Feminizing hormone therapy has important psychological benefits.Bringing the mind and body closer together eases gender dysphoria and can help trans people feel better about their bodies. People who have had gender dysphoria often describe being less anxious, less depressed,calmer, and happier when they start taking hormones. For some people this psychological change happens as soon as they start taking hormones,and for others it happens as physical changes happen.
The degree and rate of change depends on factors that are different for every person, including your age, the number of hormone receptors in your body, and how sensitive your body is to the medication. There is no way of knowing how your body will respond before you start hormones.
Taking anti-androgens alone (without estrogen)
Taking an anti-androgen without estrogen has relatively mild effects.The changes are caused by the medication blocking the effect of testosterone in your body. Most of the changes are reversible (i.e., they will reverse if you stop taking the medication).
Estrogen
Taking estrogen has stronger physical “feminizing” effects, caused by the estrogen’s direct influence on cells of your body that have estrogen receptors and also by an indirect suppression of testosterone production.
Breast and nipple growth starts early but is usually gradual – it cantake two years or more for breasts to reach their maximum size. As in non-trans women, there is great variation in how large breasts grow from estrogen. In many MTFs breasts do not grow beyond an A or B cup. If you are not happy with the size of your breasts after 18–24 months on estrogen, you can consider surgical augmentation. The implants will look most natural if you wait to get as much growth as you can from hormones.
Most of the effects of hormones happen in the first two years. During this time, the doctor who prescribes your hormones will want to see you one month after starting or changing your dose, then 3–4 times in the next year, then every six months. At appointments in the first two years,
your doctor will likely:
After two years have passed, you will likely just be asked if you notice any further changes from the hormones.
Are These Changes Permanent?
Most of the changes brought on by “feminizing” hormone therapy are not permanent. If you stop taking the medication, most of the changes will reverse themselves. There are two types of changes that may be permanent: breast growth and sterility.
If you are taking anti-androgens without estrogen because you don’t want visible changes, you should be aware that you may have some breast growth (although it will happen slowly, so you can stop early on if you need to). Breast growth from anti-androgens is usually minor and reversible, but in some cases the breast tissue has remained even after anti-androgens were stopped.
Estrogen causes permanent nipple development and breast growth. Even if you stop taking estrogen, breast tissue will not go away and your nipples will not shrink.
Both anti-androgens and estrogen affect your production of sperm. The long-term effects on fertility are not fully understood and the ability to make sperm may or may not come back even if you stop taking the medication. We strongly recommend that you talk about options for sperm banking before starting hormone therapy. If you have already started hormones, you can work with your doctor to go off them, give sperm samples, and store them if they are viable (then go back on hormones).
What Won’t Change?
The point of hormone therapy is to feel more comfortable with your body by bringing physical characteristics closer to your internal sense of self. This relief can increase self-esteem and make you feel more confident and attractive. However, you will find that there are also attractiveness
standards after hormone therapy, and you may not fit them.
It can be hard to separate out gender dysphoria from body image problems. Professional and peer counselling can be helpful to sort out your expectations about your appearance, and to work towards greater self-acceptance
Many people experience positive emotional changes with hormone therapy. But you’ll likely find, after the excitement wears off and you’ve incorporated the changes into your day-to-day life, that if you were shy you’re still shy, if you didn’t like your laugh you still don’t, and you’re still afraid of spiders. Whatever things you think of as your strengths and weaknesses will still be there. Hopefully, you will be happier, and that is good for anyone. Hormone therapy may help you to be more accepting of yourself. But if you are expecting that all your problems will pass away, and that everything is going to be easy emotionally and socially from here on in, you’re probably going to be disappointed.
This extends to mental health concerns as well. Trans people who were depressed because of gender dysphoria may find that taking hormones greatly alleviates their depression. However, if you have depression caused by biological factors, the stresses of transphobia or unresolved personal issues, you may still be depressed after you start hormones. Likewise, if you are having problems with drugs or alcohol, hormones will not necessarily get rid of those problems
For some trans people, hormone therapy is a ritual affirming that they are who they say they are. Making physical changes is a way to bring who you are to the rest of the world so other people can see it. This process of self-emergence can be very liberating but it does not guarantee that you will find acceptance or understanding.
Some MTFs hope that after they make physical changes they will be validated as “real” women, or feel more accepted by the trans community. But the idea that trans people aren’t “real” unless they’ve changed their bodies is transphobic, and communities or groups that have this belief are not likely to be fully respectful in terms of trans people’s identities and bodies.
During the various stages of transition, it’s common to dream about finding an ideal community of trans people. When starting hormones there can be a particular drive to find other people who have gone through similar experiences. There are a lot of very cool trans people to talk with about hormones. But having taken hormones doesn’t automatically make trans people welcoming, approachable, or sensitive to the needs of others, and despite having some experiences in common you will likely find that no trans person will exactly mirror your personal experiences, identity, and beliefs. Being realistic about the likelihood that you will at times feel lonely and alone after you start taking hormones is part of emotionally preparing for hormone therapy.
Some physical characteristics aren’t changed by hormone therapy, or are only slightly changed. This includes aspects of your body that develop before birth (penis, sex chromosomes, etc.) and also physical characteristics that developed from the increase in testosterone at puberty.
Hormone therapy may make facial and body hair grow more slowly and be less noticeable, but hair will not go away completely. Electrolysis and/or laser treatments are used by many MTFs for hair removal (electrolysis is permanent; it is not yet clear how long-lasting laser hair removal is).
While “male”-pattern baldness may slow down or stop, bald areas will not regrow hair. Some MTFs use wigs or hairpieces, while others get hair transplants or other medical treatments.
“Feminizing” hormone therapy does not change voice pitch or speech patterns. Speech therapy can help change pitch and other aspects of speech associated with sex/gender. Some MTFs have surgery on their vocal cords or the surrounding cartilage to try to further raise voice pitch.
Once your bones have stopped growing after puberty, feminizing hormone therapy won’t change the size or shape of your bones. Facial feminizing surgery can be used to change the shape of the skull and facial features, and to reduce a prominent Adam’s apple. There are no treatments you can take to reduce your height or the size of your hands/feet.
Although anti-androgens and estrogen affect sperm production and can make you permanently sterile, there may still be a chance that you could make someone pregnant even after starting hormone therapy. Depending on how you have sex, you may need to consider birth control options.
Hormone therapy doesn’t decrease the risks of HIV and sexually transmitted infections. Depending on how you have sex, you may need to consider condoms, gloves, or other latex barriers. “Feminizing” hormones can make erections less firm, increasing the risk of condom leakage. In this situation your partner can use a special condom that they put inside their anus or vagina (they’re called “female condoms” but can be used by people of any gender).
The degree and rate of change depends on factors that are different for every person, including your age, the number of hormone receptors in your body, and how sensitive your body is to the medication. There is no way of knowing how your body will respond before you start hormones.
Taking anti-androgens alone (without estrogen)
Taking an anti-androgen without estrogen has relatively mild effects.The changes are caused by the medication blocking the effect of testosterone in your body. Most of the changes are reversible (i.e., they will reverse if you stop taking the medication).
Estrogen
Taking estrogen has stronger physical “feminizing” effects, caused by the estrogen’s direct influence on cells of your body that have estrogen receptors and also by an indirect suppression of testosterone production.
Breast and nipple growth starts early but is usually gradual – it cantake two years or more for breasts to reach their maximum size. As in non-trans women, there is great variation in how large breasts grow from estrogen. In many MTFs breasts do not grow beyond an A or B cup. If you are not happy with the size of your breasts after 18–24 months on estrogen, you can consider surgical augmentation. The implants will look most natural if you wait to get as much growth as you can from hormones.
Most of the effects of hormones happen in the first two years. During this time, the doctor who prescribes your hormones will want to see you one month after starting or changing your dose, then 3–4 times in the next year, then every six months. At appointments in the first two years,
your doctor will likely:
- look at your facial/body hair and ask how fast your hair grows back after you remove it
- measure your breasts, hips, and testicles, and examine your breast/nipple development
- ask about changes to your sex drive, erections, or other sexual changes
- order a blood test to see what your hormone levels are
- ask how you feel about the changes that have happened thus far
After two years have passed, you will likely just be asked if you notice any further changes from the hormones.
Also Read: Possible Side Effects/Risks of Feminizing Hormones
Most of the changes brought on by “feminizing” hormone therapy are not permanent. If you stop taking the medication, most of the changes will reverse themselves. There are two types of changes that may be permanent: breast growth and sterility.
If you are taking anti-androgens without estrogen because you don’t want visible changes, you should be aware that you may have some breast growth (although it will happen slowly, so you can stop early on if you need to). Breast growth from anti-androgens is usually minor and reversible, but in some cases the breast tissue has remained even after anti-androgens were stopped.
Estrogen causes permanent nipple development and breast growth. Even if you stop taking estrogen, breast tissue will not go away and your nipples will not shrink.
Both anti-androgens and estrogen affect your production of sperm. The long-term effects on fertility are not fully understood and the ability to make sperm may or may not come back even if you stop taking the medication. We strongly recommend that you talk about options for sperm banking before starting hormone therapy. If you have already started hormones, you can work with your doctor to go off them, give sperm samples, and store them if they are viable (then go back on hormones).
What Won’t Change?
- Hormone therapy won’t solve all body image problems.
The point of hormone therapy is to feel more comfortable with your body by bringing physical characteristics closer to your internal sense of self. This relief can increase self-esteem and make you feel more confident and attractive. However, you will find that there are also attractiveness
standards after hormone therapy, and you may not fit them.
It can be hard to separate out gender dysphoria from body image problems. Professional and peer counselling can be helpful to sort out your expectations about your appearance, and to work towards greater self-acceptance
- Hormone therapy won’t make you into somebody else.
Many people experience positive emotional changes with hormone therapy. But you’ll likely find, after the excitement wears off and you’ve incorporated the changes into your day-to-day life, that if you were shy you’re still shy, if you didn’t like your laugh you still don’t, and you’re still afraid of spiders. Whatever things you think of as your strengths and weaknesses will still be there. Hopefully, you will be happier, and that is good for anyone. Hormone therapy may help you to be more accepting of yourself. But if you are expecting that all your problems will pass away, and that everything is going to be easy emotionally and socially from here on in, you’re probably going to be disappointed.
This extends to mental health concerns as well. Trans people who were depressed because of gender dysphoria may find that taking hormones greatly alleviates their depression. However, if you have depression caused by biological factors, the stresses of transphobia or unresolved personal issues, you may still be depressed after you start hormones. Likewise, if you are having problems with drugs or alcohol, hormones will not necessarily get rid of those problems
- Hormone therapy won’t provide you with a perfect community.
For some trans people, hormone therapy is a ritual affirming that they are who they say they are. Making physical changes is a way to bring who you are to the rest of the world so other people can see it. This process of self-emergence can be very liberating but it does not guarantee that you will find acceptance or understanding.
Some MTFs hope that after they make physical changes they will be validated as “real” women, or feel more accepted by the trans community. But the idea that trans people aren’t “real” unless they’ve changed their bodies is transphobic, and communities or groups that have this belief are not likely to be fully respectful in terms of trans people’s identities and bodies.
During the various stages of transition, it’s common to dream about finding an ideal community of trans people. When starting hormones there can be a particular drive to find other people who have gone through similar experiences. There are a lot of very cool trans people to talk with about hormones. But having taken hormones doesn’t automatically make trans people welcoming, approachable, or sensitive to the needs of others, and despite having some experiences in common you will likely find that no trans person will exactly mirror your personal experiences, identity, and beliefs. Being realistic about the likelihood that you will at times feel lonely and alone after you start taking hormones is part of emotionally preparing for hormone therapy.
Also Read: Feminizing Foods
- Hormone therapy won’t remove all “male”/“masculine” aspects of your body.
Some physical characteristics aren’t changed by hormone therapy, or are only slightly changed. This includes aspects of your body that develop before birth (penis, sex chromosomes, etc.) and also physical characteristics that developed from the increase in testosterone at puberty.
Hormone therapy may make facial and body hair grow more slowly and be less noticeable, but hair will not go away completely. Electrolysis and/or laser treatments are used by many MTFs for hair removal (electrolysis is permanent; it is not yet clear how long-lasting laser hair removal is).
While “male”-pattern baldness may slow down or stop, bald areas will not regrow hair. Some MTFs use wigs or hairpieces, while others get hair transplants or other medical treatments.
“Feminizing” hormone therapy does not change voice pitch or speech patterns. Speech therapy can help change pitch and other aspects of speech associated with sex/gender. Some MTFs have surgery on their vocal cords or the surrounding cartilage to try to further raise voice pitch.
Once your bones have stopped growing after puberty, feminizing hormone therapy won’t change the size or shape of your bones. Facial feminizing surgery can be used to change the shape of the skull and facial features, and to reduce a prominent Adam’s apple. There are no treatments you can take to reduce your height or the size of your hands/feet.
Although anti-androgens and estrogen affect sperm production and can make you permanently sterile, there may still be a chance that you could make someone pregnant even after starting hormone therapy. Depending on how you have sex, you may need to consider birth control options.
Hormone therapy doesn’t decrease the risks of HIV and sexually transmitted infections. Depending on how you have sex, you may need to consider condoms, gloves, or other latex barriers. “Feminizing” hormones can make erections less firm, increasing the risk of condom leakage. In this situation your partner can use a special condom that they put inside their anus or vagina (they’re called “female condoms” but can be used by people of any gender).
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