Estrogen-based hormones
Some transgender, Two-Spirit and non-binary people benefit from estrogen-based hormone therapy to align physical characteristics with their gender.
What are estrogen-based therapies?
Estrogen-based therapies include estrogen, testosterone blockers and progesterone.
- Estrogen is a hormone that is used to induce secondary sex characteristics like breast growth, rounder hips and softer skin. It also reduces testosterone-related features, such as facial hair.
- Testosterone blockers reduce natural testosterone production and its effects (such as promoting muscle mass).
- The role of progesterone is not well understood. Most guidelines do not recommend the use of it as part of a standard regimen but discuss the possibility of using it as an additional medication for a period of time.
Different estrogen-therapy combinations
Your health care provider will help you tailor your hormone therapy to meet your goals, health needs and budget. Your hormone therapy may include any of the following:
- Estrogen alone
- Estrogen and testosterone blockers
- Estrogen and testosterone blockers and progesterone
- Testosterone blockers alone (this is not safe for long periods of time)
Expected effects of estrogen-based hormone therapies
Increasing breast development
- Usually starts 3–6 months after beginning therapy
- Breasts reach full size in 2–5 years
- Size varies; A or B cup size is typical
- A permanent change
Redistributing body fat
- Usually starts 3–6 months after beginning therapy
- Reaches maximum effect in 2–5 years
- Less fat on abdomen
- More fat on buttocks, hips and thighs
- Not a permanent change
Reducing muscle mass and strength
- Usually starts 3–6 months after beginning therapy
- Reaches maximum effect in 1–2 years
- Reduced muscle and strength in upper body
- Not a permanent change
Softening of the skin
- Usually starts 3–6 months after beginning therapy
- Skin will be softer and less oily
- Not a permanent change
Thinning of facial and body hair
- Usually starts 6–12 months after beginning therapy
- Maximum effect in more than 3 years
- Body hair may appear less noticeable
- Body hair will grow more slowly
- Facial hair may grow more slowly, become thinner and appear less noticeable, but will not go away
- If you have scalp hair loss, it may slow down
- Hair that has already been lost likely will not grow back
- Not a permanent change if you stop taking hormones
Reduced sexual response
- Usually starts 1–3 months after beginning therapy
- Timing of maximum effect varies from person to person
- Less spontaneous physical arousal (erections)
- Not a permanent change if you stop taking hormones
Fertility
- Timeline varies
- Sperm may no longer reach maturity
- Orgasmic fluid (ejaculate) production is reduced or may go away entirely
- May not be able to get erection firm enough for penetrative sex
- May become permanently unable to contribute to a pregnancy (but birth control is still recommended since this will not be the case for everyone)
Smaller erogenous tissue (penis) & gonads (testes)
- Usually starts 3–6 months after therapy begins
- Timing of maximum effect varies from person to person
- Erogenous tissue may become smaller
- Gonads shrink down to half their initial size
- May or may not be a permanent change
Emotional changes
- Overall emotional state may or may not change; this varies from person to person
- May experience a narrower or wider range of emotions or feelings
- Not a permanent change
Risks associated with estrogen-based hormone therapies
Estrogen is known to increase the risk of blood clots and gallstones. Estrogen-based treatment may also affect your cardiovascular risk by causing changes to cholesterol, blood pressure, blood sugar and weight. There are other potential risks, depending on the specific medication you use, and you should discuss them with your provider.
There is either no increased risk of breast cancer, or the research is inconclusive.
Mood changes are variable; they may be positive or negative, or may have an adjustment period. Many people experience positive mood changes after starting hormone therapy. Any mood changes that cause you concern should be discussed with your provider.