Massage Therapy Journal Summer 2025

64 • Massage Therapy Journal

AMTA Continuing Education

produced by the ovaries and testes. The most common gonadal hormones used by transgender individuals are androgens (mainly testosterone) and estrogens; sometimes progestogen is used. Hormone blockers are also used. • Estrogen is produced by the ovaries and is commonly used for feminizing therapy. The drug is given in a cream or by oral, sublingual or transdermal routes. • Androgen blockers (antiandrogens) suppress testosterone production and male secondary sexual characteristics. However, the effect is less reliable because the sexual characteristics established by puberty are largely not reversible. Androgen blockers may also be used to decrease masculinization in patients with contraindications to estrogen therapy. • Testosterone is produced by the testes and can be administered by injections; implanted as pellets; used orally; or administered transdermally by creams, gels or patches. Hormonal Therapy and Massage There are a few massage considerations for transgender clients taking masculinizing hormones such as testosterone or feminizing hormones such as estrogen. • Topical secondary exposure is the unintentional transfer of topically applied hormones to another person. There are several things that can be done to reduce this risk. First, ask the client to bathe or shower before the massage, which helps reduce the risk of secondary exposure by over 80%. 47 Handwashing after the massage also reduces risk, which is the standard of care. You can also use barrier methods, which include the client wearing clothing over the application site and your wearing disposable gloves during massage to the area of application. 48 • Skin rash is a side effect that can occur from taking testosterone and may present as acne or blemishes on the skin. These

areas are local contraindications and should be avoided. • Breast tenderness from breast development can occur from taking estrogen. Consider placing a soft pillow under the chest and/or across the shoulders for comfort and support while the client is lying prone. 50 • Blood clots or deep vein thrombosis (DVT) is a greater risk for those taking feminizing or masculinizing hormone therapy. 51 If a client has been diagnosed with DVT, the affected extremity is a local contraindication and should be avoided. Otherwise, look for signs and symptoms of DVT. These include unilateral leg swelling, heat, redness or noticeable discoloration and pain. If signs and symptoms of DVT avoided. Massage has been found safe with precautions taken, such as screening for DVT and avoiding the affected extremity. 52 Most DVTs are in the leg or calf region. 53 Gender Reassignment/ Affirming Surgery Surgeries available to the transgender population can alter a person’s physical appearance and sexual characteristics to match their identified gender. 54 There are many types of gender-affirming surgeries, and a few are listed here. A transgender individual can also have vocal surgery to change the pitch of their voice. • Facial reconstructive surgery can make facial features more masculine or feminine, such as reshaping the nose, chin and jaw. It also includes brow lift and lip augmentation. • Top, or chest, surgery includes changes to the chest to remove breast tissue for a more masculine appearance or enhance breast size and shape for a more feminine appearance. • Bottom, or genital, surgery includes changes to the genitals and includes are present, the affected extremity is a local contraindication and should be

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