What to Expect When Taking Gender-Affirming Hormone Therapy

Non-binary and transgender people often desire a gender transition with physical body changes to better align with their gender identity. This can be accomplished with gender-affirming hormone therapy in the form of feminizing hormone therapy in transgender women or masculinizing hormone therapy in transgender men.

Please continue reading to learn more. This article will help you understand what gender-diverse people should know before they undergo hormone therapy, including what physical and emotional changes to expect after starting hormone therapy.

What are estrogen and testosterone?

Estrogen and testosterone have traditionally been considered the female and male sex hormones, respectively. However, both hormones are present in both sexes. The difference is that in men, estrogen is present in low concentrations in the blood, and testosterone is present in high concentrations. The reverse is true for women - testosterone is present in low concentrations in the blood and estrogen is present in high concentrations.

Testosterone plays a role in the development of masculine secondary sex characteristics during puberty, sperm production, sex drive, muscle strength, body fat distribution, facial and body hair growth, and mood.

Estrogen plays a role in the development of feminine secondary sex characteristics during puberty, breast development, regulation of menstrual cycles, pregnancy, lactation, blood clotting, and bone formation.

What is feminizing hormone therapy and masculinizing hormone therapy?

Feminizing hormone therapy is used by non-binary people and transgender women (sex assigned at birth is male, gender identity female) to produce physical changes that are caused by female hormones during puberty.

Masculinizing hormone therapy is used by non-binary people and transgender men (sex assigned at birth is female, gender identity male) to produce physical changes that are caused by male hormones during puberty.

Masculinizing or feminizing hormone therapy can be done alone or in combination with sex reassignment surgery consisting of:

Facial reconstruction for a more feminine or masculine appearance.
Chest “top” surgery with breast tissue removal for a more masculine appearance or breast augmentation surgery for a more feminine appearance.
Genital “bottom” surgery to reconstruct the genitalia.

Feminizing hormone therapy

Feminizing hormone treatment typically starts with taking spironolactone (Aldactone), a medicine that blocks male sex hormone receptors and lowers testosterone production by the body. This is followed 4-8 weeks later by taking estrogen therapy in the form of pills, shots, creams, sprays, or gels. This also lowers testosterone levels in the body and triggers feminizing changes caused by female hormones during puberty.

Masculinizing hormone therapy

Masculinizing gender-affirming hormone therapy achieves the opposite effect. You begin hormone therapy by taking testosterone, initially at a low dose and then at higher doses. Synthetic testosterone is available as an injection, gel, or skin patch. It triggers masculinizing changes in the body that are caused by male hormones during puberty.

What happens when you start taking hormone therapy?

Gender-affirming hormone therapy has physical effects that can help you develop a more feminine or masculine appearance. It can make you look more like people assigned male or female at birth. This can help your physical appearance align better with your gender identity.

Physical changes that you can experience after you start feminizing hormone therapy include:

Fewer erections, decreased ejaculation, decreased libido (reduced interest in sex), and smaller testicles.
Breast growth.
Softer, less oily skin.
Slower scalp hair loss.
Less hair on the face and body.
Decreased muscle mass.
More body fat.

Physical changes that you can experience after you start therapy with masculinizing hormone testosterone include:

Enlargement of the clitoris and thinning and dryness of the vaginal lining.
Stopping menstruation.
Deepening of the voice.
More hair on the face and body.
Increased muscle mass and strength.
Body fat redistribution.

How long does it take your body to adjust to hormone therapy?

It can take 3 to 5 years for your body to show the full effects of gender-affirming hormone therapy. Some hormone changes occur fairly quickly (1-3 months after starting treatment), while others take up to 5 years to develop.

How does hormone therapy make you feel?

In addition to the physical changes described above, masculinizing or feminizing hormone therapy can cause emotional changes. If you are sexually active, hormone therapy can improve satisfaction with sex as well as your overall psychological well-being and quality of life. Hormone therapy can also help to ease gender dysphoria (the emotional stress caused by a mismatch between your biological gender and your gender identity).

What are the risks of hormone therapy?

Risks of feminizing hormone therapy include blood clots, high blood pressure, heart problems, type 2 diabetes, stroke, electrolyte abnormalities (high potassium), hormonal changes, weight gain, nipple discharge, and infertility (inability to have biological children). Feminizing hormone therapy can also increase your risk of prostate and breast cancer compared to cisgender men.

Risks of masculinizing hormone therapy include acne, male pattern baldness, sleep apnea, blood clots, high cholesterol, high blood pressure, type 2 diabetes, polycythemia (excess red blood cells), pelvic pain, clitoris pain, drying and thinning of the vaginal lining, and infertility. Masculinizing hormone therapy does not appear to increase the risk of breast cancer, endometrial cancer, or heart disease compared to cisgender women. The risk of uterine and ovarian cancer is unclear and further research is needed.