Feminizing Hormones

What are the commonly prescribed feminizing hormones?

Your healthcare provider will help you tailor your hormone therapy to meet your goals, health needs and budget.

Your hormone therapy may include any of the following combinations:

  • Just estrogen
  • Estrogen + testosterone blockers
  • Estrogen + testosterone blockers + progesterone
  • Just testosterone blockers (not safe for long periods of time)

You can use the tables below to compare common estrogen, testosterone blocker, and progesterone therapies. The advantages and disadvantages listed here are not exhaustive. Also included on this page are the expected effects and potential risks associated with feminizing hormones. Talk to your healthcare provider to determine the best fit for you.

Some quick notes about progesterone therapies:

  • The use of progesterone in feminizing regimens is controversial.
  • Most guidelines do not recommend the use of progesterone as part of a standard regimen but discuss the possibility of using it as an adjunctive medication for a period of time.
  • Unproven benefits may include positive effects on the development of the nipple and areola and improved libido.
  • Common side effects include weight gain, edema, lipid changes and depression.
  • Using the combination of progesterone and estrogen as compared to estrogen alone is believed to increase risk of strokes, pulmonary emboli, breast cancer and heart disease.
  • Micronized progesterone may be safer than medroxyprogesterone but is more expensive.

Common estrogen therapies

Option What is it? Advantages Disadvantages

Oral Estrogen

(e.g. Estrace)

A pill you swallow or dissolve under your tongue each day.

Less expensive (around $14/month).

Higher cardiovascular risk for people over 40, or people with other risk factors.

Estrogen Patch (e.g. Estradot, Estraderm, Oesclim)

A patch you wear on your skin that gets changed twice a week.

Lower cardiovascular risk for people over 40, or people with other risk factors.

More expensive (around $25/month). Some people have a skin reaction to the adhesive in the patch.

Injectable Estrogen (e.g. estradiol valerate)

A substance you inject every two weeks.

Lower cardiovascular risk for people over 40, or people with other risk factors.

More expensive. Less widely available. Some people find injections to be painful. Improper injection can be dangerous.

 

Common testosterone blocker therapies

Option What is it? Advantages Disadvantages

Spironolactone (e.g.Aldactone)

A pill that you swallow once or twice a day.

Most common because it’s less expensive ($22/month) and usually well-tolerated.

Some people find pills hard to swallow.

May make you have to pee more often. May require dietary restrictions.

Cyproterone (e.g.Androcur)

A pill that you swallow once a day.

Potent testosterone blocker.

More expensive (around $50/month). May cause liver inflammation and depression.

Finasteride (e.g.Proscar)

A pill that you put under your tongue once a day or every other day. Usually used with one of the above anti-androgen therapies.

Can help stop hereditary hair loss.

Costs around $60/month.

Common progesterone therapies

Option What is it? Advantages Disadvantages

Medroxyprogesterone (e.g. Provera)

A pill you take daily.

Widely available. Less expensive at around $33/month. May help with breast development.

Thought to be higher risk.

Micronized Progesterone (e.g.Prometrium)

A pill you take daily.

Thought to be lower risk.

More expensive at about $90/month. Not as widely available.

 

Expected effects of feminizing hormone therapies

Effect Notes

Breast development

Usually starts in 3-6 months

Breasts reach full size in 2-3 years

Size varies. A or B cup-size is typical

This is a permanent change

Body fat redistribution

Usually starts in 3-6 months

Reaches maximum effect in 2-5 years

Less fat on abdomen

More fat on buttocks, hips and thighs

Usually not a permanent change if you stop taking hormones

Reduced muscle mass and strength

Usually starts in 3-6 months

Reaches maximum effect in 1-2 years

Reduced muscle and strength in upper body

Usually not a permanent change if you stop taking hormones

Softening of skin

Usually starts in 3-6 months

Skin will be softer and less oily

Usually not a permanent change if you stop taking hormones

Less body and facial hair

Usually starts in 6-12 months

Maximum effect in more than 3 years

Body hair will appear less noticeable

Body hair will grow more slowly

Beard and mustache may grow more slowly and appear less noticeable, but will not go away

If you have male pattern baldness, it may slow down

Hair that has already been lost likely will not grow back

This is usually not a permanent change if you stop taking hormones

Reduced sex drive

Usually starts in 1-3 months

Reaches maximum effect in 1-2 years

Fewer morning erections

Fewer spontaneous erections

Usually not a permanent change if you stop taking hormones

Fertility

Timeline varies

Sperm may no longer to reach maturity

Won’t produce as much semen

May not be able to get hard enough for penetrative sex

May become permanently unable to make someone pregnant (but birth control is still recommended)

Smaller  testes*testes* (with an asterisk) is used to acknowledge the many different words that are used for this body part

Usually starts in 3-6 months

Maximum effect in 2-3 years

May shrink down to half their initial size

This may or may not be a permanent change if you stop taking hormones

Emotional Changes

Your overall emotional state may or may not change; this varies from person to person. You may find that you experience to a narrower range of emotions or feelings. You may find that you experience to a wider range of emotions or feelings.

 

Risks associated with feminizing hormone therapies

Risk Level Feminizing Hormones

Likely increased risk

Serious blood clots (Venous thromboembolic disease)

Gallstones

Elevated liver enzymes

Weight gain

Hypertriglyceridemia (risk factor for heart disease and pancreas problems)

Likely increased risk with presence of additional risk factors

Cardiovascular disease

Possible increased risk

High Blood Pressure (Hypertension)

HyperprolactinemiaThe presence of abnormally high levels of prolactin in the blood. Prolactin is a peptide hormone produced by the anterior pituitary gland that is primarily associated with lactation and plays a vital role in breast development during pregnancy. Hyperprolactinaemia may cause galactorrhea (production and spontaneous flow of breast milk) and hypogonadism, infertility and erectile dysfunction. or  prolactinomaA benign tumor (adenoma) of the pituitary gland that produces a hormone called prolactin. Symptoms of prolactinoma are caused by too much prolactin in the blood (hyperprolactinemia) or by pressure of the tumor on surrounding tissues. Prolactin stimulates the breast to produce milk, and has many other functions such as regulation of mood. It is responsible for the sexual refractory period after orgasm and excess levels can lead to erectile dysfunction.

Possible increased risk with presence of additional risk factors

Type 2 Diabetes

No increased risk or inconclusive research

Breast cancer