Hormone Replacement Therapy is NOT Used to Help Decide Gender Identity
Gender-affirming hormone therapy (GAHT) is initiated AFTER an individual has already established their gender identity and is experiencing persistent gender dysphoria—it is a treatment to align physical appearance with an already-determined gender identity, not a diagnostic tool to help someone decide their gender. 1, 2, 3
The Correct Sequence of Gender-Affirming Care
The evidence clearly establishes that hormone therapy comes AFTER gender identity determination, not before:
Gender identity is an individual's inner sense of self as female, male, neither, or a combination—this exists independently of any medical intervention. 4
GAHT is initiated only after confirming persistent gender dysphoria and obtaining informed consent, with the goal of aligning physical appearance with an already-established gender identity. 1, 3
Transgender individuals pursue GAHT specifically to align their gender identity and gender expression—meaning the identity must already be present before treatment begins. 4
What GAHT Actually Does
Hormone therapy serves to create physical changes that match an existing gender identity:
For transgender women (male-to-female), estradiol plus anti-androgens are used to achieve feminization, including breast development, decreased muscle mass, and softening of skin. 1, 3
For transgender men (female-to-male), testosterone is used to induce virilization, including increased muscle mass, deepening of voice, and cessation of menses. 1, 2
The most anticipated changes reflect alignment with existing identity: transgender men most desire cessation of menses (52.7%) and deepened voice (32.4%), while transgender women most desire breast development (35.4%) and gynoid fat deposition (29.2%). 5
The Evidence on GAHT Outcomes
The purpose and effect of GAHT is therapeutic, not exploratory:
GAHT is medically necessary for many transgender individuals, with strong evidence showing it improves quality of life and relieves psychological distress associated with gender dysphoria. 4, 6
The majority of studies demonstrate that GAHT reduces gender dysphoria, body dissatisfaction, and uneasiness, subsequently improving psychological well-being and quality of life. 7
Discontinuation rates of GAHT are under 10% in most studies, with continuation reflecting that individuals have correctly identified their gender identity before starting treatment. 8
Critical Pitfall to Avoid
The fundamental misunderstanding is thinking that hormone therapy is experimental or exploratory—it is not. Gender identity is established through psychological assessment and persistent self-identification, not through trial of hormones. 4, 1, 2
Mental health evaluation is important before initiating GAHT, as this helps confirm persistent gender dysphoria and readiness for treatment—but the evaluation assesses existing identity, it doesn't create or determine it. 2
The term "gender dysphoria" describes psychological discomfort experienced by some transgender people when their physical characteristics don't match their gender identity—GAHT treats this dysphoria by changing the physical characteristics, not by helping determine what the identity is. 4