By: Dr. Jenny Wares (she/her), Associate Medical Director of Clinical Services with a Plume Community Member (she/her). Reviewed by Dr. Elaina Tully (she/her), Medical Director of Clinical Services.
Can you transition without feminizing hormones? Many people think herbal supplements and diet changes can be enough for feminizing transition. However, taking certain or large amounts of herbs or vitamins without medical supervision may cause a host of health concerns. To be safe and feel affirmed, it’s important to work with a knowledgeable care provider.
Some trans folks may prefer to self-treat by increasing their intake of certain herbs and foods. (There are many reasons why a trans person may think that taking supplements is preferable to getting a prescription for gender-affirming hormone therapy from a Western clinician like a doctor, nurse practitioner, or physician’s assistant.) This article reviews the pros and cons about this complex topic.
The science of foods and transition
Food sources of estradiol are called phytoestrogens. Because of the way bodies break down what we eat, you would have to eat large amounts of the hormone-rich foods to have any real impact on your sex hormones, if at all—especially when compared to hormones prescribed and supervised by a clinician. The food you eat might contain phytoestrogens, which is the estradiol in plants. However, sometimes the food has to be manipulated or processed in order to produce a significant amount of phytoestrogen (such as sesame seed powder instead of sesame seeds).
Often, the amount of food that you would have to consume is more than most people are willing to eat, and would make your overall nutrition poor. For example, this might be the equivalent of eating a pound of powders or seeds, instead of adding a tablespoon of it to your smoothie. Some people have tried carrots, cinnamon, ginger, chia seeds, and eating a lot of Luna Bars. (Seriously.) For most of these, you will get tired of the food before you can get any benefit. Luna Bars or other treats are definitely not best in large quantities.
Herbal products and the real results
Herbal products that some people try are: catnip, beetroot, ashwagandha, dandelion root, maca, and reishi mushrooms. One of the best resources for herbal product research is Natural Medicines (which clinicians can use with paid subscription); unfortunately, on review, none of these products have reported science to support changing hormone levels.
One product people commonly ask about is Pueraria mirifica. This is a plant native to Thailand, and has been looked at in small studies to help menopausal symptoms in cis women. Some patients describe breast pain, and some trans people report breast growth. There are no studies on transgender people, and adverse effects such as anemia (low blood counts), chest pain, and palpitations have been reported with its use. In animal studies, breast cancer occurred with high dose use. There is no standard dosing, and we do not know how estradiol blood levels, which we use to monitor safety and progress, are affected. Furthermore, this product is subject to the general herbal issues listed above. Given the safety and effectiveness of oral, injectable, and topical estradiol for trans people, we advise caution with using Pueraria for your transition.
The facts about herbal products
Herbal supplements and remedies are subject to different regulations by the Food and Drug Administration (FDA) than medications. This means they do not have the same high level of testing as medications. Herbal products have some standards that companies that produce them must maintain, and some adhere to good manufacturing practices. However, not all companies or products are required to undergo vigorous testing. Because of this, herbal products can have the following issues:
- They can be adulterated (have things added) with heavy metals or other products.
- In studies, herbal products and supplements might not contain the stated amount of product.
- The way herbal products are made changes the potency or active ingredient. If not done correctly for the problem they are treating, they will not be beneficial (like using the root of the plant instead of the leaves.)
- Herbal supplements can be easily falsified, especially when bought from places like Amazon.
- They rely on the plant being correctly identified, which is much more difficult than it might seem.
- Drug-herb interactions are what happen when a medication and herbal product interact in a way that can lead to health problems. These are common, and not well-studied. Some herbal supplements can make your prescription medication not work well, or make your hormone levels too high, by competing with the proteins the body uses to break medication down.
- Just like prescription medication, many herbal medicines can have unwanted side effects.
While good quality herbal products and manufacturers exist, it’s important to know these cautions. There are risks to taking any unregulated substance.
“Natural” vs. prescribed estrogen
Some people may think that using herbal products is better for our bodies because they come from naturally occurring sources. However, the estradiol we use for transgender medicine is bioidentical, which means it is identical to the hormone a human makes in their body. You can read more about starting E here:
- How do you know if hormones are right for you?
- A guide to gender-affirming microdosing
- Understanding your gender-affirming hormone options when you start estrogen with Plume
In addition, providers formerly used a type of estradiol (the same used in birth control pills) which was far less safe for trans people, but that is no longer the case. Studies have shown that prescription estradiol is safe for most people, especially when monitored by a clinician. In addition, prescribed estradiol has been proven to have little to no effect on the livers or kidneys of trans people.
Trans healthcare and discrimination
Trans people have a higher rate of medical trauma and abuse, so they are less likely to go to the doctor, even when they are sick. With this in mind, it’s no wonder some trans people may seek a more “natural” route to physical transition if they think it means they can avoid being discriminated against in a medical clinic. Not every clinician is supportive or informed about trans healthcare, but informed and supportive clinicians do exist.
At Plume, you can count on your Care Team being supportive and knowledgeable about your trans-specific health needs, and you will never be discriminated against in our online clinics. Plume clinicians can prescribe to online pharmacies which allows for your prescriptions to be mailed directly to your home, so you don’t have to worry about picking them up from a pharmacy.
In addition to existing medical trauma, other trans people seeking estradiol may also feel embarrassed about asking their doctor for gender-affirming hormones. In the early stages of coming out, it can be difficult to verbalize who you are and what you need, so it may seem like ordering herbal compounds or making diet changes can keep you from having that seemingly difficult conversation.
At Plume, your Care Team will help you feel at ease and supported. If you’re taking supplements, or using supplements instead of microdosing or other gender-affirming medications, just let your clinician know. You can then discuss any potential medication-herb interactions, and create a plan best for you!
Whether you’re coping with coming-out shyness, medical trauma, or just don’t know where to start, we can help. Plume provides healthcare for trans people that is safe and secure. Because all our appointments are done over telehealth, you can get the care you need without leaving the comfort of your home.
If you’re not sure that hormones are right for you, that’s OK. You can pay for a one-time initial consultation with a Plume medical provider with no commitment to continue a Membership. If you’re determined to not be eligible for hormones due to medical risk, your money is refunded.
You deserve a transition that is monitored, safe, and that will deliver real, tangible results. We all walk different roads on our gender travels, but if you think GAHT may be right for you and are ready to speak to a medical professional, you can sign up for an appointment with Plume today.
This Plume Community Member (she/her) is a transfeminine creative and freelance writer. She lives in the Pacific Northwest with her wife and dogs.
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.
