Hormone Therapy and its Effect on Chest Reconstruction and Breast Augmentation Surgery

Any individual seeking plastic surgery to alter sex characteristics to align their outward appearance with their gender identification should begin by learning as much as they can about gender dysphoria as it is defined in the ICD-10 (International Classification of Diseases-10, published by the WHO-World Health Organization) or the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association .

The Three-phase Approach to Treating Gender Dysphoria

Before contemplating plastic surgery to alter physical characteristics it is recommended to first seek counseling with a psychologist or psychiatrist to explore and treat the emotional damage sometimes caused by dissatisfaction with gender identity. Then, a physical examination is recommended to determine whether there are any health issues that might prevent the use of hormone therapy and/or plastic surgery to alleviate gender dysphoria.

Hormone therapy can be one part of a 3-phase approach to the treatment of gender dissatisfaction. In accordance with the guidelines published by the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC), these 3 phases of treatment are described as:

• Counseling to determine mental and emotional health and degree of distress.
• Hormone therapy and/or plastic surgery to alter physical characteristics.
• Social integration by living for a supervised period of time in the desired gender identity.

While there are no fixed medical standards for the order in which treatment is given, there is logical progression to treatment which can be suited to each individual case. Psychological counseling to determine the severity of distress can lead to a diagnosis which prescribes hormone therapy and/or plastic surgery. Undergoing hormone therapy before making the decision to make the irreversible physical changes of plastic surgery carries its own logic. Also, living in the desired gender for a period of time before making irreversible physical changes also makes sense.

The Beneficial Effects of Hormone Therapy on Surgery

Another sound medical reason for undergoing hormone therapy before plastic surgery is that hormones effect feminizing or masculinizing body changes which can affect the aesthetic results of plastic surgery.  However it is important to note that, especially for FTM top surgery, testosterone is not required.  This is partly because testosterone might help chest muscle development a bit, which might help the surgeon a small amount during incision planning.  However, an outstanding result can be achieved with or without these testosterone-induced changes, and many nonbinary patients will never be taking testosterone, so it important to note that by no means is testosterone therapy a required element of an outstanding result.

FTM Chest Hormone Therapy Results

When masculinizing hormones are taken by FTM patients, changes in skin tone and texture, breast volume and size of mammary glands, and changes in hair growth patterns can all affect the overall aesthetic results of chest reconstruction surgery. Treatment with testosterone results in deepening of the voice, clitoral enlargement, some mild breast tissue atrophy, an increase in facial and body hair and often male pattern baldness. If hormones are discontinued, reversible changes may include weight gain, a return of upper body strength, increased sexual interest and arousal, and a loss of fat around the hips.

Factors such as the patient’s age, breast size and shape, general health, and individual aesthetic goals all play a part in determining the timing of hormone therapy and surgery.

MTF Breast Augmentation Hormone Therapy Results

When feminizing hormones are taken by MTF patients, changes in skin tone and texture, breast volume and size of mammary glands, and changes in hair growth patterns can all contribute to the overall aesthetic results of breast augmentation surgery. Treatment with estrogens results in breast growth, softening of skin, decrease in body hair, slowing or secession of hair loss on the scalp, a decrease in size and fertility of testicles, and less frequently, less firm erections. If hormone therapy is discontinued most changes are reversible but breast enlargement will not completely reverse.

Factors such as the age of the patient, the skin tone and elasticity in the chest area, general health, and individual aesthetic goals are important in achieving the maximum aesthetic effect.

Possible Negative Side Effects of Hormone Therapy

Any physician prescribing hormone therapy is obliged to fully inform patients of possible negative side effects. Hormone therapy may result in a variety of complications.

In MTF individuals, side effects and/or complications may include venous thromboembolism, development of benign pituitary prolactinomas, infertility, weight gain, changes to emotional reactions and frequent mood changes, liver disease, gallstone formation, somnolence, hypertension, and diabetes mellitus.

In FTM individuals, side effects and/or complications of hormone therapy may include infertility, acne, changes to emotional reactions and frequent mood changes, increases in sexual desire, shift of lipid profile with increasing risk of cardiovascular disease, and the potential to develop benign or malignant liver tumors and hepatic dysfunction.

Patients suffering from gender dissatisfaction should be made aware of both the desired effects of hormone therapy as well as the possible negative effects in order to give fully informed consent for ongoing hormone therapy.