies.
Masculinizing hormone therapy may help transgender male patients (assigned female at birth, identifying as male) achieve therapeutic effects like stopping menstruation, increased muscle mass, and other body composition changes. These therapies typically involve reaching male physiologic ranges of testosterone. Patients transitioning from female to male may also want additional support suppressing estrogen levels, a feminizing hormone. It can take up to 4 years for masculinizing gender-affirming hormone therapy to reach maximum potential for gender reassignment and therapeutic strategy will depend on the patient’s goals. Some GAHT effects are permanent or irreversible, including voice changes, and may also impact fertility with masculinizing therapies.
