Transgender Male to Female Hormone Therapy. What to Expect
A guide to gender-affirming care
Gender identity is an innate sense of feeling different than one’s anatomy. Estrogen Hormone Therapy is a possible way to transition from a male to a female. People want the changes from hormone therapy to happen rapidly, but there are some expectations, long-term considerations, medications, and other factors that need to be understood. These factors can include genetics, a person’s age when taking the hormone therapy, and the overall state of health of a patient.
Changes from Estrogen Hormone Therapy
There are four main stages that the changes happen in as the Estrogen Hormone Therapy continues.
As Estrogen Hormone Therapy progresses, the skin can become thinner and drier. Pores produce less oil and become smaller. You may notice that you develop cuts or bruises more often and the odor from your urine and sweat change. You may sweat less as well.
You may experience temperature and pain differently due to a difference in touch. Small ‘buds’ can develop under the nipples within a few weeks. Touching them may result in slight pain, and they can also look uneven. This is a normal process for breast development, and the pain will diminish over the next few months. The size and shape of the breasts can vary from person to person.
The body also begins to redistribute fat to different parts of the body. Fat will collect around the thighs and hips while the muscles on the legs and arms will look less defined. Strength and muscle mass will also decrease, which is why at HEALOR, we recommend exercising to maintain general health and muscle tone.
The face and eyes also look more feminine as the fat shifts or increases. It may take a few years to develop, which is why it is better to wait at least two years before you take any drastic feminization steps via procedures.
The hair on the body, including arms, back, and chest will grow less thick. Their growth will also slow down with time. Facial hair will also grow slower and thin out. However, it will not go away completely without laser treatments and electrolysis.
Some people also notice changes in height or shoe size, but this is very minor.
Changes in the emotional state vary according to the person. The transition is often similar to puberty and feels like a roller coaster. You may feel like you are experiencing more feelings or emotions and even developing different pastimes, tastes, interests, and behavior in relationships. If these changes are affecting the quality of life then we generally will discuss reducing dose of Estrogen. Some people may need supportive psychotherapy during these changes.
After beginning Estrogen Hormone Therapy, you will notice that the number of erections you experience has lessened. It may also not be firm enough or last long enough to penetrate. However, you will be able to experience orgasms and even have erotic sensations.
Some people also find that different parts of the body and sex acts are pleasurable now. Orgasms can have less peak intensity and begin to feel as though they impact the whole body rather than just the genitals. People may have ejaculations with white or clear fluid or even none at all. Exploring and experimenting with this newfound sexuality and body through sex toys and vibrators can be great, as well as involving a significant other.
The testicles can also shrink to half their original size.
Reproductive System Changes
Within a few months of Estrogen Hormone Therapy, you should assume that you are irreversibly and permanently sterile. Some may maintain a sperm count or have their sperm count return to normal after stopping Estrogen Hormone Therapy, but that is a very rare occurrence.
If you want to have children through your own sperm, you can speak to us at HEALOR about preserving your sperm before starting this therapy. While you are on the hormone treatment and have sex with a woman who can become pregnant, it is a good idea to use birth control.
Estrogen Hormone Therapy Treatment
The hormone, estrogen, influences most feminine characteristics. It can be given by pill, injection, or skin preparations like patches, sprays, gels, and creams. Pills are effective, cheap, and convenient, but if you’re older than 35 or smoke, their safety can be compromised. Patches are also safe and effective, but you will need to wear them all the time. They can also irritate the skin. We generally start Estrogen at dose of 2 mg/day and titrate the dose to achieve the desired results while limiting negative side effects.
Most transwomen take in estrogen via injection. Injections can cause fluctuating or high estrogen levels, resulting in weight gain, mood swings, anxiety, migraines, or hot flashes. There isn’t much information with regards to taking high levels of estrogen over a long time.
Contrary to popular belief, relatively small doses of estrogen can actually have the most effect on the transition. Taking higher doses don’t necessarily make the changes happen quickly and may even harm your health. After going through orchiectomy (the removal of testicles) or genital surgery, the estrogen dosage should be lowered by the doctor. Without testicles, you will need less estrogen for good health and feminine characteristics.
You will periodically need to get liver function, cholesterol, and diabetes screenings to check on your health while on estrogen.
The risks of strokes, cancer, and blood clots are small but do increase. Doctors do believe that the risk of prostate cancer may go down, but there isn’t enough scientific evidence for this. It is better to follow standard testing guidelines according to your age. The risk of breast cancer can slightly increase but still remains lower than that of a non-transgender female. After 2-3 years of Estrogen Hormone Therapy, it is a good idea to get breast cancer screenings, depending on your age and risk factors.
There hasn’t been a lot of research on the use of estrogen by transwomen. This is why there may be other risks that may exist that doctors aren’t aware of. This is especially true for transwomen who have been using estrogen for many years.
At the end of the day, it is important to consider all the different changes you will go through with a clear mindset. Transitioning is an important step for anyone, and proper care should be taken with your health as you go through it.
Transgender health and Transgender hormone therapy is a highly specialized field and it is important to find a transgender clinic that has experience in managing hormone therapy for transgender patients.