Feminizing Hormone Therapy: What to Expect

Good to Know: 

• Feminizing hormone therapy is a gender-affirming treatment that uses hormones to create a more feminine appearance, commonly used by transwomen assigned male at birth (AMAB). 
• Feminizing hormone therapy usually involves taking anti-androgens medications, estrogen and possibly progesterone, whether by pill, injection, patch, or cream.  
• It’s important to work with a healthcare provider when undergoing hormone therapy, as they can help you achieve the right dose and monitor for side effects and complications. 

Transitioning is the process of changing how you look and how other people see you so that you become the gender that you feel on the inside. There are a number of different ways to transition—socially, medically, and legally. For each transgender person, this transition may look somewhat different. Some people may choose to transition only socially; some may choose not to transition socially, medically, or legally at all. 

One way for transwomen to transition medically is via feminizing hormone therapy. This is a medical process by which hormone therapy is used to create feminine characteristics in the person, like less body hair, breasts, and the redistribution of body fat toward hips and breasts, among others. If you’re interested in or considering feminizing hormone therapy, we’ve got all the info you need to know about what to expect below. 

What is feminizing hormone therapy? 

Feminizing hormone therapy is a gender-affirming treatment that uses hormones to create a more feminine appearance. Hormone therapy can be used either on its own or in combination with gender affirmation surgery.

Who is feminizing hormone therapy for? 

Feminizing hormone therapy is used by transwomen, people who were assigned male at birth (AMAB) but identify as women. For those who experience gender dysphoria, a sense of unease due to a mismatch between biological sex and gender identity, feminizing hormone therapy is a common treatment. 

Feminizing hormone therapy, however, is also an option for nonbinary and intersex people as well. Nonbinary people are those that feel their gender cannot be defined within the margins of gender binary, while intersex people are born with reproductive or sexual characteristics that don’t fit traditional perceptions of male and female bodies. 

In short, feminizing hormone therapy is for anyone who feels that there is a mismatch between their external appearance and what they feel their authentic gender to be. 

What can I expect from feminizing hormone therapy? 

Those assigned male at birth (AMAB) can be expected to produce low levels of estrogen, a hormone that is responsible for sexual and reproductive development in women. During feminizing hormone therapy, you can expect both physical and emotional changes that are more consistent with feminine anatomy and behavior. 

When undergoing feminizing hormone therapy, treatment may involve a number of substances, including anti-androgens medication, estrogen and possibly progesterone. 

Anti-androgens are taken as a way to block male sex hormone production. Changes from this therapy include: 

• Decreased muscle mass
• Fewer erections
• Change in sex drive (libido)
• Smaller testicles
• Thinning facial and body hair

Estrogen is taken to promote physical changes that are more consistent with a feminine appearance. Progestin may also be taken to help with this as well. Changes from estrogen or progestin therapy include:

• Softer skin
• More fat on the hips, buttocks and face
• Full breasts
• Mood changes, anxiety or depression

Can I undergo feminizing hormone therapy without the supervision of a medical provider? 

If you are undergoing feminizing hormone therapy, your healthcare provider will be able to monitor your progress, ensuring you receive the correct dose for your needs. They can help you achieve the best possible results and avoid complications. Taking these substances without the help of a healthcare provider is dangerous and should be avoided.

What type of healthcare provider should I see? 

There are many different types of healthcare providers who may be able to help you with this treatment, though you may want to see someone who specializes in transgender health. These include: 

• Primary care physician
• Endocrinologist
• Gynecologist
• Psychiatrist 

When can I start feminizing hormone therapy? 

When you decide to begin hormone therapy is entirely up to you and your healthcare provider. Some people are most comfortable changing their name or dressing differently before starting this phase of their transition, but that of course isn’t a requirement. 

If you are an adolescent, you can start feminizing hormone therapy as young as 16. The advantages of starting hormone therapy at a young age include blocking the effects of puberty for your assigned gender and the ability to proceed with in a manner consistent with your authentic gender identity.   

How does feminizing hormone therapy work? 

To start feminizing hormone therapy, you’ll take anti-androgens to block testosterone production first. A few weeks later, you’ll proceed by taking estrogen. Estrogen is available in a variety of forms, including: 

• Pills
• Injections 
• Creams 
• Patches

You’ll likely start with a low dose of estrogen, working with your healthcare provider to determine what is the right dose for you and monitoring complications and side effects. As your body adapts to the therapy and you feel you have achieved the desired result, you take the appropriate dose for the rest of your life. 

How soon will I see changes in my body? 

The speed at which you will see changes is different for every single person and depends on a variety of factors, like your dose and your body’s response. On average, most people achieve the therapy’s full effects somewhere between 18 to 24 months. 

Many transwomen experience profound relief as a result of feminizing hormone therapy. Experiencing your body in a way that matches your gender identity can be comforting, and can even reduce the likelihood of depression and anxiety. Hormone therapy can foster a better self-image and improved self-esteem, contributing to a better life and better overall health. 

Sources 

• What Do I Need to Know About the Transitioning Process? (n.d.). Planned Parenthood.
• Feminizing Hormone Therapy: What To Expect & How It Works. (2021, June 4). Cleveland Clinic.
• Overview of gender-affirming treatments and procedures. (2016, June 17). UCSF Transgender Care. 
• Gender Affirmation Surgery: What Happens, Risks & Benefits. (2021, May 3). Cleveland Clinic.
• NHS website. (2022, May 19). Gender dysphoria. NHS.
• Understanding Non-Binary People: How to Be Respectful and Supportive. (2020, September 4). National Center for Transgender Equality.
• What is Intersex? (n.d.). Planned Parenthood. 
• Estrogen’s Effects on the Female Body. (2019, November 19). Johns Hopkins Medicine.