does hormone therapy make people metabolize alcohol differently

Vanity Fair‘s July 2015 cover story brought an unprecedented amount of attention to one of America’s most marginalized communities. Caitlyn Jenner, who until just the previous April had been known as Olympian Bruce Jenner, graced the cover, sitting on a stool with her hands behind her back in a white corset. Shortly after, Jenner sent out a tweet that Time ranked as the 10th most retweeted tweet in 2015: “I’m so happy after such a long struggle to be living my true self. Welcome to the world Caitlyn. Can’t wait for you to get to know her/me.”

Jenner helped make 2015, as CNN later put it, the year “that transgender people, long relegated to society’s shadows, are finally stepping into the light.” Years of being ignored, however, have left plenty of unanswered medical questions in the community.

One lingering question is how alcohol affects people who undergo hormone replacement therapy (HRT). We know that male and female bodies metabolize alcohol differently. Women’s bodies in general have less water than men’s, so even if a woman is the same weight as a man, she will get more drunk from the same amount of alcohol. But we also know that the biggest factor in how alcohol affects people is the size of the person. Would hormone replacement therapy impact how trans people metabolize alcohol?

Hormone replacement therapy, the National Institutes of Health writes, can affect a person’s height and build, how fat is distributed throughout the body and the amount of muscle mass. It can make someone’s body appear more feminine or masculine, but “whether you are a trans man or a trans woman, you will need to be realistic about the extent of the changes you can expect. Although hormones taken in adulthood can help to keep your bones healthy, they cannot alter your skeletal shape or your height.”

As far as studies on how HRT impacts alcohol metabolization specifically, the data just doesn’t exist yet, John Steever, a doctor at Mount Sinai in New York City, tells me over the phone.

“I do know that testosterone is metabolized by the liver, and so if you have liver damage for whatever reason — and alcohol can be one of those things — then your ability to metabolize the testosterone can be impaired,” Steever says. “Generally speaking, in a healthy person, there shouldn’t be much difference pre- and post-transition.” At the end of the day, metabolizing alcohol has more to do with body size than hormone therapy, Steever says.

Several threads about drinking alcohol can be found on Reddit’s asktransgender subreddit. The responses vary and rely heavily on anecdotes in the absence of research. “I found that I can’t hold my booze as well as I used to,” user uragaaru posted. Other’s advise to only drink in moderation. Still others, like user tt5969, say that a transgender woman metabolizes alcohol “slightly worse than your average cis woman of similar proportions actually, as the liver has a (sic) additional burden due to HRT.”

All but one of the transgender people and support organizations I reached out to denied an interview to talk about science or personal anecdotes on the record. One person went as far as to tell me over the phone that a story about alcohol would do damage to the community. It’s easy to comprehend why people are reticent. The Office of Justice Programs reports that one in two transgender individuals are sexually abused or assaulted at some point, and the current political climate hasn’t exactly been conducive to empathy and understanding.

The good news is that funding and research are coming. The NIH is funding research that looks into hormones and the effects of hormones on the body, Steever says. Mount Sinai is setting up a transgender medicine and surgery program, which will have a research arm.

“Hopefully in the next few years, data will be generated around the medical transition, physical health and mental health,” Steever says.

Above all, he says, “like everyone else, you’ve got to drink in moderation.”