HRT

Hormone replacement therapy (HRT) is a medical treatment that provides hormones to replace or supplement those the body no longer produces in sufficient amounts. It is commonly used for symptoms of menopause and for hormone deficiencies, and it is a central component of gender-affirming care for many transgender and nonbinary people.

Regimens vary by indication and may include estrogen alone or with a progestin for individuals with a uterus to reduce endometrial cancer risk. Routes include oral tablets, transdermal patches or gels, and vaginal preparations. For conditions characterized by low testosterone, testosterone therapy is used. In transgender care, regimens are tailored to align secondary sex characteristics with gender identity: trans women typically use estrogen with anti-androgens; trans men use testosterone.

Benefits can include relief of vasomotor symptoms, improved bone density, mood and sleep, and changes in body composition. In transgender care, hormonal therapy aims to align physical traits with gender goals. Risks depend on the regimen and the patient, and may include blood clots, cardiovascular events, breast or endometrial cancer risk patterns, liver effects, and changes in lipid profiles. Fertility considerations may also be relevant.

Monitoring involves baseline assessment and regular follow-up, with laboratory tests for hormone levels, blood counts, liver enzymes, and lipids; as well as monitoring blood pressure and screening for cancers as appropriate. Doses are adjusted to achieve target hormone levels. HRT is contraindicated in certain conditions, such as active liver disease, history of hormone-sensitive cancer, pregnancy, or certain thromboembolic or cardiovascular disorders.