HRT produces a variety of changes similar to puberty in your body, not all of which are permanent. Your doctor will discuss them fully with you before you start treatment.
Hormone replacement therapy (HRT) is a form of gender affirming care. It’s a way of replacing the primary hormones present in your body. In this context, we’re referring to HRT as a way of medically transitioning (as opposed to other reasons for HRT use, such as menopause).
HRT involves receiving a regular dose of testosterone or estrogen to bring about desired changes to your secondary sex characteristics (such as beard or breast growth). The goal of HRT is usually — but not always — to raise your hormone level to the average level of that hormone that is found in cis people.
Everyone’s body has both testosterone and estrogen, but our dominant sex hormones differ. In addition to their many other uses, HRT treatments can be used in transition to change which sex hormone is dominant. This article explores the general effects HRT may have on different individuals.
Many different kinds of people take estrogen-based HRT, including trans women, transfeminine people, nonbinary people, agender people, and intersex people.
Here are some of the most common results of estrogen-based HRT for transfeminine people:
- softer skin
- breast growth
- decreased muscle mass/growth
- redistribution of body fat
- thinning or slowed growth of body and facial hair
- decreased testicular volume
- decreased libido
- potential infertility
- erectile dysfunction
- decreased sperm production
Most changes are expected to happen in the first few months and can last indefinitely until you stop HRT. But certain changes, such as breast growth, are irreversible. Fat distribution, softened skin, and slowed growth of body hair are all examples of reversible changes.
The people who may use testosterone-based HRT include trans men, transmasculine people, certain nonbinary folks, and intersex people. If estrogen has been a more dominant hormone in your body, seeking testosterone-based HRT will help change your secondary sex characteristics.
Here are some of the most common results of testosterone-based HRT for transmasculine folks:
- lower voice
- oilier skin and acne
- increased muscle mass/strength
- more facial hair or overall body hair
- potential hair loss on your scalp (depending on your genetics)
- redistribution of body fat
- weight gain
- potential infertility
- increased libido
- “bottom growth” (clitoral enlargement)
- vaginal atrophy and more cramps
- lack of menstruation
Some changes, such as acne and muscle mass, are reversible, but others, such as a lower voice and hair loss, may not be.
“Microdosing” refers to taking HRT at lower doses and potentially over shorter periods. The results will be similar to those of taking full doses of HRT, but they may happen more slowly and appear more subtle, since some people may not want to full effects of traditional HRT.
Currently, clinics offer informed consent for HRT and provide information and brochures about the effects it has on your body in the short term (1–2 years), but the idea of microdosing for nonbinary or gender nonconforming people is very new, and more research on long-term HRT use is necessary.
There is not one way to be nonbinary, and taking HRT is not the definitive marker of what makes someone transgender. However, HRT for trans people can be especially helpful and gender-affirming and can alleviate gender dysphoria, anxiety, and depression.
It’s also important to note that intersex people who take HRT will have varied results and may need lower doses than endosex people (those whose sex fits neatly into either the male or the female box).
If you’re interested in a lower dose of HRT, talk with your doctor about what effects you should expect and how to navigate a lower dosing schedule.
Still have questions about what to expect with HRT? We’ve got the answers to some of your most-asked questions.
How long does it take to see the effects of HRT?
Each individual is different, and it depends on their genetics and their dosage. But on average, most people can start to see prominent effects of HRT within the first year.
For example, for transfeminine people, breast growth, fat redistribution, skin softening, and decreased sex drive can all be expected in the first 1–3 months.
Transmasculine people’s voices usually drop within the first year or even the first 6 months, and cessation of periods, bottom growth (clitoral enlargement), and fat distribution all happen within 3–6 months as well. This does not mean that all effects will be finished within the first year. It can take 3-5 years before some transmasculine people see fuller facial hair.
Also, keep in mind that timelines vary from person to person. Some people may experience the effects of HRT nearly immediately (especially the emotional and psychological gender euphoria), while for others, it takes months. Either way, there is no “correct” timeline, only your own.
Are there any negative side effects of HRT?
There may be some negative side effects of HRT, but this also can be subjective from a point of view. For instance, some people may not want the risk of balding that comes with testosterone-based HRT, but some trans men may find it oddly affirming to find themselves facing the same problem as their fathers.
Here are some examples of the possible negative side effects (apart from any expected effects that some people may not desire from HRT):
For transfeminine people:
- bone loss
- heart disease
- deep vein thrombosis
- stroke and seizure disorders
- heart disease or high blood pressure
- increased risk for breast cancer
- pulmonary embolism (blockage in a blood vessel in the lungs) or blood clots
- changes in liver function
For transmasculine people:
- polycythemia (overproduction of red blood cells)
- high blood pressure
- cardiovascular conditions
- migraine episodes
- sleep apnea
Can the changes from HRT be reversed?
Some changes from HRT are reversible, but some are not.
Voice deepening, facial hair growth, body hair growth, clitoral growth, and pattern baldness are all permanent results of testosterone-based HRT.
Breast growth, decreased testicular volume, and (potentially) sperm production are permanent results of estrogen-based HRT.
Many other effects of HRT, such as body fat redistribution, decrease or increase in libido, and muscle mass, can be reversed if you stop treatment. Transmasculine folks who wish to become pregnant can often stop taking testosterone long enough to carry a healthy child. Talk with your doctor about any side effects of HRT that you are concerned about.
HRT is one form of medical transition that is available and will most likely relieve gender dysphoria for many transgender or nonbinary people. Only you can decide whether the changes that HRT causes are right for you.
When deciding whether to start HRT, make sure to consult trusted medical professionals and other trans people and consider how you might feel about your body changing. It’s a very exciting and joyous process for many people, and everyone deserves to experience joy in their body.
Though HRT is considered safe for people without underlying health conditions, some complications are possible. Your doctor will be able to assess whether HRT would be safe for you and help you find the dosage that works for you.