On January 25, 2025, Mr. Anukul Pruksanusak, Deputy Spokesperson for the Prime Minister’s Office, announced that the National Health Security Office (NHSO) had approved a budget of 145.63 million baht to introduce new benefits under the national health insurance system. The focus is on supporting hormone therapy for transgender individuals, targeting over 200,000 people nationwide. The aim of this funding is to reduce health disparities, as in the past, individuals seeking hormone therapy had to bear the financial burden themselves, making access to proper treatment challenging for some. Moreover, the lack of professional medical guidance increased risks associated with using medication without proper advice.
This new benefit not only enables transgender individuals to access hormone therapy safely but also positively impacts their mental health and quality of life. It helps align their physical bodies with their gender identity and internal sense of self. The NHSO’s initiative marks a significant step forward in promoting health equity and improving access to comprehensive healthcare services for the transgender community in Thailand.
What is Hormone Replacement Therapy (HRT)?
Hormone Replacement Therapy (HRT) is a medical process that uses hormones to balance the body’s hormone levels in alignment with a person’s gender identity. This treatment is essential for transgender individuals who wish to have their physical appearance and bodily characteristics match their gender identity. Additionally, HRT is used in some cases to treat hormonal deficiencies, such as in postmenopausal women or individuals with hormone-related health conditions.
Hormone Replacement Therapy for Transgender Individuals
For transgender individuals, HRT plays a vital role in helping their bodies align with the gender they identify with. The therapy can be divided into two main categories:
Transgender Women (Male-to-Female)
1. Estrogen (Estradiol)
Estrogen is a key female hormone responsible for the development of female sexual characteristics and regulating various bodily processes. It is primarily produced in the ovaries and can also be found in the adrenal glands and body fat. Although estrogen is predominantly associated with women, it is also present in men at lower levels.
This hormone is critical for transgender women in developing female physical traits, such as breast development, softer skin, and fat redistribution to resemble a more traditionally feminine form.
Types of Estrogen
| Estrone (E1) |
| Found primarily in postmenopausal women. It is a less potent form of estrogen compared to others. |
| Estradiol (E2) |
| The most abundant form of estrogen in women of reproductive age. Plays a crucial role in regulating the menstrual cycle and developing female sexual characteristics. |
| Estriol (E3) |
| Found in high levels during pregnancy. Produced by the placenta to support the development of the fetus. |
Roles of Estrogen in the Body
- Development of Female Sexual Characteristics
- Stimulates the development of reproductive organs such as the uterus, vagina, and ovaries.
- Promotes breast development during puberty.
- Encourages fat distribution in areas like the hips and thighs to create a more traditionally feminine shape.
- Regulation of the Menstrual Cycle
- Plays a key role in controlling the menstrual cycle by stimulating the thickening of the uterine lining to prepare for pregnancy.
- Bone Health
- Helps maintain bone density and reduces the risk of osteoporosis in women.
- Cardiovascular Regulation
- Lowers bad cholesterol (LDL) and increases good cholesterol (HDL).
- Improves vascular flexibility, reducing the risk of heart disease.
- Impact on the Brain and Mood
- Influences brain chemicals like serotonin, helping regulate mood, reduce stress, and support cognitive function.
2. Anti-androgens
Anti-androgens are medications used to reduce the effects of male hormones, known as androgens, such as testosterone, in the body. These medications work by blocking androgen receptors, thereby inhibiting the action of male hormones and diminishing their influence on the body.
Anti-androgens are utilized in various cases, including:
Medical Treatments
Managing conditions caused by excessive androgen levels, such as prostate cancer or excessive hair growth (hirsutism).
Gender-affirming Therapy
In transgender women (male-to-female), anti-androgens are used to suppress the effects of testosterone, allowing for clearer expression of feminine physical traits, such as reduced body hair and softer skin.
Uses of Anti-androgens
- Transgender Women (Male-to-Female)
- Key role in gender-affirming therapy: Anti-androgens help suppress the effects of male hormones, such as reducing facial and body hair, deep voice, and oily skin.
- Used with estrogen: To enhance feminine traits, such as breast development and reduction in muscle mass.
- Treatment of High Androgen Levels in Women
- Used to manage conditions caused by excessive male hormones, such as:
- Polycystic Ovary Syndrome (PCOS)
- Hirsutism (excessive hair growth in women)
- Prostate Cancer Treatment
- Prostate cancer grows in response to male hormones. Anti-androgens inhibit the effects of testosterone, slowing cancer growth.
- Treatment of Androgenic Alopecia (Male/Female Pattern Baldness)
- Used in both men and women to combat hair loss caused by the effects of male hormones on hair follicles.
Transgender Men (Female-to-Male)
Testosterone
Testosterone, the primary male hormone, plays a crucial role in the development and maintenance of male physical characteristics. It also regulates various bodily functions, such as sperm production, muscle growth, and bone density. Testosterone is primarily produced in the testes in men and, to a lesser extent, in the adrenal glands.
In women, testosterone is present at lower levels, produced in the ovaries and adrenal glands. For transgender men (female-to-male), testosterone is used as part of hormone therapy to promote male physical traits and align their body with their gender identity.
Functions of Testosterone in the Body
- Development of Male Sexual Characteristics
- Stimulates the development of male traits during puberty, such as the enlargement of male genitalia, a deeper voice, and body hair growth.
- Promotes sperm production and supports the functioning of the reproductive system.
- Muscle Growth
- Testosterone increases muscle mass and strength.
- Enhances the body’s energy metabolism.
- Bone Density Maintenance
- Plays a key role in maintaining bone strength and preventing osteoporosis.
- Boosting Energy and Confidence
- Testosterone helps increase energy levels, sexual desire, and self-confidence.
- Impact on Mood and Stress Management
- Influences mood stability and enhances the ability to manage stress effectively.
Conditions Related to Testosterone
| Condition | Causes | Symptoms | Treatment |
| Low Testosterone | – Aging – Testicular abnormalities – Chronic illnesses (e.g., diabetes, obesity) |
– Fatigue and mood swings – Decreased libido – Loss of muscle mass and bone density |
Hormone replacement therapy (TRT) under medical supervision |
| High Testosterone | – Overuse of hormone supplements – Hormone-producing tumors |
– Acne and oily skin – Aggressive behavior – Increased risk of cardiovascular diseases |
Adjust hormone usage under medical advice |
Benefits of Hormone Therapy for Transgender Individuals
Key Benefits of Hormone Therapy
- Development of Gender-Aligned Physical Traits
- For transgender women: Estrogen and anti-androgens help enhance feminine characteristics, such as:
- Breast development
- Reduction of body hair
- Softer and smoother skin
- Reduced muscle mass and fat redistribution to a more traditionally feminine form
- For transgender men: Testosterone promotes masculine traits, such as:
- Increased facial and body hair
- Greater muscle mass
- Deepening of the voice
- Stimulation of male genital growth
- For transgender women: Estrogen and anti-androgens help enhance feminine characteristics, such as:
- Reducing Stress from Gender Dysphoria
- Many transgender individuals experience distress due to the mismatch between their gender identity and physical body (gender dysphoria). Hormone therapy helps alleviate discomfort and enhances self-confidence.
- Improving Mental Health
- Achieving physical traits that align with gender identity reduces anxiety, stress, and depression often caused by societal stigma or rejection.
- Enhancing Quality of Life
- Hormone therapy enables transgender individuals to feel confident in themselves and fully express their true identity.
- Increased self-confidence positively impacts relationships within families and communities.
- Reducing Risky Behaviors
- Receiving proper hormone therapy reduces the risks associated with using non-standard or self-purchased hormone treatments.
Additional Health Benefits
- Balancing Hormones
- Maintains hormonal balance in the body, reducing health issues caused by hormonal imbalances, such as mood swings or physical health problems.
- Promoting Bone Health
- For transgender women: Estrogen helps maintain bone density and reduces the risk of osteoporosis.
- For transgender men: Testosterone increases bone mass and strength.
- Regulating Metabolism
- Hormones enhance energy metabolism, helping the body adapt to changes in weight and muscle mass.
Positive Outcomes of the Hormone Therapy Support Policy
1. Enhancing Quality of Life for Transgender Individuals
This policy reduces stress and pressure caused by a lack of healthcare support, allowing transgender individuals to live confidently and reach their full potential without worrying about access to appropriate medical care.
2. Reducing Discrimination and Stigmatization
Providing healthcare benefits for transgender individuals helps mitigate discrimination and inequities in the healthcare system. Additionally, it raises societal awareness about the importance of gender diversity and fosters greater acceptance within communities.
3. Promoting Long-term Health
Access to standardized hormone therapy reduces risks associated with using low-quality or self-administered treatments without medical supervision. It also supports comprehensive healthcare, such as regular health check-ups, psychological counseling, and other services that enhance the long-term quality of life for transgender individuals.
Future Approaches to Supporting the Transgender Community
Building a society that accepts and supports transgender individuals requires proactive efforts in multiple areas, including policy, legislation, education, and comprehensive healthcare. These measures aim to ensure that transgender individuals are treated equally and enjoy a high quality of life.
1. Developing Comprehensive Policies and Legislation
- Promoting Equal Legal Rights
- Support the amendment of legal documents, such as allowing transgender individuals to change their name and gender on identification cards to match their gender identity.
- Advocate for the right of same-sex and transgender couples to marry, granting them equal access to rights such as health insurance, adoption, and other legal benefits.
- Introducing Specific Health Policies
- Expand healthcare benefits, including access to hormone therapy, gender-affirming surgeries, and psychological support services.
- Promote research on the long-term effects of hormone therapy to develop safer and more appropriate treatments.
- Preventing Discrimination
- Enact anti-discrimination laws across all sectors, such as employment, education, healthcare, and access to public services.
2. Education and Awareness Raising in Society
- Education in Schools
- Integrate content about gender diversity into sex education curricula to foster understanding of gender identity and sexual orientation from a young age.
- Train teachers and educational staff to support and create a safe environment for transgender students.
- Public Awareness Campaigns
- Organize activities and campaigns to raise public awareness about gender diversity and reduce stigma.
- Promote the inclusion of transgender stories in media, such as films, TV shows, and articles, to enhance understanding and reduce bias.
- Workplace Training
- Conduct workplace training programs on fostering equality and reducing discrimination against transgender individuals.
- Encourage employers to support hiring transgender employees and create inclusive and friendly workplace environments.
3. Developing the Healthcare System
- Establishing Specialized Clinics for Transgender Individuals
- Create clinics or health centers dedicated to serving transgender individuals, offering services such as counseling, sexual health check-ups, gender-affirming surgeries, and psychological support.
- Training Healthcare Professionals
- Train doctors and nurses to understand gender diversity and provide appropriate, non-discriminatory healthcare services tailored to the needs of transgender patients.
- Improving Access to Hormone Therapy
- Reduce barriers to accessing hormone therapy by lowering costs, expanding insurance coverage for transgender healthcare, and increasing service availability in rural areas.
4. Mental Health and Economic Support for Transgender Individuals
- Specialized Counseling Services
- Establish psychological and mental health counseling centers specifically for transgender individuals to reduce stress, anxiety, and mental health issues caused by stigma or societal rejection.
- Family Support
- Organize activities or counseling programs for families of transgender individuals to foster understanding and provide a strong support system at the family level.
5. Economic Support and Employment
- Creating Economic Opportunities
- Promote the establishment of businesses or projects that create jobs for transgender individuals to reduce employment inequality.
- Support access to loans or funding for businesses operated by transgender entrepreneurs.
- Preventing Workplace Discrimination
- Implement organizational policies that promote equality, such as providing gender-appropriate restroom access and recognizing employees’ gender identities.
6. Creating Safe Spaces in Communities
- Establishing Support Networks
- Develop support groups for transgender individuals within communities to provide a space for sharing experiences and offering assistance in various areas.
- Promoting Inclusive Spaces
- Encourage community events that celebrate diversity and equality, such as festivals or awareness campaigns, to foster acceptance and understanding.
“Hormone therapy is not just about balancing hormones; it is a vital key that enables transgender individuals to align their bodies with their gender identity, alleviating the distress caused by gender dysphoria. It boosts self-confidence and enhances quality of life. This treatment is more than medical care—it represents support for human rights and the creation of equality within society.”
FAQs
▷ Sex hormones are categorized based on biological sex: Female hormones: Estrogen, Male hormones: Androgens or Testosterone
▷ Self-medicating with hormones is not recommended. Using such medications without professional supervision can lead to severe side effects. Always consult a medical professional before starting hormone therapy to ensure safety and effectiveness.
▷ Regular health check-ups are crucial during therapy. This includes blood tests to monitor hormone levels and general health screenings to detect and manage any side effects.
▷ Results vary for each individual. Initial changes are typically noticeable within 3-6 months, while full transformations may take several years.
▷ Potential side effects include acne, high blood pressure, mood changes, or a risk of blood clots, depending on the type and dosage of hormones used. Regular monitoring by a doctor is essential.
▷ Choose hormones with minimal side effects and appropriate dosages for your body. Educate yourself on proper usage, the risks of overdosing, and undergo regular tests to monitor hormone levels and long-term side effects.
▷ The duration of hormone therapy depends on your health goals and gender identity, as well as advice from a specialist. For many transgender individuals, long-term or even lifelong hormone therapy may be necessary to maintain desired physical characteristics.
▷ Hormone therapy can generally begin during adolescence or after age 18. In some cases, it may start earlier under the supervision of a specialist.
▷ Consult with a specialist, undergo general health and hormone level evaluations, and discuss your goals and expectations for therapy.
▷ Surgery is not always necessary. Hormone therapy alone can help achieve desired physical traits without surgery. The decision depends on individual preferences and needs.
Related Article
The NHSO’s approval of funding for hormone therapy for transgender individuals marks a significant step toward supporting equal healthcare rights and promoting acceptance of gender diversity in Thailand. This policy not only enhances the quality of life for transgender individuals but also fosters greater societal understanding of gender diversity. Good health begins with equitable access to services. If you or someone close to you identifies as transgender, don’t hesitate to learn about the benefits you are entitled to. Be part of creating a society that accepts and supports all forms of diversity! For transgender women interested in hormone level testing, you can book an appointment online through services available at www.love2test.org
Reference
จัดงบ 145.63 ล้านบาท เพิ่มสิทธิประโยชน์ใหม่ “ยาฮอร์โมน” ดูแลกลุ่มคนข้ามเพศ
- pptvhd36.com/health/news/6462
‘สมศักดิ์’ มอบ สปสช. เดินหน้าสิทธิประโยชน์ ‘ฮอร์โมน’ สำหรับกลุ่มคนข้ามเพศ
- thecoverage.info/news/content/8064
รัฐบาลเดินหน้านโยบายรองรับบริการด้านสุขภาพสำหรับกลุ่มคนข้ามเพศ
- thaigov.go.th/news/contents/details/92731