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Gender Identity

40 Year Old MTF Transition

Louise D.
Is 40 too old?

Although many sources will indicate the ideal time for transition is late childhood or early teens, there is no real cut-off time for what is considered “too old”. Many trans women have delayed transition or coming out in the past due to the stigma and level of personal danger associated with being transgender at an earlier time. The same is true for trans men and women from previous generations.

This has meant that more and more middle-aged or even elderly trans women have started hormone therapy (Estrogen) and transition at a later time in their lives than what might be common for the younger generations.

The most important element of hormone therapy that trans women should be aware of when they start to transition is that hormone therapy, at its maintenance stage, is kept at the level that maintains normative levels of Estrogen for cisgender women of a similar age.

The same would be the case for expectations surrounding surgery outcomes. Expectations should be realistic for what can be expected for a cisgender woman of a similar age. For many transgender individuals, this is the ideal, and they do not want to look like a younger age version of themselves. Regardless, it is still something to be aware of. The first year after you start HRT, there will be significant changes, and you will go through a second type of puberty, but after that, your hormones will be kept at a normative level.

The purpose of initial high doses of Estrogen will only be related to encouraging breasts to grow and other sex characteristics to develop. After that, a person must lower their Estrogen doses to be more normative in order to avoid negative reactions to high levels of Estrogen later in life. Especially if you have a lot of body fat while taking hormones, your doctor will try to keep your doses lower as fat has a significant impact on Estrogen levels and can have a negative impact on your transition process.

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Social Transition For Older Transgender People

Social support is extremely important for trans people during their transition journey. This means that the point at which a person decides to come out to friends and coworkers is an important step for most people.

It is helpful to come out before starting hormone therapy because hormones like Estrogen and anti-androgens will have noticeable physical effects, and it will be less awkward if people in your life already know that it is coming. If you want to live true to your gender identity and make use of hormone therapy, then a person is likely to notice when you start growing breasts, for example.

It might be very difficult for a person 40 years or older to come out in this way. Change is frightening, especially when the norm has been around for that long. But, it is important for your mental health to be true to yourself, and although not everyone will approve, others will be supportive through the process, and you might even gain an ally or two. It can also end up being a great relief to finally come out.

Gender Affirming Hormone Therapy

As briefly discussed above, hormone replacement therapy for transgender women is designed to develop secondary sex characteristics as far as possible over a year or two and then to be managed at a maintenance level. Your hormone levels will be checked regularly and dosages adjusted to keep your hormone levels within the expected range for a cisgender woman of your age.

Your experience here will likely be a little bit different from what a younger person experienced during their transition.

This means that you will likely only be on a higher level for a short time before being adjusted to suit a menopausal or post-menopausal woman’s levels. This is important because it impacts your risk of developing hormone-related cancers. Even something like breast cancer is a real risk for a transgender woman (remember that even cisgender men can get breast cancer), and high levels of female hormones can slightly increase the risk for this type of cancer. These risks are balanced out against the need for characteristics like breasts to be allowed to grow as much as possible before surgical steps are taken.

Breast Development

The good news is that even if you start hormone replacement therapy later in life, you can still expect physical changes like breast development. Breast development usually peeks around the one-year mark after starting hormone therapy.

It is important to discuss your expectations for breast growth with your doctor so that you can be sure that your expectations are realistic. You will further notice that surgeons will require a one-year waiting period after starting hormone therapy to allow for breast growth to setting before considering top surgery procedures.

Remember that each journey is unique, and you might find after the year has passed that your gender dysphoria has dropped so much that you might not want to undergo surgery anymore. The breast growth is usually not all that much, but it will certainly be noticeable, and along with other physical changes, it is enough for some transgender women.

It is a very personal decision to choose to undergo surgery, but if it is the only way to fully address your gender dysphoria, then it is definitely something that you should seriously consider. Gender-affirming surgery is as much a medically necessary step in your health care as hormone therapy and gender expression is.

MTF Breast Augmentation

As mentioned in the previous section, hormone therapy might be enough to address dysphoria levels for most trans women, but if you find that you still want to undergo breast augmentation surgery, then it is something that you should seriously explore with your doctor.

If you are past the age of 40, then you are naturally at greater risk for certain complications associated with surgery. These are not necessarily specifically connected to transgender patients but are likely a general concern for all people above 40.

Possible Complications Associated with MTF Top Surgery and Other Gender Affirming Surgery

People over the age of 40 are at an increased risk of developing blood clots that can result in a stroke. This can lead to death or permanent disability. It is important to talk to your surgeon about this risk.

Others include things like infection, embolisms, etc. These are also usually heightened if you have a lot of body fat around incision sites. If you are over 40, then the elasticity of your skin is also a consideration that will need to be made. Especially if you have been wearing tight clothing items around your chest area, such as binders or bras. These restrict blood flow in capillaries around your top layers of skin which affects the integrity of the skin in those areas.

All of that being said, do not let these risks deter you from discussing surgery options with your doctors. If surgery will help improve your feelings about your gender identity and your overall mental health, then you should still explore options. There might be steps that you can take before surgery to help with your ods. A healthy lifestyle greatly diminishes these risks.

Further Secondary Sex Characteristics

In addition to development of breast tissue, you will also experience other changes to your sex characteristics. Being treated with the hormone Estrogen for your gender identity as a transgender woman will mean a decrease in muscle mass.

Facial hair will stop growing over time, and you will also notice redistribution of body hair over time. Changes to sexual function are common. You can either experience a decreased libido or just changes to your libido overall. If changes to your hair growth are taking too long (it can take a few years depending on the individual person), it is safe for you to explore hair removal or to simply continue your hair removal practices as they are.

The size of your genitals will decrease noticeably, which is likely to result in fewer erections, and then your breasts grow at least a cup size as well. These will be very noticeable changes, and your doctors will help you to achieve the maximum effect that you can from hormone therapy.

Fat distribution is the thing that takes the longest to settle (usually). Most changes will be quite evident in the first six months of hormone therapy, but redistribution of fat can take longer for most people.

All of these changes can be expected no matter at what age you start hormone therapy.

Additional Support for A Trans Person Transitioning at 40

Starting hormones like Estrogen and an anti-androgen medications around the age of 40 can be a wild ride. Despite the many risks involved in any medical treatment at that age, any doctor will tell you that medical care will indicate gender-affirming treatment at any age to address gender dysphoria.

Your health insurance will also cover this kind of treatment at any point in your life.

While hormone therapy, as mentioned in other articles on this site, does not change your personality, it can have unexpected changes to your temperament and might cause mood swings while your doctor tries to find a balance between an acceptable dose and maximum effect from Estrogen treatment.

To manage these changes, as well as any remaining dysphoria connected to your sex assigned at birth, you might benefit from seeking out mental health treatment. Many people make the mistake of thinking that transition will solve all of their problems and help them completely accept their body through the physical process.

This is, unfortunately, usually not the case. It will undoubtedly help your dysphoria, but it is not a magic wand that fixes all of your problems. There will still be elements on your body that Estrogen cannot change. If you keep comparing yourself to cis women, you will likely maintain a lot of your unhappiness and stress related to your body.

If you are striving for perfection in your male-to-female journey, or even affirmation for gender-nonconforming people, you will likely be disappointed. Perfection is never an attainable goal. Not even cisgender women have the perfect breasts or the perfect hips, and they are often also not entirely happy with their body. It is important not to confuse the unrealistic goal of perfection for shortcomings in your Estrogen hormone therapy.

Support from a professional source can really help you to get the best possible mental benefit from your transition. They can help you work through any anxieties you may have and can explain how your transition will be different from that of younger trans girls.

Self Medication of Estrogen At This Point In Life

As much as we recognize that self-medication is sometimes people’s only option, we do not advise self-medication at this point in life. While birth control pills are relatively easy to come by and are usually quite affordable, it is extremely difficult to manage hormone levels this way.

You are also putting strain on your liver and other internal organs by taking this type of medication at 40. It is uncommon for a cisgender woman to be taking birth control pills around 40 or older, and even so, it remains risky to do so no matter what your gender identity might be.

If you must make use of self-medication in a situation where you cannot have your hormones regularly monitored, which is, unfortunately, the case for some people, we would suggest that you research it in-depth and make sure to use the right type of birth control pill. Estrogen levels in these pills vary substantially, and many of them are not ONLY Estrogen but contain other hormones as well, and those hormones might not be conducive to transitioning.

It might be best to seek out a doctor online who can give you at least some guidance on which brand to try and how to best manage your self-medication if you do not have access to such health care locally.

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