“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; for others, it happens as physical changes happen.

The degree and rate of change depend 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 to know how your body will respond before starting hormones.

1. Taking anti-androgens alone (without estrogen)

Spironolactone aldactone 25mg tablets — This medicine may cause enlargement of breasts in male patients as a side effect. Aldactone Tablet is a type of diuretic (water pill). This medicine reduces excess fluid levels and testosterone in the body and is used to treat edema (fluid overload). It makes you lose excess water through urine. This medicine should be taken only during day time to avoid frequent urination at night. It may be used alone or in combination with other medicines.

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).

Typical changes from anti-androgens (vary from person to person)

See Average timeline Effect of blocking testosterone

1–3 months after starting anti-androgens	Gradual changes (usually at least two years)
Gradual changes (usually at least 2 years)	• slower growth of facial and body hair • slowed or stopped “male”-pattern balding • slight breast growth (reversible in some cases, not in others)

Anti-androgens affect the entire body.
It’s not possible to pick some changes and not others.

2. Estrogen

estradiol 2mg 28 tablet — Estradiol (2 MG) is a form of estrogen. Estradiol is used to treat symptoms of menopause, such as hot flashes, vaginal dryness, burning, and irritation.

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.

Typical changes from estrogen (vary from person to person)

See Average Timeline Effect of Estrogen

1–3 months after starting estrogen

• softening of the skin
• decrease in muscle mass and increase in body fat
• redistribution of body fat to a more “feminine” pattern
• decrease in sex drive
• fewer instances of waking up with an erection or spontaneously
having an erection; some MTFs also find their erections are less
firm during sex, or can’t get erect at all
• decreased ability to make sperm and ejaculatory fluid

Gradual changes
(maximum change
after 1–2 years
on estrogen)

• nipple and breast growth
• slower growth of facial and body hair
• slowed or stopped “male”-pattern balding
• decrease in testicular size

Estrogen affects the entire body.
It’s not possible to pick some changes and not others.

Breast and nipple growth starts early but is usually gradual – it can take 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 unhappy with the size of your breasts after 18–24 months on estrogen, you can consider surgical augmentation (see Surgery: A guide for MTFs booklet).

The implants will look most natural if you wait to get as much growth as possible 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.

Medications and Dosage

Anti Androgens

Two anti-androgen options seem to be more widely used than others. These are:

Cyproterone Acetate at 100mg – 150mg daily, taken orally. This one seems to carry an increased risk of depressive symptoms, and should this side effect occur, the medication is often changed.
Spironolactone – 100mg- 200mg daily, taken orally. This one might be a good option if you have high blood pressure or are concerned about blood clots or venous thromboembolism as it is a potassium-sparing diuretic.

Other options include:

Medroxyprogesterone – 5mg – 10mg daily, taken orally, or 150mg monthly via intramuscular injection.
Nilutamide – 300mg daily, taken orally. This one can cause androgen production in rare cases, so it is usually not the first choice.
Flutamide – 250mg three times daily, taken orally. This one can also potentially cause androgen production, so it is not the first choice.

Estrogen Treatment

Ethinyl Estradiol – 100 micrograms daily, taken orally. Most effective and easy to come by. It can be in the form of an oral contraceptive pill.
Conjugated Equine Estrogens – 5mg t- 10mg daily, taken orally. This one is usually not advised as it increases the risk of thrombosis.
17ß Estradiol – 2mg – 8mg daily, taken orally, or 200mg monthly intramuscular injection, or 50 – 100 micrograms transdermally. This is a synthetic hormone therapy. This option appears to be the most expensive.
Estriol – 4mg – 6mg daily, taken orally. High doses are necessary for gender-affirming hormone therapy.