Introduction
What is HRT?
Hormone Replacement Therapy (HRT) is a medical treatment designed to adjust or replace the body's natural hormone levels. It is widely used by transfeminine individuals (those who were assigned male at birth but identify as female or feminine) to support their gender transition.
The therapy typically involves administering estrogen to promote feminization, alongside antiandrogens that suppress testosterone. HRT helps align one's physical characteristics with their gender identity, providing both physical and emotional benefits.
Effects of HRT
The information below is from Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
Fat Redistribution
INFO
Start Time: 3-6 months
Maximal Effect: 2-5 years
The fat in the body begins to redistribute from areas like the abdomen and upper body to more traditionally feminine areas like the hips, thighs, and buttocks.
Reduction in Muscle Mass/Strength
INFO
Start Time: 3-6 months
Maximal Effect: 1-2 years
HRT reduces muscle mass and strength, leading to a softer appearance.
Skin Softening and Decreased Oiliness
INFO
Start Time: 3-6 months
Maximal Effect: Unknown
HRT typically leads to softer, thinner skin and reduced oil production, which may also reduce acne over time.
Decreased Libido
INFO
Start Time: 1-3 months
Maximal Effect: Unknown
Many individuals experience a reduction in sexual desire after starting HRT.
Reduced Spontaneous Erections
INFO
Start Time: 1-3 months
Maximal Effect: 3-6 months
Over time, HRT diminishes the frequency of spontaneous erections due to the suppression of testosterone.
Impairment of Male Sexual Function
INFO
Start Time: Unknown (maybe tomorrow)
Maximal Effect: 2 years
Erectile function often becomes impaired after long-term use of HRT.
Breast Development
INFO
Start Time: 3-6 months
Maximal Effect: 2-5 years
Breast development begins within the first few months and continues over several years, with final size and shape varying between individuals.
Testicular Shrinkage
INFO
Start Time: 3-6 months
Maximal Effect: Ongoing (indeterminate endpoint)
Testicular size usually decreases as testosterone levels are suppressed. This change may continue indefinitely.
Reduced Growth of Terminal Hair (Body Hair)
INFO
Start Time: 6-12 months
Maximal Effect: Over 3 years
Body hair growth generally decreases in thickness and speed, particularly on the arms and legs. Complete elimination of body hair is rare.
Scalp Hair Growth
INFO
Start Time: Variable
Maximal Effect: Variable
Some individuals may experience improved scalp hair growth, especially if they start HRT early. However, this effect varies and may not lead to significant changes for everyone.
Voice Changes
INFO
Effect: None
HRT does not alter the pitch of the voice. Transfeminine individuals often require voice training or surgery to achieve a more feminine voice.
For GnRH
For individuals who take GnRH agonists (puberty blockers) before their voice deepens (usually happened in Tanner Stage III or IV[1]), they may prevent the deepening of the voice typically caused by testosterone during puberty.
Risks of HRT
HRT, while beneficial for many, comes with certain risks that individuals should be aware of before starting.
Estrogen, for instance, is associated with an increased risk of blood clots, particularly deep vein thrombosis (DVT). Additionally, HRT may heighten the chances of developing cardiovascular issues, especially for those with pre-existing conditions such as high blood pressure or cholesterol problems. Liver function is another area of concern, as oral hormone treatments may affect liver enzymes over time. [2]
Bone density can also be impacted, especially if the hormone balance is not carefully managed. Lastly, it’s important to note that HRT is able to permanently reduce fertility, making it essential for individuals to explore fertility preservation options before starting treatment if having biological children in the future is a goal.
Mental health can also be affected, with some individuals experiencing heightened emotional fluctuations, depression, or anxiety during the adjustment period.
Harries MLL, Walker JM, Williams DM, et alChanges in the male voice at pubertyArchives of Disease in Childhood 1997;77:445-447. ↩︎
Wikipedia contributors. (2024, September 15). Estradiol (medication). In Wikipedia, The Free Encyclopedia. Retrieved 12:23, October 8, 2024, from https://en.wikipedia.org/w/index.php?title=Estradiol_(medication)&oldid=1245926487 ↩︎