Who needs it?
To fully understand what Hormone Replacement Therapy (HRT) is, we need to understand who is it for. HRT is administered on people whose do not identify with the gender assigned to them at birth. To explain this simply, I may have been told since childhood that I am a man, but while growing up I feel that I am a woman. However, this does not prevent my body from producing the male hormones. So in order to achieve this identity of being a woman, I may choose a medical option. The two most common options are sex change surgery or HRT. The process of moving from one's gender assigned at birth to one's gender identity is known as transitioning, and depending on the individual, a person may choose to undergo sex change surgery, HRT or for that matter neither and stay as is.
What is it?
HRT differs for transmen (female-born individuals who transition to being men) and transwomen (male-born individuals who transition to being women). In this process, if you are a female born individual who is transitioning, masculinizing hormones such as testosterone are injected in your body so as to induce body and facial hair growth, increase muscle mass and strength, deepen voice etc. In Transwomen (Male-born individuals) feminizing hormones just as estrogen etc are injected for breast growth, decreasing sperm production, thinning and slowed growth of body and facial hair et al.
These hormones can be taken in different forms, either orally, or epidermally, or through injections, and they differ for transwomen and transmen, and the time period to achieve expected results varies from anywhere between one year to five years.
Is the process complex?
HRT is a highly individualized process. It not only differs for transmen and transwomen but needs to be tailored according to the individual. The process of getting HRT is also long drawn. Initially, the individuals are tested by a psychiatrist for persistent, well-documented gender dysphoria (discomfort or distress caused by a discrepancy between what gender does a person associate to and the sex assigned to them at birth). Then, informed consent is obtained from the individual. Along with this, the individual is also tested for mental health concerns, that can stem from stress, stigma, etc. It is only after a certificate is issued by the psychiatrists that a trained endocrinologist can administer HRT. Once HRT has started, the individual has to take these hormones throughout their life, although the dosage reduces over the course of time.
Here, a word of caution: Not all gender non-conforming (those who don’t relate to gender assigned at birth) individuals experience gender dysphoria. More so, gender non-conformity in itself isn't a disease. If you do get the feelings that the body you're born in isn't the same that you want to be in, then these feelings are totally normal and you should know that a lot of individuals go through this. You can talk it out with people who understand this, or look up on websites what you're going through.
Is HRT necessary?
Transitioning in itself is a very long process and you have all the rights to decide how far do you want to go with your transition. Some people are satisfied with cross-dressing, while some trans people get Sex Reassignment Surgeries (SRS) done so as to feel the congruence between their gender identity and body. It totally depends on the individual.
However, if you are planning to get SRS done, then the doctors advise you to be on HRT for at least a year, during which HRT is carefully administered and observed for the body's reaction to the new hormones. Here, HRT becomes important, and it is only then that SRS is performed. This also gives individuals the time to get comfortable in their skin.
Yet, it is always the decision of the individual how far to go with the transitioning. You can dress or behave in manners that you think are more aligned to your gender, or you can choose to go through HRT and then continue with SRS further. There is no right or wrong in this.
Is it easily available?
The availability of HRT depends on many factors. The most important of it all whether there is a trained endocrinologist in your area. It's almost exclusively available in the bigger cities. Along with that, at a private hospital, the cost of going through HRT often goes up to 3000-4000 rupees per month, not calculating the fee of the psychiatrist and endocrinologist and the other tests that one has to go through. This makes HRT only available to those who have a strong financial background, can travel to places for therapy, and find caring and understanding doctors along with the support of friends and family.
What are the side-effects?
Apart from the cost of the therapy, there can be some side effects as well. Remember, your body is going through changes and any kind of induced change within the body will have side effects. Some people might experience fatigue due to muscle loss, others might experience pain or weight gain. All of this is a common occurrence and depends on your age, the hormones you are taking and the dosage. Make sure that you are in constant consultation with your doctors throughout the process and you know all the effects of replacing hormones before you begin therapy. This is your body, and you ought to have full control over it.
Is it worth the effort?
Transitioning is a complex process, and HRT is only a part of it. It will always depend on you at what age you want to transition, how you want to transition and how much you want to transition. You get to decide what's best for you. The key is to have an open and honest dialogue with the doctors involved, who will help you guide through this process and not be ashamed to seek help.