SEcOnD PUbERTy anD yOU: A Guide to Navigating Medical Transition

Psst! Have you ever thought about transing your gender? Or maybe you know someone who wants to go on hormones but is unsure about how to start. Well, as someone who has been described as a “model transgender” by a New Zealand Family Court judge, I have some hot tips and tricks to help the whole process go smoothly.

First things first, if you want to get on hormones, the best place to start is your doctor! Having done all of this before, I know that talking to your doctor about this topic can be awkward and anxiety inducing, especially if your doctor is some old guy who’s been your family doctor since you were a toddler. If it’d be more comfortable, you can always go see another GP that’s maybe less involved with your family, or you can bring a support person to stick up for you.

You might not know this, but any GP can prescribe HRT. So, if you’re lucky, you might have a GP that’s comfortable with trans patients and you can handle everything through them. It’s far more likely that your GP will be unsure about how to handle HRT, though, so they’ll probably refer you on to an endocrinologist or a sexual health physician. An endocrinologist is a specialist doctor that deals with hormones and a sexual health physician is a doctor who has undergone training covering stuff related to sexual health (which includes trans healthcare).

At this point you’ll be put on a waiting list. Luckily, there’s a trick that might shorten your wait. When you make your appointment, ask to be put on the cancellation list. This means if someone else cancels their appointment, that slot might be offered to you at short notice. Receptionists and admin people are very busy, though, so it doesn’t hurt to ring up every now and then to check if there are any earlier appointments available. With any luck, the wait won’t be too long, and you’ll be face-to-face with a doctor comfortable managing hormone therapy.

There’s another important point I should make here. In 2023, the consensus from the medical community is that a gender dysphoria diagnosis from a psychologist or psychiatrist is not required to access hormone therapy. If any doctor at any point in the process requires you to get diagnosed before they will treat you, then you are well within your rights to walk out and see another doctor that is more familiar with the modern standards of care. As a patient, your doctor has a duty of care to you. This means that you have a right to be treated with respect, no matter who you are. If you feel you haven’t been treated with respect, then you are well within your rights to complain. I know it’s not easy to advocate for yourself, especially if you belong to a vulnerable minority. If the worst happens and you find yourself in this situation, then there’s nothing wrong with leaning on support for help, or even just letting it be because you have better things to be doing with your life.

Once you’re face to face with a doctor willing to prescribe hormone therapy, the first thing they’ll get you to do is take a blood test. This is to get a baseline read of your sex hormones, and other biometrics that are an indicator of general health. Your doctor needs this to get an idea of what your starting dose should be. After this we come to the final step (provided your blood tests report no problems) – informed consent. As a society we’ve agreed that as an adult, you should be able to make decisions about your own body without getting permission from someone else first. Informed consent encapsulates this idea. You sign a document that says you understand what hormone therapy will do, how much of it is reversible, and the risks involved.

Hopefully that day you’ll walk out with a prescription. If you want masculinizing hormone therapy, you only need one medication – testosterone (also known as T). This comes in either gel form or as an injectable, although doctors will usually start you on gel. If you want feminizing hormone therapy, you’ll be prescribed at least two medications – a testosterone blocker (also known as a blocker) and estrogen (also known as E). Testosterone blockers only really come in pill form, whereas estrogen comes as a pill, gel, or patch. There are a few testosterone blockers that are used, and each has its own side effects which your doctor will explain to you. Depending on how old you are, or some other factors, your doctor may put you on a puberty blocker before or during hormone therapy. Puberty blockers are the same no matter which equipment you started with, and only come as injectables. Contrary to what some people on the internet say, puberty blockers are well known to be safe, reversible, and effective. Anyone who claims that puberty blockers will turn a child’s bones into paper mâché is a dipshit.

I’ve had some trans people ask me if their doctor is short-changing them with their dosages, and it’s easy to find out. Your doctor is legally obliged to share your health records with you, and this includes blood tests. To make it easier, you can set up MyHealthRecord and have your blood tests sent automatically to an app on your phone. Blood tests are easy to read and include the reference ranges right on the form. Since different people respond to these medications differently, there’s no “right” dosage, only the right dosage for you. If you feel like you don’t have enough hormones, but your levels are okay, then your dosage is probably fine. However, if you’re feeling side effects, then bring those up to your doctor. There may be some medical problems unrelated to your levels directly but are being influenced by hormone therapy.

Finally, you might be wondering what hormones will do for you, and when those changes will take place. Will you grow a Viking beard two days after starting T? Truth is, no one can tell you that ahead of time. I’m not going to talk about what hormones actually do, since doctors seem to really want us to know the potential effects of hormones before starting and you’ll inevitably get that talk during the process. When that happens, though, I really want you to listen to your doctor and imagine yourself having had those changes. Is that a person you want to be? Is that a body you’d be happy living in? If yes, then you’re probably going to get something out of hormone therapy. In which case, I’m genuinely very happy for you, and wish you a joyful transition.