Introduction

Gender-affirming care helps individuals align their physical characteristics with their gender identity. For many trans women, hormone therapy is a crucial step in this journey. Traditionally, hormone therapy for trans women has included both estrogen and antiandrogen medications. However, there is growing interest in exploring estrogen-only hormone therapy as an alternative. In this article, we will delve into the concept of estrogen-only hormone therapy for trans women, its potential benefits, considerations, and the importance of informed medical guidance.

Understanding Estrogen-Only Hormone Therapy

Estrogen is a primary hormone responsible for the development of secondary sexual characteristics, including breast development, softer skin, and changes in fat distribution. Traditionally, trans women have been prescribed both estrogen and antiandrogens (such as spironolactone or cyproterone acetate) to suppress testosterone levels and enhance feminisation. However, some trans women are choosing to explore estrogen-only hormone therapy, which involves taking estrogen alone without an antiandrogen.

Estrogen monotherapy involves the use of estrogen as the sole hormone therapy, without the concurrent use of antiandrogens. This approach is preferred by some transgender individuals for various reasons, including those who have had genital reassignment surgery (orchiectomy) to remove the testes. Additionally, nonbinary individuals seeking a partial shift towards feminisation while preserving some masculine characteristics may find estrogen monotherapy appealing.

Suitability for Trans Women

Estrogen monotherapy may be a suitable option for transgender women under specific circumstances:

• Post-Orchiectomy: Trans women who have undergone orchiectomy (testicle removal surgery) have significantly reduced testosterone production. For them, estrogen monotherapy will be effective in achieving desired feminising effects without the need for antiandrogens.
• Non-binary Individuals: Some non-binary individuals may desire a combination of feminising and masculinising effects. In such cases, estrogen monotherapy can help achieve a partial shift towards feminisation while allowing the retention of some masculine characteristics associated with testosterone.

Benefits of Estrogen-Only Hormone Therapy

• Reduced Side Effects: One of the primary advantages of estrogen-only hormone therapy is the potential reduction in side effects associated with antiandrogen medications. Antiandrogens can sometimes lead to side effects like fatigue, mood swings, and electrolyte imbalances. By avoiding antiandrogens, trans women may experience fewer of these side effects.
• Individualised Approach: Estrogen-only therapy allows for a more individualised approach to hormone therapy. Some trans women may naturally have lower testosterone levels, making it possible to achieve feminisation goals with estrogen alone. A tailored approach can help avoid unnecessary medications and their associated risks.
• Minimised Health Risks: Some antiandrogen medications may carry risks such as liver toxicity and potential interactions with other medications. Estrogen-only therapy may help minimise these risks, especially for individuals with pre-existing medical conditions.

Considerations for Estrogen-Only Hormone Therapy

• Monitoring: It is essential for trans women considering estrogen-only therapy to undergo regular hormone level monitoring. This helps ensure that estrogen levels are within the desired therapeutic range and that testosterone is adequately suppressed. Adjustments to the hormone regimen may be necessary over time.
• Individual Variability: Hormone therapy affects individuals differently. The effectiveness of estrogen-only therapy may vary from person to person. Some trans women may find it sufficient, while others may eventually require antiandrogens for optimal results.

Conclusion

Estrogen-only hormone therapy is an evolving option for trans women seeking gender-affirming care. While it offers potential benefits such as reduced side effects and a more personalised approach, it is essential to emphasise the importance of individualised treatment plans, regular monitoring of testosterone levels, and informed medical guidance.