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For trans men and women, hormone therapy can change lives

(NewsNation) — Juno Krahn was in her 40s the first time she stepped on stage as a burlesque performer.

Until then, Krahn, a trans woman, had never been out to a club or even danced in public, she said. Her newfound confidence, however, encouraged her to perform and promote the acceptance of all bodies.

“It was like, I have so much confidence I have to do something with this,” Krahn said. “So I started doing burlesque two weeks after I started hormones, actually. “

For the first time she can remember, Krahn began to feel in harmony with her body after starting gender-affirming hormone treatment.

“I (was) just trying to learn to accept my body because I’m thinking, well, this is what I got, right?” Krahn said. “And then the internet happened and I realized, oh, you can take hormones as an adult. … It’s not too late.”

What is hormone therapy?

Hormone therapy is a process used to help people medically transition by taking prescribed hormones. For transgender women, that may include taking estrogen and testosterone blockers or for transgender men, taking testosterone according to Johns Hopkins Medicine.

The process, however, is unique for each trans and gender-diverse patient, said Dr. Tiffany Karas, a medical director at Northwestern Medicine and part of the health care system’s Gender Pathways Program.

“It’s such a privilege,” Karas said. “It’s also daunting because I don’t want to cause harm for anyone. When a 60-, 70-year-old comes to see me and they have a plethora of other medical problems — chronic heart disease or diabetes — we have to take all of that into account.”

The majority of patients Karas works with are between 20 and 40 years old, and all of them are older than 18. The hormone therapy that she and other endocrinologists provide isn’t the same as what’s sometimes known as puberty blockers.

“The puberty blocker question comes in for younger people, kids who have not yet reached puberty or are just starting puberty,” Karas said. “We can give a medication, another hormone that actually stops the pituitary (gland) from having that body produce the gendered hormones that that individual will have…It halts the pituitary…so that they can have the opportunity to figure out where they’re headed.”

Who is it for?

Appropriate gender-affirming care varies by patient, whether they transition later in life or in adolescence, American Academy of Pediatrics President Moira Szilagyi wrote in an August statement, saying the care can be “life-saving.”

“There is strong consensus among the most prominent medical organizations worldwide that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate,” Szilagyi said. “… The decision of whether and when to start gender-affirming treatment, which does not necessarily lead to hormone therapy or surgery, is personal and involves careful consideration by each patient and their family.”

The demand for gender-affirming treatment that Karas offers tends to outweigh the availability of doctors who provide it, she said.

During a November interview with NewsNation, Karas said she was booked until March.

“I have specific spots where I put (those appointments) because they generally take a lot longer in the initial interview than somebody who’s coming for a thyroid disease or something that is more common,” she said. “There aren’t a lot of hoops to jump through once you get to the right person. But sometimes it’s just finding the right human to talk to.”

That search can be discouraging for some.

For several years, Krahn struggled to find a doctor who was up to speed on the latest research and who she felt understood what she was experiencing. The trial-and-error of hormones began to take a toll, too.

“I had to do three sessions with a therapist … to get a referral to an endocrinologist,” she said, adding that the appointments were a prerequisite to her treatment. “And really, those three sessions were kind of a waste of time.”

What’s the impact?

There is a lot about being transgender that public discourse gets wrong, but perhaps most notably, Karas said, is the notion that it’s “a phase.”

In her experience, patients report less anxiety, depression and dysphoria with hormone therapy, Karas said.

“I’ve not talked to one person (for) whom this was a spur-of-the-moment decision,” she said. “This is something that is inherently just innate. Those of us who are cisgendered have a privilege that we don’t understand until we meet someone who just doesn’t feel right in their skin.”

The decision to permanently de-transition, or go back to living full-time as the gender someone was assigned at birth is relatively rare.

According to the same study, 8% of respondents had de-transitioned temporarily or permanently at some point. Of those who de-transition at some point, most did so temporarily. Sixty-two percent were currently living full-time as a gender different than the one they were assigned at birth.

Those who de-transitioned at one time cited mostly external reasons, including pressure from a parent, spouse or family member, or harassment and discrimination.

“When you’re stuck in a binary world, sometimes you get trapped in this binary thinking when really, it’s just like, what do you actually want? ” Krahn said.