Gender Affirming Hormone Therapy

The gender affirmation journey

The gender affirmation journey is a deeply personal process of aligning your gender expression with your inner identity. For many transgender and non-binary people, hormone therapy is an important step in this journey, but it is not mandatory.

The medical community uses the term gender dysphoria to describe the distress that can arise from a discordance between the sex assigned at birth and one's lived gender. This is a measurable reality: according to the 2021 Canadian census (Statistics Canada), about 1 in 300 people aged 15 and older identify as transgender or non-binary nationally; among 15-34 year-olds in Quebec, that proportion rises to about 1 in 200. It's important to note, however, that not all trans or non-binary people experience this discordance as distress: gender identity itself is not a disorder to be corrected — it is specifically the distress that can arise from it, not the identity, that the clinical term refers to.

Hormone therapy is only one possible path. Some people choose a social transition (name, pronouns, presentation) without medical intervention; others combine hormone therapy with surgery; others don't medically transition at all. None of these paths is more legitimate than another.

There is no "right" or "wrong" way to transition. What matters is having access to accurate information and non-judgmental support to make informed decisions, at your own pace.

Is hormone therapy the right option for me?

This decision is entirely yours. Hormone therapy can greatly improve well-being and reduce gender dysphoria, but it is not a prerequisite for trans or non-binary people.

For adults

In Quebec, access to hormones is based on an informed consent model. While support from a mental health professional can be a valuable asset, a psychological evaluation is no longer required to start treatment. What matters most is having a transparent discussion with a health professional about the expected effects and risks.

Before starting, it's worth thinking about: hormone therapy can permanently affect fertility. If having biological children matters to you, it's best to discuss this with a professional before starting, to explore fertility preservation options.

And for minors?

Access to gender-affirming care, including puberty blockers and hormone therapy, is also possible for teenagers in Quebec. The process is different, however, and requires:

Consent from parents or legal guardians.
A comprehensive evaluation by a medical team specialized in pediatrics (such as those at major university hospital centres like CHU Sainte-Justine).

Access ages vary by treatment: puberty blocker medications can begin as soon as the first signs of puberty appear (generally between ages 9 and 14), while hormone therapy targets a minimum age of 16 in Quebec, with possible adjustments depending on the case.

The goal is to ensure that the young person is well informed and supported throughout the process. Organizations such as Jeunesse Lambda and Jeunes identités créatives (Gender Creative Kids Canada) are valuable resources for youth and their famili

The pharmacotherapy explained

Feminizing hormone therapy

The goal is to induce secondary female physical characteristics using estrogen and anti-androgens.

Available forms: Oral tablets, transdermal patches, topical gels, and estrogen injections.
Expected effects and timeline:
- Onset (1-3 months): Decreased libido, softer skin.
- Development (3-6 months): Beginning of breast development, fat redistribution.
- Ongoing effects (1-2+ years): Testicular atrophy, decreased body hair. Maximum breast growth can take several years.
- Permanent changes: Breast development is permanent. Infertility is possible and often permanent.

Masculinizing hormone therapy

The goal is to induce secondary male physical characteristics using testosterone.

Available forms: Mainly injections and topical gels.
Expected effects and timeline:
- Onset (1-6 months): Cessation of menstruation, oilier skin, increased libido, voice starting to deepen.
- Development (6-12 months): Increased muscle mass, growth of body and facial hair.
- Permanent changes: A deeper voice, clitoral growth, facial hair, and possible hair loss.

Source: Standards of Care, Version 8, World Professional Association for Transgender Health (WPATH).

These timelines are general benchmarks; the pace and extent of effects vary from person to person. It's completely normal to adjust the pace of treatment with your care team to match what feels right for you: some prefer gradual changes, others want to move faster. What matters most is that you feel good with the changes as they happen, at your own pace.

Regular medical follow-up is essential to ensure the transition proceeds safely. Your doctor or care team will order blood work to check, among other things, hormone levels, liver enzymes, and lipid profile (cholesterol), to make sure the treatment isn't harming other organs. It's important to be well supported by a health professional throughout the process.

Beyond hormones: Other tools and sexual health

Gender-affirming accessories

Tools like binders (chest compression), packers (penile prostheses), or gaffs (to flatten the genital area) can be important allies in your daily life.

Prevention and contraception

This is a crucial point. Hormone therapy is not a method of contraception and does not protect against HIV and STIs. PrEP, condoms, and regular testing remain pillars of your sexual health.

Your pharmacist: a partner in your journey

It's recommended to choose a pharmacist who is accessible and trained to support you. Our role is to:

Teach you safe injection techniques.
Discuss the pros and cons of each formulation with you.
Ensure necessary biological follow-up (blood work) in collaboration with your medical team.
Manage your refills to ensure continuity of care.
Provide a confidential, safe space where you can ask questions without fear of being misgendered or judged.