How to Use Progesterone as a Gender-Affirming Medication

Why do some transfeminine people take progesterone?

Progesterone is a hormonal medication that can be prescribed for transfeminine and non-binary people as part of their gender-affirming hormone therapy (GAHT) regimen. There is some evidence to suggest that taking progesterone as part of a hormone regimen may improve breast development. Anecdotally, patients report increased breast fullness and areolar enlargement. Some patients also report increased libido. While the evidence is lacking, many patients do report positive effects from taking progesterone and want to try it.

While much of what we know about progesterone is gleaned from studies with people assigned female at birth, there is a growing body of research to support using progesterone in feminizing GAHT. A 2024 study found that taking progesterone as part of GAHT resulted in greater satisfaction with breast development and improved mental health outcomes within 6 months, as compared to the use of estrogen alone.

In addition, further research has indicated that progesterone, in combination with other medications, can facilitate lactation, the production of breast milk, for transfeminine people desiring to breastfeed. While taking progesterone alone is not enough to induce lactation, it is used as one part of that regimen.

Potential effects, risks, and benefits

As with any medication, there are both risks and benefits to taking progesterone. Many of these come from individual factors like age, family history, other health conditions, and more. You should always discuss potential changes to your hormone regimen with your healthcare provider. In general, here are some things to consider:

Benefits

• Greater satisfaction with breast development
• Potential to induce lactation for those desiring to breastfeed infants
• Reduced testosterone production
• Improved perception of mental health
• Increased libido

Risks

• Not seeing the intended breast changes
• Thickening of the genital tissue around the testicles 
• Possible changes to fertility
• Worsening depression symptoms that could include thoughts of hurting oneself
• Drowsiness
• Weight gain
• “Brain fog”
• Leg swelling
• Abnormal lipid changes

In addition, some studies cite the potential for increased risk of breast cancer later in life among trans women who take GAHT, including those taking progesterone. More research is needed to gauge this risk, as well as to establish best practices for breast cancer screening through mammograms and specialized care for people who have taken GAHT.

Forms of progesterone

Progesterone is usually taken in an oral form. Micronized bioidentical progesterone, where the hormone is broken down into smaller particles, is one of the most commonly prescribed forms of progesterone as it is believed to improve absorption of the medication by closely matching progesterone that can be found in the bodies of cisgender women. This form of progesterone is sold under the brand name Prometrium and typically comes in capsule form. These capsules contain peanut oil and should be avoided by individuals with a peanut allergy.

Some patients will use progesterone capsules rectally. There is no evidence that this increases feminization in trans patients, but rectal progesterone has been used in cisgender women for reproductive assistance to increase the bioavailability of progesterone. Rectal administration may reduce side effects such as dizziness, drowsiness, sedation, and fatigue. The same capsules prescribed to be taken by mouth can be used rectally, although it is important that patients are counseled on the lack of evidence, including evidence for safety with rectal use.

Progesterone can also be used as an injectable. One available option is marketed under the brand name Depo-Provera and administered every 2-3 months by either a subcutaneous injection or an intramuscular injection. The other option is a micronized injectable progesterone, which is less commonly used and can be administered every 2-3 days by intramuscular injection. Patients can be taught to self-inject progesterone.

Progesterone has a tendency to make many people feel drowsy; therefore, it is recommended to use progesterone in the evening before bed.

If you are interested in taking progesterone, it is important to talk to your healthcare provider about starting progesterone. They will review your medical history and determine if it is safe for you to take progesterone. It is important to follow the instructions given by your healthcare provider and to share with them if you have any questions, concerns, or side effects.

Does progesterone help with breast growth?

Yes, progesterone can have an impact on the development and maturation of breast tissue. People taking progesterone as part of GAHT may experience breast growth and enlargement more quickly than those taking solely estrogen.

Does progesterone make you more feminine?

Medical transition does not make you more valid in your gender identity. You are enough as you are today! Choosing to take hormones does not mean you are more feminine, and choosing not to does not make you any less so.

When it comes to the development of secondary sex characteristics, taking progesterone can give you a more traditionally feminine appearance through traits like breast growth. Some people feel more feminine after developing these changes. Your path in medical transition is unique and does not have to look like anyone else’s.

Can progesterone increase libido?

Potentially, yes — some people experience changes in their sex drive after starting estrogen, like diminished libido, difficulty with orgasm, or anxiety around sex. Though not everyone experiences increased desire, some studies have found that patients taking progesterone reported greater satisfaction with their libido 6–9 months into treatment.

There is emerging evidence to suggest that adding progesterone may help improve sexual symptoms, though more research is needed. In addition to the medication, some people may benefit from working with a sexual health provider, like a therapist or prescriber, who is trans-informed.

Does progesterone make you gain weight?

While everyone is different, current research does not indicate that progesterone causes weight gain.

What form of progesterone is best for feminization?

Two forms of progesterone — Depo-Provera and Prometrium — are prescribed for feminization in GAHT. Prometrium is more commonly prescribed and is taken orally or rectally in capsule form. Depo-Provera is prescribed as an injection in some cases. The best option is the one recommended for you by your healthcare provider, as they have very similar effects.

Does progesterone increase testosterone?

No, progesterone does not appear to increase testosterone production or concentration in the body. There is evidence that taking progesterone has an anti-androgen effect, which actually does the opposite — reduces the secretion of testosterone.

Does progesterone increase breast size?

Progesterone may increase breast size depending on several individual factors, including age, stage of development, sensitivity to hormones, and genetics. While the growth of breast tissue will vary from person to person, research shows that taking progesterone is linked to greater satisfaction with breast development. If you are taking progesterone, breast growth is something you and your healthcare provider will monitor to evaluate the effectiveness of the medication for you.

When should you start progesterone during your transition, and why?

You can start progesterone at any point in your hormone journey. Most people start taking progesterone in the first 1-6 months after starting estrogen. Being on a stable estrogen dose before adding in progesterone may allow you and your healthcare provider to truly evaluate the benefits and any side effects that may be directly caused by progesterone.  However, this decision of whether and when to start progesterone is personal and depends on several individual factors. What works for you may be different than someone else.

Decisions about starting or altering gender-affirming hormone treatment, including those involving progesterone, should always be made with an affirming medical provider. If you are curious to know more, check out our website to learn more about Plume’s services and get started with a gender-affirming care provider today.

References

1. AHFS Patient Medication Information [Internet]. Bethesda (MD): American Society of Health-System Pharmacists, Inc.; c2025. Progesterone; [updated 2016 Apr 15; cited 2025 April 17]; [about 6 p.]. https://medlineplus.gov/druginfo/meds/a604017.html
2. Bahr, C., Ewald, J., Dragovich, R., Gothard, M. D. Journal of the American Pharmacists Association. 2024 January-February;64(1):268-272. https://www.sciencedirect.com/science/article/pii/S1544319123002522
3. Berliere, M., Coche, M., Lacroix, C., Riggi, J., Coyette, M., Coulie, J., Galant, C., Fellah, L., Leconte, I., Maiter, D., Duhoux, F. P., & François, A. (2022). Effects of Hormones on Breast Development and Breast Cancer Risk in Transgender Women. Cancers, 15(1), 245.
4. Deutsch, M. B. (2016, June 17). Overview of feminizing hormone therapy. Overview of feminizing hormone therapy | Gender Affirming Health Program. https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy
5. Fenway Health. (n.d.). Hormone options: Progesterone therapy. Fenway Health. https://fenwayhealth.org/wp-content/uploads/Progesterone-Options-English.pdf
6. Milionis C, Ilias I, Koukkou E. Progesterone in gender-affirming therapy of trans women. World J Biol Chem. 2022 May 27;13(3):66-71. https://pmc.ncbi.nlm.nih.gov/articles/PMC10558402/
7. Szymczyk, S., Mączka, K., Mądrzak, L., Grymowicz, M., & Smolarczyk, R. (2024). The Potential Health Risks and Benefits of Progesterone in the Transgender Woman Population—A Narrative Review. Journal of Clinical Medicine, 13(22), 6795. https://doi.org/10.3390/jcm13226795