Feminizing Hormone Therapy

What medications are used for feminizing hormone therapy?

The goals of feminizing hormone therapy are to raise the estrogen level and to lower the testosterone level so that both levels are in the normal, physiologic female range.  There are three different kinds of medications that are typically used: estrogen, testosterone blockers, and progesterone.

Estrogen

Estrogen is the hormone responsible for most feminine characteristics.  It can be given as an oral pill, a patch on the skin, or an injection.

Antiandrogens

Antiandrogens or testosterone blockers, are medications that reduce the testosterone level.  Both are given as oral pills.

Progesterone

Progesterone is a female hormone that is controversial in feminizing hormone therapy.  There is very little scientific evidence to support the use of progesterone and there are some adverse effects.  However, some transgender women believe that progesterone is beneficial.

Our clinic prefers to use estrogen in the form of estradiol taken as a pill dissolved under the tongue or as a patch applied to the skin.  We generally use oral spironolactone.  In general, we do not prescribe progesterone.  These are general guidelines only and each patient’s medication regimen is tailored to the needs of the individual.

Effects of Feminizing Hormone Therapy (Estrogen) Effects in BOLD are permanent changes.
Effect First Noticeable Maximum Effect

 

Breast enlargement

 

3-6 months 2-3 years

 

Decreased volume  (shrinking) of testes

 

3-6 months 2-3 years

 

Decreased sperm production

 

Variable Variable

 

Decreased libido (sex drive)

 

1-3 months 1-2 years

 

Decreased spontaneous erections

 

1-3 months 3-6 months

 

Decreased muscle mass / strength

 

3-6 months 1-2 years

 

Softening of skin, less oily skin

 

3-6 months Unknown

 

Slower, thinner growth of facial and body hair

 

6-12 months 3 years

 

Decrease in male pattern baldness

 

Hair loss stops in 1-3 months but hair does not grow back 1-2 years

 

Body fat redistribution (more fat on buttocks, hips, thighs, face)

 

3-6 months 2-5 years

What are the emotional and intellectual effects of estrogen?

People are very different so their emotional and intellectual changes vary widely.  People taking estrogen have reported:

  • Feeling more emotional and more in touch with their feelings
  • Crying more easily
  • Mood swings
  • Depression or sadness
  • Thinking differently, having different ways of looking at things
  • Feeling “more like myself” when taking a hormone that aligns with gender identity; feeling more comfortable in one’s body

What estrogen does not do:

  • Change a person’s bone structure
  • Change a person’s height
  • Stop the growth of facial hair or eliminate a beard
  • Cause male pattern balding on the scalp to grow back
  • Raise the pitch of the voice to a higher level
  • Provide reliable birth control
  • Protect against sexually transmitted infections

What are the risks of taking estrogen? 

The major risks are:

  • Blood clots ― can result in stroke or even death
  • Gallbladder disease
  • Liver disease
  • Weight gain
  • High cholesterol which causes heart disease
  • High blood pressure