It is important to get connected to a healthcare provider who can provide supportive and affirming medical care. If you are looking for an affirming pediatric physician to take care of your general medical needs, please review our primary care providers at multiple CHOP locations.
The medical staff at the Gender and Sexuality Development Clinic can help support you during your medical transition. You will not find a complete account of all options below, but instead an account of all options offered by CHOP’s Gender and Sexuality Development Clinic. Please note that transition options not listed here are not supported or advised by clinic and have the potential to be dangerous.
Medical options are typically discussed with patients depending on their age and stage of pubertal development. Patients who have already hit puberty have different options for treatment than those whose bodies have yet to mature.
The changes that occur during puberty are not something you can undo. If a transgender child goes through a testosterone-based puberty, they will not be able to “undo” the vocal cord thickening caused by the testosterone. Similarly, if a transgender child goes through an estrogen-based puberty, they will not be able to “undo” breast tissue development. While the changes of puberty can be managed in various ways that may seemingly reverse them, there is no quick “undo.”
Some individuals may experience anxiety or distress about going through puberty. Before an individual enters a certain stage of puberty, different medical options are available that allow someone to block, or “pause” this process from starting. We call these options “puberty blockers.”
Puberty blockers allow an individual to spend more time exploring and figuring out their gender while avoiding any distress puberty could cause. By giving someone more time, they can check in with themself about what type of pubertal changes they may be comfortable with. The changes that occur during puberty are not something you can undo, so it can be helpful to have this additional time to not worry or stress about what your body is going through while you spend time figuring out what you want.
The clinic offers two options for puberty blocking: an injection (Lupron) and an implant (Supprelin®). Your medical provider at the clinic can help discuss both options to decide which will be best for you.
If you are not sure if you have started puberty, you can request an appointment with your primary care physician for an assessment. This is often completed by a physical exam, but may also include bloodwork and a bone X-ray.
Some transgender people will take hormones to change their bodies to align with their vision of their gender. It is important to understand that hormones change everyone’s body in a different way; and there is no way for you to know before taking the hormones what changes you will experience. Just like in puberty, the changes caused by these hormones take place over the span of years, and some will happen before others. Some estimate that the full effect of hormone therapy for transgender people takes about five (5) years.
As previously stated, the changes of puberty cannot be reversed. If a patient is early in puberty, they may be prescribed hormone blockers to stop any more changes from happening, but the changes their body has already gone through will not be “undone” by hormone blockers.
Still, hormone blockers have their uses, even in post-pubescent patients. The hormone blockers that our clinic uses are anti-androgens. Patients who were born with testes make testosterone, a masculinizing hormone and androgen. Thus, many trans-feminine patients elect to take anti-androgens to stop the changes made by testosterone from increasing. Anti-androgens are often prescribed alongside feminizing hormones to aid estrogen and progesterone in having their full effect.
Estrogen is considered a feminizing hormone, because it plays a role in the development of bodily traits usually thought of as being feminine. Trans-feminine patients can be prescribed estrogen in a pill, patch, or injection. Each of these methods varies in terms of dosage and cost, but all are effective options for feminizing hormone therapy.
Because hormones interact with our genes to cause changes in our bodies, it is hard to know exactly how a person’s body will respond to hormone therapy. For example estrogen will cause breast tissue development; however, we can’t say at what point breast tissue development will stop, because that is determined by a person’s genes. Also, some people will be unable to take estrogen or other feminizing hormones due to genetic risk factors or current health status. It is very important that you share your family history of heart disease, cancer, and other genetic risk factors with your doctor to assess your risk level.
The following is a summary of potential changes that may occur during feminizing hormone therapy. Not everyone will experience all changes, and this is not a complete list of possible changes:
- Breast tissue development
- Body fat redistribution (to hips, thighs and buttocks)
- Mood and/or emotional changes
- Stunted growth of testes
- Skin changes (softer, less oily)
- Hair changes (softer, grows slower)
- Decrease in balding
- Sperm production slows or stops completely
- Decreased sex drive
- More difficult to achieve and maintain an erection
- Weight gain
- Changes in appetite
- Increased risk of:
- High blood pressure
- High cholesterol
- Heart attacks
- Blood clots
Testosterone is considered a masculinizing hormone, because it plays a role in the development of bodily traits usually thought of as being masculine. Trans-masculine patients can be prescribed testosterone in an injection, patch or gel. Each of these methods varies in terms of dosage and cost, but all are effective options for masculinizing hormone therapy.
Because hormones interact with our genes to cause changes in our bodies, it is hard to know exactly how a person’s body will respond to hormone therapy. For example testosterone will cause facial hair growth; however, we can’t say where the facial hair will grow or at what point facial hair growth will stop, because that is determined by a person’s genes. Also, some people will be unable to take testosterone due to genetic risk factors or current health status. It is very important that you share your family history of heart disease, cancer, and other genetic risk factors with your doctor to assess your risk level.
The following is a summary of potential changes that may occur during masculinizing hormone therapy. Not everyone will experience all changes, and this is not a complete list of possible changes:
- Facial hair growth
- Hair changes (thickening, additional body hair growth)
- Receding hairline/balding
- Vocal cord thickening (lower voice)
- Phallic growth (growth of clitoris)
- Higher sex drive
- Higher energy levels
- Increased muscle mass
- Fat redistribution
- Mood and/or emotional changes
- Cessation of menstrual cycle
- Skin changes (more oily, more acne)
- Increased risk of:
- High blood pressure
- Blood clots
- Inflamed liver
- Heart disease
- Higher cholesterol
- Higher red blood cell count
- Swelling of hands, feet, and legs
Menstruation, or periods, is a topic that is usually avoided in discussions. There is a lot of shame, fear and uncertainty surrounding menstruation, especially for those who are transgender. It is a process that is mistakenly over-associated with gender. Not all women menstruate (including cisgender women), and some men menstruate as well. It is important to keep this in mind, because little changes in the way that we talk can mean a whole world of difference to someone experiencing dysphoria due to their ability — or lack of ability — to menstruate.
Changing the way that we talk about things isn’t always easy, but this Sex Etc. article, “Transguys Get Their Periods Too,” talks about how we can shift the language surrounding menstruation to be properly gender-neutral.
If you do not experience dysphoria due to menstruation, have no worries: not every trans person does. Dysphoria has a way of being different for everyone. Out of two transgender men, one may experience intense anxiety and dysphoria around menstruation, while for the other, menstruation is just another part of life. Some nonbinary folks may experience dysphoria over it, while others do not. Even some transgender women will sometimes feel dysphoric over menstruation, especially their lack of ability to menstruate, while some transgender women never give it another thought. Every individual experiences dysphoria differently since everyone attaches their own meanings to different aspects of gender.
For those who are dysphoric about having their periods, the Gender & Sexuality Development Clinic offers different options to help suppress menstruation.
Hello Clue is a gender neutral menstrual tracking app that can be used to log and predict someone’s personal menstrual cycle.
At this time, we do not offer surgery at Children’s Hospital of Philadelphia (CHOP). However, if you have questions or are trying to find a referral for a surgeon, please contact us.