Discover the significance of differentiating between true gender vs preferred gender in society. Gain insight and understanding on this crucial topic.In a world that is increasingly recognizing the importance of gender diversity and inclusivity, the language we use plays a crucial role in shaping attitudes and perceptions. While the term “preferred gender” has been used in the past to describe a person’s self-identified gender, we argue that the term “true gender” is a more accurate, respectful, and inclusive way to refer to an individual’s gender identity. 

To shed more light on the topic, this article will explore the many reasons why “true gender” is the better terminology over “preferred gender.”

True Gender vs Preferred Gender

Acknowledging Self-Identification

The term “true gender” emphasizes the significance of self-identification. It recognizes that an individual’s gender identity is an integral part of who they are, and it is not a mere preference or choice. 

Using “preferred gender” can inadvertently suggest that gender identity is a whim or a passing preference, which dismisses the lived experiences and emotions of transgender and gender-nonconforming individuals. By using “true gender,” we honor and validate the authenticity of each person’s self-identification.

Reducing Stigmatization

Language holds immense power in shaping social attitudes. When we use the term “preferred gender,” it implies that an option or a choice is being made. This language can reinforce harmful stereotypes and discrimination against transgender and gender-diverse individuals, suggesting that their gender identities are less valid than cisgender identities. On the other hand, “true gender” affirms that everyone’s gender identity is equally valid, reducing the potential for stigmatization and discrimination.

Fostering Respect and Dignity

Another reason why choosing to use “true gender” is a better option is that it demonstrates respect for each person’s gender identity journey. It conveys the message that their gender identity is real and deserves recognition, regardless of whether or not it aligns with the sex they were assigned at birth. This inclusive language, in turn, promotes dignity and empathy, fostering an environment where individuals can be their authentic selves without fear of judgment or prejudice.

Encouraging Open Dialogue

Keep in mind that the language we use can either facilitate or hinder open and productive conversations about gender diversity. “True gender” encourages inclusive conversations by signaling a willingness to engage in a respectful dialogue about gender identity. In contrast, “preferred gender” may unintentionally shut down these conversations by invalidating the experiences and identities of transgender individuals. Choosing the term “true gender” paves the way for greater understanding and acceptance.

Aligning With Contemporary Terminology

Much like with norms and pop culture, language evolves with the times because it reflects societal changes and advancements in understanding. 

In recent years, there has been a shift towards using more accurate and respectful terminology when discussing gender identity. “True gender” aligns with contemporary language trends and the principles of inclusivity, making it the logical choice for those who wish to stay current and sensitive to the experiences of transgender and gender-diverse individuals.

Supporting Mental Health and Well-Being

Due to the hurdles they’re encountering, transgender and gender-nonconforming individuals often face higher rates of mental health challenges, discrimination, and gender dysphoria. Something as standard as using “true gender” can contribute to a more supportive and affirming environment, which can then have a positive impact on the mental health and well-being of gender-diverse individuals. 

Despite being such a small act, using inclusive language in our daily lives is a significant step in fostering a more compassionate society.

Be a Part of the Journey Toward Inclusivity

Language matters, and the choice between “true gender” and “preferred gender” is not merely a matter of semantics. It reflects our commitment to inclusivity, respect, and empathy toward transgender and gender-diverse individuals. 

By embracing “true gender” as the correct terminology, we affirm the dignity and validity of all gender identities, paving the way for a more understanding and inclusive society where everyone can live their truth.

Discover the criteria and clinical process for Diagnosis of Gender Dysphoria. Gain valuable insights and understanding in this comprehensive blog post.

Gender dysphoria is characterized by a marked incongruence between an individual’s experienced or expressed gender and the gender they were assigned at birth. Diagnosis of Gender Dysphoria is a complex process that involves careful assessment by mental health professionals. Let’s explore the criteria used for Diagnosis of Gender Dysphoria, the role of mental health professionals in the diagnostic process, and the steps involved in reaching a diagnosis.

Gender Identity: An Overview

Gender identity refers to an individual’s deeply held sense of gender. It can include identities like male, female, or something unique to the individual. This internal sense of gender is intrinsic and self-defined, not necessarily related to external physical characteristics or societal expectations.

The connection between gender identity and gender dysphoria lies in the incongruence between an individual’s deeply felt gender identity and their assigned gender. When a person’s assigned gender at birth matches their gender identity, they are cisgender. However, for transgender individuals, a discrepancy exists between their experienced or expressed gender and the gender they were assigned at birth.

The old term for gender dysphoria was “gender identity disorder.” However, this term has been retired as it could imply that being transgender is a disorder.

Criteria for Diagnosis of Gender Dysphoria

To diagnose gender dysphoria, mental health professionals rely on established criteria outlined in diagnostic manuals such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The same manual suggests that the prevalence of gender dysphoria is within 0.005–0.014% of the population for individuals assigned male at birth and around 0.002–0.003% for those assigned female at birth. The key criteria for diagnosing gender dysphoria are as follows:

A Strong Desire To Be of a Different Gender

Individuals with gender dysphoria typically experience a strong and persistent desire to be of a different gender than the one they were assigned at birth. This desire may manifest in various ways, including wishing to dress and present themselves as the desired gender.

Incongruence Between Expressed Gender and Assigned Gender

Significant incongruence should exist between the individual’s experienced or expressed gender and their assigned gender. This gender incongruence must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Duration and Persistence

The diagnostic criteria require that these feelings of incongruence and distress be present for a significant duration, typically at least six months. This criterion helps distinguish between transient gender exploration and more persistent experiences of gender dysphoria.

Not Attributable to Another Condition

Mental health professionals must rule out the possibility that the distress is due to another mental health or medical condition. Conditions like schizophrenia, where delusions of gender identity may occur, must be considered.

Mental Health Professionals Involved in Diagnosis

Diagnosing gender dysphoria is a multidisciplinary process that involves several mental health professionals working together to provide comprehensive care. Here are the key professionals involved:

Psychologists and Psychiatrists

Psychologists and psychiatrists play a central role in assessing and diagnosing gender dysphoria. They conduct clinical interviews and assessments to understand the individual’s gender identity, explore co-occurring mental health conditions, and evaluate the persistence and severity of dysphoric feelings.

Licensed Therapists and Counselors

Licensed therapists and counselors provide ongoing support and therapy to individuals with gender dysphoria. They help clients cope with distress, navigate the challenges of gender transition, and address any mental health concerns that may arise during the diagnostic process.

Endocrinologists

In cases where individuals pursue medical interventions like hormone replacement therapy (HRT) or gender-affirming surgeries, endocrinologists play a vital role. They assess the physical and hormonal aspects of gender transition, monitor hormone levels, and manage associated medical concerns.

Pediatricians and Adolescent Medicine Specialists

Pediatricians and adolescent medicine specialists can contribute to the diagnostic process for children and adolescents with gender dysphoria. They assess physical development, guide families, and collaborate with mental health professionals to ensure appropriate care.

The Diagnostic Process

The diagnostic process for gender dysphoria is comprehensive and patient-centered. It involves several steps to ensure an accurate diagnosis and to provide individuals with the necessary support and care:

Initial Assessment and Clinical Interview

The process begins with an initial assessment and clinical interview conducted by a mental health professional, typically a psychologist or psychiatrist. During this interview, the individual discusses their feelings, experiences, and history related to gender identity.

Psychological Evaluation

A psychological evaluation may include standardized assessments and questionnaires that help quantify the individual’s distress and the extent of gender dysphoria. This evaluation aims to measure the individual’s psychological well-being objectively.

Exploration of Gender Identity

The mental health professional explores the individual’s gender identity, including their preferred name, pronouns, and the extent of their desired gender expression. This exploration is conducted in a supportive and non-judgmental manner, respecting the individual’s autonomy and self-identification.

Assessing Co-occurring Conditions

Assessing co-occurring mental health conditions is crucial as they can impact the diagnostic process and treatment planning. Mental health professionals must address depression, anxiety, or substance abuse.

Collaborative Care Planning

Once a diagnosis of gender dysphoria is confirmed, mental health professionals collaborate with the individual to create a personalized care plan. This plan may include psychotherapy, hormone therapy, and, in some cases, gender-affirming surgeries. It ultimately depends on the individual’s preferences and medical suitability.

Cultural Competence and Sensitivity

Cultural competence and sensitivity are integral to the diagnostic process for gender dysphoria. Mental health professionals must be attuned to the unique experiences and challenges faced by transgender and gender-diverse individuals. This includes respecting the individual’s chosen name and pronouns, understanding cultural factors that may influence their identity, and providing a safe and affirming environment for disclosure.

Conclusion

Diagnosing gender dysphoria is a complex but essential process that involves a careful assessment by mental health professionals. The diagnostic criteria outlined in diagnostic manuals help ensure a standardized approach to diagnosis. At the same time, a multidisciplinary team of professionals collaborates to provide comprehensive care.

Through culturally competent and patient-centered evaluation, individuals with gender dysphoria can receive the support and treatment they need to navigate their gender journey and achieve better mental health and well-being. As our understanding of gender diversity evolves, mental health professionals must continue to adapt their diagnostic and treatment approaches to meet the diverse needs of this population.

Discover the Best Age to Start Gender Reaffirmation With HRT and take a step closer to your authentic self. Hormones are essential for both developing and maintaining characteristics related to gender. At HEALOR ™ transgender care clinic in Las Vegas, our compassionate team is pleased to offer hormone replacement therapy (HRT) to help patients of all needs and backgrounds begin their gender reaffirmation journey. During this time, board-certified physician Dr. Raj Singh believes it's important that you feel fully informed and prepared.

One common question people have about gender reassignment is when to start HRT. Some people say the best age to start is as early as 16, while others make the decision later in life. Because there are no set guidelines, the decision should be made with careful consideration of what would work best for you. If you want to know the pros and cons of HRT, call our Las Vegas, NV clinic for a discussion.

What is hormone replacement therapy?

Hormone replacement therapy is the process of changing the hormone levels in your body. During treatment, estrogen or testosterone can be administered through injections, pills, or topically. This is performed for transgender individuals who would like to transition their physical appearance, so it better aligns with their gender identity.

For example, estrogen can be used for more feminine characteristics, like breast development, while testosterone is for more masculine traits like facial hair. In a gender reaffirmation consultation with the providers at HEALOR ™ transgender care clinic in Las Vegas, we can learn about your goals and create a personal treatment plan for hormone replacement. We're here to make your journey as smooth as possible.

Many of our patients want to learn the pros and cons of HRT at an early age. Here are some well-known benefits of hormone replacement in Las Vegas, NV:

• Breast development
• Fat redistribution
• Hair growth
• Alleviation of gender dysphoria
• More confidence

When should I start HRT?

There is some debate about what age to start hormone replacement therapy. Some people start at 16 because many medical professionals agree that the teenage years may be easier to transition through. By starting hormones during adolescence, transgender people can begin making immediate changes.

However, it's also normal for people to wait until later in life to begin their transition. If you aren't having difficulties with your assigned gender, then there's no need to rush into something that may be challenging or painful for you. At our clinic, we believe the best age is based on an individual's maturity and understanding of the process.

What if I'm unsure?

If you're still uncertain or hesitant about what age to start hormone replacement therapy, Dr. Singh and the trusted team at HEALOR ™ transgender care clinic in Las Vegas can answer your questions and guide you on the path to treatment. Whether we see you for an initial gender reaffirmation consultation or as a returning patient, our providers are here to support you. We're proud to have worked with many transgender people in their personal journeys.

Start when you’re ready

You may wonder if there's a "best age" to start hormone replacement therapy. If you're considering transitioning, the best time to start hormones is on your timeline. If you want more information about the pros and cons of HRT from a board-certified physician, call Dr. Raj Singh for a hormone assessment in Las Vegas, NV. The compassionate staff at HEALOR™ transgender care clinic is ready to get started with you.

Members of the LGBTQIA+ community are often denied the respect and compassionate services they deserve as human beings. Discover important resources and tips to prioritize Health and Well-being for the LGBTQIA Community. Now, it’s time to give our LGBT community the attention and care they need to not only survive in this world, but thrive — not just emotionally, but physically as well.

The Health of LGBT People

Gay individuals, lesbians, queer folks, bisexuals, and other members suffer from numerous health issues. The most notable ones are listed below. 

STIs

Sexually transmitted infections (STIs) are most common among gay and bisexual individuals. The most prevalent types of STIs are syphilis, chlamydia, and gonorrhea. Having STIs can heighten the risk of either getting or transmitting HIV. 

Mental Health Issues

Due to the treatment that this particular community has received, such as bullying, discrimination, and avoidance, transgender and gender non-conforming individuals are more likely to develop mental health issues than heteronormative individuals.

Because of this, members of the LGBTQIA community are more prone to depression, eating disorders, substance abuse, and suicidal ideation. 

Violence

History shows that the LGBT community experiences higher levels of violence than any other group. Whether it be in words or actions, LGBTQ people face unnecessary hate and hurt that trigger serious health concerns. 

Support the LGBTQIA Community

It’s not enough to recognize what the LGBTQ community is facing. We need to help them overcome these challenges and receive the healthcare they deserve. 

Fortunately, the government is taking action. But we also need to lend a helping hand and encourage the community to seek healthcare professionals who are knowledgeable about their unique situation and can provide the support they need. 

Outside of professional assistance, we as a society need to advocate for acceptance and understanding so we can create a safe and healthy environment for those in the LGBTQIA+ community to thrive.

Questions about the best form of estradiol therapy for Feminizing hormone therapy?

Feminizing hormone therapy with Estrogen is a treatment that can be utilized to help alleviate the symptoms of gender dysphoria. Often it's combined with progesterone and testosterone blockers, which can help transition more smoothly

For some people, feminizing hormone therapy is an important part of their journey to authenticity. The goal for this type of treatment would typically be inducing physical changes that match gender identity and expression- like developing breasts or less facial hair.

For example:

Reduction in facial hair, most individuals will notice a decreased need to shave. For best results, we recommend laser hair removal or electrolysis. Laser hair removal may be the perfect solution for some individuals to reduce their need or desire in shaving. Laser treatments work by targeting and destroying hairs with high-energy light, while electrolysis uses an electric current that causes pores on your skin to strip away cells creating space between follicles causing them to die off over time.

The process of redistribution, or storing fat into different areas can cause a woman's figure to develop. Estrogen is what causes this change in shape because it increases the storage and development of body fats throughout your entire system - including breasts as well as hips. Here is a detailed article to address the development of breasts with hormone therapy

• Changes in voice pitch
• Prevention of male pattern baldness
• Decrease in the size of testis
• Skin becomes much softer

Before treatment can be started we require:

• Basic lab work. This includes CBC, comprehensive metabolic panel, hemoglobin A1c to exclude diabetes, TSH to test for thyroid problems
• Baseline hormone levels of estrogen, progesterone, and testosterone
• Established diagnosis of gender dysphoria.
• Informed consent

Dose versus duration:

Some providers are using much higher doses of estradiol therapy in an attempt to accelerate feminization. There is no data supporting this practice, however. The duration of hormones is an important factor to consider when it comes to physical changes. Hormone therapy can take up to 2 years before you start seeing maximal results, and those who use them for a long enough period will notice that their voice may change over time. We discourage the use of high doses and supraphysiological levels of estrogen as this can lead to significant side effects such as a risk increase in blood clots, cancers, anxiety/depression, and heart disease.

Potential side effects of feminization therapy

• Increased risk of blood clots such as DVT and pulmonary emboli
• Increase risk of elevated liver enzymes is thought to be secondary to fat deposits in the liver
• Increase risk of gallstones
• Hyperlipidemia
• Weight gain through increased fat storage deposits
• Symptoms of hypothyroidism such as cold feeling, constipation, fatigue. Estrogen tends to block the effect of thyroid hormone at the tissue level. TSH and thyroid hormone typically are normal

Best form of estradiol therapy for Feminizing hormone therapy

Estrogen:

This is the mainstay of Feminizing hormone therapy. Estradiol is a steroid sex hormone that is produced by the ovaries and adrenal glands in biological females. Individuals who are overweight also tend to have a conversion of testosterone to estrogen in body fat by an enzyme called aromatase. Estrogen therapy also helps suppress the production of androgen such as testosterone.

Types of estrogen therapy

• Ethinyl estradiol: This is a synthetic version of estrogen, and is extremely potent. This estrogen is derived from horse urine and is found in commonly prescribed oral contraceptives. This type of Ethinyl estradiol is not recommended for feminization therapy as it has a very high rate of blood clots.
• Estradiol 2-4 mg in divided doses is most commonly prescribed due to affordability and predictable blood levels. Current smokers should be on a much lower dose to reduce the likelihood of developing blood clots.
• Transdermal patch of estradiol: This is a much safer version of estradiol, however, tends to be expensive and absorption from the skin is variable leading to inadequate levels. We do not use this type of estradiol in our practice
• Estradiol valerate: Typical dose is 5 to 30 mg IM every two weeks. We often do not use this therapy as it has been shown to accumulate in the body and can cause toxicity. There is also a concern of receptor desensitization from consistently elevated levels of estrogen
• Estradiol pellets: These are the size of a rice grain, are inserted in the fat layer in a quick 10-minute outpatient procedure, and slowly dissolve over several months. This is our preferred approach due to the use of bioidentical estradiol which tends to be much milder than synthetic versions of estrogen. This also eliminates the need to take tablets and injections. Since the pellets are slowly dissolved, this avoids the negative effects associated with estradiol injections. You can watch a video of the procedure here

Other useful tips

• Avoid cruciferous vegetables as they are naturally occurring estrogen blockers. Individuals with a very high intake of these vegetables such as broccoli, Kale, may require higher doses of estradiol therapy.
• Estrogen therapy should always be combined with progesterone. This may help reduce many side effects of estrogen therapy such as feelings of bloating, anxiety. Progesterone also binds to GABA receptors in the brain which may help with insomnia and anxiety.
• Avoid smoking as this can increase the risk of complications associated with estrogen therapy
• Do not take higher doses of estradiol as this can increase the risk of complications however does not help with the feminization process

Have more questions? Schedule a consultation with one of our licensed providers to get started.

Eating disorders are difficult for anyone, but they affect transgender people differently and harshly. Trans people have a very high prevalence of eating disorders due to our intersecting mental health difficulties, and we deserve treatment all the same. Stick with me for a discussion about this important topic, and learn some ways to care for nutrition during transition.

A quick intro: Hi, I’m Summer and I’m HEALOR™ new blog writer. I hold a Master’s in Psychology, and I’m keenly interested in wellness, mental and physical. For my first piece, I’d like to explore an under-discussed topic that’s pretty close to my heart.

Eating Disorders in transgender minds

Eating disorders are an umbrella of experiences and diagnoses involving eating habits that are damaging to well-being. They appear in many thought patterns and behaviors and do not always correspond to high or low body weight. Many people who have eating disorders appear ‘healthy’ but experience serious emotional distress. Once the disorder progresses, it can weaken the immune system, worsen mental health, and permanently damage the vital organs.

Eating disorders are strongly related to self-esteem, social settings, and feelings of control. Many disordered behaviors involving food can be traced to a loss of control or an intense desire for control. These are often tied to cultural expectations of how a person ‘should’ look in their family or society.

While not all transgender people experience gender dysphoria, most of us do. Gender dysphoria often manifests as a negative feeling about our appearance. Gender dysphoria is also a massive contributor to depression and anxiety, which can disrupt our self-image and eating patterns. There are also emotional consequences to being transgender in the face of discrimination: we often have a punishing desire to be read as our gender (or ‘pass’) so that we can live peacefully. We’re also influenced by expectations of how cis and trans people ‘should’ look in media and society.

To recap: our self-esteem is often shaken and tied to a desire to change our bodies. We are at enormous risk of depression and anxiety. We live with high social pressure to change ourselves for the benefit of others. For these reasons, being transgender places us in a perfect storm of risk for eating disorders.

Can eating disorders affect trans people differently?

Short answer: yes!

Most research into eating disorders is done on cisgender people. It also prioritizes the young, cis women who make up the majority of diagnoses. This isn’t unreasonable, but the data has left trans people behind.

Eating disorders are very gendered, and trans people experience gendered expectations and roles differently to cis people. Cisgender American women are diagnosed more than twice as often as men for anorexia and bulimia nervosa but are by no means the only people affected.

Where trans people differ is that we experience eating disorders alongside the bodily dissatisfaction of gender dysphoria and other mental health challenges. This leads to higher rates of eating disorders among adolescent and young adult trans people. Our situation is made worse by the fact that treatment can be very trans-exclusionary.

Some of the ways these disorders can manifest in trans people are:

• Using disordered eating to modify the body without hormone treatment
• Developing disorders alongside body dissatisfaction and dysphoria
• Non-binary people restrict their weight to be thinner, in line with androgynous stereotypes

What can trans people do about this risk?

It’s important, to be honest, and willing to ask for help. Eating disorders thrive on dishonesty: they fill our minds with falsehoods about how we look, and how we ‘should’ look to be more valid human beings. They prey on our anxieties and trauma to warp our self-esteem. Mental distress like anxiety, depression, and eating disorders are insidious because they damage the ability to self-assess our well-being or make recovery decisions. Mental distress is punishing because it damages our agency.

If you see warning signs like a strong interest in modifying body weight or starting heavy, unsupervised exercise, it’s good to seek other opinions. Healthy weight loss is possible, but it is best done with medical supervision. If you're interested, read resources from advocacy groups to see if your feelings align with eating disorders. If you have a GP or therapist, consult them for an expert opinion.

Remember that eating disorders aren’t just about weight. They’re about emotional distress and control (or loss of control). Distressed thoughts and behaviors merely become a vehicle for the bodily changes. Managing weight without addressing the underlying thought patterns is often unsustainable. Recovering from harmful mental patterns can bring wholesome well-being, even if bodily health takes time to follow.

Reflect on your eating as part of your collective well-being. Disruptions in eating or sleep are one of the first signs that something is amiss and there’s a reason that doctors ask about them. Reflection is really important for dysphoric trans people impacted by dysphoria and other mental stressors. Ask yourself if you’ve been eating as much as you’d like to. Ask yourself if you’re comfortable with how much you eat. Ask yourself if other stressors in your life are challenging your self-esteem.

And lastly, remember the difference between healthy and unhealthy desires. Most trans people are familiar with the dreadful assertion that being transgender is something that needs to be 'treated'. Having gender dysphoria and an eating disorder can entrench this because the dysphoria and eating disorders often stem cast similar shadows. Both stem from profound disruptions in self-esteem and bodily satisfaction, and both come with a strong desire for changing oneself.

The reason that eating disorders should be countered and transition should be supported is a fundamental difference in outcomes. The natural outcome of letting a well-supported gender transition is a happier, more vibrant person. The natural outcome of an unmanaged eating disorder is physical and mental deterioration, with a high risk of death. The harms of transition are often attached to discrimination and healthcare denial. The harms of eating disorders are societal and psychological. Always remember that your gendered self is valid, with or without the challenges that accompany it.

But most importantly…

Seek help when the time is right. Once you feel ready to talk to a clinician about your eating habits, don’t hesitate to make the call. Like any form of mental distress, earlier is better for long-term care. Mental distress isn’t always treatable through medicine alone, and disordered eating is a star example of this. The best cases of recovery come from dedicated clinicians, social support (family and friends), and personal effort. Recovery isn't a slope of continuous progress, either. It's full if missteps, relapses and learning.

But from someone in recovery – it’s never too late to try.

Note: This article was reviewed by Dr. Raj Singh prior to publication.

Hormone Disorders and Their Impact on Transgender Hormone Therapy

Hormone disorders can impact transgender hormone therapy by affecting the body's ability to absorb, metabolize, and utilize the hormones administered. Hormone disorders can occur when the body produces too much or too little of certain hormones or when there is an imbalance in the levels of hormones in the body. This informative article will discuss thyroid disorders, polycystic ovary syndrome (PCOS), adrenal disorders and hypogonadism and their effect on transgender hormone therapy.

PCOS and Transgender Hormone Therapy

Polycystic ovary syndrome is associated with increased ovarian production of androgens such as testosterone, typically between ages 15-45. There is also an increased rate of anxiety and depression with PCOS.

Masculinizing hormone therapy is a medical treatment used to induce masculinization in transgender men or gender non-conforming individuals who wish to achieve a more masculine appearance or gender identity. This typically involves testosterone therapy, which can help promote the development of male characteristics such as cessation of the menstrual cycle, facial and body hair growth, a deeper voice, and increased muscle mass.

Masculinizing hormone therapy typically will begin producing changes in your body within weeks to months. In individuals with PCOS, the timeline of these changes may differ from those without PCOS.

Although this is an area of limited research, recent data has shown that starting testosterone therapy does not exacerbate PCOS symptoms and may help improve some of the metabolic problems associated with PCOS.

Thyroid disorders and Transgender Hormone Therapy

Thyroid disorders are conditions that affect the function of the thyroid gland, a butterfly-shaped gland located in the neck that produces hormones that regulate metabolism and other bodily functions. The two most common thyroid disorders are hypothyroidism and hyperthyroidism.

Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormone, slowing the body's metabolic processes. This can cause fatigue, weight gain, constipation, dry skin, and cold intolerance.

Hyperthyroidism, on the other hand, occurs when the thyroid gland produces too much thyroid hormone, accelerating the body's metabolic processes. This can cause symptoms such as weight loss, rapid heartbeat, anxiety, sweating, and tremors.

Transgender individuals on feminizing hormone therapy

Transgender HRT with estrogen can have a higher incidence of hypothyroidism than the general population. Estrogen therapy is associated with increased production of thyroid-binding globulins (TBG), which bind to thyroxine or T4 and prevent conversion to the active or free form of thyroid hormones called Tri-Iodothyronine or T3 hormone. The net result is the thyroid produces more T4 to compensate for this effect. This can overstress a weak thyroid gland and cause long-term hypothyroidism issues.

Individuals on estrogen-feminizing therapy can have typical symptoms of hypothyroidism. However, thyroid-binding globulin levels are not routinely checked, and thyroid hormones can remain normal. This often results in an undiagnosed or undertreated thyroid problem and may exacerbate underlying depression and chronic fatigue in transgender patients. Transgender individuals on estrogen therapy with symptoms of hypothyroidism should request their doctor to order thyroid-binding globulin (TBG) and free thyroid hormone (FT4, FT3) levels to diagnose this condition.

Transgender Individuals on Masculinizing hormone therapy

Hypothyroidism is also associated with high total testosterone and low free Testosterone levels, possibly due to increased production of sex hormone binding globulin ( SHBG ) by the liver. This results in too much bound or inactive form of testosterone. Transgender men with untreated hypothyroidism can require higher doses of testosterone to achieve the desired results, which may result in accelerated aromatization to estrogen and a higher percentage conversion to dihydrotestosterone (DHT) which can lead to adverse effects.

Just like hypothyroidism, individuals with hyperthyroidism can have high total testosterone and low free Testosterone levels, (area of debate) associated with significant elevations of the mean total testosterone and sex hormone-binding globulin (SHBG) levels and significant reduction of free Testosterone.

In addition, elevated estradiol levels and enlarged breasts (gynecomastia) are common in hyperthyroidism, which can negatively impact a transgender person's masculinization journey.

Adrenal disorders and Transgender Hormone Therapy

The adrenal glands are two small, triangular-shaped glands located on top of the kidneys. They play an important role in regulating various bodily functions, including metabolism, blood pressure, immune system function, and the body's response to stress.

Disorders of the adrenal glands can occur when these glands produce too much or too little of certain hormones, leading to a wide range of symptoms and health problems. Some common adrenal disorders include:

Addison's disease:

A condition in which the adrenal glands do not produce enough cortisol and aldosterone, leading to symptoms such as fatigue, weight loss, low blood pressure, and electrolyte imbalances.

Antiphospholipid antibody syndrome (APL) is a potential cause of Addison's disease. APL is a condition where individuals have a higher risk of developing blood clots. This can be particularly concerning for transgender women who are undergoing estrogen therapy, as they may be at an increased risk for blood clots and other complications.

Adrenal glands, also produce prohormones like dehydroepiandrosterone (DHEA) and DHEA sulfate. People with Addison's disease may experience low libido and chronic fatigue due to the lack of these hormones. While DHEA supplementation can help alleviate these symptoms and improve overall well-being, it can also complicate hormone therapy for transgender patients with Addison's disease. This is because DHEA can be converted into testosterone and estrogen, which can interfere with hormone therapy management.

Congenital adrenal hyperplasia (CAH):

is a genetic disorder that affects the production of adrenal hormones, leading to symptoms such as abnormal genitalia, infertility, and electrolyte imbalances. In some cases, CAH can also affect the production of sex hormones, leading to variations in gender identity and sexual development. Individuals with CAH may experience differences in gender identity and sexual orientation, as well as physical changes such as ambiguous genitalia or early onset of puberty.

Some individuals with CAH may identify as transgender or may seek gender-affirming treatments such as hormone therapy or surgery. For transgender individuals with CAH, hormone therapy can be complicated due to the underlying hormone imbalances associated with the condition. Testosterone therapy for transgender men with CAH may increase the production of androgens, which can exacerbate symptoms of CAH such as acne and excessive hair growth. Similarly, estrogen therapy for transgender women with CAH may exacerbate symptoms of CAH such as menstrual irregularities and electrolyte imbalances.

Hypogonadism and Transgender Hormone therapy

Hypogonadism is a condition in which the body does not produce enough of the sex hormones testosterone and/or estrogen. For transgender individuals undergoing hormone replacement therapy (HRT) as part of their gender transition, hypogonadism may be a concern. This condition requires lifelong treatment with either testosterone or estrogen, depending on the individual's gender identity. Due to the lack of hormone production by their native glands, higher doses of hormones may be necessary to achieve the desired physical changes. Pellets are a form of hormone therapy that offers a unique advantage over other methods such as injections, gels, or oral medication. They provide long-term hormone therapy, making them an attractive option for those with hypogonadism.

Gender euphoria in PCOS

The relationship between PCOS and gender euphoria is complex and multifaceted, and the experience of gender identity and euphoria is unique to each individual. It is important to understand that not all individuals with PCOS identify as transgender or experience gender euphoria. However, for some transgender men with PCOS, the physical changes that come with the condition may align with their gender identity and be affirming.

As this is a relatively unexplored topic, I have made every effort to ensure the accuracy of the information presented. However, I welcome any feedback or differing opinions you may have. Please feel free to share your own experiences and thoughts by leaving a comment below.

Thanks for Reading!

Raj Singh MD, FACP, FASN

I am often asked what we can expect in terms of breast development after starting estrogen therapy by a many of of my transgender patients. This is an area of very limited research and I will do our best to shed some light on this topic

Breast Development in Transgender Women

Normal breast development: breast development is a complicated process that starts at birth in biological females and then accelerates during puberty.

There are 5 stages of breast development in biological females and transgender women. The timeline of breast development in transgender woman can vary significantly depending upon the age, dose and duration of feminizing hormone therapy with estrogen. There can also be variation depending upon the type of estrogen modality used such as oral estradiol versus topical, estradiol injection or estradiol pellets.

Transgender women MTF Transition Pictures

We are sincerely thankful to our patients for allowing us to use their transition pictures to help guide others in their journey.

Progesterone therapy:

Progesterone therapy is recommended for transgender patients to decrease the negative side effects of estrogen. In my personal opinion, Progesterone supplementation does not significantly change the development of breast tissue.

Testosterone blockade:

Testosterone suppression with anti androgen such as spironolactone, bicalutamide, finasteride or additional medications are required to augment breast development. Elevated testosterone levels have a negative effect on breast tissue development and ideally should be maintained below 100 ng per dL.

Dr. Raj Singh MD, FACP, FASN

Starting transgender hormone therapy can be overwhelming, but it doesn't have to be. Get your questions answered with this list of the top 9 transgender hormone therapy FAQ.

At HEALOR™, we have treated hundreds of patients with gender dysphoria and based on our experience we have compiled a list of the most commonly asked questions when it comes to Feminizing or masculinizing hormone therapy.

QUESTION 1. DO I NEED A LETTER FROM MY PSYCHIATRIST OR COUNSELOR BEFORE I CAN START HORMONE THERAPY?

As most hormone therapies can have irreversible effects both physically and mentally, we at healor, require a letter or statement from the patient's psychiatrist or counselor before Feminizing or masculinizing hormone therapy can begin. This is in compliance with Nevada state law. Regulations and laws vary across different states and we encourage you to discuss this with your medical provider.

QUESTION 2. WHAT ARE SOME OF THE PHYSICAL EFFECTS OF HORMONE THERAPY?

In female to male transition, you can expect enlargement of the clitoris, deepening of the voice, increase in facial and body hair, irregular menstrual cycles followed by complete cessation of the menstrual period, and a decrease in the percentage of body fat. In male to female transition, you can expect a decrease in testicular size, decreased erections, an increase in percentage body fat, and some growth of breast tissue.

QUESTION 3. WILL HAVE MORE SKIN PROBLEMS AFTER STARTING HORMONE THERAPY?

Testosterone therapy can increase the production of sebum which makes the skin to be more oily which can result in the development of acne and flare-up of acne.

QUESTION 4. HOW MUCH SCALP HAIR WILL LOSE TESTOSTERONE HORMONE THERAPY?

Scalp Hair loss is very variable, as the sensitivity of hair follicles to dihydrotestosterone or DHT may vary. Patients who are on higher doses of testosterone will experience male pattern baldness. We at healor, will prescribe customized formulations containing finasteride to block DHT conversion, which protects scalp hair from damage. we do not recommend oral finasteride due to the risk of irreversible sexual dysfunction.

QUESTION 5. WHEN WILL I STOP HAVING MY MENSTRUAL CYCLE?

Patient’s on masculinizing hormone therapy can expect complete cessation of the menstrual cycle in 6 months.

QUESTION 6. WHEN WILL NOTICE A DEEPENING OF MY VOICE?

Deepening of voice on masculinizing hormone therapy generally takes about 6-12 months and is irreversible.

QUESTION 7. WHEN WILL I NOTICE ENLARGEMENT IN MY BREASTS WITH HORMONE REPLACEMENT THERAPY?

Growth of Breasts varies on the age of the client, estrogen levels, and appropriate use of androgen blockers for best results. Among Anti Androgen drugs, Bicalutamide tends to have the most effect on breast growth, however, this medication can cause liver enzyme elevation and must not be used in individuals with liver problems The development of breast tissue is variable, typically results are seen in about 3 months and breast tissue growth may continue for up to 2 years. Many patients are happy with the results, however, some may require surgical breast augmentation. Read this blog titled " Breast growth with Estrogen Therapy in transgender patients" for more details on this topic.

QUESTION 8. WHAT ARE SOME OF THE RISKS AND SIDE EFFECTS ASSOCIATED WITH MASCULINIZING HORMONE THERAPY?

Patients can experience male pattern baldness, the development of acne, increase in red blood cell production which can raise hemoglobin levels and cause secondary polycythemia. Secondary polycythemia can increase the risk of heart disease and stroke. Some other risks include the development of osteopenia and osteoporosis, the elevation of cholesterol and liver enzymes.

QUESTION 9. WHAT ARE SOME OF THE RISKS AND SIDE EFFECTS ASSOCIATED WITH FEMINIZING HORMONE THERAPY?

Patients can experience More blood clots, the elevation of liver enzymes, elevation of lipids especially triglycerides and breast cancer.

I hope this was helpful in improving your understanding of hormone therapy.

Wondering When Will You See Results After Hormone Replacement Therapy

Transitioning is an important decision for many of our patients in Las Vegas, NV. When you’re interested in transitioning, hormone replacement therapy can help. During a consultation, you will meet with our knowledgeable double board-certified physician, Dr. Raj Singh, at HEALOR™ to learn more about LGBTQ health. He has worked with the LGBTQ community for a long time and has helped many begin their gender affirmation journey.

Gender dysphoria is the feeling that someone’s identity doesn’t match their biological sex. This can lead to depression, anxiety, discontentment, and even suicidal thoughts. Patients with gender dysphoria oftentimes choose to transition to their preferred gender. To do so, they must first learn if they are a candidate for hormone replacement therapy. We will evaluate if you’re healthy enough for treatment and run the necessary testing to help determine which hormones would work best for you.

What is transgender hormone therapy?

Transgender hormone therapy administers different hormones to patients to help them acquire the look of their preferred gender. At HEALOR™, Dr. Singh provides a safe space for patients receiving this transgender hormone therapy. Treatment varies from patient to patient. We administer hormones with pills, topical creams, or even by injection.

Dr. Singh can determine the proper method and dosage of hormones for each patient at his Las Vegas, NV office. Hormone replacement therapy results occur over time. We begin with low dosages to make sure your treatment is always safe. Many of our patients experience changes in their appearance about six months to a year after beginning transgender hormone therapy. During your visit to HEALOR Primary Care, we can discuss any possible side effects of hormone replacement therapy, so you are well aware of these possible changes.

FAQs about hormone replacement therapy

When you’re considering hormone replacement therapy in Las Vegas, you may have questions. Here we address some of the most commonly asked questions asked during consultations at HEALOR Primary Care, including:

1. Do I need a letter from a psychiatrist to start treatment?

Yes, we do require a letter of statement from a psychiatrist or counselor before you can begin your gender affirmation journey at HEALOR™.

2. When will I stop having my period?

Patients receiving hormone replacement therapy can expect cessation of their period after about six months.

3. What are some risks for transitioning?

During female to male transition, patients can experience male pattern baldness, increased red blood cell production, and elevated cholesterol or liver enzymes. For a male to female transition, some patients may experience elevated lipid levels, including triglycerides, an increased risk of developing breast cancer, and an increased chance of developing blood clots.

4. When will I start to see results after hormone replacement therapy?

This depends on which hormone you’re taking and your dosage. However, Dr. Singh expects you will start to notice some changes within a few months. For some patients on progesterone or estrogen at HEALOR Primary Care, they have seen changes in just two weeks.

Learn more about hormone replacement therapy in Las Vegas

At HEALOR™, we offer confidential care for the LGBTQ community. Dr. Raj Singh is experienced with hormone replacement therapy and can help his patients safely transition to their preferred gender. If you are experiencing gender dysphoria symptoms and want to learn more about transgender hormone therapy, call our Las Vegas, NV office to schedule a consultation.