MTF Hormone Requirements

Posted: April 6, 2018

MTF Hormone Requirements

This article is for transgender women’s hormone requirements for surgery.

Top Surgery

Strictly speaking if we are looking at WPATH criteria there are no real hormonal requirements before undergoing breast augmentation, however it is strongly recommended, and is often required before most insurances will approve surgery. If you are wishing to feminize your chest, it is recommended that you are on hormones for at least one year. Here are two very good reasons for this:

  • A lot of transgender women will get good breast growth, and may not ever want or need breast augmentation, after the hormones have done their work. It takes at least a year for this to happen, sometimes two years, but it is better to give the hormones a chance to do their job.
  • The second reason to wait for at least a year before breast augmentation is that, often when you start on the estrogen and the breast tissue starts responding, it can be painful for transgender women and so it is advisable to wait before undergoing breast augmentation surgery. Therefore one year of hormones is recommended before top surgery. 

Bottom Surgery

The rule generally is that one year of hormones is required before any bottom surgery – vaginoplasty, including penile inversion and zero-depth as well as orchiectomy. There is one exception to this, and that is in the case of a transgender woman who is not doing well on a testosterone blocker.

The most common testosterone blocker used is a medication called Spironolactone. This medication is actually a diuretic which does a couple of things. It causes patients to urinate more often and also causes the blood pressure to drop. As a result of this patients can develop a condition called Orthostatic Hypertension and the symptoms of that condition are basically head rushes when getting up, and can cause fainting.

In some cases, after discussion with the patient’s medical doctor or hormone provider, we have gone ahead and provided an orchiectomy or removal of the testicles. This will take away the testosterone. Once the testicles are removed, there is no longer the need for a blocker. That is the one exception. In the case of patients going through insurance, the insurance companies will want to see at least one year on hormones before bottom surgery and will require a letter from your hormone prescriber citing medical reasons why you should not be on a blocker.

In summary then for top surgery hormone therapy is not always necessary, but very strongly recommended for at least one year, and sometimes two before all breast growth is completed.

For bottom surgery one year of hormone therapy is required.

Dr. Sidhbh Gallagher
University Gender Affirmation Surgery

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