Estrogen-based hormone therapy can cause a person to experience physical, emotional, sexual, and reproductive changes. Some changes can reach their full extent within 2 to 3 years, while others can take up to 6 years.
Some transgender people transition with the help of medical procedures, such as estrogen-based hormone therapy.
This article looks at what changes a person can expect and how long these changes take when undergoing estrogen-based hormone therapy.
The use of binary terms such as “male” and “female” or “men” and “women” in this article reflects the language of the sources we’ve used. Unless otherwise noted, it’s unclear whether the research we reference included participants with expansive gender identities.
Estrogen-based hormone therapy involves an individual assigned male at birth taking the hormone estrogen to develop certain “feminine” characteristics.
Estrogen stops the pituitary gland from forming gonadotropin, which reduces androgen production. Androgens are a group of hormones that help with reproductive development, among other things.
Reducing the number of androgens in the body helps a person transition by encouraging changes in fat distribution, breast development, and male pattern hair growth.
Doctors may also prescribe other anti-androgen drugs to help the transitioning process.
A person may not notice significant changes when starting estrogen-based hormone therapy. The timeline varies, and some people may see more significant changes than others.
People may notice more changes if they use anti-androgen therapy alongside estrogen therapy.
Estrogen hormone therapy can cause physical changes.
Changes to the skin
The University of California (UCSF) notes that estrogen hormone therapy can cause:
- the skin to become dry or thin
- the pores to become smaller
- less oil production
Additionally, a person may become more prone to cuts or bruising and perceive temperature and pain differently.
Breast development
A person undergoing estrogen hormone therapy might notice small buds developing underneath the nipples. This can be painful but will typically resolve over several months.
Breast development will vary between people. The breasts can vary in size and shape and may be uneven. However, the UCSF notes that most people can expect to develop an “A” cup or perhaps a small “B” cup.
People should wait for approximately 1 year before considering breast augmentation surgery.
Fat redistribution
A person can expect fat to collect around their hips and thighs. Muscle mass and strength will decrease.
Additionally, arms and legs will appear smoother. This is because the fat below the skin becomes thicker.
As the fat under the skin increases and moves, the eyes and face may take on a more “feminine” appearance.
Hair growth
Facial hair, and hair on the chest, arms, and back, will grow at a slower rate. However, it will not stop growing entirely. Additionally, the rate of baldness may slow down or stop.
When will these physical changes occur?
According to a
After 3 to 6 months, a person can expect:
- a decrease in muscle mass
- softer skin
- redistribution of body fat
- breast growth
- testicles will shrink
It may take 2 to 3 years for these changes to reach their full extent.
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People may experience:
- more confidence
- fewer symptoms of depression
- higher self-esteem
- less dissociative symptoms
- alleviation of gender dysphoria
The UCSF states that a person may notice that they experience a wider range of emotions. They may also develop different tastes and interests. These emotional changes should settle.
During this time, some people might find it helpful to talk with a mental health professional to help explore and understand these new emotions and thoughts.
Once a person starts taking estrogen-based hormone therapy, they may begin to experience erectile dysfunction and fewer erections. However, a person will still be able to reach orgasm.
If a person is concerned about maintaining an erection, they can talk with a healthcare professional about taking medications, such as Viagra (sildenafil).
A person’s testicles will also shrink to approximately less than half their original size. This can occur
Although there is a decrease in testicle volume, the amount of scrotal skin does not change. If a person decides to undergo gender affirming surgery, the surgeon will use the scrotal skin to create the labia majora.
Anecdotally, some transgender women note that their orgasms feel different once they begin estrogen-based hormone therapy. Some state that their orgasms become “full-body orgasms” rather than being centered on their genitals.
Studies have investigated the effect of estrogen-based hormone therapy on the reproductive system. However, the results are not clear.
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In most cases, people regain fertility once they stop taking the hormones. However, there is some evidence that the longer a person takes estrogen-based hormone therapy, the less likely they are to have fertile sperm.
People may take into account several considerations before deciding to use estrogen-based hormone therapy.
Health considerations
A 2019 article suggests that transgender women may have an increased risk of heart disease and bone loss.
Estrogen-based hormone therapy may increase the risk of bone loss due to the use of anti-androgens other than estrogen.
Doctors may recommend bone screening procedures, especially if a person is at high risk, to monitor the effects the hormones have on the bones.
One type of estrogen, ethinyl estradiol, can lead to an increase in the risk of cardiovascular events, like venous thromboembolism. It may also increase the risk of myocardial infarction and stroke.
Doctors are less likely to prescribe this form of estrogen due to the risks.
Reproduction considerations
While the research does not suggest that infertility due to estrogen-based hormone therapy is irreversible, some people may find fertility procedures beneficial.
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Transgender women who have not undergone an orchiectomy, which is removing the testicles, can use a sperm bank to preserve their sperm.
The UCSF note that using a sperm bank can cost $2,000 to $3,000.
The following table describes the different types and dosages of estrogen or progesterone that a person may take:
| Application | Estrogen or progesterone type | Doses |
|---|---|---|
| Oral | Estradiol | 1 milligram (mg) to 8 mg daily |
| Shot | Estradiol valerate | 2 mg to 20 mg weekly |
| Shot | Estradiol cypionate | 1 mg to 5 mg weekly |
| Transdermal patch | Estradiol | 50 micrograms (mcg) to 400 mcg, with the patch to be changed as per the brand or product’s instructions |
| Oral | Medroxyprogesterone acetate (progesterone) | 2.5 mg to 10 mg at night |
| Oral | Micronized progesterone | 100 mg to 200mg at night |
The following table outlines the types and dosages of and anti-androgens a person may take:
| Hormone | Doses |
|---|---|
| Spironolactone | 25 mg daily or 50 mg to 200 mg each night |
| Finasteride | 1 mg to 5 mg daily |
| Dutasteride | 0.5 mg daily |
If a person decides to transition, it is essential to receive estrogen-based hormone therapy from healthcare professionals.
Buying and taking hormones from other sources carries many risks, such as poor quality of drugs, improper doses, and possible harm.
In order to start the process, a person must discuss their options with a healthcare professional.
Transcaresite has a directory of trans-friendly medical professionals. If an individual’s healthcare insurance covers the cost of transitioning, it is important to check that the healthcare professional a person chooses is in their insurance network.
A healthcare professional will ask a person about their history of
- psychiatric, including any mental health conditions
- social, such as social support and legal history
- family, such as a history of psychiatric illnesses, suicides, and substance use
- developmental, such as education level and any history of trauma
- any instances of substance use
A doctor will also ask a person about their medical history as some people are at increased risk for cardiovascular complications, blood clots, and other potential risks.
It is crucial to ask a doctor any questions a person has about estrogen hormone therapy. It is necessary to understand the risks and benefits and to discuss fertility options and the possibility of surgery in the future.
Preparation before taking hormones
Before starting estrogen hormone therapy, it is important to gain as much information as possible. So always discuss the risks and side effects that hormone therapy may cause with a healthcare professional.
It is also essential that a person manages their expectations of when they will begin to see changes. Some people can take hormones for over a year before seeing any noticeable changes.
A healthcare professional may ask people to come back for health checks regularly to ensure they are taking the correct medication dosage.
The cost of estrogen hormone therapy can vary according to a range of factors. These include the type of hormones a person takes and how they use them.
A person wanting to transition must check that their health insurance covers the costs.
People must also check that the healthcare professional or medical center that their doctor has referred them to is in their insurance network.
Alternatively, they can speak with their physician or local practice to see if they offer the option of Direct Primary Care (DPC). The DPC model allows a person to pay the physician or practice directly. A person may be able to pay for their care in a flat monthly or annual fee.
Another option is to ask about concierge medicine models. These are annual memberships that a person can pay for monthly or annually. The concierge medicine model is usually more expensive than the DPC model.
Several organizations and charities provide support to the trans community, including:
It is important to contact a doctor if a person decides to transition. A person must also have regular health checks to ensure that they are taking the correct medication dosage.
Some people may need additional health checks, such as those who are at a higher risk of bone loss or cardiovascular disease.
Estrogen hormone therapy is a longer-term process that can help people develop physical characteristics to alleviate their gender dysphoria.
There are multiple ways to take hormone therapy, and some people may find better results when taking additional anti-androgens alongside estrogen.
It can take some time for people to notice physical and emotional changes while taking estrogen hormone therapy. Some people may see these changes within months, whereas others may only notice changes after a year.
It is important to receive estrogen hormone therapy from a healthcare professional. Sourcing estrogen and anti-androgens online can carry many risks. A healthcare professional can ensure that a person takes the correct dosage of their medication and treats any additional health conditions.