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Feminizing hormone therapy helps transgender women and gender nonconforming people achieve a more traditionally feminine appearance. It may involve antiandrogens to block testosterone and/or estrogen to promote female characteristics, like fuller breasts and softer skin. A healthcare provider specializing in transgender care can guide you through this therapy.
Feminizing hormone therapy (FHT) is a gender-affirming hormonal therapy (GAHT). It uses certain manufactured hormones to reduce traditionally masculine features and develop physical female characteristics.
You may choose to use feminizing hormone therapy as a stand-alone therapy. Or you may use it in combination with other types of gender-affirming medical care, like surgery and voice therapy.
The process of transitioning from your sex assigned at birth to your identified gender is as unique as you are. It’s deeply personal, and you know what’s right for you. But if you’re considering feminizing hormone therapy, it’s best to work with a healthcare provider who specializes in it. Together, you can make sure the process is medically safe for you and that it can help you reach your desired goals.
Many healthcare providers can help you, particularly ones specializing in transgender health. You may work with one or more of the following providers:
You might want to look for providers who have certification through organizations like the World Professional Association for Transgender Health (WPATH) Gender Education Institute (GEI).
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Feminizing hormone therapy involves the use of prescription medications. It always includes the use of estrogen (estradiol). Depending on your goals, your healthcare provider may prescribe it in combination with a testosterone‐blocking, or antiandrogen, medication (like spironolactone). Occasionally, providers may also prescribe synthetic progesterone. But the data on the safety and benefits of progesterone use is limited.
Estradiol comes in many forms, including:
You may decide to take either estradiol or antiandrogens, or both. You and your provider will also discuss the dose ranges to start with. Some people want to begin this therapy at the typical starting dose, as they desire maximal transition changes. Others want more gradual changes, have concerns about side effects or drug interactions or simply desire more androgynous characteristics. Together, you and your provider will determine the type and dose that’s right for you.
Your provider will check your hormone levels regularly with blood tests to make sure they’re in the desired and healthy range. After reaching the desired results, you may take a lower dose for the rest of your life to maintain the changes.
Adolescents going through puberty who meet the criteria to receive feminizing hormone therapy typically start with puberty blockers before taking estrogen. But this depends on several factors, including state laws and various health considerations.
Feminizing hormone therapy produces changes in certain secondary sex characteristics. These are the physical features that aren’t directly involved with reproduction, like facial hair, breast size, and muscle and body fat distribution. Secondary sex characteristics typically arise during puberty.
Antiandrogen therapy blocks testosterone production, which affects secondary male sex characteristics. Changes from antiandrogen therapy typically include:
Estrogen (estradiol) promotes secondary female sex characteristics. Changes from estrogen therapy typically include:
It’s important to note that feminizing hormone therapy doesn’t change the pitch or sound of your voice. But other options may help alter your voice, like voice feminization surgery and voice therapy.
The changes from feminizing hormone therapy come about at different rates and depend on various factors. Your healthcare team will explain what changes to expect and when to expect them.
Most people experience desired physical changes within the first three to six months of starting feminizing hormone therapy. It typically takes 18 to 24 months to achieve the full effect. But remember that everyone’s body is different. Try to give yourself — and your body — grace if the changes don’t happen as fast as you’d like.
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You’ll need to take several steps to prepare for feminizing hormone therapy. Your healthcare team will be by your side throughout this process. Don’t hesitate to ask questions or raise any concerns.
One of the criteria for starting feminizing hormone therapy is having a diagnosis of persistent gender dysphoria or gender incongruence.
You’ll likely meet with a mental health professional for this. They use criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to make a diagnosis of gender dysphoria. The International Classification of Diseases (ICD-11) gives specific diagnostic criteria for gender incongruence.
Your healthcare team will also want to make sure that any other mental health conditions you have (like depression, anxiety or an eating disorder) are well-managed before starting feminizing hormone therapy.
Another criterion for receiving hormone therapy is being of the age of legal medical consent and having sufficient mental capacity to give informed consent. There are extra requirements for adolescents who haven’t reached the legal age of consent. These laws vary by state in the U.S.
Your healthcare team will explain how feminizing hormone therapy works and what to expect. Together, you’ll discuss reasonable expectations and the timeline of anticipated physical changes. You’ll also review the risks and benefits of the therapy.
Your provider will want to check for conditions that feminizing hormone therapy can make worse, like a history of:
They’ll also do a physical exam and may recommend some tests to assess your overall health, like:
Feminizing hormone therapy is an effective medical therapy. It can lead to significant improvements in mental, physical and sexual well-being for transgender women and gender nonconforming people.
Having physical attributes that match your gender identity can help improve your self-esteem and self-image. These factors contribute to a better quality of life.
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Estrogen and anti-androgen therapy may increase your risk of:
The level of increased risk for these conditions varies based on a few factors. Your healthcare team will go over them with you before you start hormone therapy. They’ll also let you know what signs to look for and when to seek medical care if any of these conditions develop.
Steps you can take to stay healthy while on feminizing hormone therapy include:
You’ll need to see your healthcare provider for follow-up visits and if any complications develop.
You’ll have several follow-up appointments with your healthcare provider after you start hormone therapy. This is so they can track your response to the therapy. Care also includes tests (like blood tests) to check your hormone levels and check for signs of complications. Occasionally, you may need a bone density test (DEXA scan).
In general, you can expect to see your provider:
Certain side effects of estrogen and antiandrogens can be signs of complications. Some can become severe or need immediate medical attention. Call your healthcare provider if you experience:
Taking estradiol, progesterone or antiandrogens without a healthcare provider’s guidance is dangerous. A healthcare provider will ensure you receive the correct dose for your needs. This helps you achieve the best possible results and avoid complications.
A note from Cleveland Clinic
Living with gender dysphoria can be distressing and isolating. Femininizing hormone therapy is one of many options that can help address these issues by matching your appearance with your authentic gender identity. Know that you won’t be alone during this process. A healthcare team specializing in transgender care will be by your side to answer any questions about hormone therapy and what to expect.
Last reviewed on 07/08/2024.
Learn more about our editorial process.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy