Feminizing hormone therapy helps male-to-female transgender individuals (transwomen) achieve a more feminine appearance. It uses anti-androgens to block male hormones. Taking estrogen and progestin helps you develop breasts, softer skin, rounder hips and more.
This gender-affirming treatment uses female hormones to create a more feminine appearance. Feminizing hormone therapy may be used as a standalone treatment or combined with gender affirmation surgery.
Feminizing hormone therapy is an option for transwomen — people who were assigned male at birth (AMAB) but identify as women. This therapy is a common treatment for gender dysphoria (a condition in which differences between physical appearance and assigned gender cause distress).
Nonbinary or intersex people may also choose to undergo feminizing hormone therapy. Nonbinary people have gender identities that don’t fit inside traditional male or female categories. Intersex people are born with reproductive or sexual characteristics that don’t fit traditional perceptions of male and female bodies. They may have conditions affecting their gonads, external genitals or chromosome patterns.
Stated simply, feminizing hormone therapy is for anyone who feels that there’s a mismatch between their external appearance and their authentic sense of gender and self.
People assigned male at birth produce low levels of estrogen. Feminizing hormone therapy brings about physical and emotional changes that are more consistent with feminine anatomy and behavior.
With this treatment, you will receive hormones and other substances. They include anti-androgens medication, estrogen and possibly progesterone.
Anti-androgen therapy blocks male sex hormone (testosterone) production.
Changes from anti-androgen therapy include:
Estrogen (estradiol) promotes physical changes that are more consistent with a feminine appearance.
Progestin therapy may also help produce feminine physical changes. Changes from estrogen or progestin therapy include:
Taking estradiol and progestins or anti-androgens 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.
Many healthcare providers can help you, particularly ones specializing in transgender health.
This may be a:
The timing is up to you and your healthcare provider. Some people affirm their new gender identity first by changing their names and dressing differently. But this isn’t a requirement.
Adolescents may wish to consider starting feminizing hormone therapy at age 16. Starting at a young age makes it possible to:
There are many steps to help you prepare, including:
You start by taking anti-androgens to block testosterone production. Then, after a few weeks, you take estrogen. This hormone comes in many forms, including:
People who choose feminizing hormone therapy start with a low dose of estrogen. The appropriate amount is different for each person. Your healthcare provider determines the type and dose that’s right for you.
Starting with a low dose helps reduce the risk of complications and side effects. Then, as your body gets used to it, your provider will increase the dosage. After achieving the desired results, you take a lower dose for the rest of your life.
The speed at which changes occur depends on various factors. These include the dose and your body’s response. For most people, it takes 18 to 24 months to achieve the full effect.
Side effects may include:
Steps you can take to stay healthy on feminizing hormone therapy include:
These appointments enable healthcare providers to track your response to treatment. Care includes tests to check for signs of complications. These often include blood tests. Occasionally, you may need a bone density test (DEXA [DXA] scan).
You can expect to see your healthcare provider:
Many transwomen find relief from gender dysphoria with this type of therapy. Having physical attributes that match your gender identity can ease anxiety and depression. Transwomen also have improved self-esteem and self-image. These factors contribute to a better quality of life.
Feminizing hormone therapy is often the first step in the gender affirmation process. Some transwomen also choose surgery to make more changes to their appearance. While surgery isn’t a requirement, there are many options available to you, including:
There is no right or wrong approach when it comes to gender-affirming treatments. What might be right for one person may not be right for you. It’s important to discuss your options with your provider in detail so you can achieve your desired results and live as your authentic self.
Certain side effects of estrogen and anti-androgens can be a sign of complications. Some can become severe or need immediate medical attention.
Call your healthcare provider if you experience:
A note from Cleveland Clinic
Living with gender dysphoria can be lonely and isolating. Many trans, nonbinary and intersex people also face discrimination in society, which can make anxiety and depression worse. Feminine hormone therapy can help address these issues by matching your appearance with your authentic gender identity. Discuss your options with your healthcare provider and take your first step to a more fulfilling life.
Last reviewed by a Cleveland Clinic medical professional on 06/04/2021.
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