Feminizing hormone therapy involves the administration of anti-androgens, estrogen, and progesterone through pills, intramuscular (IM) injections, subcutaneous (SubQ) injections, transdermal (through the skin) patches, and/or topical gel or nasal spray.

It’s important that you only take your medications as prescribed. Taking higher doses than you’re prescribed can lead to serious long-term health consequences, including organ failure–taking more medication does not mean that you’re going to see changes faster. Like with cisgender puberty, it will take time and patience to see all of the changes that you’re hoping to see.

There is no guaranteed “plan” or formula for how to fast track certain results or end up with the same results as someone else. Everyone’s body will react differently to hormones, you’ll need to work with your doctor to find the right combination for you.

Breast development can be somewhat uncomfortable at first when the breast buds are first developing, but the discomfort goes away over time. It’s normal if the left and right sides are not perfectly symmetrical–it’s actually quite normal that one will end up slightly different than the other in cisgender women as well.

Feminizing hormone therapy won’t change your voice in the same way that transmasculine individuals experience with testosterone. If you experience vocal dysphoria, there are several videos available online that teach people how to try to speak differently, as well as vocal coaches and speech therapists that you may be able to work with. However, it’s also perfectly fine if you don’t want to change your voice much/at all, and that’s valid too!

With feminizing hormone therapy, you may experience lower libido, a reduction in the number or viability of erections, as well as a reduction in the size of the testicles. For some, these are desired changes, but for others, it can feel concerning–speak to your doctor about any medications or changes that might help you feel more comfortable with this.

If having a biological child is important to you, it can be worth asking your doctor about banking sperm. A side effect of feminizing hormone therapy can be a reduced sperm count, and there’s no guarantee that going off hormones later will fully restore those numbers.

You may need to take a testosterone blocker in addition to your other hormones until you have an orchiectomy/vaginoplasty. Spironolactone can affect your sodium or potassium levels or lead to increased urination, but may be tolerated by many people. Lupron and finasteride are other options that are also generally well-tolerated.
Often, you’ll be started on estrogen and a testosterone blocker around the same time before introducing progesterone later, if needed.

Resources:

UCSF–Information on Estrogen Hormone Therapy

UCSF–Overview of Feminizing Hormone Therapy

Mayo Clinic–Feminizing Hormone Therapy

Planned Parenthood–Effects of Feminizing Hormone Therapy

Planned Parenthood–Information for Informed Consent, Feminizing Hormone Therapy

Transfeminine Science–Puberty Blockers

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