Hormones and Their Role in Gender Transitioning

Every person’s transition journey is different and personal to them. The first step for many is taking hormones. Whether it’s oestrogen or testosterone assisting you on your journey of transitioning, it plays a vital role not only in your appearance, but in the way you feel and behave. It’s perfectly normal.

There may be ups and downs in mood and libido (Trust us the highs are high and the lows can be low!), but overall, your brain and your body will eventually align. Over time, you may even experience gender euphoria! (The dream).

If you’re just getting started on your journey, it’s important to note that taking hormones causes some changes which are irreversible. It’s also important to bear in mind that HRT is not a magical cure-all that will change your body overnight. It takes time, sometimes a lot of time, for effects to become visible, in some more so than in others. So try to be patient with your body! There are four key areas where you can expect changes to occur as your hormone therapy progresses: physical, emotional, sexual, and reproductive.

Here are some of the major changes you can expect from hormone therapy:

Transgender women

• Softer skin, less oily
• Softening/feminising soft tissue of the face
• Development of breast tissue
• Slower hair growth
• Feminisation of body shape – fat redistribution
• Likelihood of reduced libido
• Estrogen may reduce fertility and consultation with a reproductive specialist is recommended

Transgender Men

• Voice deepens
• Increase in abdominal fat and muscle mass
• Growth of facial and body hair
  Oily, coarse skin, possibly acne
  Clitoral growth
  Increased libido
  Increased appetite
  Testosterone therapy may reduce fertility and consultation with a reproductive specialist is recommended

A second puberty?

Hormone therapy can almost be considered a second puberty. Remember the confusing roller coaster of emotions, the uncontrolled outbursts, the bad skin associated with your teen years? Yep, that is exactly what you can expect.
It’s however important to remember that the extent of, and rate at which your changes take place, depend on many factors including your genetics, age, and your overall state of health.
It’s also important to note that taking higher doses of hormones will not necessarily bring about faster changes. It’s like trying to bake a cake at a higher temperature for shorter? It almost always flops! Remember, patience is a virtue! Taking higher doses also poses a serious medical threat. Avoid comparing with what you may have read online or with your friends. Everyone is different, which means your medicines and dosages will vary widely to others.

No one-size-fits-all

There’s no one-size-fits all approach to transitioning. Every body is different! Taking HRT can be a fast process or achingly slow, it just depends on who you speak to and their own personal experience. The bottom line is, if HRT makes you able to smile in pictures again, look at yourself in the mirror with confidence, and put on clothes and go out into the world and rock it, you know you’re definitely on the right track!

Vocal Health: helping the transgender community find their voice.

Literally.

One of the primary ways people express their gender is through their voice. Which is why it can be incredibly frustrating when you’ve transitioned but your voice hasn’t caught up. And while estrogen-based hormones don’t have an impact on your vocal chords, working with a vocal coach can feminize the tone and timbre of your voice.

We know that ‘trying on’ and ‘testing out’ a new voice will initially feel a bit strange (probably a lot like acting). But over time, your new voice will become second nature.

Voice plays a vital role

Voice features such as pitch, voice quality and inflection can signal a person’s gender to others. Which is why for so many transgender women, voice is one of the most crucial and often unguided aspects of transition, especially because oestrogen therapy cannot feminise the voice in trans women.

If you Google Male to Female Voice training, your search results will be flooded with “How To’s” and YouTube tutorials.

While these instruction videos might work for one person, there’s no guarantee they’ll work for another. In addition, medical experts warn that the voice is a muscle, and it can get injured or strained if not used properly. There’s also a risk that you pinch your voice without realizing because no one is there to guide and correct you.

Recent advances in voice therapy is making significant strides in helping to empower transgender women through their voice. Feminine-sounding voices are generally perceived as higher pitched, slightly breathier and with more varied inflection than masculine-sounding voices.

Voice therapy retrains the voice by retraining the brain and focuses on five parts of speech: pitch, intonation, volume, articulation and resonance.

The training also focuses on helping to feminize body language, facial expressions, and mannerisms.

The bottom line

Some people want to change how their speaking voice sounds as part of their gender expression. Others do not. It is your choice. For many, finding their voice is about so much more than just the way they sound and are perceived by others, it forms a vital piece of their identity. But, for those undergoing vocal training, it is critical to take your time and not push yourself too hard.

Remember you’re using muscles in a new way, which means they’re bound to get sore. Just as you can’t run a marathon on your first day of practice, you won’t be able to learn and perfect a female voice overnight. The most important thing is to look after yourself and your vocal chords!

Drink plenty of water, avoid overexertion, avoid raising your voice, rest your voice when tired, and allow adequate time to warmup and warm-down your voice.

Remember, patience is a virtue! “Rivers know this: there is no hurry. We shall get there some day.” ― A.A. Milne, Winnie-the-Pooh.

November is Trans Awareness month on our QWC sexual health calendar. In this series of articles we will aim to assist you in better undertanding the issues facing the Trans community.

Essential tips for tucking, strapping & packing

Whether it’s tucking, strapping or packing, we all have our own philosophies when it comes to our bodies that help us not only create our desired body shape but contribute to making us feel whole.  And with so many new products coming onto the market, it’s becoming even easier to express ourselves in a painless, comfortable, safe, and in many cases, a fashion-forward way.

The most important thing is to learn to love your body and embrace being your unique self. As Oscar Wilde famously put it – “Be yourself; everyone else is already taken”.  For many of us tucking, binding and packing is a huge part of our daily realities. But, like with everything in life, there are risks involved if not done properly. We outline key tips to keep in mind to ensure you stay safe (and away from the ER) when tucking, strapping and packing.

1. Chest Binding

Binding for so many is an absolute non-negotiable.  But, while chest binding can significantly improve mental health and anxiety, it can cause negative side effects. A 2016 study that examined 2 outcomes among people who bind found only 2.8% of individuals out of 1800 had rare and severe outcomes like rib fractures. This reinforces the fact that binding is not inherently harmful if the right precautions are taken.

Safe ways to bind include:

• Take a break every couple hours. Prolonged binding could cause adverse side effects including breast, back and chest pain, skin irritation, or fungal infections. The golden rule is to try to give yourself a break every 8 to 12 hours. Make sure you also avoid exercising and sleeping in your binder.
• Find the right fit. Wearing binders that are too tight will not only restrict your breathing but can cause tissue and muscle damage. Bodies change over time, especially if you’re on hormones. Make sure you wear a binder that fits your body comfortably and correctly and change the size when you need to. Trust us, you don’t want to be out somewhere and not be able to breathe!!
• Bind properly. Commercial binders, sports bras, strategic layering, and bandages, are the safest ways to bind. Do NOT bind your chest with duct tape or plastic wrap as this can damage your skin.
• Be careful how you wash it. Hand wash and air dry your binder regularly (Every few days). Make sure you don’t put your binder in the tumble drier as there’s a very high chance it’ll shrink.

2. Tucking

As with binding, tucking (no matter how you choose to tuck) needs to be done safely and comfortably to ensure no adverse and damaging side effects. Risks associated with improper tucking include skin irritation and discomfort, UTIs, dehydration, infections, and bladder and kidney damage.

Safe ways to tuck include:

• Don’t tuck for too long. Tucking for too long can lead to testicular discomfort and pain. As with chest binding, we recommend taking regular breaks from tucking.
• Be mindful of the tape you choose. Not all tape is skin safe to use, especially when it comes to sensitive skin. It’s therefore super important to choose the right adhesive to avoid chafing and skin irritation. We recommend testing a small area before full application. It’s also a good idea to shave the area where the tape will be used, so there’s no irritation or pain when the tape is removed.
• Keep it clean. The increased moisture caused by tucking can cause skin irritation, rashes, and infections. Make sure you keep the area dry and clean. Consider applying anti-fungal powder or creams to prevent odours and infections.

3. Packing

While packing comes with far fewer health risks than binding and tucking, a small percentage of people do report some negative side-effects from wearing certain prosthetics.

Safe ways to pack include:

• Be careful if you have allergies. If you’re allergic, be extra careful to check ingredients carefully when purchasing a prosthesis. We recommend purchasing silicone because it is non-allergenic and non-porous. Silicone is also much easier to clean.
• Store your packer carefully. You obviously want your packer to retain its shape which means storing it carefully as opposed to throwing it into a cupboard or into the bottom of your bedside drawer.
• Watch out for the adhesive. Be careful of the ingredients contained in the adhesives used to hold the packer in place. This is directly applied to the skin and can cause significant skin irritation, especially if you’re allergic.

The bottom line

Binding, tucking and packing are vital for so many for a variety of reasons.  Just make sure you do it as safely as possible to mitigate any potential health risks and side effects. So, what are you waiting for? Get outside and rock the look that makes you feel whole and happy. With a little tuck here or a little packing there, you do YOU! Above all, feel comfortable, be safe and take care.

Transgender Community Health Section

Medical centres where transgender people are made to feel welcome are scarce in South Africa. The Queer Wellness Centre (QWC) aims to address this gap by offering holistic services to transgender people that are supportive and understanding of their unique needs. We help transgender, gender nonconforming, and non-binary adults access to the highest quality gender affirming medical care.

QWC offers experienced doctors as well as referrals to specialists such as plastic surgeons, psychiatrists, psychologists, endocrinologists in support of our transgender patients. We hope that our clinic will help to quicken the pace of what can be a very long and bureaucratic journey.

1. Hormone Therapy

a. Getting started on transition Hormone therapy In Johannesburg

Transgender hormone therapy is when sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals to assist them with more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is to become a transgender woman or a transgender man: 

• The impact of your gender identity at work, school, home and social environments, including issues related to discrimination, relationship abuse and minority stress
• Mood or other mental health concerns
• Sexual health concerns
• Risk-taking behaviors, including substance use and use of nonmedical-grade silicone injections or unapproved hormone therapy or supplements
• Protective factors such as social support from family, friends and peers
• Your goals, risks and expectations of treatment and your future plans for your care

b. Hormone level checks

Before starting hormone therapy, your doctor will evaluate your health to rule out any medical conditions that might affect or contraindicate treatment. This evaluation might include:

• A review of your personal and family medical history
• A physical exam, including an assessment of your external reproductive organs
• Lab tests measuring your lipids, blood sugar, blood count, liver enzymes, electrolytes and the hormone prolactin
• A review of your immunizations
• Age- and sex-appropriate screenings
• Identification and management of tobacco use, drug abuse, alcohol abuse, HIV and other sexually transmitted infections
• Discussion about sperm freezing or egg freezing

You might also need a mental health evaluation by a provider with expertise in transgender health. The evaluation might assess:

• Your gender identity and dysphoria
• The impact of your gender identity at work, school, home and social environments, including issues related to discrimination, relationship abuse and minority stress
• Mood or other mental health concerns
• Sexual health concerns
• Risk-taking behaviors, including substance use and use of nonmedical-grade silicone injections or unapproved hormone therapy or supplements
• Protective factors such as social support from family, friends and peers
• Your goals, risks and expectations of treatment and your future plans for your care

 c. Hormone Injection Assistance at QWC

Hate needles? We’re good at handling pricks. Bring your hormones.
If you have an aversion to needles we are more than happy to administer your injections for you