4 Mental Health Effects of Hormone Therapy for Trans Folks
Hormone replacement therapy (HRT) is a common medical intervention for transgender folks seeking to align their physical characteristics with their gender identity. The psychiatric changes that occur with HRT can vary among individuals and may depend on several factors, including the individual's pre-existing mental health, the specific hormones being used, and the dosage and duration of treatment.
It's important to note that individual experiences can differ, and the following overview provides a general understanding of the potential psychiatric changes associated with transgender HRT.
Alleviation of Gender Dysphoria
For many transgender folks, HRT can significantly alleviate gender dysphoria, which is the distress experienced due to a misalignment between one's gender identity and assigned sex at birth.
By aligning their physical characteristics with their gender identity, HRT can contribute to improved mental well-being and reduced distress.
The ability to navigate the world with a greater sense of safety, and finally see evidence in your own body of the way you’ve felt internally for years is an indescribable relief for people.
The term gender euphoria describes this. It’s the feeling of joy, happiness, and exuberance we can feel in the simplest of moments when we experience a sense of congruence between our internal identity and our outward appearance. What brings gender euphoria is different for everyone, but it’s often associated with some sort of shift in secondary sex characteristics. I encourage my patients to savor and allow themselves to feel the joy. It’s so healing.
2. Improved Mood and Mental Health
Many trans folks report improved mood and overall mental well-being after starting HRT.
This can be attributed to the alignment of their physical appearance with their gender identity, reducing feelings of discomfort or incongruence. They may feel a bit safer in the world as well, and able to navigate public spaces with more comfort—though this isn’t universal. Sometimes it’s actually the opposite, if they’d previously been dressing or grooming themselves in ways consistent with their sex assigned at birth. But for most, the sense of freedom and congruence they feel when starting HRT outweighs the potential negative experiences they have.
People also start feeling and processing their emotions differently, which I’ll discuss more in the next section. For many folks, the evidence of hormones influencing internal processes can feel very affirming too, even if that’s not associated with some external-facing change.
I’ve seen a remarkable change in some of my patients’ mental health symptoms, including depression, anxiety, suicidality, and the severity of PTSD symptoms
Because the symptom severity, and sometimes the symptoms themselves—were always secondary to gender dysphoria.
Amazing things happen when people finally start to feel a sense of congruence between their gender identity and how their bodies are able to express this!
However, it's important to note that HRT alone may not address all mental health concerns, and additional support or therapy may still be necessary.
3. Changes in the Experience and Processing of Emotion
Hormones can influence emotions, and some people may experience changes in emotional patterns or intensity.
For example, transgender women or transfeminine individuals who undergo estrogen therapy may report increased emotional sensitivity and range. This may feel really affirming to them, or it might feel a little jarring and scary. These emotional changes can be both positive and challenging, requiring adjustment and support. I’ve known and worked with many transfeminine folks who, after starting HRT, needed a bit more support in processing the widened range of feelings they’d never had to deal with before. It can be a little intense.
For trans men or transmasculine folks, it often goes the other direction. While they had access to a broad range of emotion previously, found crying to be cathartic, and had a handle on their emotional range, it tends to be restricted with testosterone. The prevailing trend is that experiences seem to be processed through more activating emotions like anger, irritability, and frustration as opposed to sadness or despair. Some people can be pretty uncomfortable with this shift, especially if they’ve been on the receiving end of any abuse from someone with an angry temperament.
It’s also more difficult to cry.
The only time I have cried since starting testosterone almost 3 years ago was when I watched the finale of The Good Place. Why it was the Good Place? Who knows…but that’s the only thing that did it. (It’s an excellent show with a very moving finale, if you’ve never seen it. Highly recommend.)
Other times I will sort of well up with tears, but my eyes just suck them back in. It’s very strange, and a little frustrating not to have that catharsis available to me like it used to be. This is an experience that I’d say 75% or more of my transmasculine patients experience as well, so it’s incredibly common to go through this.
It’s a tricky balance as a mental health provider to be validating and supportive about the life-affirming and life-saving intervention that is HRT—while also being able to talk about the fact that sometimes, there are not-so-great side effects associated with any treatment.
It’s normal to experience some of these shifts in your emotional life when starting hormone treatment. It’s important that trans people are supported and guided through this by others who are understanding, because for some, it can be an unexpected and jarring change.
4. Sexual Function and Libido
HRT can definitely affect sexual function and libido.
Transgender folks may experience changes in their sexual desires, including an increase or decrease in libido. The specific effects can vary depending on the hormones used and individual responses. Remember that in starting HRT, what you’re doing is essentially prompting the start of a second puberty (for adults or older adolescents, at least), so sex drive and libido is certainly a part of that experience.
In general, feminizing HRT tends to be associated with a decrease in sex drive while masculinizing HRT is associated with an increase.
That said, the treatment of gender dysphoria can lead to a lot of people feeling an increase in their sex drive because prior to treatment, they were so uncomfortable in their bodies that sex was….well, complicated, and anxiety-provoking. It’s amazing to me that even without any surgical intervention, so many people start to feel less dysphoric about their sexual anatomy when they start HRT. It’s as if treating some dysphoria helps to alleviate overall dysphoria because at least SOMETHING is starting to look and feel right.
Obviously—this differs depending on the individual.
For some, the positive changes they experience from HRT seem to highlight the things that HRT cannot change, and that makes sex drive, sexual functioning, and libido more challenging.
Some of these people ultimately explore surgical intervention to bring these things more in line with how they see themselves.
Some changes can often occur to the sexual anatomy secondary to hormone treatment that may or may not feel affirming to people as well. There are a range of things that can happen with sexual desire, functioning, and libido. They all are mediated by the very personal and private relationship people have with their bodies, so though I can describe general trends, there is going to be a lot of variability here.
In summary….
It's important to emphasize that HRT is a complex medical intervention, and its effects can be influenced by various factors.
Regular monitoring, open communication with healthcare professionals, and personalized care are crucial to ensuring the overall well-being of transgender individuals undergoing HRT. A lot of the changes people experience are exciting, desired, and lead to an overall improvement in well-being. There are some changes that are less appealing for some. But overall, we know from research and practice that being able to change your appearance and your body’s way of working to align with your internal sense of gender provides a number of mental health benefits.
Jess Romeo (he/they) is a proud trans man, psychiatric nurse practitioner, and clinical social worker. He has a private practice in Maryland/Washington, DC and has a mentorship program to help other service providers improve their skills and competencies in working with LGBTQIA+ clients.
For more information regarding his trainings/consultation for service professionals, please visit this page.
