What is hormone replacement therapy (HRT)?
Gender-affirming hormone therapy (HRT) is medical treatment that involves the use of hormones to help align an individual’s physical traits with their gender identity.
For transgender and non-binary individuals, HRT can play a crucial role in reducing gender dysphoria and promoting overall well-being.
HRT may include the use of estrogen or testosterone to induce physical changes, such as changes in body hair, skin texture, voice, and fat distribution. The specific treatment plan is tailored to your individual needs and goals, and we provide you with the information you need to make informed choices about your healthcare.
- Safer Six Inclusive Health Clinic
Informed Consent
Under the informed consent model (ICM), providers can prescribe hormones without requiring psychological evaluations or a formal diagnosis of gender dysphoria.
In Ontario, if you are receiving HRT in the formal healthcare setting, your provider will go through - at length - about the risks associated with the prescription drugs you ultimately choose for your HRT regimen. Different drug (and delivery) options are available because our bodies are different (e.g., risk profiles, affinity with a chosen drug, goals, etc).
Feminising Hormone Therapy
Feminising hormone therapy is used to make changes (i.e., secondary sex characteristics) in the body that are caused by female hormones during puberty.
Quick Guides for Feminising HRT
- Feminizing Hormone Therapy from Rainbow Health Ontario
- An Introduction to Hormone Therapy for Transfeminine People from Transfeminine Science
- Hormones: A guide for MTFs from Trans Care Project
Medications for Feminising HRT
Below are a list of medications used for feminising HRT. In Ontario, you will see the use of estrogens, anti-androgens, and in more limited cases, progestogens, in standard feminising HRT. Standard HRT regimens are safe, established, and evidence-based practices backed by WPATH, major endocrinology organisations, and Ontario Health guidelines.
Other drugs, such as SERMs, are often treated as ‘experimental’ approaches because they are used off-guideline for customised regimens (e.g., for specific goals by a non-binary person). These patients are actively operating outside of established clinical guidelines and are actively advocating for themselves. There are some providers - very little anecdotal experiences in Canada - that are willing to consider ‘experimental’ approaches.
Estrogens
| Name | Description |
|---|---|
| 17-beta estradiol | This is the most commonly - and recommended - bioidentical class of estrogen for feminising hormone therapy. It is most commonly taken orally (tablets), transdermal (patches or gel), or through injections. Each drug delivery route has its own pros and cons, and the linked resources in this guide will discuss them at length. |
| Ethinyl estradiol & Conjugated equine estrogens (Premarin) | These are synthetic or animal-derived estrogens. They are generally NOT recommended for gender affirming care due to a significantly increased risk of blood clots and cardiovascular side effects. |
Anti-Androgens
| Name | Description |
|---|---|
| Spironolactone | This is one of the two common anti-androgens used to suppress testosterone. Its on-label use is a blood pressure medication. |
| Cyproterone | This is the second of the two common anti-androgens used in Ontario. Its on-label use is part of the process to treat prostate cancer. |
| Bicalutamide & GnRH Agonists |
Progestogens
Progestogens use continues to be controversial. There are anecdotal reports that progestogens contribute to better breast development, mood, sleep, and libido. It can be considered a ‘wildcard’ where some will experience favourable effects while others experience negative effects.
| Name | Description |
|---|---|
| Progesterone (Prometrium) | This is the most common bioidentical form added to some feminising regimens. |
| Synthetic progestins | These are sometimes used but can carry higher potential risks such as blood clots. |
Selective Estrogen Receptor Modulators (SERMs)
| Name | Description |
|---|---|
| Raloxifene | A SERM used experimentally (often by non-binary people) seeking feminisation (i.e., skin softening) without breast development. In short, it acts as an estrogen in most of the body but is anti-estrogenic in breast tissue. Anecdotally, it is combined with an anti-androgen or with a very low dose of estrogen. |
| Tamoxifen, Toremifene, Clomiphene | These are SERMs most often seen in breast cancer or fertility treatments. It is often avoided in gender affirming care given its higher risks, effectiveness (compared to other options), or costs. |
Other
| Name | Description |
|---|---|
| Dutasteride |
Masculinising Hormone Therapy
Masculinising hormone therapy is used to make changes (i.e., secondary sex characteristics) in the body that are caused by male hormones during puberty.
Quick Guides for Masculinising HRT
- Masculinizing Hormone Therapy from Rainbow Health Ontario
- Hormones: A Guide for FTMs from Trans Care Project
Commonly Used Medications for Feminising HRT
Testosterone
DHT Blockers
Finasteride