Estrogen-based hormones

Estrogen-based hormones

Some transgender, Two-Spirit and non-binary people benefit from estrogen-based hormone therapy to align physical characteristics with their gender. 

What are estrogen-based therapies?

A note about language

Estrogen-based therapies are also known as “feminizing hormones.” To be more inclusive of diverse gender identities, we are using language that focuses on anatomy, treatments and presenting concerns, rather than gender.

Estrogen-based therapies include estrogen, testosterone blockers and progesterone. 

  • Estrogen is a hormone that is used to induce secondary sex characteristics Physical traits that develop after sexual maturity (puberty), such as facial hair growth, deepening of the voice or breast development. like breast growth, rounder hips and softer skin. It also reduces testosterone-related features, such as facial hair.
  • Testosterone blockers reduce natural testosterone production and its effects (such as promoting muscle mass). 
  • The role of progesterone is not well understood. Most guidelines do not recommend the use of it as part of a standard regimen but discuss the possibility of using it as an additional medication for a period of time.

This page describes the advantages, disadvantages, expected effects and potential risks of these therapies. The list of therapies is not exhaustive. Talk to your health care provider to determine the best fit for you.

Different estrogen-therapy combinations

Your health care 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:

  • Estrogen alone
  • Estrogen and testosterone blockers
  • Estrogen and testosterone blockers and progesterone
  • Testosterone blockers alone (this is not safe for long periods of time)

Common estrogen therapies

 Oral estrogen Estrogen patch Injectable estrogen
BrandEstraceEstradot, Estraderm, Oesclimestradiol valerate
DescriptionA pill you swallow or dissolve under your tongue each dayA patch you wear on your skin that gets changed twice a weekA substance you inject every week or two (sometimes twice weekly)
AdvantagesLess expensive (approximately $20–$40 per month)Lower cardiovascular risk for people over 40, especially with other risk factorsPossibly lower cardiovascular risk for people over 40, especially with other risk factors
DisadvantagesHigher cardiovascular risk for people over 40, especially with other risk factorsMore expensive ($35–$50 per month); some people have a skin reaction to the adhesive in the patchRequires a compounding pharmacy; more expensive and less widely available; some people find injections to be painful; no public options to cover the costs of injectable estrogen.

Common testosterone blocker therapies

DescriptionA pill that you swallow once or twice a dayA pill that you swallow once a dayA pill that you put under your tongue once a day or every other day; will not suppress testosterone levels on its own
AdvantagesMost common because it’s less expensive ($20–$40 per month) and usually well toleratePotent testosterone blockerCan help slow scalp hair loss
DisadvantagesSome people find pills hard to swallow; may make you have to pee more often; may require dietary restrictionsMore expensive ($32–$100 per month); may cause liver inflammation (especially in higher doses) and depression.More expensive (approximately $60 per month)

Common progesterone therapies

The role of progesterone in estrogen-based therapy is not well understood. Benefits may include positive effects on the development of the nipple and areola and improved libido, but this is unproven. 

Side effects may include weight gain, swelling and depression. Taking progesterone along with estrogen may increase health risks in comparison to taking estrogen alone.

 MedroxyprogesteroneMicronized progesterone 
DescriptionA pill you take dailyA pill you take daily
AdvantagesWidely available and less expensiveThought to be lower risk than medroxyprogesterone
DisadvantagesThought to be higher risk compared with micronized progesteroneMore expensive (about $90 a month)   

Expected effects of estrogen-based hormone therapies

Increasing breast development

  • Usually starts 3–6 months after beginning therapy
  • Breasts reach full size in 2–5 years
  • Size varies; A or B cup size is typical
  • A permanent change

Redistributing body fat

  • Usually starts 3–6 months after beginning therapy
  • Reaches maximum effect in 2–5 years
  • Less fat on abdomen
  • More fat on buttocks, hips and thighs
  • Not a permanent change

Reducing muscle mass and strength

  • Usually starts 3–6 months after beginning therapy
  • Reaches maximum effect in 1–2 years
  • Reduced muscle and strength in upper body
  • Not a permanent change

Softening of the skin

  • Usually starts 3–6 months after beginning therapy
  • Skin will be softer and less oily
  • Not a permanent change

Thinning of facial and body hair

  • Usually starts 6–12 months after beginning therapy
  • Maximum effect in more than 3 years
  • Body hair may appear less noticeable
  • Body hair will grow more slowly
  • Facial hair may grow more slowly, become thinner and appear less noticeable, but will not go away
  • If you have scalp hair loss, it may slow down
  • Hair that has already been lost likely will not grow back
  • Not a permanent change if you stop taking hormones

Reduced sexual response

  • Usually starts 1–3 months after beginning therapy
  • Timing of maximum effect varies from person to person
  • Less spontaneous physical arousal (erections)
  • Not a permanent change if you stop taking hormones


  • Timeline varies
  • Sperm may no longer reach maturity
  • Orgasmic fluid (ejaculate) production is reduced or may go away entirely
  • May not be able to get erection firm enough for penetrative sex
  • May become permanently unable to contribute to a pregnancy (but birth control is still recommended since this will not be the case for everyone)

Smaller erogenous tissue (penis) & gonads (testes)

  • Usually starts 3–6 months after therapy begins
  • Timing of maximum effect varies from person to person
  • Erogenous tissue may become smaller
  • Gonads shrink down to half their initial size
  • May or may not be a permanent change

Emotional changes

  • Overall emotional state may or may not change; this varies from person to person
  • May experience a narrower or wider range of emotions or feelings
  • Not a permanent change

Risks associated with estrogen-based hormone therapies

Estrogen is known to increase the risk of blood clots and gallstones. Estrogen-based treatment may also affect your cardiovascular risk by causing changes to cholesterol, blood pressure, blood sugar and weight. There are other potential risks, depending on the specific medication you use, and you should discuss them with your provider.

There is either no increased risk of breast cancer, or the research is inconclusive. 

Mood changes are variable; they may be positive or negative, or may have an adjustment period. Many people experience positive mood changes after starting hormone therapy. Any mood changes that cause you concern should be discussed with your provider.

Community Voices

Read some unique perspectives, stories, and insights from trans, non-binary, and Two-Spirit community members.
Person in a hijab riding a bike
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You will be the last person to notice changes. That is what I was always told and, for me, it was very true. Since I see myself every day, I felt like nothing had changed and felt worried about this. But my friends and family, especially if they hadn't seen me in a while, pointed out changes that I hadn't noticed as much myself.

—R, on noticing the effects of estrogen