Hormone Replacement Therapy for Transgender Women

Hormone replacement therapy (HRT) plays a crucial role in the transition process for many transgender women. It helps feminize the body and reduce gender dysphoria.

In this article, we will provide an overview of Hormone Replacement Therapy for Transgender Women, answering some commonly asked questions.


Starting HRT

One of the most frequently asked questions is at what age do transgender women typically start HRT. Many begin taking estrogen and testosterone blockers around age 18, though this can vary considerably depending on the individual.

The effects of HRT are most pronounced when started at a younger age before the body has been altered much by endogenous puberty. However, HRT can still feminize the body even when initiated later in life.


Hormones Used

The two main components of HRT for transgender women are estrogen and testosterone blockers. Estrogen is the primary female sex hormone. It induces fat redistribution to the hips/thighs, breast growth, softening of the skin, and changes the odor of sweat/urine.

Testosterone blockers reduce testosterone levels, helping to minimize masculine features. Common forms of estrogen used include estradiol, estradiol valerate, and estradiol cypionate. Spironolactone is a frequently prescribed testosterone blocker.

Some transgender women also take progesterone, but this is not as universally used. The risks of progesterone are debated, with concerns about increased risk of breast cancer. Therefore, many doctors do not prescribe progesterone.


Effects on Sex Drive

A common question is whether HRT reduces sex drive. In the initial months after starting HRT, sex drive often declines significantly. This is likely due to the body adjusting to the new hormonal environment.

However, sex drive often rebounds after some time on HRT. The extent to which sex drive is impacted varies considerably between individuals.


Breast Development

Breast growth is one of the most significant effects of HRT. The amount of growth differs based on genetics, body weight, age at the start of HRT, and other factors.

Maximum growth typically occurs within the first 3 years on HRT. Total growth can range from minimal to large breasts. The areola and nipple areas are often feminized in appearance.

Other Physical Changes

Aside from breast development, HRT induces a wide array of changes, including:

  • Fat redistribution to hips/thighs/buttocks
  • Decreased muscle mass and strength
  • Skin softening
  • Changes in body odor and sweating
  • Decreased facial and body hair growth
  • Rounding of facial features
  • Slowed balding for those prone to male-pattern baldness

The physical changes take place gradually over the first few years of HRT. The extent of changes depends on the individual and when HRT was initiated.


Mood Changes

Many transgender women report mood changes after initiating HRT. Some experience heightened emotions, feeling greater joy but also sadness. Mood swings are also common, especially in the first few months.

These effects may subside over time as hormone levels stabilize. The mental/emotional impact of HRT varies greatly.



HRT plays a crucial role in the transition for many transgender women. When started at a young age, it can shape a feminine appearance. HRT impacts sex drive, breast development, fat redistribution, emotions, and many other aspects of the mind and body.

With increased education and awareness, healthcare providers can better help transgender patients with safe, effective hormone therapy.