This article was clinically reviewed by Jess Schwab, DNP.
Over the past decade, the term "gender affirming" has become more frequently adopted by healthcare providers and members of the queer and transgender community to better express the medical treatment process of transitioning. What we know now as gender affirming surgery (previously known as sex reassignment surgery or SRS) is an example of another linguistic shift in the broader space of transgender health.
These shifts in culture and appropriate verbiage are vital when holding the experiences of queer and transgender people central in healthcare spaces. The transition—no pun intended—from hormone replacement therapy (HRT) to gender affirming hormone therapy (GAHT) is a recent effort to get specific about the healthcare needs of the transgender, non-binary, and gender non-conforming community.
The term HRT—hormone replacement therapy—is already commonly known within the LGBTQ+ healthcare space. More recently, clinicians and patients have been shifting towards the acronym GAHT—gender affirming hormone therapy—to describe the experience of medical transitioning by starting medications such as testosterone, estrogen, and/or anti-androgens. Both terms can be used interchangeably for testosterone or estrogen hormone therapy, but do they really mean the same thing?
While many transgender women, transgender men, nonbinary people, and other gender diverse folks use HRT as a shorthand for the gender affirming hormone care they are receiving, HRT is actually a bit more generic than this. People of all genders, including cisgender people, can get a HRT prescription for estrogen or testosterone to help balance their hormones.
For example, I'm a cisgender woman prescribed progesterone, a hormone typically used to kickstart menstrual cycles or relieve severe PMS symptoms. While my intentions aren't necessarily gender-focused, I'm still technically on HRT. Androgen blockers (including progesterone) are also commonly used in the treatment of things such as hypertension, acne, and hair loss, which is still considered HRT.
Even though the term HRT is technically universal to anyone using any type of hormone intervention, it has specifically been adopted by the trans community to describe the process of gender affirming hormone therapy. The term GAHT signals, more specifically, that the hormone therapy they receive is part of their gender journey. (More broadly, the term “gender affirming care” is now being used more universally over the former term “transgender healthcare”.)
Many folks prefer the term GAHT because it communicates the reason for undergoing hormone therapy in the first place. However, HRT is still widely accepted as the baseline term for intentionally changing hormone levels for both cisgender and transgender patients.
When first starting your path on GAHT, it can be easy to get overwhelmed by the abundance of information, side effects, different routes, and dosages. When referring to the specifics of GAHT/HRT, there are a few common terms that can be helpful to know.
Estradiol (or estrogen) is a type of gender affirming hormone therapy that can be taken orally, via injection, or transdermally. When starting with estrogen, you'll be able to work with your clinician to start a dose that's appropriate for you. Similarly, there are a few different paths to take if you would prefer to receive doses via injection. Estradiol valerate and estradiol cypionate are both effective options for HRT and both can be injected. Another option is an estrogen patch. To read more about the specifics of each method, see here.
Anti-Androgens/Progesterone is another option for estrogen HRT. Some people use this in addition to estradiol HRT because androgens “regulate the development of sex characteristics.” The anti-androgens work to block some of the effects of androgens. For instance, FOLX clinicians can prescribe members spironolactone, finasteride, and dutasteride.
Testosterone is another form of gender affirming hormone therapy that can be taken a few different ways. Testosterone cypionate is one type of injectable HRT that can be injected either intramuscular (IM) or subcutaneous (sub-Q). Depending on the injection method, it can be administered in a few locations. Intramuscular injections can be performed in the outer thigh or glute (buttocks) and subcutaneous injections can be done in the thigh or belly. Testosterone enanthate is a second option for injections. See our extensive article on the differences between the two here.
Transdermal T is a gel version of testosterone that can be applied to certain areas of the skin. You can read more about testosterone gel here.
Panels are a series of blood tests run to measure levels of a particular occurrence in your body. At FOLX, we don’t run a full panel, but instead, perform the following specific lab tests based on which medications a member is on. For Estradiol, we check estradiol and total testosterone levels. For Spironolactone, we check potassium and creatinine levels. For testosterone, we check total testosterone and hemoglobin levels.
Dosage is the amount and increment of HRT taken over a period of time. This varies depending on the hormone, method of dosage, and where someone is at in their journey. FOLX provides helpful resources in understanding what high and low doses of each type of HRT look like. For testosterone HRT, see here and for estrogen HRT see here.
Oral or sublingual hormone therapy simply means medication comes as a pill form consumed by mouth. Oral medication is swallowed whereas sublingual medication (such as estradiol) is placed under the tongue to dissolve. This allows for more rapid absorption of the medication into the bloodstream (without the decrease in concentration that occurs with some medications when they are swallowed and processed by the liver).
Injections are used for all types of hormone therapy. The two methods of injections include subcutaneous and intramuscular. Subcutaneous (sub-Q) is injected into the fatty tissue with a smaller needle while intramuscular (IM) is injected straight into the muscle. IM shots are injected at a 90-degree angle, whereas sub-Q are injected at a 45-degree angle.
Transdermal hormone therapy is a gel or patch you use on the skin. This method is the least invasive.
The process of GAHT/HRT involves understanding terms and mechanisms that you may have otherwise never wanted or needed to know. In addition to learning about the complexities of your own health, learning the correct and appropriate terminology can be just as integral. Gender affirming hormone therapy and hormone replacement therapy can refer to the same process, but GAHT is the most accurate terminology for folks who identify themselves as going on hormone therapy for reasons of gender identity.
If you’re new to FOLX and interested in gender affirming healthcare, learn more about our estrogen and testosterone offerings. If you have additional questions, please contact firstname.lastname@example.org. FOLX members with questions about their hormone treatment are encouraged to follow up with their clinician.