What is GAHT?
Gender-affirming hormone therapy (GAHT) uses hormones to help physical characteristics align with a person's gender. Transfeminine people commonly use estrogen; transmasculine people commonly use testosterone.[1],[2]
The World Professional Association for Transgender Health (WPATH) Standards of Care Version 8 emphasise that physical goals differ between individuals, so treatment plans need not be identical. Some people want full physical change, others only certain changes, and every path is equally valid.[1]
Why preparation matters
Good preparation clarifies goals, ensures fully informed consent and sets up safe follow-up.[1] In many places, including Thailand, many trans women start hormones on their own on the advice of friends or pharmacies, which can mean unsuitable medicines or doses and no monitoring of risk.
Planning is not about asking “permission” to be yourself. It is about making the changes you want happen as safely as possible.
Gender diversity is not a mental illness
The World Health Organization moved gender incongruence out of the mental disorders chapter of ICD-11 and into a chapter on sexual health.[3] Using GAHT is not a measure of mental illness. Care needs vary with goals and access to services and cannot be generalised to every gender-diverse person.
What hormones change
Hormones change secondary sex characteristics such as fat distribution, hair, skin, breasts and voice. Some changes are permanent; others reverse if hormones stop.[1],[2]
- Feminising hormones develop breasts, soften skin, redistribute fat and reduce body hair. Breast growth is usually permanent, but hormones do not raise the pitch of the voice.
- Masculinising hormones deepen the voice, increase facial and body hair, build muscle and stop periods. A deeper voice and facial hair are permanent.
- Both affect fertility, which can fall sharply and may not fully recover.
What is assessed before starting
Assessment is not about judging whether anyone's identity is “real”. It is about understanding goals, understanding of the information and capacity to decide, together with physical health, mental health, medicines and fertility plans.[1],[2]
Baseline tests depend on the planned regimen and individual risks, such as blood pressure, weight, clot history, smoking, liver disease and relevant blood tests.[1],[2] Mental health conditions such as depression or anxiety should be cared for alongside, and generally do not need to delay hormones when they are reasonably well controlled.
Steps before starting hormones
Always discuss fertility first. Hormones can greatly reduce sperm production or ovulation. Anyone who may want biological children should consider preserving eggs or sperm before starting.[1],[2]
Agree a follow-up plan, including how often blood tests, blood pressure checks and side-effect reviews will happen, so doses can be adjusted appropriately.
Use licensed products under medical care. Assessment by a knowledgeable professional and local service requirements matter. WPATH Version 8 does not require every adult to obtain a psychiatrist's letter before starting hormones, but does require assessment by a suitably qualified professional.[1]
How we care for you at Dr. Kris Clinic
We provide transgender health care with respect for your identity, using the name and pronouns you choose, in a private setting, in English or Thai. We listen to your goals, explain expected changes and risks in full, and plan your regimen and follow-up together.
If you already take hormones on your own, we offer judgement-free advice, safety checks and help moving to a more suitable regimen. If you need fertility advice or surgical consultation, we can arrange referral.
Frequently asked questions
Do I need a psychiatrist's letter to start hormones?
WPATH Version 8 does not require every adult to have one, but you do need assessment by a knowledgeable professional. Requirements can vary between services.
Can I stop hormones once I start?
Yes. Some changes reverse, but others are permanent, such as a deeper voice or breast growth.
I may want children in future. What are my options?
Talk to your doctor before starting hormones about preserving sperm or eggs.
Can I use the contraceptive pill instead of GAHT?
It is not recommended. Combined pills contain synthetic estrogen that raises clot risk and is not designed for gender affirmation.
GAHT relies on shared decisions and individual care, not one regimen for everyone.[1] Good preparation around goals, fertility and follow-up helps the changes you want happen safely.
Talk to a doctor about this
Confidential care in Surat Thani, the mainland gateway to Koh Samui, Koh Phangan and Koh Tao. Tue–Fri 17:00–20:00 · Sat–Sun 10:00–15:00 (UTC+7)
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Dr. Krida Uakridathikarn (Dr. Kris)
Board-certified family physician with certificate training in clinical sexology and sexual medicine. He works at Suratthani Hospital and provides sexual health, hormone and LGBTQ+ inclusive care at Dr. Kris Clinic. Profile and CV
References
- WPATH Standards of Care, Version 8 (2022)
- Endocrine Society: Gender Dysphoria/Gender Incongruence (2017)
- WHO: Gender incongruence and transgender health in ICD-11
Keep reading
Main guide: Gender-affirming care
Testosterone for Trans Men and Transmasculine People
Hormones for Trans Women and Transfeminine People: Safe Regimens and What to Expect
Oral, Transdermal and Injectable Estrogen: How They Differ and Which Is SaferThis article is general education, not personal medical advice or a promise of results. Diagnosis and treatment require assessment by a doctor. Content reflects the cited sources as of the update date.