Hormone therapy for transgender people

What does it mean to be transgender?

The term ‘transgender’ refers to individuals whose gender identity does not align with the sex they were assigned at birth. A transgender woman is someone assigned male at birth who identifies as a woman, while a transgender man is someone assigned female at birth who identifies as a man.

We distinguish between assigned sex—the sex a person is born with—and gender identity, which is the gender a person experiences themselves as. For most people, these align, but for some, there is a varying degree of mismatch.

The distress caused by gender discomfort can be significant enough for an individual to seek medical assistance to modify their gender expression. This does not mean changing one’s gender but rather undergoing treatment to align gender expression with one’s experienced gender. This is known as gender-affirming treatment—it is not a ‘sex change.’

Being transgender is not related to sexuality; it is purely about gender identity: ‘My gender does not match how I feel.’

How many people are affected?

Recent studies suggest that between 0.5% and 2% of the Danish population experience some degree of gender discomfort. For perspective, approximately 0.5% of the Danish population has type 1 diabetes.

At the clinic in Odense, we receive around 220 referrals each year.

Do we know why people experience gender discomfort?

The short answer is no—we don’t know. While greater societal awareness and improved access to treatment play a role, we cannot fully explain why the number of referrals to our clinics continues to increase.

What types of treatment are available?

Treatments are referred to as gender-affirming or gender-confirming care. In other words, they help align a person’s gender expression with their experienced gender.

There is medical treatment, which involves hormone therapy—either male or female sex hormones. Trans women receive female hormones, often alongside a blocker—a medication that suppresses male hormone production. Among other effects, this leads to testicular shrinkage and reduced sperm production.

Trans men receive testosterone (male hormone), with the dosage gradually increased to suppress female hormones. This results in changes such as a deeper voice and increased hair growth, including beard growth.

Medical treatment can be discontinued if the patient wishes, but some effects remain permanent even after stopping. That is why it is crucial to discuss in advance that, in principle, this is a lifelong treatment.

Surgical treatment, on the other hand, is irreversible. Gender-affirming surgery may involve the removal of breast tissue or genital organs. The National Board of Health requires that the effects of hormone therapy be assessed for at least a year before surgery is considered. Before approving surgical treatment, a mandatory reflection period is required, along with a multidisciplinary evaluation of the request in relation to gender discomfort.

How does one access hormone therapy?

To begin hormone therapy, you need a referral to one of Denmark’s three gender identity clinics, which you can obtain from your GP. The clinics are in Odense, where I work, as well as in Aalborg and Copenhagen.

At the Centre for Gender Identity, the first step for new patients is always a consultation with a psychologist. This helps assess whether the individual is experiencing gender discomfort and ensures they have a persistent desire for the treatment we offer.

Doctors and psychologists carry out a joint assessment. Gender discomfort must be significant enough to warrant lifelong medical treatment and, in some cases, surgery. As with any other patients, we have a great responsibility to provide the best possible care.

Children are referred to the clinic in Copenhagen.

Why is research into transgender healthcare important?

We know that hormone therapy can have physical side effects, and some individuals do not experience improvements in mental health. That is why it is essential to gather as much knowledge as possible about its effects on the body. Sex hormones can have long-term impacts on cardiovascular health.

We also know that transgender individuals often face mental health challenges. It is important to explore how we can offer better support—for instance, by identifying those who may have a greater need for psychological care.

The most important aspect of our research is ensuring that it remains patient-centred. We must continuously evaluate and refine our approach to provide the best possible care with the fewest side effects.

The National Board of Health sets the framework for gender-affirming treatment. They collaborate with professionals working in and researching this field to develop guidelines.

What does the future hold for your research field?

We are now starting to see the first results from a study examining the short- and long-term effects of hormone therapy in transgender individuals, with a particular focus on mental health and cardiovascular health.

The project includes both a registry-based study involving over 4,000 transgender individuals from across Denmark and a clinical study assessing physical and mental health changes in 400 transgender individuals receiving care at the Centre for Gender Identity in Odense.