Hormone replacement therapy (HRT) in Sweden

Hormone replacement therapy (HRT) is one of several treatments offered in gender-affirming care. Hormones can affect, among other things, voice, body hair, and the distribution of fat on the body. You can read more about the effects of HRT below.

There is no requirement to undergo HRT in gender-affirming care. Instead, the treatment is set up individually according to exactly what you need to feel as well as possible.

In this text we use some medical terms for body parts that you are born with.

How you are affected is individual

How your body is affected by hormone treatment is individual. There are changes that are typical for testosterone and oestrogen respectively. It is known that some of these changes usually come early and that others often take a while. But it's like the body's own puberty: it looks different for different people and is hard to predict. Just as the body's own puberty can take several years, changes that come with gender-affirming hormone therapy can take a long time. It is usually assumed that you have had the biggest changes after taking hormones for 1–2 years. But it is quite common for the body to continue to change over a longer period of time. Even after 5–6 years, things like voice pitch, facial and body hair, muscle mass and distribution of body fat can continue to change.

Some people want to take hormones in order for their body to change as much as possible in a typically female or typically male direction. Others want their body to become more gender neutral or androgynous. Together with an endocrinologist or gynecologist, you can discuss for example so-called microdosing (smaller doses) of hormones. This make the changes happen more slowly. However, there is no way to choose which effects you want from the hormone treatment or to control how it turns out for you.

For some, changes happen very quickly on HRT. You therefore need to be prepared for the fact that the body can change in ways you don't want. Many of these changes won't go back either. The endocrinologist or gynecologist can tell you what effects you can expect from the treatment but also about side effects. Certain forms of medicine, such as hormone patches or gels, make it easier to quickly stop treatment if you need to.

Gender dysphoria diagnosis required to receive hormones

If you are trans and want gender-affirming hormone therapy in Sweden, you must have a gender dysphoria diagnosis. It is therefore required that you undergo a gender dysphoria assessment. HRT is available to both binary and non-binary trans people. If you are under 18, the rules look different. Hormones are only given in exceptional cases, despite a gender dysphoria diagnosis.

Diagnosis is usually made after approximately 12 months of assessment. When the diagnosis is made, a referral is sent to a hormone doctor, a so-called endocrinologist. It could also be sent to a gynaecologist, who is a doctor who specialises in gynaecology. There is usually a waiting period of a few months. When you meet the doctor, you usually do a blood test, talk about your health and discuss which form of hormone preparation suits you best. A prescription for hormones is then written and you can start the hormone treatment.

It is usually the endocrinologist or gyneacologist who renews your prescription for hormones. It is also the doctor who follows up your values over time, adjusts the dose to the right level and with whom you can talk about any side effects. During the first year on hormones, it is common to stay in contact with the gender dysphoria clinic that made the diagnosis. Especially if you want to change your legal gender or undergo pelvic surgery. The staff at the gender dysphoria clinic are also people you can talk to about side effects, effects or other thoughts about your treatment.

Not everyone undergoes hormone replacement therapy

Not everyone wants HRT or can take hormones for various medical reasons. Some stop because of side effects of the hormones. For some it is enough to take them for a period and then stop. There is no requirement to undergo any treatment just because it is available. Some take hormone therapy for a period of time and then stop. If you have not surgically removed the parts of the body that produce your own sex hormones, the gonads, you can end the hormone treatment and wait for the body to start producing hormones again. If you have had your gonads removed, sex hormones will need to be added to keep you healthy. Then you can instead take the type of hormones that the body would have produced itself. If you want to stop hormone therapy or have questions about it, talk to your endocrinologist/gyneacologist.

HRT for those who are non-binary

HRT is available to both binary and non-binary trans people. The purpose of the treatment is to reduce gender dysphoria. But for some non-binary people, the effects of HRT can be negative if they become too pronounced. It is therefore important to talk to the doctor about your expectations of the treatment and which effects are permanent.

If you have an intersex variation

The text assumes that you have a hormone production that follows the medical norm. That you who were assigned male at birth produce more testosterone or that you who were assigned female at birth produce more oestrogen. If you have an intersex variation that affects how your body produces or absorbs sex hormones, not all parts of this text apply to you. Something that can be good to know if you have an intersex variation is that it is rarely an obstacle to being able to receive gender-affirming hormone treatment.

If you are under 18 years of age

In general, you must be 18 years of age to receive treatment with gender-affirming hormones such as testosterone and oestrogen. The National Board of Health and Welfare updated the guidelines for the treatment of young people with gender-affirming hormones and puberty blockers in 2022 . Since then, these treatments are only given in exceptional cases. Puberty blockers are a way to "pause" puberty. This thus stops the body from undergoing changes that doesn’t feel right. 

Hormone blockers can be given for a maximum of 2-3 years, partly because they can affect the skeleton. If you receive hormone blockers, the endocrinologist will follow your stats over time and will also tell you what side effects the medicine can cause. If you want help with stoppig bleedings (what is also known as menstruation), it is possible to get help with this without a gender dysphoria diagnosis. You can get help to stop bleedings at your youth clinic.

To continue or stop HRT, depending on your needs

Some effects of hormone therapy are permanent, others are reversible if you stop the treatment. In order to retain all the effects, you must therefore continue the treatment throughout your life. However, if you want to stop hormone treatment, this is usually okay from a medical point of view. If you still have the body parts that produce the body's own hormones (what are medically called gonads: testicles or ovaries), the body's own hormone production can almost always start again by itself if you stop taking hormones. If you do not have your gonads, you need to take the hormones that the body would otherwise have produced itself.

Can you get HRT without a diagnosis?

It is not possible to get hormones via the public health care system in Sweden without first having received a gender dysphoria diagnosis. It is also not possible to get HRT in private care in Sweden. However, it is possible to get hormones via private clinics in other countries. Costs and rules vary.

Some take hormones on their own, something that is often called self-medication. There are risks in taking hormones without having them prescribed by an endocrinologist or gynaecologist and without regular medical check-ups. You can read more about self-medication with hormones here.