Feminizing HRT Overview, Guide & Information for All People Seeking It
Getting Your Prescription
To start taking estrogen, you will need to find a general practitioner, family doctor, endocrinologist or informed consent clinic where you can discuss gender affirming care with knowledgeable staff. Planned Parenthood is a good option for many trans people in general. Your mental health may also be evaluated, and your heart health and screening for a few other health conditions, as well as having access to your family health history if possible will be required.
Check to see if you have medical insurance, either through your family, your job, or if you are low income, a program like medicaid. Search for low income insurance plans in your area if it is needed, many places offer insurance plans for those who can't afford care on their own.
Treatment typically starts with spironolactone (aldactone), an anti-androgen that blocks androgen receptors ("male" sex hormones) for a few weeks, and then add estrogen, but many folks start with spiro and estrogen at the same time. Spiro will lower the amount of testosterone your body makes. For some people, spiro isn't necessary at all!
Some forms of spironolactone are reported to make folks pee like crazy, others do not have as bad of a time with it. Your mileage will vary depending on manufacturer. Spironolactone is intended to be a blood pressure medication, meaning it is a diuretic and is intended to help your body flush out fluids + salt. You will need to keep yourself hydrated if you notice this effect, as well as increasing electrolyte intake where possible.
Estrogen also lowers how much testosterone your body makes, and triggers changes in the body that occur during puberty in afab & adjacent people. Estrogen can be taken several ways, and is usually taken daily, and several times a day. You can take it in a pill or shot, and several forms of estrogen that can be applied to the skin like creams, gels and patches.
Make sure you thoroughly sanitize the skin of any injection sites or areas you will be applying gel or patches. If you are given topical estrogen, make sure you wash your hands after application and do not have someone else apply it for you. Make sure you do not go swimming or shower within several hours of application to make sure your skin absorbs the hormone.
You may not need to take anti androgens if you are doing estrogen injections, depending on how effective the estrogen injections are for you. Some people may not end up needing anti-androgens at all, and may be able to skip that entirely as spiro has unwanted side effects. Your natural hormone levels will dictate whether or not it's necessary, but it is not necessary for everyone.
You may end up being recommended to switch from one form of estrogen to another as your transition progresses, depending on how your body responds.
It's recommended to not take estrogen as a pill if you have personal/family history of blood clots in a deep vein or in lungs (venous thrombosis).
Some people also end up taking progesterone as well alongside estrogen. Progesterone is typically taken to encourage breast tissue growth, as this is the most prominent effect of the hormone. If sufficient breast tissue growth isn't seen from estrogen alone, progesterone can be added to your regimen, though this is only done later on into treatment, around a year or so in.
If you choose injectable estrogen, make sure to listen to your provider and ask for instructions about how to use needles and syringes, as well as injection angles, how and where you'll be injecting. Do not inject in the exact same spot every time, this can prevent the issue from healing properly and create scar tissue or cause infections or skin tissue necrosis (death). You also need a sharps container to safely dispose of your needle tips. Never re-use a needle, even if it was used previously on yourself. Always ask the pharmacy if you need more needles. A lot of places let you get them in bulk.
If you are going the injection route, make sure you know whether or not you are instructed to do intramuscular or subcutaneous injections. Intramuscular injections usually taper out of the system more quickly and need to be done more frequently, where as many patients find subcutaneous injections less painful and easier as they can be done less frequently.
For more information on safe intramuscular or subcutaneous injection for estrogen, please read here.
Another option for feminizing HRT is to take gonadotropin-releasing hormone (Gn-RH) analogs. They lower the amount of testosterone your body makes and may allow you to take lower doses of estrogen without using Spiro. Gn-RH analogs are usually more expensive, but are an option if for whatever reason the conventional route can't work for you.
DON'T GIVE UP IF YOU DON'T SEE THE EFFECTS YOU WANT TO SEE RIGHT AWAY! Many of them can take a long time to develop, often times patience is the key. If you wait it out and still don't see the results you'd like, you can try another route. Don't give up, a lot of people get deterred in the early stage of transition, you'll get there with patience and communication.
Stay patient, stay positive!
What to Expect from Feminizing HRT
Less facial and body hair growth: typically happens 6 - 12 months after treatment starts. Full effects within ~3 years on average.
Slower scalp hair loss: begins 1 - 3 moths after treatment begins. Full effect between 1 - 2 years on average.
Softer, less oily skin, and changes in general skin texture: 3 - 6 months after treatment starts, full effects within 2 - 3 years on average
Rounder, softer features including face and body, and more body fat: 3 - 6 months after treatment starts, full effects in 2 - 5 years.
Breast development: begins 3 - 6 months after treatment starts, full effects within 2 - 5 years on average or more, according to medical studies, but it can vary wildly from person to person, give dosage and hormones taken. If desired effects are not seen, progesterone can be taken alongside estrogen to help after around one year on estrogen. When breast growth begins, it starts with hard lumps under the nipples along with some soreness and itchiness. Some have sore breasts for a long time, and some may get scared and think they have cancer during this stage. Breasts will be swollen and tender for good while, and nipples may be especially sensitive to even light touch.
Reduced muscle mass/density: 3 - 6 months after treatment starts, full effect in 1 - 2 years on average
Potential decrease in libido if on estrogen alone, though not guaranteed: If it happens, it's generally within 1 - 3 months in and can last a while, but may even out over time
Fewer erections, decreased ejaculate volume, and erections that can become painful or uncomfortable if frequent erections are not maintained. This begins 1 - 3 months after treatment starts, and the full effect is within 3 - 6 months. Regularly maintaining erections and frequent ejaculation can ease some of these uncomfortable feelings in some people.
Changes in how orgasms feel, changes in texture and degree of sensation of penis and scrotum skin as well as changes in body odor: typically begins within 3 - 6 months, though it varies from person to person. Often times the way one's body responds to orgasms completely changes, many people find themselves experiencing full-body orgasms and more intense erogenous zones elsewhere in the body other than the genitals.
Smaller testicles, or testicular atrophy happens within 3 - 6 months and the full effects are usually seen within 2 - 3 years.
Increase in size of bladder and decrease in size of prostate over time which can lead to making one's gspot harder to find, and make prostate examinations more difficult, though they are still vital, as prostate cancer is still a possible factor.
Potential mood fluctuations while adjusting to the hormones, many report increased crying and sadness during the first 3 - 6 months with this tapering off after a full year at most.
Increased fatigue while adjusting to the hormones, sleepiness and becoming easily exhausted are common reports. This can vary drastically from person to person, ymmv.
If you have testicles and choose to have them removed, you may need to take testosterone as well as estrogen in order to have a healthy endocrine system. You will need to discuss the effects of this with your specialists if you want to go this route. If your androgen levels get too low because your body cannot synthesize enough testosterone after bottom surgery, you may need additional medication.
Keep track of your progress when and where you are able, and don't be afraid to bring up any concerns you may have with your professionals or trans friends, or any other trans resource. Your transition is in your hands and you're allowed to modify it as you see fit.. 😘
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