Hormone therapy

Hormone therapy in young people, gender affirming hormone treatment to masculinise with testosterone or feminise with oestrogen, is, where possible, preceded by hormone blockers in the early stages of pubertal development. This intervention temporarily interrupts puberty and is considered reversible. It enables decisions about the future to be made without the stress of the unwanted physical developments associated with puberty. The existing NHS protocols make gender affirming hormone therapy (oestrogen for those identifying as feminine, and testosterone for those identifying as masculine (NHS, 2020) accessible to those who have been on hormone blockers for at least 12 months and have reached the age of 16.
Regular blood tests are important to monitor the effects of hormone therapy. You can read more about this on the NHS website (NHS, 2020).
A person can be trans or gender diverse and not wish to take hormones. However, for those who do, access to timely hormone therapy is vital so early referral to specialist services is advised.
In our interviews parents and carers talked about their children’s experiences with hormone therapy. In this section, you can read what they said about:
• Accessing hormone therapy;
• Choosing between private and NHS healthcare;
• Managing hormone therapy and what effects it has on the young person.

Accessing hormone therapy

Parents and carers we talked to spoke about their children’s experiences of trying to access hormone therapy. They shared a range of experiences and views about it, but many emphasised that accessing hormone therapy on the NHS is a lengthy and not always transparent process for the young person.

Lesley felt hormone therapy was prescribed for other issues within the NHS, but there was ‘a level of gate keeping’ for trans people.

Josie felt trying to access hormone therapy for her daughter was a Catch 22.

Whilst the existing NHS protocol makes hormone therapy available to people over the age of 16, some parents we spoke to thought that was not the case in practice. Ross felt that the Gender Identity Development Service was not able to prescribe hormones to under 18s. He felt that ‘they (GIDS) are doing all they can, but their hands are tied by legislation, I imagine.’ Ross wished his child could have accessed hormones earlier to avoid ‘two or three years of mental health decline’ and him having the ‘job of trying to put ’em back together and build ’em up and kind of get them through’. He acknowledged that starting hormone therapy was a big decision, but also felt his child was ‘rock solid’ in their wish to have testosterone for years, before they could access it.
Other parents, like for example Kate, whose son was on the waiting list to the Gender Identity Development Service, also felt that being able to access hormones sooner would be beneficial for their young person. Kate felt her son’s voice was causing him to be mis-gendered at school and she felt hormone therapy would help with that.
Not everyone we spoke to wanted their young person to be able to access hormone therapy or hormone blockers. Elijah didn’t agree with taking hormones. He felt that the use of some hormone blockers for trans and gender diverse people was ‘an off label use of a drug with scant evidence to back it up’. He hoped his daughter would not take hormone blockers but instead would become ‘comfortable in her own skin’: ‘once you start puberty blockers you are on a path, medicalised path for the rest of your life. And I can’t see this as being the best outcome.’
Other parents and carers we spoke to emphasised the risk of young people sourcing hormones from the Internet, if they are not able to access them on the NHS. Leigh, who is active in a local support group shared: ‘Therere lots of trans youth who Id worked with who have bought hormone blockers on the internet who are taking now cross sex hormones from the internet, no idea how theyre regulated ,these trans youth are doing it whatever way they can.’

Her daughter was desperate to start hormone therapy and Ali considered private providers as she worried she might get hormones from the internet.

Parents, whose children were older, stressed that accessing hormone therapy was easier for young adults. This was the case for Josie who felt that after her daughter moved to the adult Gender Identity Clinic the process was very different and much more straightforward. She emphasised that: ‘They [GIC] listened and believed what she was saying, instead of this constant niggling, of this challenging, She came out so happy. She had two appointments and then was cleared to start oestrogen. And ever since she started on, the oestrogen her health has improved so much.’
In some circumstances, hormone therapy can be accessed via a GP. A GP can provide bridging hormones (or refer the young person to an endocrinologist who can do the same). This option worked well for Jan’s daughter, who could stop using the private service and have her hormone therapy integrated into her local NHS primary care.
For some young people, whose parents we spoke to, accessing hormone therapy helped them to rethink whether they wanted to continue to take hormones and allowed them to explore their gender identity anew.

Accessing hormone therapy gave Adele’s son an instant improvement in mental health and an opportunity to ‘explore all of his options’, including considering whether he wanted to keep taking the medicine.

Choosing between the NHS and private healthcare

The NHS couldn’t help’ Andrew’s daughter, so the family decided to pay for the hormone therapy privately.

Negotiating the existing NHS protocols, the long waiting list and the young person’s often-strong wishes to start hormone therapy can be stressful for parents and carers. In our interviews, parents and carers often spoke about a sense of urgency to get their young person on hormone blockers or start hormone therapy. Some, like Lesley and Ross emphasised that it was important for their child to access hormone therapy to stop their child’s mental health from deteriorating. Ross said that the wait involved to access hormones ‘was a long time’ for them and reflected that they were ‘a bit on the knife edge whether they would actually make it that far.’
Some parents we spoke to considered paying for hormone therapy privately, or even going overseas to bypass the long waiting times within the NHS or the requirement for the young person to be 16. These were often difficult decisions that they had to make, weighing in all the options and trying to decide what was best for their child. Those who have gone private often also stressed that they would have preferred to be able to access hormone therapy on the NHS, even if they were satisfied with the care their child received from the private provider. However, private healthcare can be expensive, reconciling it with NHS protocols can pose difficulties, and not everyone we spoke to could afford, or felt comfortable going private.

Adele talks about the ‘thought process’ as a parent choosing to pay privately for hormones for her son.

Leigh wanted to take things slow and felt that having that extra time that the NHS pathway allowed was a positive thing.

Integrating private care with the NHS can be challenging and it sometimes requires a lot of organising and work from the parents. For example, having to manage the process made Adele feel like a ‘case worker’ for her son. Some parents spoke about the challenges and the gaps in the process of delivering the hormone therapy privately.

Andrew talks about managing his daughter’s hormone therapy with the private provider.

Adele talks about the process of monitoring her son’s bloods with the GP and how there are many details to be worked out managing hormone therapy between the private and NHS care.

Managing hormone therapy and what effects it has on the young person

Taking testosterone as gel works for Ross’s child. He supports his child’s choice because it’s their life.

Several parents spoke about hormone therapy having a significant positive impact on their child’s wellbeing Jan said about her daughter: ‘as soon as she was able to start taking oestrogen as well, you know, her physical health improved. She felt so much better. But more than that, she just feels comfortable, she feels comfortable in herself now. She was comfortable in her body.’ Similarly, Ross emphasised that for his child ‘the fact that theyre taking testosterone has eased a lot [of] the mental health stress.’
For parents and carers whose young person has been on the hormone blockers for a while and experienced negative side effects, starting hormone therapy was important. Adele said about her son: ‘the testosterone just in the physical side of things, yes, it was really needed. You know, he wouldn’t, he needed to have hormones in his body.’
Hormone therapy can have long-term impact on fertility. For parents whose children were younger, hormone therapy was something to research and discuss with their children in terms of its side effects and impact on future fertility. These discussions often took place long before hormone therapy were an actual option for their young person. For example, FAM06 emphasised that as a parent ‘you think about all these things, because obviously thats one of the things that you do worry about, if you were gonna go down the route of puberty blockers, cross sex hormones and things, youre gonna go down that route then the child needs to know that that is gonna affect their fertility.

Lisa had thought about impact of hormones on her son’s fertility and felt it was ‘quite difficult to get that information’ about the options for her son to leave the door open’ to be able to become pregnant in the future.

In some instances, seeing the physical changes caused by hormone therapy could make it easier for people to deal with the young person’s transition. E shared about her son: ‘we saw the physical changes. Obviously, with the growth in facial hair, deeper voice and things, it’s easier to then gradually, you know, we told all our friends and family who were very supportive and they all called him, [by his male name] and people gradually started using the male pronouns.’
However, seeing your child transition socially or the changes brought about by hormone therapy can still be challenging for parents and carers. Find out more about how parents made sense of their childs gender identity.

Views on hormone/puberty blockers

Hormone blockers, also called puberty blockers, pause the physical changes of puberty that can be distressing for many trans or gender diverse young people. Hormone...