A Beginner’s Guide to Gender-Affirming Hormone Therapy and Puberty Blockers
As a psychiatrist who works with transgender, non-binary, and gender-questioning individuals across New York and California, I’m often asked about the safety, effects, and emotional impact of starting hormone therapy. Whether someone is considering puberty blockers, estrogen, or testosterone, these decisions are deeply personal—and sometimes overwhelming.
That’s why I created this guide: to break down the basics of gender-affirming hormone treatment in a clear, accessible way. Whether you’re a teen, parent, or adult exploring your options, I hope this information helps you feel more informed and empowered.
What Is Gender-Affirming Hormone Therapy?
Gender-affirming hormone therapy (GAHT) uses medications to help people develop physical traits that match their gender identity. These treatments can be life-changing for many transgender and non-binary individuals, helping reduce gender dysphoria, improve mental health, and support overall well-being.
There are two main types of hormone therapy:
Feminizing hormones: Used by people seeking more traditionally feminine traits.
Masculinizing hormones: Used by people seeking more traditionally masculine traits.
Feminizing Hormone Therapy
Feminizing hormone therapy usually includes:
1. Estrogen (Estradiol)
Promotes breast growth, softens skin, and changes fat distribution.
Forms: Pill, patch, injection, or gel
Brand names: Estrace, Delestrogen, Climara
2. Anti-androgens (to block testosterone effects)
Spironolactone (Aldactone): Also used for blood pressure
Finasteride (Propecia): Often used for hair loss
Cyproterone acetate: Used outside the U.S.
Feminizing changes may include:
Softer skin
Breast development
Less facial and body hair
Smaller testicles
Lower libido
Masculinizing Hormone Therapy
Masculinizing therapy uses testosterone to promote more masculine physical changes.
Forms of Testosterone:
Injections: Depo-Testosterone, Delatestryl
Gel: AndroGel, Testim
Patch: Androderm
Masculinizing changes may include:
Deeper voice
Facial and body hair growth
Increased muscle mass
Periods stopping
Fat shifting to the stomach area
What Are Puberty Blockers?
Puberty blockers temporarily pause puberty and are often used in transgender or gender-questioning youth. They prevent unwanted changes like breast growth or a deeper voice, giving young people time to explore their identity.
Common Puberty Blockers:
Leuprolide acetate (Lupron Depot): Injection every 1–3 months
Histrelin implant (Supprelin LA): Implant lasts 12 months
These medications are reversible. Once stopped, puberty continues.
Are There Side Effects?
Yes. Like any medical treatment, hormone therapy and puberty blockers come with potential side effects.
Feminizing Hormone Therapy Side Effects:
Estrogen: Blood clots, high blood pressure, weight gain
Spironolactone: Low potassium, dizziness, increased urination
May increase risk of venous thromboembolism (VTE) and possibly breast cancer, especially with oral estrogen
Masculinizing Hormone Therapy Side Effects:
Acne, oily skin
Mood changes or irritability
Increased red blood cell count
Slight risk of high cholesterol or liver strain
Voice changes are permanent
Puberty Blockers Side Effects:
Hot flashes, fatigue, or mood swings
Possible bone density loss (especially with long-term use)
Rare: delay in fertility if followed directly by hormones with no natural puberty
Do These Treatments Affect Fertility?
Yes. Both estrogen and testosterone can reduce fertility. This may be reversible for some, but not all. If having biological children in the future is important, fertility preservation (such as freezing sperm or eggs) should be discussed before starting treatment.
Puberty blockers alone do not cause permanent infertility, but if a person begins hormone therapy before developing sperm or eggs, their fertility may be impacted long term.
FAQs
1. Is gender-affirming hormone therapy safe?
Yes, when supervised by a doctor. Regular blood tests and check-ins help reduce risks and keep treatment safe.
2. What are the risks of feminizing hormone therapy?
Blood clots, elevated blood pressure, breast tenderness, and electrolyte imbalances. Transdermal estrogen (patches) may carry fewer risks than pills.
3. What are the risks of masculinizing hormone therapy?
Acne, irritability, increased cholesterol, and higher red blood cell count. Mood monitoring is important.
4. Can puberty blockers affect mental health?
Some people experience mood changes, but others report reduced anxiety after starting blockers. Everyone reacts differently, so emotional changes should be monitored by a mental health provider.
5. Are these treatments permanent?
Some changes—like breast growth or voice deepening—are permanent. Others (like fat distribution or libido) may reverse if hormones are stopped.
6. Can non-binary people use hormone therapy?
Yes! Treatments can be customized based on your goals. You do not need to want "full" transition to use gender-affirming hormones.
7. Do puberty blockers affect fertility long term?
Not directly. But if you go straight from blockers into hormone therapy without natural puberty, you may lose the ability to produce sperm or eggs. This is why it’s important to talk with a doctor about fertility preservation.
Types of Gender-Affirming Hormone Treatments: Delivery Methods, Brand Names, and Effects
Hormone Therapy & Mental Health Medications: Drug Interactions
At North Star Psychiatry, we provide integrated care, which means we look at how hormone treatments interact with psychiatric medications like antidepressants, mood stabilizers, and ADHD meds.
Estrogen + Psych Meds:
May reduce the effect of Lamictal (lamotrigine)
Estrogen can affect liver metabolism of SSRIs; slight serotonin syndrome risk with multiple meds
Spironolactone:
Can lower potassium—be careful with SSRIs, ACE inhibitors, or lithium
Watch for dizziness or electrolyte imbalances
Testosterone:
May raise blood pressure—caution with stimulants like Adderall
Can increase mood swings or impulsivity in some patients
Puberty Blockers:
No major drug interactions, but emotional changes should still be monitored, especially in teens
Common Drug Interactions Between Gender-Affirming Hormones and Psychiatric Medications
Gender-Affirming Care in NYC and California
At North Star Psychiatry, we provide gender-affirming medication management and therapy for transgender, non-binary, and LGBTQIA+ individuals of all ages. Our care is trauma-informed, evidence-based, and deeply respectful of your lived experience.
📍 Offices in New York City and California (via telehealth)
📞 Ready to take the next step? Contact us today to schedule your consultation.
