You’re Right to Ask Questions About Gender-Affirming Hormones for Trans Youth and Adults

Recently, a high school classmate of mine posted a meme on Facebook that he must have thought was clever. It read: “Liberalism is when you think injecting cattle with hormones is evil... but injecting kids with hormones to change their gender is just fine.” He meant it as a joke, but I felt more sadness than outrage. Not because I expect everyone to understand the complexities of gender-affirming care, but because this kind of mockery reduces a deeply personal, often life-saving medical decision to a punchline.

That meme prompted me to revisit an essay on Medium.com, titled "HRT Rewires the Brain: The Neuroscience of Transition." It was written by Kira Ry, a trans woman, psychologist, and parent of two children. I’ve revised and expanded it here, blending in my own reflections and lived experience, not to argue with my classmate, but to offer a compassionate, informed, and honest picture of what hormone therapy actually means for trans people, children, youth, and adults alike. It’s not about ideology. It’s about identity, authenticity, and sometimes, survival.

Here’s what I want him, and others, to know—Some of the answers may surprise you

When people begin hormone replacement therapy (HRT), most of the focus tends to be on the physical changes. For example, in trans women, this might include breast development, fat redistribution, skin softening, changes in facial and body hair, or shifts in muscle tone. These visible markers of transition can be deeply affirming.

But for many of us, the most profound effects of HRT are not the ones we see in the mirror.

They’re the ones we feel, deep in our minds, our moods, our emotional range, in the growing sense that we are finally at home in ourselves.

A Moment That Caught Me by Surprise

I was about four weeks into my medical transition, using both estrogen patches and Spironolactone. I was sitting at my computer, working on a graphic design project, with an iTunes playlist playing softly in the background. A Beatles love song came on, I don’t even remember which one.

But something unexpected happened. A wave of emotion came over me. I wasn’t thinking about anything in particular. I hadn’t had a bad day. But suddenly, I was quietly sobbing. Not a dramatic, cinematic moment, just a quiet unraveling. I had to stop what I was doing, blow my nose, and sit with it.

I had never reacted like that to a song playing in the background. But in that moment, I knew, as cliché as it might sound, the hormones were doing something real. They weren’t just changing my body. They were giving me access to myself in a new and deeper way.

The Brain Needs Hormones Too

Hormones are often thought of as agents of physical development. But they also play a central role in how the brain functions, from emotional regulation to cognition, motivation, and self-perception.

Regions like the hypothalamus, amygdala, hippocampus, and prefrontal cortex all contain receptors for sex hormones. These areas are involved in stress response, memory, empathy, and executive function. When hormone levels shift, the brain responds, often in subtle but profound ways.

Estrogen has been shown to modulate serotonin and oxytocin, neurotransmitters tied to mood, emotional resilience, and social bonding. Testosterone affects dopamine, which plays a role in motivation, focus, and drive.

But this isn’t about turning someone into a stereotype. Hormones don’t erase who you are. They create conditions in the brain where you can begin to show up more fully and congruently, and often with greater ease.

The Role of HRT in Youth: Preventing Unwanted Changes and Saving Futures

When hormone therapy begins early, around or before puberty, it helps prevent the development of secondary sex characteristics that later often require surgeries or expensive procedures to alter. For trans girls, this may mean avoiding facial hair, deepening of the voice, or masculinized facial features. For trans boys, earlier testosterone use may prevent breast growth or other traits misaligned with their identities. The result? Affirmation in real time, and potentially avoiding future surgeries like chest reconstruction, voice procedures, or facial surgeries.

This is more than cosmetic. It can be cost-saving, emotionally protective, and medically prudent.

A 2024 UBC guide based on a national survey of trans, Two-Spirit, and nonbinary (TTNB) youth notes that “hormone therapy can improve emotional well‑being, relieve gender‑related distress, and help people feel more at ease in their bodies.”¹

In a 2023 study published in The New England Journal of Medicine, trans and nonbinary youth who accessed gender-affirming hormones reported broad improvements in depression, anxiety, body satisfaction, and life satisfaction after one year.²

A JAMA Network Open cohort study (2022) also found that access to puberty blockers or hormones was associated with significantly lower odds of depression and suicidal ideation compared to youth who could not access such care.³

When trans youth are supported and affirmed early, they don’t just survive, they thrive.

What Hormones Will Not Do

Despite what pop culture or TikTok may imply, HRT is not a magic wand.

• It won’t reverse bone structure or raise the pitch of the voice (for trans women), or deepen it (for trans men).
• It won’t erase male-pattern baldness. For those predisposed to androgenic hair loss, especially if it’s already progressed, estrogen won’t bring your hair back. Many trans women continue to use wigs, hair systems, or consider transplant surgery if that’s important to them.
• It won’t permanently remove facial hair. Estrogen may slow hair growth over time, but it won’t eliminate it. Many trans women undergo electrolysis or laser hair removal, both of which can be expensive, time-consuming, and physically uncomfortable. It took me over 200 hours of electrolysis spread across two years to become facial hair–free, something I could only do because I had the means. For younger trans girls, starting HRT before facial hair begins to take root can help reduce the extent of this burden later on.
• It won’t remove all dysphoria. HRT can be incredibly helpful, but it is not a replacement for social, emotional, or therapeutic support.
• It won’t create uniform results. Outcomes vary based on age, genetics, health, duration of use, and even stress levels.

For Trans Men, the Effects Are Powerful, and Personal

While much public conversation around HRT has centered on trans women, the effects for trans men are equally significant.

• Testosterone therapy generally results in:
• A deepening of the voice (often irreversible)
• Facial and body hair growth
• Cessation of menstruation
• Increased muscle mass and changes in fat distribution
• A boost in libido and sometimes in assertiveness or focus

Many trans men describe feeling more embodied, grounded, and confident after starting T. Others note a shift in emotional range, not less emotional, but differently emotional, as responses feel more internalized or muted.

But again, these shifts are not universal. Some trans men cry more, some feel calmer, others experience a period of emotional recalibration. There is no one template.

For Trans Women, the Effects Can Be Profound

Estrogen, often combined with antiandrogens, brings about a range of physical, emotional, and psychological changes in trans women. These include:

• Softer skin and fat redistribution (often toward the hips, thighs, and chest)
• Decrease in spontaneous erections and sexual drive (though this can evolve over time)
• Reduction in muscle mass and upper body strength
• Breast development (to varying degrees)
• Possible reduction in testicular volume and fertility

Emotionally, many trans women report increased emotional sensitivity, greater access to feelings, and more fluid emotional expression. Crying, for instance, something they may have struggled to access for years, often returns. Some describe this shift as a softening of internal tension, or as finally being able to feel “without armour.”

That said, HRT does not erase dysphoria for everyone. Some features, such as voice pitch, facial bone structure, and hair loss, often require additional interventions to address. But for many trans women, HRT is the first time their body begins to feel like a sanctuary rather than a source of distress.

A Word About Nonbinary People

Not everyone who takes hormones identifies strictly as male or female. Many nonbinary people also pursue HRT, sometimes at lower doses or with different goals. For example, a nonbinary person assigned male at birth may take a small amount of estrogen to soften features or support emotional regulation without seeking full feminization. Others may use testosterone to deepen the voice or increase energy without fully transitioning socially.

In all cases, the goal is not to conform to someone else’s idea of “male” or “female,” but to create internal harmony, a lived experience that matches one's identity, needs, and sense of self.

What the Science Tells Us

Studies using MRI scans have shown that HRT produces measurable changes in brain structure and function:

• Trans women may experience a decrease in white matter volume and thinning of some cortical regions, alongside increased emotional processing and sensitivity.
• Trans men often see increases in gray and white matter, with cortical thickening in areas related to movement, planning, and spatial reasoning.

More importantly, studies show improvements in mental health. A 2025 longitudinal study of U.S. trans adults starting HRT via telehealth found that:

• 60% no longer experienced suicidal ideation after just 3 months
• 42% reported significant reductions in depression and anxiety⁴

These shifts reflect what many of us know intuitively: HRT isn’t cosmetic. It’s a recalibration of the body and brain, and often a lifeline.

Common Misconceptions About HRT

Many myths are circulating these days. Let’s clarify a few:

• Myth: HRT turns you into the opposite sex.
  Truth: HRT aligns your physical and psychological experience with your affirmed gender. It doesn’t erase your history; it helps integrate your truth.
• Myth: Hormones cause personality changes.
  Truth: Hormones may impact mood and emotional tone, but they don’t change your character. They often help uncover the self that was always there.
• Myth: Everyone responds the same way.
  Truth: Hormone effects are highly individualized. Some see rapid changes, others more gradual. No two journeys are alike.

Becoming Yourself

For so many trans people, HRT is the first step toward coherence, a sense that body, mind, and spirit are no longer at odds.

Some of the changes are dramatic, others are subtle. Some unfold quickly; others take years. But what unites our stories is the emergence of authenticity, a sense of finally being able to live without pretending, suppressing, or enduring disconnection.

As I think back to that unexpected sobbing at my desk, triggered by a love song I’d heard a hundred times before, I now see it as the first time my nervous system felt safe enough to respond. The floodgates didn’t open because I was weak. They opened because I was finally allowed to feel.

Final Thoughts

Hormones don’t create a new self. They help return you to the one you’ve always been, waiting patiently beneath the surface.

HRT won’t give you everything. But if what you’re seeking is peace, clarity, and the freedom to inhabit your body and mind without constant friction, it may give you everything that matters.

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Footnotes

1. UBC Nursing HEET Project. Gender-Affirming Healthcare Guide for Trans, Two-Spirit, and Nonbinary Youth (2024).
   https://nursing-heet-2024.sites.olt.ubc.ca/files/2024/10/Part_3_Gender_Affirming_Healthcare_2024_JBY.pdf
2. Tordoff, D. M., et al. Psychosocial Functioning in Transgender Youth After 1 Year of Hormones. New England Journal of Medicine, 2023.
   https://www.nejm.org/doi/full/10.1056/NEJMoa2206297
3. Turban, J. L., et al. Access to Gender-Affirming Hormones During Adolescence and Mental Health Outcomes Among Transgender Adults. JAMA Network Open, 2022.
   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423
4. Levine, D. A., et al. Mental Health Changes in US Transgender Adults Beginning Hormone Therapy via Telehealth: Longitudinal Cohort Study. JMIR Mental Health, 2025.