Introduction

Gender-affirming care, a cornerstone of treatment for transgender and gender-diverse individuals, often involves the use of hormone therapy. This therapy includes antiandrogens and hormone blockers, which are used to aligning an individual’s physical characteristics with their gender identity. This article delves into the role of these medications, their impact on hormone levels, and considerations for adjusting doses.

Understanding Antiandrogens and Hormone Blockers

Antiandrogens are medications that reduce the effects of androgens, such as testosterone, in the body. They are commonly used in transgender women and non-binary individuals assigned male at birth (AMAB) to decrease masculine features. Hormone blockers, are used to suppress the body’s natural production of hormones like estrogen and testosterone, thus preventing further development or maintenance of unwanted secondary sex characteristics.

Effects on Estrogen and Testosterone Levels

The primary goal of using antiandrogens in gender-affirming care is to reduce testosterone levels, which in turn, minimises the development of masculine features such as facial hair and a deeper voice. For transgender women and non-binary individuals AMAB, this enables a more effective response to estrogen therapy, leading to the development of femininastion characteristics like breast growth and fat redistribution.

Similarly, hormone blockers can be used in transgender men and non-binary individuals assigned female at birth (AFAB) to suppress estrogen production, thus preventing menstruation and reducing feminisation traits. When combined with testosterone therapy, that promotes the development of masculinisation features, such as increased muscle mass and body hair.

When to Adjust Dosages

Adjusting the dosage of antiandrogens and hormone blockers is a nuanced process and depends on various factors:

1. Initial Stages of Transition: Higher doses might be necessary to counteract the body’s natural hormone levels effectively.
2. Monitoring Hormone Levels: Regular blood tests are crucial to monitor hormone levels. Adjustments are made based on these results to ensure levels are within the desired range.
3. Physical Changes and Side Effects: Dosage may be altered based on the physical changes experienced and any side effects. For instance, if feminising or masculinising changes are insufficient, or if adverse effects occur, dosage adjustments might be necessary.
4. Long-Term Maintenance: Over time, once desired changes are achieved, it might be best to reduce dosages to maintain hormone levels while minimising side effects.
5. Individual Goals and Health Considerations: Personal goals for gender expression and individual health conditions play a significant role in determining appropriate dosages.

Conclusion

The use of antiandrogens and hormone blockers is a key component of gender-affirming care, helping individuals align their physical appearance with their gender identity. The careful management of these medications, including when to increase, decrease, or maintain doses, requires a personalised approach under the guidance of experts experienced in transgender health. As research and understanding of gender-affirming care continue to evolve, so too will the strategies for optimising hormone therapy for each individual’s unique journey.