What Is Gender-Affirming Hormone Therapy?
Gender-affirming hormone therapy (GAHT) refers to the use of hormones and hormone-modifying medications to align a person's physical characteristics with their gender identity. The Endocrine Society recognizes gender dysphoria and gender incongruence as conditions with well-established endocrine management pathways, and recommends that transgender and gender-diverse individuals receive individualized, guideline-based hormonal care under the supervision of a qualified endocrinologist.
At District Endocrine, Dr. Michael Yan provides gender-affirming hormone therapy for adults, following the Endocrine Society's evidence-based clinical practice guidelines throughout every step of evaluation, initiation, and long-term monitoring.
Who Is a Candidate?
According to the Endocrine Society guidelines, adults who experience persistent gender dysphoria or gender incongruence — and who have no contraindications to hormone therapy — are candidates for gender-affirming hormone treatment. Evaluation includes a thorough medical and mental health history, review of relevant laboratory values, and an informed consent discussion covering the expected effects, timeline, and potential risks of therapy.
The Endocrine Society recommends that hormone therapy be initiated only after a comprehensive evaluation and that patients be informed about the effects on fertility so that reproductive options can be considered before treatment begins.
Feminizing Hormone Therapy (for Transgender Women)
Feminizing hormone therapy typically involves estrogen combined with androgen-suppressing medications. The Endocrine Society guidelines recommend maintaining estradiol and testosterone levels within ranges consistent with cisgender female physiology. Goals include breast development, reduction of facial and body hair, redistribution of body fat, softening of skin, and reduced spontaneous erections.
Estrogen Therapy
Estradiol is the preferred estrogen for transgender women due to its favorable safety profile. It can be administered transdermally (patch or gel), orally, or by injection. The Endocrine Society recommends against ethinyl estradiol due to its elevated thromboembolic risk.
Androgen Suppression
Medications used to suppress testosterone — including spironolactone and GnRH analogues — are used alongside estrogen to achieve feminization goals. The choice of agent is individualized based on health history, insurance coverage, and patient preference.
Masculinizing Hormone Therapy (for Transgender Men)
Masculinizing hormone therapy involves testosterone administration to achieve hormone levels consistent with cisgender male physiology. Per the Endocrine Society guidelines, goals include voice deepening, facial and body hair growth, clitoral enlargement, cessation of menses, and redistribution of body fat and muscle mass.
Testosterone Therapy
Testosterone can be administered via intramuscular injection, subcutaneous injection, or transdermal gel or patch. Dosing is titrated to achieve serum testosterone levels in the mid-normal male range. The Endocrine Society recommends monitoring hematocrit and lipid levels regularly during testosterone therapy.
Expected Timeline of Changes
Fertility Preservation
The Endocrine Society strongly recommends that all patients considering gender-affirming hormone therapy be counseled about potential effects on fertility prior to initiating treatment. Hormonal therapy may impair fertility, and in some cases these effects may be irreversible. Patients interested in preserving fertility are referred to a reproductive specialist before beginning hormone therapy.
Long-Term Monitoring
Per the Endocrine Society guidelines, ongoing monitoring includes:
- ✔Hormone levels — Regular measurement to confirm target ranges are achieved and maintained
- ✔Cardiovascular health — Lipids, blood pressure, and metabolic parameters monitored regularly
- ✔Bone density — DEXA scanning recommended for patients at risk, especially those on long-term androgen suppression
- ✔Hematologic monitoring — Hematocrit monitored in patients receiving testosterone to assess for polycythemia
- ✔Cancer screening — Organ-specific screening follows guidelines applicable to present anatomy, regardless of gender identity
🔑 Key Takeaways
- Care at District Endocrine follows the Endocrine Society Clinical Practice Guideline for all gender-affirming hormone therapy.
- Evaluation includes thorough medical history, laboratory assessment, and informed consent discussion.
- Fertility counseling is provided before initiating any hormone therapy.
- Feminizing therapy uses estradiol with androgen suppression; masculinizing therapy uses testosterone titrated to male reference ranges.
- Hormone levels, metabolic markers, and bone density are monitored on an ongoing basis.
- Cancer screening follows guidelines based on present anatomy, not gender identity.
- Care is individualized, compassionate, and coordinated with mental health providers and other specialists as needed.
Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons — Hembree et al., JCEM 2017 →
Provider for Gender-Affirming Hormone Therapy
