For many transgender people, hormone therapy is part of the affirmation of their gender identity. An increasing number of IPPF Member Associations are responding to the sexual and reproductive health needs of transgender people, and some have initiated steps to provide hormone therapy. Providing this service may assist transgender people to realize their sexual and gender rights.
As part of the commitment of IPPF and its Member Associations to improve the sexual and reproductive health and rights for all people, including people of diverse sexual orientations and gender identities, the International Medical Advisory Panel (IMAP) has released a statement on hormone therapy for transgender people. The statement provides essential information about masculinizing and feminizing hormone therapy for transgender people and offers succinct clinical guidance based on the latest evidence.
For most people, their sense of gender identity is congruent with their biological sex. That is, a person who is born as a male (defined as their ‘biological sex’) usually self‑identifies as a boy/man (defined as their ‘gender’), and a person who is born as a female (their sex) usually self‑identifies as a girl/woman (their gender). However, for some people, their sense of gender identity may not match or be congruent with their biological sex or the gender assigned to them at birth. Transgender people are individuals of any age whose gender identity and expression does not conform to norms and expectations traditionally associated with their sex assigned at birth. ‘Transgender’ or ‘trans’ has become an umbrella term that is used to describe a wide range of identities and experiences.
Transgender people have diverse needs for gender transition‑related services. However, it is important to note that not all transgender people want to physically modify their body through hormone therapy or other gender transition services. For those who do, they may seek a combination of medical and surgical services, which may include hormone therapy; sex reassignment surgery; non‑genital surgical procedures of the face, breast or body; speech and voice therapy; and removal of facial hair. The goal of gender transition services, in general, is to help align the external appearance of the body with the experienced gender. Appropriately administered hormone therapy supports this by producing masculinizing effects in a female-to-male trans person, and feminizing effects in a male-to-female trans person.
Primary care providers are appropriate professionals to provide hormone therapy for transgender people, who may otherwise go to unqualified medical providers or self‑administer hormones that may harm them. Taking hormones in an unsupervised way is quite common, and is often due to the lack of trans‑competent qualified health professionals or unwillingness among otherwise competent health professionals to prescribe hormones to transgender people.
For adolescents who experience gender dysphoria, they may benefit from medical intervention in the form of puberty suppression. This can be seen as 'buying time' until they have the capacity to make their own decisions (which may be regulated by country‑specific laws) on whether or not to start hormone therapy or other gender transition services. More importantly, puberty suppression prevents the development of secondary sexual characteristics of the gender assigned to them at birth.
The IMAP statement recommends that IPPF Member Associations should be prepared to assist and provide a range of services, including hormone therapy, to transgender people. As a starting point, they can provide accurate information to transgender people about hormone therapy and other gender transition‑related services. If Member Associations are already providing sexual health services to transgender people, they can assess the demand for hormone therapy from transgender people in their service coverage areas as well as assess the current capacity of their health care providers to provide hormone therapy.
Irrespective of the decision to provide hormone therapy, Member Associations need to build the capacity of all staff to deal sensitively and competently with transgender clients, and ensure a welcoming, non‑judgemental and non‑discriminatory environment in their clinics. Importantly, Member Associations should partner with local transgender groups and can show solidarity by supporting local advocacy efforts, which may include increasing access to sexual health services and gender transition services within public health services for transgender people.
Download the full statement: IMAP Statement on hormone therapy for transgender people