Disclaimer: I am not a doctor. Before using any medical information from the Internet, consult with a doctor first. The information provided below is for information purposes only and is not intended as medical advice. This is also not exhaustive – do your own research for information that isn’t covered here.
Why take feminizing hormones?
Starting feminizing hormones is a huge step on the path to aligning mind and body for trans women. They alter mood and body, and as the WPATH (World Professional Association for Transgender Health) SOC (Standards of Care, Version 7) points out:
Hormone therapy can provide significant comfort to patients who do not wish to make a social gender role transition or undergo surgery, or who are unable to do so (Meyer III, 2009).
Obviously, most people who socially transition also take feminizing hormones.
The comfort referred to above is related to physical and emotional changes that hormones drive.
What about anti-androgens?
Anti-androgens bind to testosterone, a masculinizing hormone, and can help reduce the amount of estrogen needed to suppress testosterone and thus drive feminization. This has the added benefit of reducing some estrogen-related medical risks. Additionally, anti-androgens tend to help reduce overall body hair and halt male pattern baldness.
Anti-androgens are not required for feminizing hormones to be effective, but as described below, this will vary from person to person. In general though, the lower the testosterone level, the more effective estrogen will be in driving physical changes, which is why estrogen is most often paired with an anti-androgen.
What physical changes will feminizing hormones bring?
Feminizing hormones drive female secondary sex characteristic development and decrease male secondary sex characteristics. In general, this means breast growth and fat redistribution to a more female pattern and loss of muscle mass/strength, impotence, and sterility.
The following table, adapted from the SOC, highlights most physical changes. Time ranges are estimates based on published and unpublished clinical observations.
|Effect||Expected onset||Expected maximum effect|
|Body fat redistribution||3-6 months||2-5 years|
|Decreased muscle mass/ strength (dependent upon amount of exercise)||3–6 months||1–2 years|
|Softening of skin/decreased oiliness||3–6 months||Unknown|
|Decreased libido||1–3 months||1–2 years|
|Decreased spontaneous erections||1–3 months||3–6 months|
|Male sexual dysfunction||Variable||Variable|
|Breast growth||3–6 months||2–3 years|
|Decreased testicular volume||3–6 months||2–3 years|
|Decreased sperm production||Variable||Variable|
|Thinning and slowed growth of body and facial hair (full hair removal only possible with electrolysis and/or laser)||6–12 months||More than 3 years|
|Male pattern baldness||No regrowth, loss stops 1–3 months||1–2 years|
Effects will be highly variable from person to person. The SOC is clear on this (emphasis added):
The degree and rate of physical effects depends in part on the dose, route of administration, and medications used, which are selected in accordance with a patient’s specific medical goals…and medical risk profile. There is no current evidence that response to hormone therapy…can be reliably predicted based on age, body habitus, ethnicity, or family appearance. All other factors being equal, there is no evidence to suggest that any medically approved type or method of administering hormones is more effective than any other in producing the desired physical changes.
What emotional changes will feminizing hormones bring?
I have been unable to find any clinical studies of the emotional impacts of feminizing hormones. Everything is anecdotal or accepted “community wisdom”. It is also hard to disentangle the relief of starting hormones, which many consider an emotionally significant step in transition, from their actual effects.
In general, many report feeling calmer in general, and for those who self-report with anxiety or depression, some may notice a lessening or cessation of symptoms. For some, emotional range and response becomes wider and more intense. Dosages and formulations seem to impact emotional response, so pay close attention in the weeks when you start or change either.
The limits of knowledge
There is no clear scientific consensus on how dosages and formulations affect physical or emotional outcomes or rate of changes. Also, while some changes (such as breast tissue growth) are permanent even if hormones are stopped, it is impossible to predict the tipping point at which hormonally-driven changes would revert to a pre-feminizing hormones state, if at all.
What this means in practical terms is that dosage and formulation prescriptions are really best guesses by your doctor based on your medical history and condition, that you may need to change one or both to drive desired physical changes, and that even then you may not achieve your desired outcome.
Just as everyone’s transition is different, your response to hormones will be different from everyone else. Listen to your body and evaluate information from your doctor before making any changes.
The risks of feminizing hormones
Taking hormones significantly increases the risks and likelihood of potentially life-threatening illnesses. These risks are compounded if you have pre-existing risk factors such as age, family history, or an existing condition. Consult with your doctor to understand your personal risk profile and how dosages and formulations impact it.
The risks include:
- Venous thromboembolic disease (blot clots)
- Elevated liver enzymes
- Weight gain
- Hypertriglyceridemia (high cholesterol)
- Cardiovascular disease (heart disease)
- Hypertension (high blood pressure)
- Hyperprolactinemia or prolactinoma (tumor growth)
- Type 2 diabetes
- Breast cancer
Some of these risks are life-threatening. Carefully consider if the risk of premature death is worth it.
What are typical dosing ranges and formulations?
Often, feminizing agents are prescribed along with an anti-androgen, but it is not required. The following table is adapted from Jamie Feldman & Joshua Safer (2009): Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of the Standards of Care , International Journal of Transgenderism, 11:3, 146-182.
As always, discuss dosages and risk factors with your doctor.
|Type||General dosage range||Class/use|
|Oral estradiol||2.0–6.0 mg/day||Feminizing agent|
|Transdermal estradiol patch||0.1–0.4 mg twice weekly (some brands are weekly dosing)||Feminizing agent|
|Injected estradiol valerate||5–30 mg every 2 weeks||Feminizing agent|
|Injected estradiol cypionate||2–10 mg every week||Feminizing agent|
|Cyproterone acetate||50–100 mg/day||Anti-androgen|
|Goserlin acetate||3.75 mg SQ monthly||Anti-androgen|
|Medroxyprogesterone||10–40 mg/day||Feminizing agent|
|Micronized progesterone||100–200 mg/day||Feminizing agent|
No matter if you’ve just begin taking feminizing hormones or have been taking them for decades, listen to your body. If something doesn’t feel right physically or you notice mood swings, consult a medical professional immediately.
Also, pay close attention to your medication. There are often several manufacturers of the same medication, and it’s not uncommon for pharmacies to switch manufacturers without notifying you, so make a note of your manufacturer (pills are stamped with a code which you can look up) and compare new prescriptions with older ones for continuity. Some people report negative effects with changes like that and it’s good to have the discussion with your doctor about ensuring you receive a formulation that works for you.
What’s it like to take feminizing hormones?
If you’re interested in the nitty-gritty of what it feels like and how it affects your body, you might be interested in reading through my weekly HRT check-ins. I’m only a single data point and everyone responds differently, but if you read my posts and compare them with others, you’ll see common themes like physical and emotional changes and what it’s like day-to-day.
Good luck and best wishes!