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Expected Rates of Bodily Changes with Gender Affirming Hormone Treatment

Many people may be eager for bodily changes to occur quickly, which is entirely understandable. However, it is important to remember that the effects of gender affirming hormone treatment take time to develop and that the rate at which the changes take place can vary between different people. Some people find it helpful to think of the effects of gender affirming hormone treatment as a kind of puberty, as puberty often takes years for the full effects to be established.

Feminising hormone treatment

Bodily changes

Because different people’s bodies may respond in different ways to feminising hormone treatment, it is often not possible to predict how each individual person will respond. Nonetheless, the table on the following page may give you a rough idea of the bodily changes that you are likely to expect. The timescales are estimated averages, but it is important to remember that there are considerable variations between people.

EffectOnset (months)Maximum (months)Details
Skin3–6Unknown– You may notice a change in the texture of your skin, which may feel drier and softer.
– The skin pores may become smaller and produce less oil.
– You may notice that you sweat less and that your odour changes.
Testicular volume3–624–36– Testicular volume is likely to decrease.
– Sperm production may decrease, but the effect is variable, and so it is recommended to use a birth control method if you are sexually active with someone who is able to become pregnant.
Breast development3–624–36– Within a few weeks, you may notice small buds developing under your nipples. These may initially be tender, but this is likely to lessen significantly over the following months.
– Breast development can differ from person to person. As with all women, the breasts of transgender women vary in size and shape.
Body shape3–624–36– You may notice that your body begins to distribute your weight differently. The contour of your body may change as fat collects more around your hips and thighs.
– You may notice that your eyes and face develop a more feminine appearance, due to changes in fat distribution under the skin.
Muscle mass3–612–24– Muscle mass may decrease in your arms and legs so that they have a smoother appearance.
– Regular exercise can help to maintain muscle strength and tone.
Bodily and facial hair6–12>36– The hair on your body and face is likely to become thinner and grow more slowly. However, it may not go away altogether, and so some people choose to pursue hair removal treatments.
– It is important to remember that many cisgender women also have bodily hair and sometimes also pursue hair removal treatments.
Scalp hairVariableVariable– Feminising hormone treatment is likely to stop balding of the scalp, although the extent to which scalp hair will grow back cannot be predicted.
This table is adapted from the Endocrine Society (Hembree et al., 2017)

Emotional changes

A substantial amount of research shows that gender affirming hormone treatment is associated with positive outcomes for mental health and wellbeing. These include improved quality of life, decreased depression, and decreased anxiety (Baker et al., 2021). For example, studies have shown that symptoms of depression halved a half after one to two years of hormone treatment (Colizzi et al., 2014; Fisher et al., 2016).

Because each person is unique, emotional changes during feminising hormone treatment vary between different people. Transition is a deeply personal and transformative experience, and people may feel unfamiliar emotions as they get to know their new bodies. Emotional changes may also reflect the changes in your relationships with others as you progress in your transition journey. If you feel like you need further support to make sense of these changes, we can recommend help and support through counselling.

Sexual changes

Soon after commencing feminising hormone treatment, you may notice that penile erections become less frequent and less strong. However, you will still be able to have erotic sensations and be able to orgasm. If the loss of erections is a problem, then medications such as sildenafil and tadalafil can help.

You may notice penile atrophy, or a decrease penis size. Sometimes this can lead to some discomfort. If penile atrophy is a concern, engaging in regular sexual activity or masturbation can help to keep the erectile tissue healthy and well developed.

You may find that you experience erotic pleasure from different parts of your body and through different kinds of sexual activity. Some people notice that their orgasms begin to feel different. It is perfectly healthy to explore and experiment with your new sense of sexuality through masturbation or by engaging in different kinds of sexual activity.

Masculinising hormone treatment

Because different people’s bodies may respond in different ways to masculinising hormone treatment, it is often not possible to predict how each individual person will respond. Nonetheless, the table on the following page may give you a rough idea of the bodily changes that you are likely to expect. The timescales are estimated averages, but it is important to remember that there are considerable variations between people.

EffectOnset (months)Maximum (months)Details
Skin1–612–24– You may notice a change in the texture of your skin, which may feel thicker and oilier.
– The skin pores may become larger and produce more oil.
– You may notice that you sweat more and that your odour changes.
– Some people notice acne, which can usually be managed with skincare practices and treatments.
Stopping periods1–6Variable– You may notice at first that your periods become lighter or are shorter in duration, but some people may notice heavier or longer periods for a few cycles before they stop altogether.
– Ovulation may stop or become less frequent, but the effect is variable, and so it is recommended to use a birth control method if you are sexually active and wish to avoid pregnancy.
Changes in genitalia3–612–24– You may notice that your clitoris grows and becomes even larger when you are aroused.
– Some people notice vaginal atrophy, which is the thinning and drying of the vaginal tissue.
Body shape1–624–60– You may notice that your body begins to distribute your weight differently. The contour of your body may change as fat decreases around your hips and thighs, and increases around your abdomen.
– You may notice that your eyes and face develop a more masculine appearance, due to changes in fat distribution under the skin.
Muscle mass6–1224–60– Muscle mass may increase in your arms and legs, although this depends on other factors such as diet and exercise.
Bodily and facial hair6–1248–60– The hair on your body and face is likely to become thicker, darker, and grow more quickly.
– It is important to remember that facial hair growth varies from person to person. As with all men, trans men have varying degrees and patterns of facial hair growth.
Scalp hair6–12Variable– Many people notice thinning of the hair on the scalp. As with all men, the extent to which scalp balding occurs is influenced by various factors and cannot be predicted.
– If balding of the scalp becomes a concern, some treatments can be prescribed, such as minoxidil and finasteride.
Voice deepening6–1212–24– Testosterone causes the vocal chords to thicken, which can result in deepening of the voice.
– It is important to remember that voice deepening varies from person to person. As with all men, the voices of trans men vary in pitch and tone.
This table is adapted from the Endocrine Society (Hembree et al., 2017)

Emotional Changes

A substantial amount of research shows that gender affirming hormone treatment is associated with positive outcomes for mental health and wellbeing. These include improved quality of life, decreased depression, and decreased anxiety (Baker et al., 2021). For example, studies have shown that symptoms of depression halved a half after one to two years of hormone treatment (Colizzi et al., 2014; Fisher et al., 2016).

Because each person is unique, emotional changes during masculinising hormone treatment vary between different people. Transition is a deeply personal and transformative experience, and people may feel unfamiliar emotions as they get to know their new bodies. Emotional changes may also reflect the changes in your relationships with others as you progress in your transition journey. If you feel like you need further support to make sense of these changes, we can recommend support through counselling.

Sexual Changes

Soon after commencing masculinising hormone treatment, you may notice your clitoris increasing in size, especially when you are sexually aroused. You may find that you experience erotic pleasure from different parts of your body and through different kinds of sexual activity. Some people notice that their orgasms begin to feel different. It is perfectly healthy to explore and experiment with your new sense of sexuality through masturbation or by engaging in different kinds of sexual activity.

You may notice vaginal atrophy, which is the thinning and drying of the vaginal tissue. Sometimes this can lead to some discomfort. Vaginal atrophy can be treated with oestriol cream, which is applied topically to the vagina.

Microdosing

A slower rate of bodily change

Microdosing is when someone takes a lower than usual dose of hormonal medication (oestrogen or testosterone) as part of their gender affirming treatment.

This can be an effective way to attain more subtle feminising or masculinising changes, which may be a desirable option for nonbinary people or for anyone who does not want to achieve full feminisiation or full masculinisation (Cocchetti et al., 2020)

Microdosing can allow the feminising or masculinising effects of oestrogen or testosterone, respectively, to occur more slowly. This may give the person more control over the rate at which they progress through their transition.

Limitations

Although microdosing can give you more control over how quickly masculinising or feminising changes occur, it is important to understand that different people’s bodies may respond in different ways to gender affirming hormone treatment and that it is often not possible to predict how each individual person will respond. Hence, it is not possible to predict the extents to which specific changes (such as breast development in feminising hormone treatment and voice deepening in masculinising hormone treatment) will occur.

References

Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., and Robinson, K. A. (2021). “Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review. Journal of the Endocrine Society, 5 (4): bvab011.

Cocchetti, C., Ristori, J., Romani, A., Maggi, M., and Fisher, A. D. (2020) “Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals”. Journal of Clinical Medicine, 9 (6): 1609.

Colizzi, M., Costa,  R., and Todarello,  O. (2014). “Transsexual Patients’ Psychiatric Comorbidity and Positive Effect of Cross-Sex Hormonal Treatment on Mental Health: Results from a Longitudinal Study”. Psychoneuroendocrinology, 39: 65–73.

Fisher, A. D., Castellini, G., Ristori, J., Casale, H., Cassioli, E., Sensi, C., Fanni, E., Amato, A. M., Bettini, E., Mosconi, M., Dèttore, D., Ricca, V., and Maggi, M. (2016). “Cross-Sex Hormone Treatment and Psychobiological Changes in Transsexual Persons: Two-Year Follow-Up Data”. Journal of Clinical Endocrinology and Metabolism, 101 (11): 4260–4269.

Hembree, W. C., Cohen-Kettenis, P., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., and T’Sjoen, G. G. (2017). “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline”. Journal of Clinical Endocrinology and Metabolism, 102 (11): 3869–3903.

Updated on February 29, 2024

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