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Transgender Care

Providing a full spectrum of services to the full spectrum of our patients

Baystate Health's transgender service provides multidisciplinary primary medical care and supportive services to patients seeking hormonal and/or surgical reassignment of gender. We offer a holistic approach to individual health, working closely with local and regional therapists and specialists as needed.

We strive to provide care that is sensitive to each individual's needs, regardless of where they see themselves on the transgender spectrum. Baystate Health provides supportive and sensitive care regardless of gender identity, gender expression, sexual orientation, race/ethnicity, religion, or socio-economic status.

Baystate Health has developed services based on the Informed Consent model of care, meaning that we work with our patients to ensure that the risks and benefits of gender-related services are fully understood at all times. Gender-related therapy is an encouraged – but not required – part of treatment for most patients.  

Our Services

Medical care

  • Primary care for adult transgender patients, including referrals and preparation for gender confirming surgeries
  • Hormone therapy – initiation and maintenance – in coordination with other supporting medical professionals
  • Routine GYN care
  • Sexually Transmitted Infection (STI) screening

Behavioral Health referrals

  • Therapy: individual and couples
  • Family and parenting services
  • Support groups

Pediatric Gender Clinic

Baystate Pediatric Endocrinology offers compassionate care for gender diverse adolescents.

Masculinizing Hormone Therapy

Masculinizing hormone therapy produces physical changes in your body caused by male hormones during puberty (secondary sex characteristics). The general approach involves the use of testosterone at gradually increasing doses.

The change might take several months to years to become complete. Some of the changes are reversible, while other are irreversible (or permanent) if therapy is discontinued. The table below outlines the masculinizing effects, average time of onset, maximum time to reach complete effect and whether or not the effect is reversible.

It is important to remember that everyone’s body is different and there is no way to predict exactly what your response will be. The appropriate dose for you might be different than the appropriate dose for someone else.

Effect   Onset  Maximum  Irreversible
Skin oiliness/acne 1-6 months 1-2 years  
Facial/body hair growth 6-12 months 4-5 years   Yes
Scalp hair loss  6-12 months Unknown   Yes
Increased muscle mass/strength 6-12 months 2-5 years   
Fat redistribution 1-6 months 2-5 years   
Cessation of menses  1-6 months    
Clitoral enlargement 1-6 months  1-2 years Yes
Vaginal atrophy 1-6 months  1-2 years  
Deepening of voice 6-12 months 1-2 years Yes

Safety & Side Effects

Although use of testosterone for female-to-male transition is not currently approved by the FDA for the treatment of gender dysphoria, research suggests that it is safe and effective.

You will need lab work periodically to assess your testosterone level and to guide dose adjustments and screen for possible side effects. These include:

  • Possible increase in blood pressure and risk of heart disease if you have certain risk factors
  • Weight gain
  • Acne
  • Balding (male pattern hair loss)
  • Inflammation of the liver
  • Cholesterol abnormalities
  • Increase in red blood cell counts (polycythemia)
  • Possible increased risk of blood clots

Talk to your doctor about fertility concerns.

It is still possible to become pregnant while on testosterone therapy, and testosterone can be harmful to a developing baby. Treatment can also affect your future fertility potential. If needed, talk to your doctor about adding a medication to prevent pregnancy.

Feminizing Hormone Therapy

Feminizing hormone therapy produces physical changes in your body caused by female hormones during puberty (secondary sex characteristics). The general approach involves the use estrogen at gradually increasing doses in addition to an androgen blocker.

The physical changes that occur with estrogen therapy can take several months to years to become complete. Some of the changes are reversible, while other are irreversible (or permanent) if therapy is discontinued. The table below outlines the feminizing effects, average time of onset, maximum time to reach complete effect and whether or not the effect is reversible.

It is important to remember that everyone’s body is different and there is no way to predict exactly what your response will be. The appropriate dose for you might be different than the appropriate dose for someone else.

Effect   Onset  Maximum  Irreversible
Redistribution of  body fat 3-6 months 2-3 years  
Decrease in muscle mass and strength 3-6 months 1-2 years   
Softening of skin/decreased oiliness  3-6 months Unknown   
Decreased sexual desire  1-3 months 3-6 months   
Decreased spontaneous erections  1-3 months 3-6 months   
Male sexual dysfunction  Varies  Varies  
Breast growth  3-6 months  2-3 years  Yes
Decreased testicular volume 3-6 months  2-3 years  Yes
Decreased sperm production Unknown  Over 3 years Yes
Decreased terminal hair growth  6-12 months  Over 3 years   
Scalp hair  Varies    
Voice changes  None     

Safety and Side Effects

Although the use of estrogen for male-to-female transition is not currently approved by the FDA for the treatment of gender dysphoria, research suggests that it is safe and effective.

You will need lab work periodically to assess your estrogen level and to guide dose adjustments and monitor for possible side effects. These include:

  • Increased risk for blood clots
  • Increase in blood pressure
  • High triglycerides
  • Elevated prolactin levels
  • Possible Increased risk of heart attack or stroke, when risk factors are present
  • Low libido, sexual dysfunction, decreased fertility

Talk to your doctor with any questions regarding fertility.

The exact dose and duration of estrogen that impairs fertility is unclear and varies greatly from person to person. How long this takes is difficult to predict and varies greatly from person to person.

Puberty Blockers

Puberty blockers are medicines that prevent puberty from happening. They work by blocking the hormones — testosterone and estrogen — that lead to puberty-related changes in your body. This stops things like periods and breast growth, or voice-deepening and facial hair growth.

The effects of GNRH agonists are reversible; once these medications are stopped, puberty restarts where it left off and there are no permanent effects or changes.

There are two kinds of puberty blockers:

  1. A flexible rod (histrelin acetate) that goes under the skin of the arm and lasts for 1-2 years
  2. A shot called (leuprolide acetate or triptorelin), which works for 1, 3, or 6 months at a time

Most people do not experience side effects from these medications. Side effects are almost always reversible and will go away after treatment is complete. Potential rare side effects include:

  • Local skin reactions (usually go away within 2 weeks)
  • Hot flashes
  • Headaches
  • Allergic reactions (very rare)
  • Worsening mental health problems (very rare)
  • Seizures (very rare)

In the 1st week, hormone levels may temporarily increase. During this time, you may notice more signs of puberty in your child, including light vaginal bleeding and breast enlargement in girls. Within 4 weeks of treatment, you should see signs in your child that puberty is stopping.

Talk to your doctor

These medications will not change your child’s body in any way. Talk to your doctor with any questions you may have.

Transgender Resources

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