Introduction

Gender-affirming hormone therapy plays a crucial role in the wellbeing of transgender individuals by aligning their physical appearance with their gender identity. Transgender people often rely on sex hormone therapy to develop secondary sexual characteristics and hormone profiles consistent with their gender identity.

Hormone therapy may involve the use of creams and gels containing estrogen, progesterone or testosterone. In this article, we’ll explore the application of creams and gels as medication in gender-affirming care, focusing on their absorption, safety, efficacy, as well as the pros and cons.

Absorption of Hormones in Creams and Gels

1. Transdermal Delivery: Creams and gels for hormone therapy offer a transdermal route of administration, meaning the hormones are absorbed through the skin into the bloodstream. This method bypasses the digestive system, allowing for more consistent hormone levels and avoids the involvement of the liver.
2. Variable Absorption: Absorption rates can vary depending on factors such as the specific formulation, skin type, application site, and individual differences. It’s crucial to apply the medication as directed to achieve reliable hormone levels.

Safety of Hormone Creams and Gels

Pros:

1. Precise Dosing: Creams and gels allow for precise dosing, enabling people to tailor hormone therapy to meet their needs. This precision minimises the risk of over or under-medication.
2. Avoids First-Pass Metabolism: Unlike oral hormone formulations, creams and gels bypass the liver’s first-pass metabolism, reducing strain on the liver and decreasing the risk of certain side effects.
3. Less Gastrointestinal Distress: Transdermal administration avoids potential gastrointestinal side effects associated with oral hormone therapy, such as nausea or digestive discomfort.

Cons:

1. Skin Irritation: Some individuals may experience skin irritation, redness, or itching at the application site. It’s essential to follow proper application guidelines and consider alternatives if skin reactions persist.
2. Transfer Risk: Creams and gels can transfer to others through close skin contact. Users should take precautions to minimise contact, particularly with children and pregnant individuals, as hormone exposure could pose risks.

Application Site

Some medication creams are designed to work specifically on the area they are applied to, such as creams for skin rashes and eczema, which target the affected skin directly. However, when it comes to gender-affirming hormone therapy, the goal is different. Hormone creams and gels used in this context are designed for transdermal absorption through the skin into the bloodstream. They are formulated to deliver hormones systemically and not to have localised effects on the area of application.

These hormone creams will not be effective at eg causing breast growth or erections or encouraging clitoral growth if they are applied directly to the genitals.

It’s important to clarify this distinction because some individuals may hope that applying hormone creams directly to specific areas, such as the breasts or genitals, will enhance their effectiveness. However, this approach does not improve outcomes and can have unintended consequences. Here’s why:

1. Ineffective Localisation: Hormones like estrogen or testosterone need to be absorbed into the bloodstream to have their intended effects on the entire body. Applying them directly to a specific body part does not increase the hormone’s concentration in that area; instead, it may hinder the hormone’s absorption and effectiveness.
2. Potential Health Risks: Applying hormones directly to the breasts, for example, has raised concerns regarding an increased risk of breast cancer. Hormones should not be applied directly to the breast tissue.
3. Genital Sensitivity: Genital skin is thin and sensitive, making it more susceptible to irritation and potential discomfort when hormone creams or gels are applied directly to this area. There is no increase in benefits or response by applying directly to genital skin.
4. Consistency and Monitoring: To achieve the desired physical changes and maintain hormonal balance, it’s best to apply directly to a large area of skin such as the arm, thigh or abdomen. Consistent application and systemic absorption of hormones are key to achieving safe and effective results.

People with eczema or other skin conditions / rashes / dermatitis

If you suffer from eczema or other skin condition, please exercise caution when applying products to your skin, even gels. Prior to using the gel on larger areas, perform a patch test on a small and discreet part of your skin to see whether your skin reacts. This can help you detect any possible adverse reactions. Remember that everyone’s skin reacts differently, and what might be effective for one person may not work for another.

Transferring Creams or Gels to Others and Considerations for Showering or Swimming

While these topical treatments can be highly effective, there are important considerations to keep in mind to prevent the unintentional transfer of creams or gels to others and to ensure their optimal effectiveness. Additionally, specific guidelines may apply when it comes to showering or swimming after applying these medications. In this article, we’ll explore strategies for protecting against transferring creams or gels to others and provide advice on showering or swimming safely while using topical treatments.

Protecting Against Transferring Creams or Gels to Others

1. Hand Hygiene: Before and after applying creams or gels, it’s crucial to practice good hand hygiene. Wash your hands thoroughly with soap and water for at least 20 seconds. This not only removes any residue from your hands but also reduces the risk of contaminating surfaces and objects you touch.
2. Avoid Direct Skin Contact: After applying a cream or gel, be cautious about direct skin contact with others, especially sensitive areas like the face, eyes, and mucous membranes. Even if the medication has absorbed, there may still be a risk of transfer.
3. Wait for Absorption: Some creams and gels may require time to be absorbed completely. Follow the instructions provided on the medication’s label regarding how long you should wait before resuming regular activities or coming into close contact with others.
4. Cover Treated Areas: Cover the area where you applied the cream or gel with clothing once the area has dried.

Showering or Swimming After Applying Creams or Gels

1. Follow Specific Instructions: Different creams and gels have varying recommendations regarding activities like showering or swimming after application. Always adhere to the medication’s instruction leaflet.
2. Wait for Absorption: In some cases, you may be advised to wait a certain amount of time after applying the cream or gel before getting wet eg an hour. This time allows for proper absorption and ensures that the medication remains effective.

Conclusion

In gender-affirming care, individuals should adhere to the guidance and instructions regarding the application of hormone creams and gels. These medications are formulated for systemic absorption and should not be applied directly to specific body parts. Regular monitoring of hormone levels, and adherence to prescribed regimens are essential for safe and effective gender-affirming hormone therapy. Any concerns or questions about hormone therapy should be discussed with a specialist to ensure the best possible care and outcomes.