How do regulatory frameworks around hormone therapy reflect broader societal anxieties about bodily autonomy?
Hormones are chemical messengers that regulate various biological processes in the human body. They influence physical, emotional, psychological, cognitive, social, and behavioral aspects of people's lives. Hormonal changes occur throughout life due to developmental stages, ageing, puberty, reproduction, and disease. Hormone replacement therapy (HRT) can be used to alleviate health problems caused by endogenous hormonal imbalances.
Postmenopausal women may take HRT to relieve symptoms such as hot flashes and vaginal dryness.
Some individuals seek HRT to change their bodies for non-medical purposes, including transgender transition and gender confirmation surgery. This raises concerns about whether it is appropriate for the government to restrict access to hormones based on what constitutes 'normal' or acceptable forms of embodiment.
The history of HRT reveals how changing cultural norms regarding gender identity have influenced medical practices. In the mid-20th century, sex was classified as a binary male/female dichotomy, with masculinity viewed as superior to femininity. Physicians often treated men who wished to transition into women with electrolysis, castration, and hysterectomies, while feminizing trans men received less attention. By the 1980s, doctors started prescribing HRT to trans patients without requiring them to undergo genital surgeries first. As medical advancements improved, more options became available, including estrogen patches and injections.
Not all countries allow easy access to HRT, which reflects society's conflicting attitudes towards gender diversity.
In the United States, the FDA has approved three types of HRT: estradiol, testosterone, and dihydrotestosterone. The U.S. Endocrine Society recommends that these hormones be administered only when medically necessary to treat ageing or menopause symptoms. The FDA also regulates other drugs such as progesterone, human chorionic gonadotropin (HCG), and oxytocin, but they are not commonly used for HRT. The Food and Drug Administration Advisory Committee recently suggested stricter regulations on compounding pharmacies that prepare customized HRT formulations due to safety concerns. This decision raises questions about who should decide what constitutes 'normal' hormonal balance, since individual needs may differ from population averages.
On a global scale, different societies have varying approaches to HRT accessibility and regulation. In Canada, for example, individuals can obtain HRT through a doctor's prescription. Brazilian laws require doctors to provide informed consent before giving hormones and prohibit HRT advertising aimed at minors. Some European countries like Sweden provide free HRT, while others restrict access based on sex characteristics. Many Asian countries do not offer any form of transgender healthcare or gender-affirming surgery. Even within one country, regional differences in policy implementation can lead to disparities.
In the US, Texas limits access to puberty blockers and hysterectomies for trans people under 18, whereas California allows them with parental consent.
Social norms surrounding body modification and gender identity affect how governments view HRT. The question remains whether regulating hormone therapy is necessary to prevent misuse or harmful effects, or if it violates bodily autonomy by denying access to those who desire it. As medical knowledge expands, new technologies emerge that enable people to manipulate their physical appearance and sexuality. How will society respond to this growing trend?
How do regulatory frameworks around hormone therapy reflect broader societal anxieties about bodily autonomy?
Historically, there have been concerns regarding women's bodies and their control over them. The concept of bodily autonomy has been a part of feminist discourse for centuries, emphasizing that one should have the right to determine what happens with one's body. With regard to medical interventions such as hormonal treatments, there is often tension between professional expertise and individual agency.