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August 27, 2023

Transgender Male to Female Hormone Therapy What to Expect

Transgender Male to Female Hormone Therapy. What to Expect

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.

Transgender Male to Female Hormone Therapy What to Expect

Changes from Estrogen Hormone Therapy

There are four main stages that the changes happen in as the Estrogen Hormone Therapy continues.

Physical Changes

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.

Emotional Changes

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.

Sexual 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 a dose of 2 mg/day and titrate the dose to achieve the desired results while limiting adverse 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 regard 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. 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.

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10 comments on “Transgender Male to Female Hormone Therapy What to Expect”

  1. I’ve been on gels now for 3 months I notice one nipple has buds growing as it’s a little sore when I press it . But the other side nothing ? Am I doing something wrong

    1. Hi Keira, Thanks for the comment. Please make sure that you are not applying the gel directly on the breast. I have a video on this topic on my youtube channel Top Mistakes to Avoid When Applying Hormone Creams. Uneven breast devlopment is common and you just started hormone therapy. if after 6 months the other breast is not developing than please discuss with your doctor.

  2. I just wanted to see if the replacement therapy can cause suicide thoughts,,, my grandson was going from male to female and I don’t think the doctors kept a eye on the levels ,,, in a year or so mentally unstable in and out hospital,, trying to kill self … and to weeks ago found died !!! I sa it was the hormones!!!!!

    1. Hi Dottie,
      Thank you for your comment and I so sorry to hear about your loss. Unfortunately, suicides and mental health problems are common in transgender individuals. suicide attempt rates of up to 30-50% have been reported in this group. This is extremely marginalized group that suffers discrimination and hostility on an daily basis. Hormone fluctuations can significantly affect mood and may cause suicidal ideations. Again, I am truly sorry for your loss.

  3. l am 37 years of age and HIV positive,been taking my medications for years now .
    l would like to begin my hormone therapy change by taking estrogen ,is there any other factors l should consider before l start ? can the pills affect my current ARV treatment ? is my age appropriate to start the therapy?

    1. Hi Andrew, Thank you for your comment and question. There is no clinical data available on Estrogen feminizing hormone therapy in transgender woman taking anti-retroviral therapy. All the available information is from HIV positive biological woman taking oral contraceptive pills. based on the limited information there are no significant clinical interactions and I do not see an issue with you starting feminizing hormone therapy.

  4. Hii
    Iam born male... but iam a transgender iam 37 yr now n want to undergo hormones therapy of hrt estrogen.
    Is it safe

    1. hi Danny, thank you so much for your comments. Transgender Hormone therapy is safe and can be transformative. We have many clients who started this treatment in their later years. Age is not a contraindication to start hormone replacement therapy however, with age we do adjust target hormone levels and medication doses as our metabolism changes with age. please find a qualified doctor in your area who Can discuss all the available hormone options after reviewing your blood work and other testing

    1. Hi Oscar, Thanks for the question. Hormone therapy can have negative side effcts if not managed properly. Most of these negative efefcts are related to estrogen or testosterone therapy. Since I dont have access to your medical history, I am unable to comment on what to expect. Please discuss with your doctor for proper advice before starting HRT

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