Alcohol is a part of many social and cultural experiences, from toasting at celebrations to unwinding after a long day. But for people on gender-affirming hormone therapy (GAHT), it’s important to understand how alcohol and hormones interact and how drinking could impact your overall health. While it’s common knowledge that alcohol affects the liver, mood, and even sleep, what does this mean when you’re a trans or nonbinary (TGNC) person taking testosterone or estrogen?
Excessive alcohol consumption is quite common in the transgender community, especially during early to middle adulthood. Reports indicate that the discrimination and stigma faced by transgender individuals often create conditions that lead to higher alcohol use. Additionally, the 2015 U.S. Transgender Survey revealed that binge drinking is more prevalent in transgender communities of color compared to white non-Hispanic peers. These factors highlight the need for us to understand how alcohol might impact our hormone therapy and overall health. Let’s dive into the impact of alcohol on GAHT, explain how alcohol might affect hormone levels, and provide practical guidance for trans people navigating these concerns.
Table of Contents
How Alcohol Affects the Body
Before we get into the specifics of alcohol and GAHT, it’s helpful to understand how alcohol generally impacts the body. Alcohol is processed by the liver, and excessive drinking can strain the liver over time, leading to conditions like fatty liver disease and even cirrhosis. When the liver is overworked, it can interfere with the body’s ability to metabolize hormones, which is why understanding this relationship is so important for people on hormone therapy.
When the liver cannot efficiently break down hormones, it can lead to an excess or deficiency of certain hormones. For example, if your liver is sluggish or unhealthy, it cannot effectively regulate and remove estrogen, which can lead to a possible hormone imbalance. Another hormone affected by alcohol is cortisol, often known as the “stress hormone.” Alcohol can increase cortisol levels, which can lead to increased stress and anxiety. High cortisol levels can also interfere with other hormones, further complicating our hormonal balance.
Another important aspect is how alcohol impacts insulin, the hormone that regulates blood sugar levels. Excessive drinking can lead to insulin resistance, making it harder for the body to manage sugar levels effectively. This can be particularly concerning for those of us who may already be dealing with hormone-related changes in our metabolism.
Prolactin, a hormone that influences lactation and reproductive health, can also be affected by alcohol. Higher levels of prolactin due to alcohol consumption can lead to issues like infertility and decreased libido.
Lastly, alcohol can interfere with the thyroid hormones, which play a crucial role in regulating our metabolism. An imbalance in thyroid hormones can lead to symptoms like weight gain, fatigue, and mood changes, making it even more challenging to maintain a healthy, active lifestyle.
In addition to the physical impact, long-term heavy drinking can impair cognitive function, disrupting sleep and increasing the risk of mental health disorders like depression and anxiety. While a drink or two might help you relax in the moment, heavy or regular drinking can actually make mental health symptoms worse in the long run. If you’re already experiencing anxiety, depression, or other mood disorders, alcohol can compound these symptoms even further. This is particularly important to keep in mind if you’re already managing anxiety or depression during your transition. By being mindful of our alcohol consumption, we can help maintain a more balanced hormonal system and support our overall health.
Alcohol and GAHT
Transgender people who consume alcohol may face additional social and health risks compared to cisgender individuals. Studies have shown that transgender people may experience greater harm from alcohol use, such as an increased risk of being targeted for violence. Additionally, heavy drinking among trans adults is linked to a higher incidence of cirrhosis, a serious liver condition.
Alcohol-related liver disease is notably higher in the transgender community. Research indicates that alcohol is the leading cause of cirrhosis in trans patients, accounting for about 60% of cases. This underscores the importance of timely interventions and education on the risks associated with alcohol consumption for those of us on gender-affirming hormone therapy.
Testosterone Therapy
For trans men and non-binary folks on testosterone, the interaction between alcohol and testosterone is an important consideration. Here’s what we know from clinical insights:
- Alcohol’s Effect on Natural Testosterone Production: In cisgender men (people assigned male at birth), chronic heavy drinking can decrease the production of testosterone. Alcohol lowers testosterone levels by impairing the function of the testes, reducing hormone production. But this decrease in testosterone production only applies to folks who rely on their body’s natural production of testosterone, such as cisgender men. Since trans men and non-binary people on GAHT receive testosterone from an external source (usually injections or gels), alcohol won’t have the same effect on testosterone levels. Your body’s natural production of testosterone is less relevant because your hormone levels are regulated by the testosterone you’re taking.
- Testosterone and Estrogen: There’s some evidence to suggest that testosterone therapy might increase estrogen levels in the body. However, this has only been observed in cis men who have alcoholic liver disease. In these cases, alcohol-induced liver damage can cause an increase in estrogen because the liver isn’t able to break down estrogen properly. While this might sound concerning, it’s only been demonstrated in people with chronic liver damage due to long-term alcohol abuse. For trans men and nonbinary folks who aren’t drinking excessively and don’t have liver disease, this isn’t a major concern. That said, it’s always a good idea to avoid heavy drinking for the sake of your liver health, especially while on GAHT.
- General Health Considerations: Alcohol’s impact on your overall health is just as important as its effect on hormone therapy. Heavy drinking can lead to weight gain, which may affect how your body responds to testosterone. It can also interfere with your sleep, mood, and energy levels, which are all crucial to feeling your best while transitioning.
Estrogen Therapy
For trans women and nonbinary people on estrogen, the interaction between alcohol and hormone therapy also warrants attention:
- Alcohol’s Effect on Natural Estrogen Production: In cis women (people assigned female at birth), alcohol can increase estrogen levels. This is because alcohol affects the liver’s ability to metabolize hormones, leading to higher levels of estrogen circulating in the body. However, the impact of alcohol on estrogen levels isn’t fully understood, and research is still ongoing. That said, trans women and non-binary folks on estrogen are already taking external estrogen, so similar to testosterone, the body’s natural production isn’t as relevant. Please note that alcohol should not be considered a method for influencing estrogen levels, as its effects on hormone balance are unpredictable and can have other health risks.
- Liver Health and Estrogen: Since the liver plays a significant role in metabolizing hormones, maintaining liver health is especially important for trans women on estrogen therapy. Chronic alcohol consumption can lead to liver damage, which can impair the liver’s ability to process estrogen. This can result in unpredictable hormone levels and increase the risk of side effects from estrogen therapy. Keeping alcohol consumption to a moderate level or less is key to ensuring your hormone therapy is as effective as possible.
- Blood Clots: One of the known risks of estrogen therapy is an increased chance of blood clots. While this risk is generally low for most people, alcohol can increase the likelihood of blood clots, especially when consumed in large quantities. This is another reason why it’s essential for people on estrogen to drink alcohol in moderation.
Tips to Manage Alcohol Consumption
By being mindful of our alcohol consumption and staying informed about how it interacts with our hormone therapy, we can help ensure that our GAHT is as effective and safe as possible. Consider shifting to moderate alcohol consumption. Moderate alcohol consumption is defined by the CDC as up to one drink per day for women (including trans women) and up to two drinks per day for men (including trans men). This amount is generally considered safe. Occasional drinking is unlikely to significantly impact hormone therapy, but frequent or heavy drinking can interfere with your overall health and the effectiveness of your treatment.
In addition to managing your alcohol consumption, we highly recommend prioritizing your liver health. Since both testosterone and estrogen are processed by the liver, it’s important to keep your liver in good shape. Drinking excessively can impair your liver’s ability to metabolize hormones, which may lead to fluctuating hormone levels and unpredictable side effects. If you’re concerned about your liver health, consider limiting alcohol to special occasions or social settings, and be mindful of how much you’re drinking.
For some trans people, alcohol is a part of their social life, and it can be hard to say no, especially in situations where others are drinking. It’s okay to make choices that prioritize your health, whether that means limiting alcohol or choosing not to drink at all. If you’re in environments where alcohol is a big part of socializing, you can still participate by sipping on non-alcoholic drinks or setting limits for yourself.
By keeping alcohol consumption in check and focusing on your mental and physical health, you can ensure that your GAHT is as effective as possible and continue to thrive on your gender journey. If you have any concerns or questions about alcohol and your hormone therapy, don’t hesitate to talk to your healthcare provider. They’re there to support you, offer guidance, and help you make informed decisions about your health.
Remember, transitioning is a deeply personal journey, and taking care of yourself along the way—whether that means moderating alcohol use or focusing on self-care—is an important part of the process.
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