What to Expect When Your Teenager Starts Hormone Replacement Therapy

What to Know When Your Child Goes on HRT - Photo Illustration by Amelia Manley - Image of a woman dressed as a healthcare provider talking to two people

Verywell / Photo Illustration by Amelia Manley / Getty Images

When a transgender or non-binary individual begins hormone replacement therapy (commonly referred to as HRT), excitement and nervousness may abound.

While not all trans people choose to utilize hormones, those who do often cite the beginning of HRT as a high point in their life, memorializing their start dates similarly to other anniversaries.

But what is HRT, and what should parents and teenagers know before embarking on this journey together? Researching HRT can feel daunting and overwhelming, so let’s break down the basics.

Not all non-binary people identify as transgender, though many do. Non-binary, genderfluid, and genderqueer identities are considered part of the trans umbrella, so for simplicity’s sake, this article refers to transgender individuals or trans people as inclusive of all people undergoing HRT for transition-related reasons.

What Is Hormone Replacement Therapy (HRT)?

While HRT in casual conversation often means all pharmaceutical treatments for trans people, the medical term "hormone replacement therapy" refers to a very specific set of medications that are used to help a trans person transition gender. The types of medications depend on the person's age, and the kind of transition they're hoping to make.

“The standard of care is to start [HRT at] 16 years of age,” says Thomas Horowitz, MD, who received the Lifetime Achievement Award from the LA County Medical Association and leads one of the top 10 LGBTQ practices in LA County.

Prior to 16, your child may receive puberty suppression therapy, also known as “puberty blockers,” but they will not receive hormone replacement therapy. This permits your kid to avoid unwanted changes to their body by testosterone or estrogen until age 16, at which point the parent/teen team can consent to HRT.

Puberty blockers hit a sort of "pause button" and may be desisted at any time without significant long-term ill effects. When your teenager continues into HRT, they may continue to take suppressors (such as the antiandrogen spironolactone) along with replacement therapy.

For transfeminine people—that is, trans people who were assigned male at birth—HRT includes supplementary estrogen and sometimes progesterone, while for transmasculine people, HRT is mainly testosterone.

What Happens Before Starting HRT?

The process of starting HRT begins with a psychological evaluation, which often includes speaking not just with your teenager but with you as parents.

Anne Horowitz, an eighth-year medical student who has helped her father expand his practice specifically with regard to LGBTQ+ adults, explains: “I like to see that the child has support to socially transition, which I consider the more important part of the transition for children. This lack of support is the number one cause of detransitioning [when a person decides to stop transitioning], even if detransitioning is extraordinarily uncommon.”

When my daughter Catherine began this process at 15, we went through multiple sessions with Dr. Linda Hawkins at the CHOP Gender Clinic in Philadelphia. She spoke with Cat on her own, with her parenting team (mom, dad, and stepdad), and with all of us together before clearing Cat to start puberty blockers and then HRT at 16. Dr. Horowitz explains, “We proceed when the psychiatrist or psychologist reports that the person is ready and there are no medical contraindications.”

What Happens After Your Child Is Approved for HRT

Exploring medical contraindications before starting puberty blockers or HRT includes standard panels of lab work, so expect blood draws once the evaluator signs off. This permits your child’s healthcare provider—usually an endocrinologist or general practitioner specializing in trans care—to make appropriate recommendations regarding dosage, administration, and follow-up intervals.

Dr. Horowitz schedules monthly follow-ups for patients until their hormone levels stabilize. This matches Cat’s experience: she went through a "ramp up" period, meeting with her endocrinologist regularly to review labs and adjust her medication. The appointments got further apart once she reached and maintained her desired hormone levels. She’s 21 now and five years in, so these days her doctor only requests labs once or twice a year.

Anne Horowitz

[Starting HRT] can be hard, as emotions change a lot...but even with the difficulty, patients are usually very happy to tackle the initial struggle because the results are worth it for them.

— Anne Horowitz

Your care team should work with your family to choose which method of HRT administration—pills, creams, injections, implants, and even suppositories are available—will assure your teenager’s comfort and ease of transition.

Estrogen and progesterone can be taken orally; testosterone cannot. I administer my testosterone in one subcutaneous injection per week, while other transmasculine individuals utilize gels or creams. No single solution is “correct,” and it's about finding the right one for your kid, though Dr. Horowitz attempts to avoid injections mostly based on patient preference. 

Anne Horowitz adds, “It's also really important to remember that a lot of the requirements are [state-determined] and not heavily influenced by physicians. What a physician does versus what they want to do can vary wildly.” Be sure to discuss any concerns about state regulations with your child's healthcare provider.

How Will HRT Impact Your Family?

Like any other important life change, starting HRT often comes with big feelings for everyone involved. As a parent, I found it important to maintain a strong relationship with my own therapist. Cat had enough on her plate without dealing with my worries or reactions.

“[Starting HRT] can be hard, as emotions change a lot...but even with the difficulty, patients are usually very happy to tackle the initial struggle because the results are worth it for them,” Anne Horowitz explains.

Your teenager may experience mood swings and increased or decreased acne along with the changes that they’re looking forward to. Most patients report that their mood stabilizes as their hormones do. "[However], we do want the patient to maintain a working relationship with their therapist,” Dr. Horowitz adds.

Social transition and current media and political landscapes are likely to affect your family as strongly as any medical decisions. Be sure to maintain an open dialogue at home and check in regularly with your child to find out how they are feeling and what's on their mind.

A Word From Verywell

When administered under the care of a physician, HRT is safe, effective, and lifesaving for transgender individuals aged 16 and older.

“A lot of parental concern I see comes from wanting to protect their child," Anne Horowitz explains. "Being trans in this world [can lead] to a lot of...difficulties the parents wouldn't want for their child. It's useful to remind parents that life is going to be hard one way or another, and in [supporting] their child, they can do a lot to make the world kinder in a way that is arguably the most important."

6 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Children's Hospital, St. Louis. Puberty blockers.

  2. Corvol P, Michaud A, Menard J, Freifeld M, Mahoudeau J. Antiandrogenic effect of spirolactones: mechanism of actionEndocrinology. 1975;97(1):52-58. doi: 10.1210/endo-97-1-52

  3. UCSF Gender Affirming Health Program. Hormone Therapy.

  4. Unger CA. Hormone therapy for transgender patientsTransl Androl Urol. 2016;5(6):877-884. doi:10.21037/tau.2016.09.04.

  5. UCSF Transgender Care. Information on testosterone hormone therapy.

  6. UCSF Transgender Care. Information on estrogen hormone therapy.

By Spider B. Perry
Spider B. Perry has been active in the queer community since the early 90s and has been writing about queer & trans issues online since 2000. In addition to working on diversity and inclusion for roleplaying games, they have written LGBTQ+ fiction and worked with multiple synagogues on updating their language for queer inclusion.