For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you.
Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.
Hormone replacement therapy for transgender women
Estrogen and testosterone-blocking medications help transgender women develop a more feminized appearance in line with their gender identity while transitioning. It reduces the discomfort of gender dysphoria, the distress caused by having a gender identity that differs from the sex you were assigned at birth. Many transgender women experience less emotional distress, improved personal relationships, and a better overall quality of life as a result of hormone replacement therapy.
Feminizing hormone replacement therapy causes a variety of physical changes like breast development and facial and body hair reduction. You may also experience a loss of muscle tone and changes in your body shape as the body redistributes fat cells.
Feminizing hormone replacement therapy medication and timing
While your healthcare provider will help you develop an individualized treatment plan, feminizing hormone therapy often begins by taking 100 to 200 milligrams daily of a diuretic called spironolactone to begin blocking male hormone receptors and suppress testosterone production. Some individuals begin taking estrogen immediately, in tandem with spironolactone, to further reduce testosterone production and develop more feminine characteristics. In other cases, estrogen is introduced after several weeks of spironolactone use. Your doctor will recommend the best plan for your needs.
There are various methods for administering estrogen, including orally, by injection, or as a cream, gel, spray, or patch. Commonly used forms of estrogen during a male-to-female transition include:
- Oral: Estradiol tablets.
Note that your doctor may advise you to let the tablets dissolve under your tongue rather than swallowing them. This is called sublingual administration, which may lower your risk for blood clots since it bypasses the liver.
- Injections: Estradiol valerate (branded options include Delestrogen®) and estradiol cypionate (branded options include DEPO®-Estradiol)
- Patches: 17B-Estradiol patch
Feminizing hormone replacement therapy side effects
You may experience one or more of the following hormone replacement therapy side effects. Your doctor can advise you about the potential risks and benefits prior to starting hormones.
- A blood clot in a deep vein (also known as deep vein thrombosis) or in your lungs
- High levels of triglycerides, a type of fat found in the blood
- Weight gain
- High potassium levels
- High blood pressure
- Reduced libido
Feminizing hormone replacement therapy may also increase your risk for some chronic health conditions. Since estrogen affects how your body responds to insulin, it can lead to changes in your blood sugar levels and a greater risk for type 2 diabetes. Research into the impact of estrogen on your cardiovascular system is ongoing, and some studies have found a connection between estrogen therapy and a greater risk for heart disease and stroke. You may also face a greater risk of breast cancer after starting hormone replacement therapy.
Certain underlying health conditions may increase your risk of health complications related to the use of estrogen and testosterone-blocking hormones. It’s important to share your full medical history with your doctor, especially if you’ve had a hormone-related cancer, like prostate cancer, or a history of blood clots.
Feminizing hormone therapy and fertility
Gender-affirming hormone replacement therapy may affect your fertility, as it impacts sperm production. While some transgender women can produce sperm again after stopping hormone treatment, research indicates that this may not be the case universally, and there is a risk of permanent infertility with long-term use of hormones. If you would like to have biological children, ask your doctor about your options with freezing your sperm before starting hormones.
Hormone replacement therapy for transgender men
Hormone replacement therapy for transgender men during a female-to-male transition also combats gender dysphoria, leading to reduced emotional discomfort and better overall mental health.
During the process, you will take testosterone, which decreases estrogen production and suppresses menstruation. Testosterone is typically administered by injection (branded options include Delatestryl® and Tesamone®) or as a gel applied to the skin (branded options include AndroGel®, Testim®, Fortesta®, and Axiron®). In some cases, it may be applied as a patch or pellets positioned under the skin. If you have a persistent menstrual flow, your doctor might recommend taking progesterone to control it.
You may observe some of the following physical changes within several months of starting hormones, though individual responses to treatment varies:
- Deepening of the voice
- Facial and body hair growth
- Body fat redistribution
- Increased muscle mass and strength
Masculinizing hormone replacement therapy side effects
There are several potential side effects that transgender men may experience as a result of hormone replacement therapy, including the following:
- Overproduction of red blood cells
- Blood clot in a deep vein or lung
- Weight gain
- Pelvic pain
- Sleep apnea
- Abnormal cholesterol levels
- High blood pressure
Masculinizing hormone replacement therapy may also increase your risk for type 2 diabetes and cardiovascular disease.
You are more likely to experience one or more of these health complications if you have had breast cancer or have a history of blood clots. It may be unsafe to continue with hormone treatment if you are pregnant or breastfeeding. Be sure to discuss the potential risks and benefits of hormone replacement therapy with your doctor, and make sure they are aware of your full medical history.
Masculinizing hormone therapy and fertility
While some transgender men have sucessfully undergone egg freezing or IVF after starting hormone therapy, long-term use of hormones may lead to permanent infertility. If you want to leave open the possibility of starting a family by having children biologically, consult your doctor about your options for egg freezing before starting treatment.
Given that individual responses to testosterone treatment vary, you have a chance of becoming pregnant even while taking hormones. Your doctor can advise you about your options for birth control.
Baseline and follow-up testing for hormone replacement therapy
Before you begin hormone replacement therapy, your doctor will order tests to measure your baseline lipid, blood sugar, liver enzyme, and electrolyte levels, which may change throughout the course of your treatment. Your doctor will also evaluate your medical history to identify any health conditions that may affect treatment. This is also a good opportunity to discuss reproductive health and fertility considerations, including potential contraception options if you are a transgender man.
Throughout hormone therapy, you will have regular follow-up appointments with your healthcare provider to document physical changes in your appearance and monitor the impact of hormones on your lipids, blood sugar, and liver enzymes.
Hormone replacement therapy affects you emotionally as well as physically. In the long term, gender-affirming treatment, including both hormone therapy and surgery, can lead to better mental health, reducing the need for depression and anxiety-related treatment.
Your doctor will likely ask questions related to your mental health during your initial consultation — including any symptoms of gender dysphoria that you have experienced and how they impact you at work, school, or home — and continue the conversation throughout your treatment.
It’s important to be honest with your doctor about how you are feeling — your mental health matters as much as your physical health. Don’t be afraid to ask for mental health-related resources if you need extra support, and remember that your doctor is here to help you without judgment.
View the National Institute of Mental Health’s suggestions for finding mental health treatment, and the Human Rights Campaign’s list of LGBTQ mental health resources.
A pharmacy partner you can rely on
Alto is here to support your journey with hormone replacement therapy. Our team of patient care pharmacists has experience working with the LGBTQ+ community and is available to answer any questions you have about the process.
We also make it as simple as possible to stay on top of your medications, with same-day delivery and mediation management tools like reminders and auto refills in our app. Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging with our care team.
This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Many trans women are interested in estrogen through injection. Estrogen injections tend to cause very high and fluctuating estrogen levels which can cause mood swings, weight gain, hot flashes, anxiety or migraines. Additionally, little is known about the effects of these high levels over the long term.What are the side effects of hormone therapy for gender dysphoria? ›
- blood clots.
- weight gain.
- dyslipidaemia (abnormal levels of fat in the blood)
- elevated liver enzymes.
- polycythaemia (high concentration of red blood cells)
- hair loss or balding (androgenic alopecia)
Transgender women have a higher risk of venous thromboembolism, stroke and meningioma compared to cisgender men and cisgender women. Compared to cisgender men, transgender women have a higher risk of breast cancer and transgender women > 50 years old have a higher risk of fractures.What are the negative effects of hormone therapy? ›
Hormone therapy side effects can include vaginal dryness, discharge, itching, or irritation. It can also cause changes to the menstrual cycle and cause vaginal bleeding that is not related to a period. Hot flashes and night sweats. Hot flashes are very common for people receiving hormone therapy.What are the negative long term effects of testosterone for transgender? ›
Excess testosterone can result in mood symptoms or irritability, bloating, pelvic cramping, or even a return of menstruation. High levels of testosterone also result in increased estrogen levels, as a percentage of all testosterone in the body is converted to estrogen.What are the risks of FTM hormone therapy? ›
- Weight gain.
- Developing male-pattern baldness.
- Sleep apnea.
- A rise in cholesterol, which may increase the risk of heart problems.
- High blood pressure.
- Making too many red blood cells — a condition called polycythemia.
- Type 2 diabetes.
Estrogen injections tend to cause very high and fluctuating estrogen levels which can cause mood swings, weight gain, hot flashes, anxiety or migraines. Additionally, little is known about the effects of these high levels over the long term.Is hormone therapy for transgender safe? ›
Research has found that feminizing hormone therapy can be safe and effective when delivered by a health care provider with expertise in transgender care. Talk to your health care provider about questions or concerns you have regarding the changes that will happen in your body as a result of feminizing hormone therapy.What are the risks of transitioning? ›
- Hormone issues. While transitioning, you'll take hormones to achieve masculine or feminine effects. ...
- Cancer. Transgender people are at a slightly higher risk of developing some cancers that are tied to hormone use. ...
- Mental health issues. ...
- Sexually transmitted infections. ...
- Substance abuse. ...
- Heart disease. ...
Recovery time varies from person to person, so always follow the advice of your surgeon. Many people begin to feel more comfortable during the second week after their surgery. You'll need plenty of rest in the first two weeks. It's common to be back to your usual activities, including work, in six to eight weeks.
The progestogen part of HRT is often the one that can give side effects. It can cause premenstrual type symptoms (low mood, irritability, bloating, acne, fatigue, headaches).Who should not take hormone therapy? ›
MHT is not recommended if you have had hormone-dependent cancer (such as breast cancer and some uterine cancers). Your doctor may also advise you not to use MHT if it could increase your health risks, for example, if you have undiagnosed vaginal bleeding or heart disease.What happens to your body when you start HRT? ›
Hormone replacement therapy (HRT) is medicine used to treat the symptoms of the menopause. It is common to have side effects in the first few months of taking HRT. These usually settle on their own within 6 to 8 weeks. Side effects include weight gain, irregular bleeding, feeling sick (nausea) and skin irritation.What are the cons of going on testosterone FTM? ›
Risks Related to Testosterone Testosterone will change your overall health risk profile to that of a cisgender man. Your risk of heart disease, diabetes, high blood pressure, and high cholesterol may go up, though these risks may be less than the risks for an individual who is assigned male at birth or cisgender man.What happens if you stop taking hormones MTF? ›
If you stop taking hormones you may lose your hair faster than if you hadn't taken hormones. You may lose muscle and strength in your upper body. Your skin may become softer. Your body will make less testosterone.Can you get hard on estrogen? ›
Estrogen treatment inhibited sexual activity, spontaneous erections, and nocturnal penile tumescence. No significant effects on psychophysiological response to film and fantasy or frequency of sexual feelings were found, but the psychophysiological data were very variable.Is HRT worth the risk? ›
The benefits of HRT usually outweigh the risks for most women. The risks are usually very small, and depend on the type of HRT you take, how long you take it and your own health risks. Speak to a GP if you're thinking about starting HRT or you're already taking it, and you're worried about any risks.What are the risks of female to male transition? ›
It does carry some risks, however. These include hair loss, fertility changes, high blood pressure, and weight gain. Results will vary depending on several factors, including when the person begins treatment. Individuals who wish to learn more about T therapy can speak with a doctor.How long does it take to transition from male to female? ›
Take your time, transitioning can take a long time. On average it takes 2-3 years.Does HRT change your voice? ›
Feminizing hormones don't modify the voice for transgender women. Anti-androgens and estrogens have no effect on the voice.
Estrogen induces spinogenesis and synaptogenesis in these two brain regions and also initiates a complex set of signal transduction pathways via estrogen receptors (ERs).What are the positive effects of HRT MTF? ›
MTF HRT effect timeline:
|Effects||Expected Onset||Expected Maximum Effect|
|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||6-12 months||>3 years|
Hormone therapy can help ease symptoms of menopause. But it is associated with a lot of serious risks if used over the long term. Although the treatment lowers the risk of bone fractures, it increases the risk of cardiovascular disease (heart and blood vessel problems) and breast cancer.What is the best hormones for transgender? ›
Estrogen. Estradiol is preferred, as it most closely resembles the hormone produced by the ovaries. It is prescribed in a similar way to hormone replacement therapy for postmenopausal women, but with slightly higher doses. The dose of estradiol valerate tablets starts at 2–4 mg daily, increasing up to 8 mg.What age can transgender take HRT? ›
In twelve Member States, both the regulations for general surgery and express thresholds for transgender hormone therapy dictate the age of 18.What are the 4 stages of transitioning? ›
The stages are shock, anger, acceptance and commitment. People's initial reaction to the change will likely be shock or denial as they refuse to accept that change is happening.What are the three types of transitioning? ›
There are three main types of transitions someone could go through: social, legal, and physical.What are the stages of transitioning? ›
- Stage 1 – Self Discovery as Transgender. Becoming aware of gender identity can take time. ...
- Stage 2 – Disclosure to Others. ...
- Stage 3 – Socialization with Other Transgender People. ...
- Stage 4 – Positive Self-Identification. ...
- Stage 5 – Integration and Acceptance. ...
- Stage 6 – A Lifelong Journey.
Some pain and discomfort is normal during recovery from gender reassignment surgery, but some patients have additional issues that impede the normal healing process and may cause pain to linger or even worsen over time.Can MTF get bottom surgery? ›
MTF Bottom Surgery
These can include: Penile skin inversion vaginoplasty, with or without scrotal skin grafting. Revision vaginoplasty using small bowel or the rectosigmoid colon. Secondary genital reconstruction.
What is transfeminine bottom surgery? The goal of transfeminine bottom surgery, or feminizing genital surgery, is to reconstruct the male genitalia into female genitalia. Transfeminine bottom surgery is typically performed as a single stage procedure.What age should you start HRT? ›
You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first. However, a blood test to measure your hormone levels may be carried out if you're aged 40 to 45.Is there a natural alternative to HRT? ›
Several products are sold in health shops for treating menopausal symptoms, including herbal remedies such as evening primrose oil, black cohosh, angelica, ginseng and St John's wort.What does being on HRT feel like? ›
Some women who use HRT say they feel bloated or have breast soreness. Nausea, dizziness, headaches, and blurry vision are also possible side effects, as is vaginal bleeding. If you haven't had a period for at least a year and have any bleeding or spotting, tell your doctor.What should you avoid on HRT? ›
Avoid visible meat fat, butter, fried foods, cakes, pastries, packaged snack foods and biscuits.Can I stay on HRT for life? ›
There's no limit on how long you can take HRT, but talk to a GP about how long they recommend you take the treatment. Most women stop taking it once their menopausal symptoms pass, which is usually after a few years.Does HRT cause weight gain? ›
Summary. HRT does not cause weight gain. Side effects of HRT may feel like it but the reality is that bodies change in midlife. In fact, many women lose weight and feel considerably fitter on HRT.What does the first week of HRT feel like? ›
When starting HRT, it's very common to experience some initial side effects or start-up symptoms such as breast tenderness or breast size increase. Some women describe slight nausea, headaches or abdominal bloating. Light erratic bleeding is also quite usual.Does HRT increase breast size? ›
HRT contains hormones that stimulate breast tissue and so breast tenderness and growth can be a side effect of your hormone therapy. Speak to your doctor if you have any concerns about this.Will I lose weight if I start HRT? ›
Many women actually find that they lose weight by using HRT as it shifts the metabolism back into a pre-menopausal metabolic state. Progesterone can sometimes cause fluid retention which can mimic weight gain, but there are alterations that can be made to the regime to minimise this impact.
Improve Your Posture. While it might seem like just a minor change, having strong, masculine posture can help deepen your voice. Be sure to push your chest out and have your chin up, this will make it easier to project the necessary power and force into your voice.What level of testosterone is needed for FTM? ›
The ideal testosterone level for transmasculine people is between 300–1000 ng/dL. Your result will be under Testosterone, serum on your lab report.How long does testosterone stay in your system FTM? ›
If you take an anabolic steroid or undergo testosterone therapy, your body stops making its own testosterone and relies on the steroids you receive. Testosterone would only stay in your system for around three to four weeks if you stopped taking the steroids.Can you feel worse on HRT? ›
If you are unlucky, you may even find that HRT can make you feel worse before you feel better. Common side effects of oestrogen include bloating, nausea, indigestion, tender breasts, vaginal bleeding and headaches.Can coming off HRT cause anxiety? ›
Common Side Effects in Men and Women
If you stop HRT cold turkey, you may experience increased anxiety, depression, and changes in mood. Women who discontinue Bioidentical Hormone Replacement Therapy (BHRT) will likely experience a return of menopausal symptoms, as well.
|Oral||Estradiol||2–4 mg daily|
|Parental (subcutaneous, intramuscular)||Estradiol valerate||5–30 mg every 2 weeks|
|Transdermal||Estradiol||0.1–0.4 mg twice weekly|
|Anti-androgens||Progesterone||20–60 mg PO daily|
Estrogen, progesterone, and testosterone all affect sexual desire and arousal. Having higher levels of estrogen in the body promotes vaginal lubrication and increases sexual desire.Why am I getting a hard on? ›
An erection is often triggered when an individual becomes aroused by thinking about, seeing, or feeling something or someone who is sexually exciting. The brain sends signals that widen the arteries connected to the penis, allowing more blood to enter.Does estrogen make you bigger? ›
Estrogen promotes the storage of fat for healthy reproductive years. When estrogen is balanced, the right amount of fat helps carry out female reproductive functions. However, when there's too little or too much estrogen, weight gain often results.What are the long term effects of gender dysphoria? ›
Anxiety, depression, self-harm, eating disorders, substance misuse and other problems can occur. People who have gender dysphoria also often experience discrimination, resulting in stress.
About 5 to 10 percent of women treated with HRT have side effects which may include breast tenderness, fluid retention and mood swings. In most cases, these side effects are mild and do not require the woman to stop HRT therapy. If you have bothersome side effects from HRT, talk to your doctor.How does feminizing hormone therapy affect the body? ›
General effects include breast development (usually to Tanner stage 2 or 3), a redistribution of facial and body subcutaneous fat, reduction of muscle mass, reduction of body hair (and to a lesser extent, facial hair), change in sweat and odor patterns, and arrest and possible reversal of scalp hair loss.What happens if you don't treat gender dysphoria? ›
Although gender dysphoria is not a mental illness, when not addressed, it may lead to worsening mood issues, depression and anxiety, and may further complicate the issues the individuals may be having. Insurance may cover some illnesses associated with gender dysphoria and gender dysphoria care.How does gender dysphoria affect the brain? ›
A recent study investigated the volume of grey matter in individuals with GD and found that they had a smaller volume in the left posterior superior hemisphere of the cerebellum compared to male controls and a smaller volume of the right inferior orbitofrontal cortex compared to female controls.What is the root cause of gender dysphoria? ›
The exact cause of gender dysphoria is unclear. Gender development is complex and there are still things that are not known or fully understood. Gender dysphoria is not related to sexual orientation. People with gender dysphoria may identify as straight, gay, lesbian or bisexual.What are the most common side effects of hormone therapy? ›
- Hot flashes.
- Decreased sexual desire.
- Erectile dysfunction (trouble getting an erection)
- Bone loss and a higher risk for fractures.
- Weight gain (especially around the belly) with decreased muscle mass.
- Memory problems.
- Increased risk of other health problems.
The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk.What is the age limit for HRT? ›
Hormone therapy can be extremely beneficial for bone health purposes for women up to the age of 60 years, and in some circumstances women may continue hormone therapy after this age, depending on their general health, family history and bone density / history of fracture.