Gender-Affirming Therapy

Gender-affirming therapy is an essential part of transgender healthcare, aiming to support individuals whose gender identity does not align with the sex assigned at birth. Its aim is to improve quality of life by easing gender dysphoria, enhancing mental well-being, and helping individuals live in a body that better reflects their identity. Gender Dysphoria refers to the significant distress, discomfort, or impairment a person may feel when there is a marked incongruence between their experienced/expressed gender and the gender they were assigned at birth.

This care can involve several approaches, including mental health support, hormone therapy, and in some cases, surgical procedures. Endocrinologists play a central role in gender-affirming care by overseeing hormone therapy. Through the safe use of oestrogen, testosterone, and other related treatments, they guide physical changes that align with a person’s affirmed gender, while ensuring close monitoring for long-term health.

On this page, we will explain what gender-affirming therapy involves, the role of our endocrinologist, and the types of hormone treatments available at our Clinic. We will also outline what to expect during your first consultation, so that you have a clear understanding of the process and the support available to you.

What is Gender-Affirming Therapy?

Gender-affirming therapy refers to a range of medical, psychological, and social interventions that help individuals live in accordance with their gender identity. The goal is to reduce gender dysphoria, promote emotional well-being, and support overall health and quality of life.

The approach is multidisciplinary. It often includes:

• Hormone therapy – supervised by an endocrinologist, using oestrogen or testosterone to bring about physical changes consistent with an individual’s affirmed gender.

• Mental health support – involving psychologists or psychiatrists who provide counselling, assess readiness for treatment, and ensure that any co-existing mental health conditions are appropriately managed.

• Surgical options – such as chest or genital surgery, when appropriate and desired, are considered later in the transition process.

Among these, hormone therapy is the area managed by Dr. Dinesh. Treatment with oestrogen or testosterone can influence secondary sex characteristics, such as body fat distribution, hair growth, voice, and skin texture, helping the body reflect the individual’s gender identity. Importantly, hormone therapy is always tailored to the patient, with ongoing monitoring to balance desired changes against potential health risks.

What to expect at The Metabolic Clinic

Our aim at the clinic is not only to prescribe the right therapy but also to ensure that treatment is safe, individualised, and closely monitored. The journey usually involves three key stages.

• Pre-visit — Memorandum from a psychologist/ psychiatrist stating the diagnosis of gender dysphoria and the exclusion of other mental health conditions that can masquerade as gender dysphoria is necessary. The patient needs to be 21 or older or have in-person parental consent. 

• Initial assessment — The visit starts with a detailed medical history  and a discussion around your transition goals and expectations. This is followed by a physical examination and a series of laboratory tests, which may include checking hormone levels, liver function, cholesterol, and bone health markers. These assessments provide a baseline and identify any health risks that could influence the choice or safety of treatment.

• Designing a tailored hormone regimen — based on your health profile and personal objectives,  options for gender affirming treatment will be discussed. This may involve oestrogen with an anti-androgen for feminising therapy, or testosterone in various forms for masculinising therapy. The regimen is adjusted to ensure gradual, safe changes that align with your desired outcomes.

• Ongoing monitoring — hormone therapy requires regular follow-up appointments. We will monitor physical changes, and with laboratory testing, adjust dosages when needed. They will also look out for potential side effects such as changes in cholesterol, liver function, blood pressure, and weight. This structured monitoring ensures that benefits are maximised while any metabolic risks remain carefully managed.

Through this process, Dr. Dinesh will provide consistent medical supervision, helping you transition safely while protecting your long-term health.

What Are the Types of Gender-Affirming Hormone Therapies Available?

Gender-affirming hormone therapy is provided under medical supervision and as touched up above, follows an assessment by a psychologist or psychiatrist with experience in gender dysphoria. This evaluation helps confirm the diagnosis and rule out other psychiatric conditions that may resemble gender dysphoria, ensuring that treatment is appropriate and safe. Any co-existing mental health conditions that could worsen with therapy also needs to be managed prior to starting therapy. Once cleared, patients may begin hormone therapy with an endocrinologist.

Feminising Hormone Therapy

Feminising therapy helps align physical characteristics with a female gender identity by suppressing testosterone and stimulating oestrogen receptors for feminisation.

• Oestrogen — oestrogen promotes physical changes such as softer skin, redistribution of body fat, breast development, and reduction in body hair over time. It is usually given as bio-identical hormone tablets in the form of oestrogen valerate. 

• Anti-androgens — these medications reduce the effects of testosterone, which allows oestrogen to work more effectively. Spironolactone is used at the metabolic clinic. 

• Monitoring — feminising therapy requires careful monitoring, particularly for risks such as blood clots, changes in liver function, and bone health. Regular blood tests and follow-up visits are essential to maintain safety while achieving desired changes.

Masculinising Hormone Therapy

Masculinising therapy supports physical changes that align with a male gender identity by increasing testosterone levels in the body and suppressing oestrogen.

• Testosterone — testosterone therapy irreversibly deepens the voice, increases body and facial hair, enhances muscle mass, and alters fat distribution. It is usually prescribed as injections, but can also be transdermal.

• Monitoring — regular supervision is necessary to track cholesterol, blood pressure, liver function, and blood counts, as testosterone can influence cardiovascular and metabolic health. The endocrinologist adjusts doses to maintain safe and effective hormone levels while supporting the physical changes sought by the patient.

Summary

Gender-affirming therapy supports individuals in aligning their physical appearance with their gender identity, with the ultimate aim of improving wellbeing. Treatment is safe, personalised, and closely monitored at The Metabolic Clinic, with regular follow-ups to safeguard long-term health.

If you are considering gender-affirming therapy, seeking care from an experienced endocrinologist is an important first step. With professional guidance, you can transition with confidence, knowing your health and goals are at the centre of your treatment plan.

If you are ready to begin your journey, schedule a consultation with The Metabolic Clinic for endocrinologist-supervised gender-affirming therapy.

Frequently Asked Questions (FAQs)