By: Plume Community Member (they/them)
You’ve just gotten a prescription to begin taking estrogen. Now what? Your first week of gender-affirming hormone therapy (GAHT, also called HRT or hormone replacement therapy) will bring lots of emotions as you embark on the path to discovering your most authentic self.
This blog post will help trans women, folks who identify as male-to-female (MTF), and nonbinary people navigate the first week on estrogen. This will help you know what to expect and—perhaps more importantly—what not to expect right away.
What does it feel like to take estrogen?
First off, you may feel relief. (I know I did!) Take a moment and congratulate yourself for taking control of your health. For people who experience gender dysphoria, gender-affirming hormone therapy truly can be life-saving.
It’s also natural to want to see physical changes as soon as possible. But whether you’re taking estrogen by injection, patch, or pill, it’s important to know some changes might be evident sooner than others. You might be interested in full feminization—which is what some people call gender transition with E. However, you might also be focused on the mental or emotional shifts E can create.
During your first week of taking estrogen, remember to nurture yourself. Hormones take time to change your body, but you will notice these changes—also called the “expression” of the hormone—over time.
Will I notice changes in the first week on E?
The pace, extent and overall amount of changes you will see will depend on a host of factors including your age, overall physical condition and medical history. (Genetics also play a role.) It’s important to have realistic expectations. Talk to your provider if you have questions about what you may notice first. Waiting for your body to change can feel very frustrating, but knowing what to expect can help ease the sense of anticipation.
You should know that your individual body may respond differently to GAHT than other people’s. For me, my doctor explained starting on estrogen later in life might result in less physical changes. This was helpful because I wasn’t comparing myself to someone beginning in their teens or twenties. I still noticed lots of changes, including the ones that are important to my sense of self and my gender identity.
Similarly, just as every person’s body is different, each person might need a unique dose. Some people take estrogen by itself, while others add progesterone, T-blockers, or other medications.
How soon will my breasts grow?
Breast growth is the most anticipated change people seek as a result of starting on estrogen, according to one survey of transgender women surveyed after one year of taking estrogen. While everyone is different and results vary, generally breast development mostly occurs in the first six months, although continued growth and development was seen during a three year follow up, according to one study. In your first week or two, you may notice breast tenderness or soreness around your nipples.
It’s important to know that breast growth does not happen overnight. (Your provider should discuss realistic expectations prior to starting E.) In one study, researchers found that while breast growth begins in about two to three months after starting GAHT, the maximum effect of breast development might not be seen for two years or more after beginning estrogen.
For some transgender women—depending on your own situation and provider’s recommendations—adding a T-blocker like spironolactone may affect breast growth. Progesterone may also change how your breasts develop.
Estrogen levels are more than skin-deep
Among the first changes in the early weeks of taking estrogen is that your skin might become less oily. In addition, you may find you sweat less and that body odor has decreased. For me, I noticed that I needed to change my skincare routine. Adding a light moisturizer helped balance my skin. I also changed my facial cleanser to a more gentle option so that I wouldn’t over-dry my usually oily skin.
You may notice that over time, your hair can become finer. This may not happen in the first week, but it is likely on the horizon! If you use hair removal options, you need to continue your routine for a few months or longer.
Estrogen lessens growth of facial hair, but medication alone often is not enough to reduce facial hair growth. Many transgender women also will opt for other interventions like waxing, shaving, laser therapy, or electrolysis to reduce facial hair. The thinning of hair usually peaks after about four months, according to one study.
How will I feel after one week on estrogen?
Hormones won’t change your personality or who you are as a person, but they may surprise you when you start E. Within my first week, I noticed that I had a wider range of emotions than I thought. Part of it may have been my excitement and relief at finally acknowledging my gender identity in this new way. Hormones made me feel life in ways I wasn’t accustomed to previously.
My medical provider explained that these changes aren’t unusual. Taking my estrogen helped me feel more empowered and feminine, but they also required some adjustment. Some transgender women starting on medication also may benefit from therapy or support groups as they navigate these new feelings. (Plume offers trans-led support groups as a Membership benefit, if you’re interested.)
If you find yourself having difficulty amid unexpected mood swings, do not hesitate to reach out to your doctor and, if in crisis, call a helpline. Your safety is paramount.
In the early days of treatment, you may notice a change in your stress levels. (In a good way!) You may start to feel less stressed. There’s evidence that using gender-affirming hormone therapy can reduce or eliminate gender dysphoria—the distress someone feels when their gender identity does not match their gender expression.
The link between starting GAHT and feeling more comfortable in your own skin is well-researched. One study found that “initiating hormonal treatment seemed to have a positive effect in reducing stress levels.” Another study noted that hormone therapy “reduces symptoms of anxiety and dissociation” and can improve quality of life and self esteem. That was my experience. Even though life as a nonbinary transfeminine person has its challenges, my emotions overall are much less stressed.
Will estrogen change my sex life?
It’s not uncommon for trans people taking estrogen to experience fewer erections as well as decreased sex drive. This may happen in the first week, or it may be something you notice over a longer period of time. For some women, this may be a desired side effect. For others, this is an unwanted side effect, talk to your provider who may be able to prescribe sexual function support medications such as Viagra.
Some transgender patients also have reported changes in their sexual identity over time. One transgender woman told researchers, “I don’t think that the hormone treatment itself changed my sexual orientation, but by completing my transition, I felt more attracted to men than to women.”
At the same time, research indicates sexual orientation often does not change; the extent to which it does varies according to each person. Since transition is a deeply personal process that affects every aspect of your life in one way or another, that may include your sex life and your sex drive. It’s so important to be patient with yourself. Communicate with your partners and give yourself plenty of time to connect with yourself. This is your time to grow and change in a way that feels affirming to you.
Your first week of estrogen is exciting and can bring many shifts to your emotions—about your identity, your potential, and yourself.
This Plume Community Member (they/them) is a freelance writer living in the Washington, DC area. A former newspaper reporter, they have written extensively on healthcare and issues such as access to life-saving medication.
As the largest provider of gender-affirming care for the trans and nonbinary community, Plume is committed to providing information about many types of information, including questions about hormones like estrogen and testosterone, gender transitioning tips and experiences, and guidance on social transition and self care.
While we strive to include a diverse range of voices and expertise, not everything will be for every person. Each individual’s experience is unique, and the information Plume provides is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Always first seek the advice of your primary and/or specialist physician, the Plume Care Team, or other qualified health provider with any questions you may have regarding a medical condition, your mental health and emotional needs, or your health care needs regarding gender-affirming hormone therapy. If you are experiencing an emergency, including a mental health crisis, call 911 or reach out to Trans LifeLine.
