Hormonal congruence is most often achieved through which approach?

• A. Testosterone alone
• B. Most often estrogen supplementation with androgen blockade, or androgen supplementation
• C. Estrogen alone
• D. No hormonal therapy

Answer: (B)

Hormonal congruence means aligning a person’s hormone exposure and resulting secondary sex characteristics with their gender identity to reduce distress and support wellbeing. In practice, achieving this typically involves regimens that both replace the hormones that match the desired gender and suppress the hormones that do not.

Most often, for someone transitioning to a female gender role, this means estrogen supplementation together with androgen blockade to reduce the body’s testosterone effects, producing feminizing changes while lowering masculine traits. For someone transitioning to a male gender role, it means providing androgen (testosterone) supplementation to promote masculinizing changes. This dual approach—either estrogen with antiandrogens or testosterone supplementation—best achieves a hormonal environment that matches the person’s gender identity.

Why the other options aren’t the best fit: estrogen alone may not fully feminize if endogenous testosterone remains active; or androgen blockade alone without adding estrogen would not feminize someone seeking female characteristics; testosterone alone would masculinize someone who does not want those changes. No hormonal therapy would leave hormone levels and traits misaligned with gender identity.