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.
Expected effects
Onset of effect: 6–12 months
Full result: 3+ years
Reversibility: Reversible
Changes to expect
- If you have head hair loss, the progression may slow down or stop
- Hair does not typically regrow, but individual hairs grow for longer before falling out.
Onset of effect:6–12 months
Full result: 3+ years
Reversibility: Reversible
Changes to expect
- Facial hair may grow more slowly, become thinner and appear less noticeable, but will not go away
- Body hair may appear less noticeable and will grow more slowly
Onset of effect: 3–6 months
Full result: Unclear how long to maximal effect
Reversibility: Reversible
Changes to expect
- Reduced oil (sebum) production results in less oily skin
- May result in decreased pore size
- May result in less acne
- Estrogen affects collagen and skin will likely feel softer and smoother
Onset of effect: 3–6 months
Full result: 2–5 years
Reversibility: Irreversible
Changes to expect
- The amount of breast development is dependent on many factors including genetics
- Breast growth does not correlate with the hormone dose
Onset of effect: 3–6 months
Full result: 1–5 years
Reversibility: Reversible
Changes to expect
- People may notice a reduction in overall muscle mass and strength.
- Muscles may feel less dense.
Onset of effect: 3–6 months
Full result: 2–5 years
Reversibility: Reversible
Changes to expect
- Fat often increases around hips and thighs, and decreases around the abdomen
- Estrogen can cause fat to redistribute under the skin, making the face appear rounder and the cheeks fuller.
Onset of effect: Timing varies
Full result: Timing varies
Reversibility: Can be irreversible. This is more likely with long-term use.
Changes to expect
- Sperm production is reduced
- Production of ejaculate is reduced or stops altogether
- Some people may not be able to get an erection firm enough for penetrative sex
- Options are available to address this if it is an undesired effect
Onset of effect: 1–3 months
Full result: Will vary depending on individual factors
Reversibility: Reversible
Changes to expect
- Some people may experience fewer moments of spontaneous physical arousal (erections)
- Orgasms may change in quality
- Sexual interests, attractions or orientation may change
- Some people may have reduced erectile function
Onset of effect: 3–6 months
Full result: Timeline varies
Reversibility: May or may not be reversible
Changes to expect
- Erogenous tissue (penis An erogenous and erectile organ located between the legs that consists of spongy tissue that can fill up with blood and may become firmer with sexual arousal. It is also a means for urination. A person may be born with a penis or have one surgically created. When referring to genitals, the Trans Care BC website uses "erogenous tissue (penis)" for trans people assigned male at birth (AMAB) and "penis" for trans people assigned female at birth (AFAB), but there are many different terms that individuals may use. ) may become smaller
- Gonads (testes) may reduce to half their initial size
Onset of effect: Timeline varies
Full result: Timeline varies
Reversibility: Reversible
Changes to expect
- Some people may experience a reduction in anxiety or mood issues but others may experience a wider range of emotions or mood changes
- People are encouraged to seek mental health support and speak with their health care provider if emotional changes are disruptive or causing distress
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 | |
|---|---|---|---|
| Brand | Estrace | Estradot, Estraderm, Oesclim | estradiol valerate |
| Description | A pill you swallow or dissolve under your tongue each day | A patch you wear on your skin that gets changed twice a week | A substance you inject every week or two (sometimes twice weekly) |
| Advantages | Less expensive (approximately $20–$40 per month) | Lower cardiovascular risk for people over 40, especially with other risk factors | Possibly lower cardiovascular risk for people over 40, especially with other risk factors |
| Disadvantages | Higher cardiovascular risk for people over 40, especially with other risk factors | More expensive ($35–$50 per month); some people have a skin reaction to the adhesive in the patch | Requires 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
| Spironolactone | Cyproterone | Finasteride | |
|---|---|---|---|
| Brand | Aldactone | Androcur | Proscar |
| Description | A pill that you swallow once or twice a day | A pill that you swallow once a day | A pill that you put under your tongue once a day or every other day; will not suppress testosterone levels on its own |
| Advantages | Most common because it’s less expensive ($20–$40 per month) and usually well tolerate | Potent testosterone blocker | Can help slow scalp hair loss |
| Disadvantages | Some people find pills hard to swallow; may make you have to pee more often; may require dietary restrictions | More 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.
| Medroxyprogesterone | Micronized progesterone | |
|---|---|---|
| Brand | Provera | Prometrium |
| Description | A pill you take daily | A pill you take daily |
| Advantages | Widely available and less expensive | Thought to be lower risk than medroxyprogesterone |
| Disadvantages | Thought to be higher risk compared with micronized progesterone | More expensive (about $90 a month) |
Risks
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
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.