How does estrogen affect weight gain, body fat, and facial features?
Common changes trans people experience when they start estrogen
This blog will describe some of the changes you might experience to your weight, body composition or body fat, and muscle strength when taking estrogen or other estrogen-based (E+) medications as a transgender woman, transfeminine person, or nonbinary person who wants to experience hormone therapy as part of their transition.
Estrogen is a life-changing and life-saving medication for many transgender and nonbinary people. Some people describe being on estrogen as a blossoming or awakening to the beauty of life. Other people experience new sensitivities and emotions. Like other types of gender-affirming hormone therapy (GAHT), estrogen (and other estrogen-based hormone medications) can help bring your gender expression into alignment with your identity. Some of the first shifts you might notice won’t be physical, but psychological—which makes sense, because any hormone changes can affect your emotions. Your transition is unique to you. Learning more about the process of gender transition with estrogen will help you prepare for what’s ahead.
While few scientific studies focus on transgender people, there is some interesting information out there that reflects our lived experience. If you have additional questions, you can always reach out to your trans-led care team of medical experts at Plume. We are also working on creating spaces where you can connect with other trans and genderqueer folks who are prescribed estrogen. Our blog, social media, and newsletter are all packed with free, accessible resources that you can use any time to learn about GAHT, too!
How Estrogen Supports Transgender Women and Transfeminine People
Estrogen therapy is a part of everyday life for many transgender women, transfeminine people, and nonbinary people. Every body makes estrogen, but different bodies make different amounts. Taking additional estrogen creates changes in the body and mind. For transgender people who choose it, estrogen (and other estrogen-based medications) affirms us. After as little as two months on estrogen, our bodies begin to change shape and we may feel more aligned. Everyone is different, but most people on estrogen notice the hormone’s feminizing effects within a year of beginning the medication. This means feminine curves as body fat redistributes itself. While you may have days when you feel like an awkward duckling, it’s all part of the process to become a beautiful swan.
The most dramatic change that many people experience with estrogen is inside themselves. Research shows that GAHT is associated with an improvement in self-perception. The person we see in the mirror begins to match the person we know we are, deep inside. Even small changes can feel affirming. As your skin and hair change texture, you may feel like you’re finally getting a glimpse of your real self—maybe for the very first time. One of the best gifts you can give yourself during this exciting and vulnerable time is a connection to a community of people who are walking a similar path. Plume has created peer support groups where you can talk to folks starting their estrogen journey, too.
Will Estrogen Give Me Feminine Curves, Hips, and Breasts?
Many people take estrogen specifically to change the shape of their body. Taking estrogen can affect your weight. It can also shift where your body fat settles on your body. For example, if you have narrower hips and a round belly, some of your belly fat might move into your hips and upper thighs. The area between the bottom of your ribcage and your upper thighs is known as the “gynoid region.” This is where the majority of your body’s fat tissue is stored. According to our culture’s beauty standard, feminine-looking people have hips, buttocks, and thighs that are softer-looking and have more fat. Bodies come in all weights, sizes, and shapes. Estrogen isn’t going to give everyone an hourglass figure. However, it will modify your pre-GAHT body shape.
Gender-affirming hormone therapy is scientifically proven to be effective for changing the shape of someone’s body. Estrogen can induce body modifications that are in line with your desired gender expression. Feminizing hormonal treatment tends to increase breast development after one year. Most of the changes happen in the first six months on estrogen. However, for most people, this change is modest. One study showed that the average breast development usually resulted in less than an AAA bra cup size. The maximum effect of estrogen on breast development can be expected after two years, according to a study published in 2016 in the Journal of Endocrinology & Metabolism.
Estrogen and E+ medications, such as blockers, do result in increased body fat in most people, especially in the gynoid region. People on all types of estrogen also tend to lose their lean muscle mass. It’s also very common to lose some of your grip strength after one year of GAHT. This may be related to changing insulin sensitivity, increased prolactin, and incretin response. Hormone therapy is powerful. Over time, it will affect your whole body, from your bones and muscles to the way your sweat smells. (Seriously!) Although this may seem overwhelming, estrogen and E+ medications are safe and effective. They may not work overnight, but they work well over time to help you achieve your transition goals.
Will Estrogen By Itself Be Enough For Me?
While many people are happy with estrogen, it’s also very common to want a more dramatic feminizing effect, which may mean exploring gender-affirming surgeries. Body fat changes will be noticeable in the first two years, especially in the gynoid region. The face also changes significantly in the first year. For example, one study measured the changes that occurred in transgender women’s faces in their first year on estrogen. The study found that cheek tissue in trans women increased, with an average of 0.50 mm in the x-axis and 1.08 mm in the z-axis. This creates a softer, more full cheek and a slightly rounder face. “Feminine” faces tend to have a less defined jaw as well. The study showed that estrogen decreased the tissue in the jaw, with an average of −0.60 mm in the x-axis and −0.18 mm in the y-axis.
However, this change is described as “partial modification towards a facial feminization.” Just as the breast tissue develops minimally, the tissue in a person’s face will not continue changing. At some point, it will settle into its new expression. Many people are satisfied with this, but it’s also normal to want more. Many transgender women, transfeminine people, and nonbinary people who use estrogen also seek additional breast augmentation besides GAHT. Some people seek facial feminization surgery (FFS), too. (If you’re thinking of breast implants or other surgery, Plume offers a letter-writing service that supports gender-affirming surgery. You can learn more about that here.)
Do I Need Medications Other Than Estrogen For My Transition?
Estrogen may not be the only medication that works for you or that you desire. Plume offers support throughout the transition process, which may include more than one E+ medication. This depends on your desired results and how you adjust to life on estrogen. We can prescribe different medications such as Dutasteride, Estradiol, Finasteride, Progesterone, Sildenafil, Spironolactone, and Tadalafil. (If you are interested in these medications, you can estimate your costs (and check out the delivery option!) on our website.)
Some E+ medications offer support for erectile dysfunction and sexual changes. Others balance your hormone levels. Many forms of estrogen are available, such as patches, injectable medications, tablets, and cream. Some people benefit from blockers, while others find that a different form of estrogen (like a pill or patch) feels more manageable than injections. If you have questions about which medications you should be taking to achieve your goals, talk to your care team. You can also start the process by becoming a member today.
Whatever your goals, our priority is making sure you have the medications you need to thrive. Every transgender person deserves to live in a way that is true to themselves. Estrogen is part of many people’s stories. It can be part of yours, too.
Plume provides gender-affirming care to trans and nonbinary people in 37 states across the United States (and growing). Learn more about our services here.
