When we first meet our patients, many are already taking hormones or have considered hormone replacement therapy (HRT) as part of their transition. Whether patients can receive surgery while on hormones is a common question and an understandable concern. Luckily, most patients can safely receive surgery without delaying their hormone treatment, and the addition of surgery can even offer added benefits to one’s treatment process.
Understanding Hormone Therapy
HRT is often one of the first steps in gender-affirming treatments and it can help transgender individuals express their gender identity in a way that matches how they feel on the inside. Feminizing hormone therapy increases estrogen in the body, leading to the development of female sex characteristics and a decrease in male sex characteristics. Results will vary but may include some degree of breast growth, fat redistribution, loss of muscle mass, thinning facial and body hair, and more.
Masculinizing hormone therapy increases testosterone in the body to develop male sex characteristics and minimize female sex characteristics. Potential changes may include increased growth of facial hair and loss of hair on the top of the head. Fat redistribution and increased muscle mass are also potential changes, in varying degrees.
Does Hormone Therapy Impact Surgical Candidacy?
Although there is ongoing research on the correlation between HRT and surgical outcomes, Dr. Deschamps-Braly has not found that hormones pose a surgical risk for his patients. He helped pioneer the latest techniques used in facial feminization and masculinization procedures and has successfully treated many patients taking hormones at the time of their surgery. For this reason, and the differing role that hormones and surgery have in a patient’s transition, HRT typically does not affect his surgical decisions.
Understanding how HRT and surgery affect facial appearance (and aid in gender transition) is an important consideration. Hormones can redistribute facial fat, leading to minor alterations in a person’s appearance, but they do not change the bone structure of the face. About 80% of the surgical procedure focuses on the skeletal structure, allowing for more fundamental and dramatic changes to the facial features.
How Long Should I Be on Hormones Before Surgery?
Patients just starting HRT or those who have been using hormones for many years can all benefit from gender-affirming procedures. In fact, HRT in combination with surgery can be especially helpful for feminizing procedures. Most of the changes seen with feminizing hormone therapy only offer subtle changes to the face. Surgery is often needed to adequately feminize the face and give patients the best possible results.
Similarly, transmasculine individuals who desire dramatic changes in their appearance may want to consider surgery early on in their hormone treatment. While some patients are satisfied with the results of hormones alone, surgery is necessary to develop a more chiseled jawline, broader forehead, and larger chin.
Schedule a Consultation
If you are considering gender-affirming surgery, the best way to plan your treatment is to meet with an expert, like Dr. Deschamps-Braly. He can discuss your individual concerns in more detail to help you determine the best course of treatment with HRT and/or surgery. Schedule your consultation today by calling our office or filling out an online contact form.
Dr. Deschamps-Braly is a board-certified plastic and craniofacial surgeon specializing in facial plastic surgery, orthognathic (jaw) surgery, and craniofacial surgery for adults and children. He is also one of the world’s foremost leaders and innovators in facial gender confirmation surgery.