By: Plume Community Member (she/her)
Reviewed by Sierra Brittingham (she/her), Nurse Practitioner. Additional review by Dr. Jenny Wares (she/her), Associate Medical Director of Clinical Services.
- 1. Talk to a medical professional who specializes in gender-affirming care
- 2. Learn more about the physical changes that come with gender-affirming hormones
- 3. Take your time and listen to yourself first
- 4. Explore how hormones may help lessen gender dysphoria
- 5. Understand how gender-affirming hormones can create psychological and emotional changes
- 6. Consider microdosing gender-affirming hormones if you’re starting out or still unsure
- 7. Take the next steps in your gender journey with gender-affirming hormones
Are you wondering if gender-affirming hormone therapy (GAHT, sometimes also called hormone replacement therapy or HRT) is right for you? Change, even it is a wanted change, can cause a lot of emotions and be a reason people question whether or not starting hormones is the right decision for them. This article will help you understand what’s available to you so that you can pursue social transition, surgeries, and/or hormones that will bring you gender euphoria and help you feel at home in your body and spirit.
For some people, it makes the most sense to start medication and see if it is the right fit for them. Of course, if at any point you are not comfortable with how your mood is feeling and you think it is related to a new dose of estradiol or testosterone, you should let your medical provider know. This article may help you make these exciting and important decisions.
1. Talk to a medical professional who specializes in gender-affirming care
Transition for MTF folks who are gender non-conforming (GNC), trans women or trans femmes, is very different from our FTM, trans men, and trans masc counterparts. Every trans person gets to decide what aspects of transition are right for them. As you make this decision, give yourself enough time to learn as much as possible.
You might start by having an open conversation about hormone therapy with your doctor or a medical professional that has experience providing gender-affirming hormone therapy. (So you know, education in gender-affirming hormone therapy isn’t something every medical school provides. Not every medical professional, including endocrinologists, will have experience working with the trans and nonbinary community. That’s one of the main reasons we started Plume: to ensure more people had access to a clinician that understands how to safety and appropriately care for our community.)
If you’re interested in becoming a Member at Plume, you can follow the Get Started process to book an initial appointment to discuss GAHT (gender-affirming hormone therapy, sometimes also called hormone replacement therapy or HRT). If you decide you’re not ready for ongoing treatment or it’s not something that’s right for you and your goals, you can simply cancel after the first one-time fee. (You will be refunded your initial consultation fee if you’re medically ineligible for gender affirming hormone therapy.)
Your medical provider can provide you with information about the hormones you’re interested in, their side effects, and their potential risks. It’s also important to consider the long-term implications of hormone therapy, so your medical provider will also be able to answer any questions you may have about physical changes, including which are permanent and which are reversible should you ever decide to stop hormone treatment.
Because of the length of time many physical changes take to reach full effect, it’s helpful to have a medical provider who has seen you over the course of your physical transition and understands your journey and goals. At Plume, we recommend memberships over single appointments as it allows you to build a relationship with your Care Team over time.
2. Learn more about the physical changes that come with gender-affirming hormones
You may find it helpful to understand the physical changes that come with taking hormones. That way, you can know if that’s something you desire. Many people choose to take hormones purely for the improvement of their mood or sense of well-being. Other people take hormones for the physical effects, since hormones will change the way your body looks and functions. Everyone’s transition goals are different, but hormones work for a broad range of people and goals.
A common phrase in the trans community is “your mileage may vary” (YMMV), meaning no two bodies are the same. How someone’s body changes on hormones is determined by a host of factors, including diet, exercise, genetics, age, and physiological systems. Some changes may take months to start and many of the physical changes won’t reach their full effect until at least a year into GAHT. (Some changes take even longer. For example, breast development in transfeminine people doesn’t reach full effect until at least two years into hormones.)
Because of the range of physical effects, (including some unwanted side effects, like hair loss), it helps to work with a knowledgeable clinician who can offer a range of treatment plans that account for your whole gender transition experience. This might include medication for hair restoration, acne, or erectile function, for example. Plume offers all of this to our Members as a benefit included in membership, because it’s so important to focus on the whole person and everything they might need. We understand that transition is much bigger than hormones alone and want to support you while you make this exciting change.
If you are seeking estradiol, which some people refer to as to as “feminizing” hormones,” you can expect your fat to redistribute so your hips widen and arms and legs grow smoother and less toned. On E, your skin softens, and your body and facial hair will start to lighten and slow growth.
Trans women, trans femmes, people who identify as MTF, and gender non-conforming (GNC) and nonbinary people seeking estradiol can also expect breast development. Most people experience full breast growth that reaches an A cup, with a few cases reaching a B cup. Estradiol also redistributes the fat on your face so your jaw will soften. Over time, your cheeks will grow rounder, making your face appear more “feminine.” E will not change or alter your voice. Here are some of the effects of estrogen with a timeline that explains when to expect which types of changes.
Testosterone is another gender-affirming hormone that can change your body and support your gender transition. Within the first year on T, you can expect your voice to deepen. You will start to grow facial and body hair. Many trans men, transmasculine people, and gender non-conforming (GNC) and nonbinary people seeking T also will notice more toned muscles and clitoral or “bottom” growth. Some will also experience hair loss. Here are some of the effects of testosterone with a timeline that explains when to expect which types of changes.
3. Take your time and listen to yourself first
It’s also essential to take your time and be sure that you’re ready for gender-affirming hormone therapy. You might want to talk to a support group, your therapist, and your community about this choice. If it feels like a major decision, you can treat it like one! Honor your feelings and listen to yourself first.
While hormones are a safe, effective way to transition, that transition doesn’t happen in a bubble. Everyone’s experience is different, but it is almost universal that your transition will affect your relationships, your lifestyle, and your overall well-being in some way.
If hormones aren’t for you, that’s okay—but you might find great relief. (In my experience, many people who try GAHT feel like they know early into treatment whether gender-affirming medications are right for them, their bodies, and their transition goals.)
4. Understand how hormones may help lessen gender dysphoria
Not everyone who pursues gender-affirming hormones experiences dysphoria nor is dysphoria a prerequisite to obtaining hormones. It can be difficult to determine whether you are experiencing gender dysphoria, but if you often wonder what your body would look like on hormones, you probably experience dysphoria to some extent. (Reading this article might be another clue!)
For those trans people who do experience gender dysphoria, GAHT can be the first step on the road to finding relief and moving toward gender euphoria. Gender dysphoria is a term that describes the feelings of unease and discomfort in relation to our physical bodies or our assigned sex at birth. For example, some people are “assigned male at birth,” or AMAB. Other people are “assigned female at birth” or AFAB. This assumed gender isn’t necessarily someone’s actual gender, but based on the way their body might look when they are born.
Gender-affirming hormone therapy can relieve many aspects of gender dysphoria for a lot of trans folks, so if it’s something you experience, you may want to consider hormones, and for those who don’t experience gender dysphoria but are still interested in GAHT, it may be more helpful to envision the physical changes that come with gender-affirming hormones to see if it stirs feelings of joy or euphoria. You deserve to feel comfortable and at ease in your body, and for many trans people, GAHT brings about that ease and comfort.
5. Understand how gender-affirming hormones can create psychological and emotional changes
Almost universally, trans people who need GAHT and take estradiol or testosterone report a significant improvement in mental health after starting hormones. This is partly due to the physical changes that are bringing our bodies in alignment with our identity. For many years, we have lived with hormones that have caused our body, physiological system, and emotional depth to feel misaligned. A large feeling of euphoria can come with finding the right hormones for our body.
Many trans people also report a feeling of grounded-ness or ease, likening gender affirming hormone therapy to “coming home.” As gender-affirming hormones bring someone into alignment with their identity, they may find themself experiencing life more fully with deeper emotions and the ability to be more present in their body.
Both those who begin estradiol or testosterone will experience emotional changes as well. For those of us on E, we can expect to feel more emotional. Many notice a quickness to tears and deeper felt emotions than before. Many will also notice a decrease in anxiety and depression. Our sex drives or libidos may decrease. Some also report feeling a greater empathy. In addition to feeling gender euphoria and at ease, those on T may also feel an increase in sex drive, irritability, and increased happiness, since T affects the dopamine centers in the brain.
6. Consider microdosing gender-affirming hormones if you’re starting out or still unsure
For individuals who are nonbinary, gender non-conforming (GNC), genderfluid, or who don’t desire the full changes that come with GAHT, there is the option to microdose hormones. (All doses should be determined by your doctor or related medical professional, such as a nurse practitioner or physician assistant for your safety. Don’t change your medications without talking to your provider first!)
At Plume, we generally recommend that people start on a lower dose, sometimes referred to as microdosing. Then, they can decide to increase their medication (or not!). Many medical providers start trans people on a lower dose of hormones at the beginning. This helps to ease the transition for the body’s adrenal system.
Microdosing hormones can bring about a lot of the emotional and physiological changes that someone might want, while lessening the physical impact of hormones. For example, taking a very low dose of T might provide some mental support, but won’t stimulate facial hair growth as dramatically as the full dose.
Estrogen and testosterone can be powerful tools in your transition, so it’s important to make sure that you’re making the right choice for yourself. If you’re a Member at Plume, you can always talk to your Care Team and get information about hormones from someone who is knowledgeable and supportive.
7. Take the next steps in your gender journey with gender-affirming hormones
Not everyone’s gender transition includes hormones, but for those of us who need them, hormone therapy can be life-saving. Whatever your transition goals are, you should feel heard and supported.
Gender-affirming hormone therapy is a long-term process, not an overnight transformation. Both estrogen and testosterone can take months or even years to produce the desired results. The results of hormone therapy are not always the same for every person, and there may be unexpected side effects. It is important to be patient and stay in contact with your treating physician or Care Team during this process.
At Plume, we know that your decision to try gender-affirming hormones is not something to be taken lightly. We’re here for you every step of the way as you make this exciting decision for yourself!
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.
