Trans 101 question answered: Why aren’t trans people just given more of the male or female hormones needed to match their outward physical self?

158 ryan said jasmine merinoLEXIE CANNES STATE OF TRANS — By guest writer Michelle Rose.

Trans folk in transition are given hormones; as much as is medically safe and consistent with the patient’s physiological profile. The average dose of estrogen (orally) [for trans women] is about 4 mg a day. I have no accurate data concerning the amount of testosterone for trans men, but I am aware that in their case, it’s mostly injectables. (Trans men, please contribute to this discussion) Trans women use oral, injectable, and dermal patches in hormone therapy. Those hormones also include progesterone and hormone suppressants such as spironolactone and finasteride.

In trans women, the results of hormone therapy include skin changes (softening and sensitivity), breast development and erectile dysfunction. There are some movements of soft tissue (fat and connective tissue) that produce rounding and softening of the body’s curves. Some muscle changes will occur, including a loss of muscle mass and density. There are no changes in the skeletal structure or in the cartilage. That requires surgical intervention to change the shape of the face, a procedure known as FFS or Female Facialization Surgery. Some trans women will experience significant increase in breast tissue, others not so much. A good rule of thumb is that a trans woman will develop approximately one cup size smaller than her closest female relation, i.e., her mother.

As I noted, the necessary changes to a trans woman’s appearance require surgery should the patient wish to appear as feminine as possible. In trans men, the two most significant surgeries would be the reduction of breast tissue and removal of the uterus and ovaries.

Some trans women opt for breast enlargement and the “bottom” surgery in order to bring their bodies in line with their inner gender map. The desired results vary tremendously, depending on the type and intensity of the hormones prescribed. I might point out the the urgency to have the bottom surgery is not so pronounced among trans women as it once was, possibly because the gatekeepers who insist on a rigid binary (one must be either completely female or completely male) no longer have the power to make these intensely personal decisions for others. I cannot say, however, that the shift has been entirely toward personal choice. There are still many medical gatekeepers who insist on that rigid binary, most likely as an expression of their own sociopolitical beliefs. (Hint: a doctor who votes Republican will undoubtedly try to prevent any such action from a trans patient and will often refuse to treat such patients)

Trans folk often opt for surgery because hormones are sometimes not sufficient to produce the changes desired by the patient. Hormones can make small alterations in the body, but those changes are often subtle and not particularly obvious. In trans women, HRT almost always contributes to a lessening of anxiety and despair. In trans men, hormone therapy contributes to feelings of confidence, self-assertion, and empowerment. But both trans men and trans women often require surgery to complete the effects that hormones can only begin.

I am, as always, reiterating only a layperson’s understanding of this exceptionally complex issue. For a more comprehensive and informative understanding of this topic, I recommend the following theorists and related research:

Lynn Conway:

Judith Butler:

Sandy Stone:

More on HRT:


Please examine this chart and note the minor variations in the estrogen molecule which provide the cascade of physiological effects found in females:

On the other hand, testosterone does indeed produce significant changes in muscle mass, density, thickening of bone and cartilage, and a generalized increase in strength and endurance. Please examine this chart:


(Michelle Rose is the co-author of the Lambda-nominated book “The Color of Sunlight” and is an associate English instructor at a major American university. This article was previously published elsewhere.)

158 ryan said jasmine merino

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Categories: Transgender, Transsexual, Trans

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6 replies

  1. Who I am is not my muscle mass, facial hair, or receding hairline. No amount of T would have changed my sense of self.. It just would have made transitioning a lot harder. probably resulting in my opting out of life.

  2. Medical practice in the United States puts a higher value on make believe fairy tales from religious texts over peer reviewed science and FDA approved treatments. I have lost count of the stunningly stupid comments from doctors over the years. As I get older I have ZERO tolerance for such nonsense and simply print out medical/clinical research that shows how and why these treatments work.
    As a side note you may want to check out the number of hospitals, insurance companies, and other medical facilities that have been shanghaied by religious organizations.

  3. No amount of Testosterone would have had the effect that Estrogen has had on me. It was the first time in my life that the internal arguments that was driving me to suicide stopped and I had a peaceful time to gather my thoughts and contemplate where to proceed next.

  4. Thanks for the comments everyone!

  5. Michelle Rose responds on Facebook:

    “Yes, the question is actually the opposite of the answer that I provided, but I did that deliberately for two important reasons:

    1) I recognized that this was a leading–and loaded–question from a troll, an agitator intent on disrupting debate and polite discussion on the Quora forum. The troll proposed that trans folk should be given hormones to ensure that they do not deviate from the social roles assigned to them at birth solely on the basis of the appearance of their external genitalia. You will note that that I made at least two references to “inner gender map,” partly as a rebuttal of his implied, rather fascist proposal, partly for the second reason I answered in this way.

    2) The other latent implication of the troll’s question was that hormones–as applied to trans folk–are being prescribed incorrectly, i.e., they should be given to trans people to ENSURE that they do not deviate from heteronormative roles in society. Rather than respond to the troll’s rather obvious attempt to cast doubt on the medical professions and the intent and identity of all trans folk, I chose to respond in a way that refuted the troll’s implied and latent signification, reiterated that the medical profession is in fact treating trans people in ways that are both medically sound and socially necessary, and thus provide a confirmation of the authenticity of trans folk.

    Bluntly, it was a trick question, so I gave the troll a trick answer. I’ve been warned by Quora moderators to “play nice” and not respond to such agitprop (see another of my posts on Quora for an explanation of that term) with scathing denunciations of a troll’s malicious intent, no matter which topic. So I answered with facts and truth, which I am quite sure annoyed and disappointed the troll, but that also was one of my intentions. I don’t like trolls. I don’t like the “clever” way they insinuate and imply unpleasant things about their intended targets, in this case, trans folk. I don’t like to play logic games with those who have no real interest in the dissemination of knowledge, but instead would much prefer ignorance, chaos, and a lot of really angry people. (In such a social state, it’s easier to commit criminal acts) I do all that I can to set the record straight, to respond with facts and truth, and to stand fast in the face of malicious intent. It’s EVERYONE’S responsibility, but most are either too tired or too angry to consider alternatives to open confrontation.

    I’m a writer. I wrote the truth in response to a damnable lie. I will continue to do so unto my dying breath. When my time comes, you will find me slumped over my keyboard, writing yet another condemnation of ignorance, stupidity, and evil.”

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