Feminizing Hormone Therapy

Expected effects of a regimen consisting of estrogen and anti-androgen

Below are estimates of the expected effects of feminizing hormone therapy from published and unpublished clinical observations. Hormone therapy will not change the underlying bone structure of the face or body.

Hover over the coloured regions to view expected information on the reversibility, onseta and maximum effectsa of physical changes

Skin changes

Skin becomes softer and less oily. Acne may decrease

Reversibility:
Reversible
Expected onset:
3 - 6 months
Expected max. effect:
Unknown

Thinned/slowed growth of body/facial hair c

Complete removal of facial and body hair requires electrolysis, laser treatment, or both.

Reversibility:
Reversible
Expected onset:
6 - 12 months
Expected max. effect:
> 3 years

Scalp hair loss (loss stops, no regrowth)

Scalp hair growth may slow or stop. No regrowth of hair.

Reversibility:
Reversible
Expected onset:
1 - 3 months
Expected max. effect:
Variable

Breast growth

Reversibility:
Irreversible
Expected onset:
3 - 6 months
Expected max. effect:
1 - 2 years

The reversibility of the following effects are variable. Decreased sperm production (infertility) as well as reduced erectile function may also occur.

Decreased testicular volume

Expected onset:
3 - 6 months
Expected max. effect:
2 - 3 years

Decreased libido

Expected onset:
1 - 3 months
Expected max. effect:
3 - 6 months

Decreased spontaneous erections

Expected onset:
1 - 3 months
Expected max. effect:
3 - 6 months

Decreased muscle mass/strengthb

Significantly dependent on amount of exercise

Reversibility:
Reversible
Expected onset:
3 - 6 months
Expected max. effect:
1 - 2 years

Body fat redistribution

Fat redistributes from abdomen and mid-section regions to the buttocks, hips and thighs.

Reversibility:
Reversible
Expected onset:
3 - 6 months
Expected max. effect:
2 - 3 years
  • Adapted from Hembree et al., The Endocrine Treatment of Gender-Dysphoric/Gender Incongruent Persons: An Endocrine Society Guideline
  • a) Estimates for onset and expected maximum effect represent published and unpublished clinical observations. Sources:
    1. Toorians AWFT, Thomassen MCLGD, Zweegman S, Magdeleyns EJP, Tans G, Gooren LJG, et al. Venous thrombosis and change of hemostatic variables during cross-sex hormone treatment in transsexual people. The Journal of Clinical Endocrinology & Metabolism 2003;88(12):5723-5729.
    2. Asscheman H, Gooren LJG, Assies J, Smits JPH, Slegte R. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrinol (Oxf)1988; 28(6): 583-588.
    3. Gooren LJ, Harmsen-Louman W, van Kessel H. Follow-up of prolactin levels in long-term oestrogen-related male-to-female transsexuals with regard to prolactinoma induction. Clin Endocrinol (Oxf) 1985; 22(2): 201-207.
  • b) Significantly dependent on amount of exercise
  • c) Complete removal of facial hair requires electrolysis, laser treatment, or both
  • Visual reference: Tetzlaff K.Patient’s guide to transgender, trans, & gender diverse health. 2015.