Hormone replacement therapy (HRT) plays an important role in both male-to-female and female-to-male gender transition. When a transgender person’s body doesn't develop in a manner that reflects their true gender identity, hormones can be administered to produce positive changes in the sexual characteristics of the body.

Dr. Alexander Sinclair of Beverly Hills Transgender Surgery is a board certified general plastic surgeon with more than three decades of experience, and a practice focused on transgender surgery. He serves transgender patients in the greater Los Angeles area and throughout the country, and he understands the positive effects hormone therapy can have on the quality of a trans person’s life. If you are considering transgender HRT, he can explain the benefits and risks and answer any questions you may have.

The process of transitioning is an all-encompassing process that refers the physical, mental, or emotional changes made to make your exterior appearance align more closely with your gender identity. Hormone replacement therapy, or HRT, is often an important part of this process. The goal of HRT in transgender men and women is to make you feel more at home in your body.

Often referred to as “second puberty,” there are several changes that you may experience as a part of HRT. Like anything you experience as a part of your transition, these changes are very personal and how they are experienced varies from individual to individual.

As impatient as you are to begin your physical transition, it is important to know the risks, expectations, and long-term effects of hormones during transition and throughout the rest of your life. The speed at which you will begin to notice changes depends upon factors such as genes, your health, and the age at which you begin your transition. You should also be aware that taking increased doses of hormones may not speed the rate of your physical transition. Your transition will be as unique as you.

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Male to Female Hormone Replacement Therapy

Feminizing HRT (male-to-female hormone replacement therapy) uses estrogen to produce more feminine sexual characteristics in trans women. Although the effects may vary from person to person, typical responses to feminizing HRT include:

Breast Development:

As it does among the genetic female population, breast development will vary greatly with HRT. It generally takes approximately 2 years to reach maximum breast development and MFTs rarely achieve a cup size larger than a B. Small buds or nodules will develop behind the nipples within the first few months of hormone therapy. The area will become tender and sensitive, much the same as it does among genetic females during puberty. This happens because the duct system behind the nipple increases with hormone therapy. Tenderness and sensitivity will usually normalize within a few months.

Skin Changes:

Your skin may change dramatically with hormone replacement therapy, becoming softer, finer, and more translucent, with smaller pores and less oil production.

Fat Distribution:

Changes in the subcutaneous fat (located just under the skin) may be expected over a period of one to two years. More fat will likely be distributed in the hips, thighs, and buttocks, with somewhat less in the stomach. Larger hips and a smaller waistline can give your physique a more feminine appearance.

Body Hair:

With MTF HRT, body hair may decrease significantly over time, and may be entirely diminished in certain areas after a period of several years. Hair on the arms, legs, chest, shoulders, and abdomen can be expected to lessen greatly and disappear altogether in some cases. However, HRT will not have the same dramatic effect on the hair in other regions -- armpits, pubic area, around the areolas, and the face.

Muscle Mass:

Much of the male upper body muscle mass will diminish over time with feminizing HRT.

Genitals:

The testicles will become significantly smaller, and the penis will likely also diminish in size. Erections may become less frequent and shorter lasting and ejaculation will lessen considerably. It is important to note that the ability to orgasm does not depend on erections or ejaculation.

Feminizing HRT uses estrogen to direct your body to align more closely with your gender identity. Estrogen is the hormone in the body responsible for creating feminine curves and characteristics such as fuller breasts, fat deposits on the hips, buttocks, and thighs. You will also be given anti-androgen which will naturally help your body to produce lower amounts of testosterone over time. Eventually, your body could change the amount of natural testosterone produced to mimic that of many of those who are born female.

Female to Male Hormone Replacement Therapy

Masculinization HRT is often one of the first steps one takes when transitioning from male to female. Testosterone is administered as a part of masculinizing HRT during a male-to-female transition, to bring about a more masculine appearance. While there are changes that happen to each physical body that goes through transition, it is important to keep your expectations realistic. Dr. Sinclair will work closely with you to discuss what to expect in body changes.

The beginning of hormone therapy can be an exciting phase in the transition for transgender men. The extent and rapidity of biological changes will depend in part on the method by which testosterone is administered. Different methods of administration include:

  • Intramuscular (injected);
  • Transdermal (skin patch or cream); and
  • Oral (taken in pill form).

Taken orally, testosterone may not be fully effective for stopping menstruation. Transdermal administration is as effective as injections for producing masculine characteristics, but it may take longer to stimulate facial and body hair growth and to stop menstruation.

Many changes occur in the body over time with FTM hormone replacement therapy:

  • Sex drive tends to increase within the first 3 months of therapy.
  • The vagina becomes drier and the clitoris increases in size by 1 to 3 cm in the first 3 months, reaching up to 5 cm after one year and beyond.
  • Chest and facial hair begins to grow and arm and leg hair becomes coarser. After a year or more on HRT, head hair loss and male pattern baldness may begin to occur.
  • Breast fat decreases and muscle mass in the chest increases, along with an increase in upper-body strength.
  • Body fat redistributes over time from the hips to the waist, producing a more masculine physique.
  • The voice begins to change, cracking and deepening, generally after 3 months of hormone therapy.
  • Menstruation usually ceases within 6 months of beginning HRT.
  • The feet may become larger, and urine and body odor may change after one year or more of hormone therapy.

As you begin your masculinizing HRT, your voice will begin to deepen, and your body hair production will increase. The distribution of fat on your body will shift to become more traditionally masculine. You will also notice an increase in your ability to gain muscle, your skin will become less smooth, and your Adam's apple more prominent.

It is important to see your doctor regularly both during your transition and after. Feminizing HRT carries poses some risk of causing liver damage, as well as uterine and breast cancer, even for those who have undergone FTM top surgery.

In our bodies, hormones are released into the bloodstream and delivered to the rest of the body. These chemical compounds direct many aspects of your physical appearance such as where and how the body stores fat, facial and body hair, breasts, the reproductive organs, and skin. Hormones also work to regulate functions in the body like blood sugar, your metabolism, and cholesterol levels.

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We invite you to schedule a consultation with Dr. Sinclair to discuss how he can assist you with your transition. Consultations for elective cosmetic procedures are complimentary.

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