Feminizing Hormone Therapy

Feminizing Hormone Therapy

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Physical Effects

Physical Effects of feminizing hormone can involve testosterone blocking medication alone, estrogen medication alone, or testosterone blocking medication along with estrogen. 

Taking testosterone blocking medication alone typically leads to sex drive, fertility, and face/body hair changes only (see Table 1). Sometimes slight breast growth is also noted with testosterone blocking medication alone. Testosterone blockers are not needed for individuals who have received an orchiectomy (removal of testes). Some individuals who have not received an orchiectomy may desire to temporarily block testosterone without the addition of estrogen. However, testosterone blockers alone are not considered safe for longer periods of time. There is also debate and conflicting reports as to whether adding progesterone results in additional feminization.

Most physical changes associated with feminizing hormone therapy occur over the course of approximately two years. However, the amount of change and the exact timeline of effects can be highly variable. Factors that influence the amount and timeline of changes include inheritance (genetic influences passed down from biological parents), age, health status, lifestyle, and dosage (amount, frequency, route of administration). 

TABLE 1: Effects and Expected Time Course of Feminizing Hormones (Print Friendly Version)

 

Expected
Onset

Maximum
Effect

Reversible?

Comments

Decreased Sex Drive

1-3 mo

1-2 yrs

Yes

  • Fewer spontaneous and morning erections
  • Can make penetrative sex more difficult as the insertive partner

Emotional Changes

1-3 mo

 

Yes

  • Highly variable person to person
  • May experience broader range of emotions

Fertility

Varies

 

Likely, although prolonged use may decrease fertility

  • Less semen and ejaculatory fluid is produced
  • Sperm may no longer reach maturity
  • Ongoing birth control still recommended

Decreased Muscle Mass/Strength

3-6 mo

1-2 yrs

Yes

  • Depends on amount of exercise

Breast Growth

3-6 mo

2-3 yrs

No, although atrophy of breast tissue may occur

  • Size varies person to person and depends on inheritance
  • Typically, A to B cup

Decreased Testicular Volume

3-6 mo

2-3 yrs

Maybe

  • Testes shrink to approximately half of initial size

Body Fat Redistribution

3-6 mo

2-5 yrs

Yes

  • Less abdominal fat
  • More fat in hips, thighs, buttocks

Skin Softening

3-6 mo

 

Yes

  • Skin also becomes less oily

Face/Body Hair Changes

6-12 mo

 

No

  • Hair follicles will continue to produce hair
  • Hair may growth more slowly and be thinner/less noticeable
  • Male pattern baldness may stop or slow down but hair already lost will likely not grow back
Decreased Sex Drive
  • Expected Onset: 1-3 mo
  • Madimum Effect: 1-2 yrs
  • Reversible?: Yes
  • Comments: 
    • Fewer spontaneous and morning erections
    • Can make penetrative sex more difficult as the insertive partner
Emotional Changes
  • Expected Onset: 1-3 mo
  • Reversible?: Yes
  • Comments: 
    • Highly variable person to person
    • May experience broader range of emotions
Fertility
  • Expected Onset: Varies
  • Reversible?: Likely, although prolonged use may decrease fertility
  • Comments: 
    • Less semen and ejaculatory fluid is produced
    • Sperm may no longer reach maturity
    • Ongoing birth control still recommended
Decreased Muscle Mass/Strength
  • Expected onset: 3-6 mo
  • Maximum effect: 1-2 yrs
  • Reversible?: Yes
  • Comments:
    • Depends on amount of exercise
Breast Growth
  • Expected onset: 3-6 mo
  • Maximum effect: 2-3 yrs
  • Reversible?: No, although atrophy of breast tissue may occur
  • Comments:
    • Size varies person to person and depends on inheritance
    • Typically, A to B cup
Decreased Testicular Volume
  • Expected onset: 3-6 mo
  • Maximum effect: 2-3 yrs
  • Reversible?: Maybe
  • Comments:
    • Testes shrink to approximately half of the initial size
Body Fat Redistribution
  • Expected onset: 3-6 mo
  • Maximum effect: 2-5 yrs
  • Reversible?: Yes
  • Comments:
    • Less abdominal fat
    • More fat in hips, thighs, buttocks
Skin Softening
  • Expected onset: 3-6 mo
  • Reversible?: Yes
  • Comments:
    • Skin also becomes less oily
Face/Body Hair Changes
  • Expected onset: 6-12 mo
  • Reversible?: No
  • Comments:
    • Hair follicles will continue to produce hair
    • Hair may growth more slowly and be thinner/less noticeable
    • Male pattern baldness may stop or slow down but hair already lost will likely not grow back

Inheritance (genetic influences passed down from biological parents), age, health status, lifestyle, and dosage (amount, frequency, route of administration) also impact the likelihood of experiencing negative side effects associated with feminizing hormone therapy. 

Your healthcare provider will collect information regarding your history, as well as your biological family’s history, in order to provide more specific feedback regarding your risks prior to starting hormone therapy. Regular follow-up appointments are critical to monitoring your health and risk over time.

TABLE 2: Risks Associate with Masculinizing Hormones 

Increased Risk Likely

Venous thromboembolic disease (blood clots)

  • A blood clot that travels to the lungs can create a life-threatening pulmonary embolism
  • Surgery/hospitalization, high cholesterol, hypertension, diabetes, cigarette smoking can increase risk

Hypertriglyceridemia (elevation of triglycerides in blood)

  • Can increase risk of cardiovascular disease
  • Very high levels can increase risk of acute pancreatitis

Weight gain

  • Regular exercise can reduce risk

Elevated liver enzymes

  • Monitored via periodic blood test

Gallstones

  • May not cause symptoms

Increased Risk Likely with Additional Risk Factors Present

Cardiovascular disease (heart disease)

  • Healthy eating, exercise, and not smoking tobacco can decrease risk

Possible Increased Risk

Hypertension (high blood pressure)

  • Risk increases with estrogen but can decrease with the testosterone blocker sprinolactone
  • Hypertension increases risk of heart attack or stroke
  • Healthy eating, exercise and not smoking tobacco can decrease risk
  • Medications can help manage symptoms

Hyperprolactinemia (elevated prolactin in blood) or prolactinoma (noncancerous pituitary gland tumor)

  • Risk appears limited to the first year of treatment

Increased Risk Possible with Additional Risk Factors Present

Type 2 diabetes

  • Healthy eating, exercise and maintaining a healthy weight can decrease risk

No Increase Risk

Breast cancer

  • Risk may still be present

Increased Risk Likely
  • Venous thromboembolic disease (blood clots)
    • A blood clot that travels to the lungs can create a life-threatening pulmonary embolism
    • Surgery/hospitalization, high cholesterol, hypertension, diabetes, cigarette smoking can increase risk
  • Hypertriglyceridemia (elevation of triglycerides in blood)
    • Can increase risk of cardiovascular disease
    • Very high levels can increase risk of acute pancreatitis
  • Weight Gain
    • Regular exercise can reduce risk
  • Elevated liver enzymes
    • Monitored via periodic blood test
  • Gallstones
    • May not cause symptoms
Increased Risk Likely with Additional Risk Factors
  • Cardiovascular disease (heart disease)
    • Healthy eating, exercise, and not smoking tobacco can decrease risk
Possible Increased Risk
  • Hypertension (high blood pressure)
    • Risk increase with estrogen but can decrease with the testosterone blocker sprinolactone
    • Hypertension increases risk of heart attack or stroke
    • Healthy eating, exercise and not smoking tobacco can decrease risk
  • Hyperprolactinemia (elevated prolactin in blood) or prolactinoma (noncancerous pituitary gland tumor)
    • Risk appears limited to the first year of treatment
Increased Risk Possible with Additional Risk Factors Present
  • Type 2 diabetes
    • Healthy eating, exercise and maintaining a healthy weight can decrease risk
No Increase Risk
  • Breast cancer
    • Risk may still be present

 Information adapted from the World Professional Association for Transgender Health (WPATH) Standards of Care Version 7 and the Endocrine Society Clinical Practice Guideline for Endocrine Treatment of Transsexual Persons.

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