HRT can be used as part of gender affirming care and to relieve menopause symptoms. Starting HRT begins with speaking with a healthcare professional. HRT treatments are generally safe and effective. However, HRT may cause side effects, depending on the type.

Healthcare professionals use hormone replacement therapy (HRT) in a few ways.

One way is as a menopause treatment. HRT can help manage menopause symptoms by replacing lost hormones.

HRT can also align a transgender person’s physical characteristics with their gender identity.

People can start using HRT after seeking professional advice and assessment from healthcare professionals.

This article discusses how to access HRT as part of menopause or gender affirming care and the side effects that may occur.

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A person seeking gender affirming care has many options, including HRT. This form of HRT is also called gender affirming hormone therapy (GAHT). GAHT uses hormones that allow some of a person’s secondary sex characteristics to align with their gender identity.

GAHT includes testosterone for female-to-male transition and estrogen with an anti-androgen for male-to-female transition.

Anti-androgens are medications that stop male hormones, such as testosterone, from working.

GAHT is an effective treatment with few severe side effects. It is an important treatment for gender dysphoria.

Gender dysphoria is the medical term for the distress and conflict a person feels from a mismatch between their sex assigned at birth and their gender identity. This distress can be severe and lead to depression and anxiety.

To start GAHT, a person can take a number of steps.

Learn what transgender means.

Speak with a doctor

To start GAHT, a person can seek treatment from:

A healthcare professional performs an assessment and recommends a person start GAHT if:

  • they have persistent and well-documented gender dysphoria
  • they can consent to treatment
  • any other underlying mental or physical medical conditions are managed

Create a hormone therapy plan

Healthcare professionals will help create an individual hormone therapy plan for each person to ensure successful outcomes. This personalized treatment plan is typically based on:

  • a person’s age
  • their individual objectives for hormone therapy
  • an analysis of the risks versus the benefits of GAHT
  • any other conditions a person has
  • socioeconomic factors

Choose which type of HRT

Both testosterone and estrogen HRT come as:

  • injections
  • skin patches
  • topical gels
  • pills

Healthcare professionals will explain the potential side effects of HRT to anyone interested in the treatment.

Side effects of testosterone

Testosterone HRT side effects may include:

  • erythrocytosis, or having high red blood cell levels resulting in thicker blood that may be less able to circulate
  • sleep apnea, which is a potentially serious sleep disorder where a person’s breathing repeatedly stops and starts
  • high blood pressure
  • weight changes
  • salt retention
  • lipid changes, or changes to fats in a person’s blood
  • acne

Side effects of estrogen

Side effects of estrogen HRT include:

  • thromboembolic disease, where a blood clot forms in a person’s vein
  • liver disease or dysfunction
  • hypertriglyceridemia, where a person’s risk of heart conditions is higher due to increased levels of fat in their blood
  • coronary artery disease
  • cerebrovascular disease, which is a collection of conditions affecting blood flow and vessels in a person’s brain
  • high blood pressure

In the United States, transgender people ages 17 years or younger need a parent or guardian’s consent to receive HRT. However, some states prohibit HRT for transgender youth, even with parental consent. A person will need to check their state’s laws.

Some healthcare facilities may also have a minimum age requirement.

Transgender people ages 18 years and older can access HRT without a parent or guardian’s consent.

Learn about gender affirming care.

LGBTQIA+ resources

To discover more evidence-based health information and resources for LGBTQIA+ individuals, visit our dedicated hub.

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Menopause is a natural bodily transition. It does not typically need treatment. When treatment is needed, HRT can relieve or sometimes eliminate menopause symptoms.

HRT does so by replacing the hormones a person loses as menstruation ends. These hormones are usually estrogen and progesterone.

To begin HRT for menopause, a person first needs to seek advice from a healthcare professional.

Speak with a doctor

Medical professionals recommend personalized HRT plans for each person based on the age at which menopause begins. For a person to receive HRT, they must:

Choose the delivery method of HRT

Delivery methods of HRT for menopause include:

  • pills
  • creams
  • skin patches
  • vaginal inserts
  • subdermal pellets, or pellets inserted under the skin

Each method has different benefits and risks. A healthcare professional can recommend a method as part of a person’s HRT treatment plan.

HRT for menopause may cause side effects such as:

HRT can also raise the risk of:

Menopause resources

Visit our dedicated hub for more research-backed information and in-depth resources on menopause.

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The following are answers to some questions people frequently ask about HRT.

Do I have to wait for a period to start HRT?

Healthcare professionals may advise waiting to start HRT at the beginning of a person’s menstrual cycle if periods are still occurring.

How quickly should HRT start working?

For menopause symptoms, HRT typically starts working within a few weeks but can take up to 3 months.

For gender affirming care, HRT’s timeline varies. In some cases, certain physical changes may be noticeable after 1 month, but in other cases, it can take 6 months or more.

HRT can provide benefits for gender affirming care and menopause. A person can start HRT by speaking with a healthcare professional.

A healthcare professional can help a transgender person create a hormone therapy plan and recommend the appropriate gender affirming hormone therapy.

Healthcare professionals can also create personalized HRT plans for people during menopause to relieve symptoms. They can also advise on HRT delivery methods.

HRT may cause side effects. Individuals can discuss all potential side effects with their healthcare professional.