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Raj Singh MD
September 6, 2023

Breast Development in Transgender Women: Hormone Therapy

Breast Development in Transgender Women

I am often asked what we can expect in terms of breast development after starting estrogen therapy by a many of of my transgender patients. This is an area of very limited research and I will do our best to shed some light on this topic

Breast Development in Transgender Women

Normal breast development: breast development is a complicated process that starts at birth in biological females and then accelerates during puberty.

There are 5 stages of breast development in biological females and transgender women. The timeline of breast development in transgender woman can vary significantly depending upon the age, dose and duration of feminizing hormone therapy with estrogen. There can also be variation depending upon the type of estrogen modality used such as oral estradiol versus topical, estradiol injection or estradiol pellets.

Stage I 3-6 months Tip of the nipple is raised
Stage II 6-12 monthsBreast buds appear, both the breast and the nipple gets enlarged.
A dark circle develops around the nipple which is called areola.
Stage III 12-16 monthsFurther enlargement of the breast tissue
Stage IV 2-3 yearsElevation of the nipple and the breast and increase in size of areola
Stage VTransgender women are unlikely to achieve this stage. Surgical breast implants are required if a larger breast size is desired.
Stages of breast development in transgender women

Transgender women MTF Transition Pictures

We are sincerely thankful to our patients for allowing us to use their transition pictures to help guide others in their journey.

Progesterone therapy:

Progesterone therapy is recommended for transgender patients to decrease the negative side effects of estrogen. In my personal opinion, Progesterone supplementation does not significantly change the development of breast tissue.

Testosterone blockade:

Testosterone suppression with anti androgen such as spironolactone, bicalutamide, finasteride or additional medications are required to augment breast development. Elevated testosterone levels have a negative effect on breast tissue development and ideally should be maintained below 100 ng per dL.

Dr. Raj Singh MD, FACP, FASN

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