By: Aleena Ortiz (he/she/they). Reviewed by Dr. Jenny Wares (she/her), Associate Medical Director of Clinical Services. Additional review by Elaina Tully, MD (she/her), Medical Director of Clinical Services.
Starting hormones is a big decision. Even when it’s something you want or look forward to, it’s normal to have questions. You may wonder what will happen to your body when you start gender-affirming hormone therapy (GAHT, also called HRT or hormone replacement therapy). You may feel a mix of excitement and anxiety when you think about telling your friends you’ve started hormones. Those feelings are valid. They’re part of many people’s decision making process.
Rather than get caught in the “what if” cycle, you can make informed choices that support your transition goals. This article will offer some helpful tips and guidance as you move through this journey.
Is gender-affirming hormone therapy safe?
Yes, GAHT for trans and nonbinary people is safe and backed by clinical research. At Plume, our care aligns with the WPATH Standards of Care for prescribing hormones, as well as other nationally recognized guidelines, such as the UCSF guidelines. These guidelines are considered the “gold standard” for transgender and nonbinary health care and are used by providers across the country.
When you begin hormones, your medical provider should take your transition goals, your individual health, and other factors into account. The two most common types of GAHT are estrogen (E) or testosterone (T). At Plume, our medical providers can prescribe estrogen that can be administered by injection, patches, tablets, or gel; and T that can be administered by injection, gel, or cream.
You can read all about the effects of estrogen on your body here. People who take E notice physical changes like redistributed body fat, chest or breast tissue development, decreased skin oils, less or lighter facial and body hair, bottom shrinkage, sexual function changes, and libido and sexuality changes. Some people call this a “feminizing” or male-to-female (MTF) transition. Some people take estrogen by itself, some take E and T blockers, and some plan to get gender-affirming surgeries.
If you’re curious about how T will affect your body, check out this article. Taking testosterone generally causes physical changes like increased appetite, increased muscle or strength, redistributed body fat, a lower or raspy voice, lighter or halted menstruation, increased facial and body hair, and bottom growth. Many people also experience libido and sex drive changes. These are often associated with what some folks call a “masculinizing” or female-to-male (FTM) transition. Gender-affirming surgeries are part of some people’s transition with T, while other folks choose to transition socially or only transition with hormones.
Can I start slow with hormones?
Yes, when you begin hormones you will likely be given a “starter dose” or “microdose.” Some people also call this the “nonbinary dose” because of the gentler or more subtle effects.
Lower doses of E or T can feel like less of a commitment if you are not sure about whether you want to use GAHT in a long-term way. Microdosing makes it possible to achieve more subtle changes in your gender presentation. It can also create a mental or emotional change that you may notice long before any physical changes. It’s important to remember that microdosing can’t prevent specific changes from happening.
If I stop taking hormones, will I go back to the way I was?
When starting hormones, you won’t wake up in a different or transformed body the next morning. The changes come on very gradually. It will likely take a few trips to the pharmacy and a few medication refills before you see any changes in the mirror. If you decide to discontinue hormones, know that some of these hormonal changes are not permanent; some changes are, however.
GAHT affects every one of your body systems. Hormones really do transform your body, inside and out. Everyone’s body produces hormones naturally at certain levels, depending on your individual body and genetic makeup. Taking GAHT can change these levels, block certain hormones, or increase your natural amounts of hormones.
If you take hormones long enough for certain effects to happen, those changes are considered permanent. Both T and E can also have a lasting impact on fertility. (Read more about your fertility and gender-affirming hormones here.) Some examples of the permanent changes your medication may cause are:
- A voice that becomes lower after taking testosterone
- Hair loss after taking testosterone
- Breast tissue growth caused by estrogen
- Nipple shape development caused by progesterone
- Facial hair growth caused by testosterone
- Bottom growth caused by testosterone
When we describe a change as permanent, that means the change will stay that way, even when you stop the hormones. Some people notice that, after stopping HRT, the permanent effects soften over time. This is because your natural hormone levels return and become more dominant in the body’s different systems.
For example, one transmasculine person who discontinued T after more than 5 years noticed that while he still had some whiskers on his face, his facial hair was much lighter. He shaved less often and the hair was finer. The balding area on his head eventually grew back and filled in after a few months of using a hair restoration medication. His voice remained deep but was less identifiable as “masculine.” His bottom growth did not reverse, but his orgasms and sensitivity changed.
Another friend—a trans girl—shared that she chose to microdose estrogen for a while, then take a break from her medication. Her skin and hair texture changed slowly, but stayed fairly soft. Her breasts and nipples stayed the same, but her sensitivity in that area lessened. Her sexual or erectile function returned almost immediately. (And she and her girlfriend were able to conceive their first baby!) When she restarted E, she noticed these changes reversing again as her body became more feminine.
These are not universal experiences, but they do illustrate that stopping hormones is possible, safe, and manageable when you have support. The point is, everyone’s experience is unique because everyone’s body, natural hormone levels, individual health, and even GAHT dose is different! There is no magic formula to predict how, when, and what changes you will experience on hormones—or what you may experience when you stop. This is why Plume suggests working closely with your medical provider.
Is it safe to try hormones and then stop?
There isn’t a lot of research about trans people who discontinue hormones. The regret rate for gender-affirming health care such as hormones and surgery is quite small—less than 1 percent of people. If you have mixed feelings about hormones, that is OK. You don’t have to take GAHT to be valid or to transition!
It is safe to take hormones such as E or T and then stop. Because hormones can affect your entire body (including your moods!) it is really important to talk to your medical provider about making this change. You may need extra support or have questions that a clinician can help you answer.
You should never feel fearful or ashamed about advocating for yourself in a clinical setting. If you are a Member with Plume, you’ll work with a trans-led Care Team who offers unlimited support and as many appointments as you need. Our job is to listen to your gender transition goals and do everything we can to help you reach them safely.
What if I’m still not sure about GAHT?
As a trans person questioning whether the changes you’ll get from GAHT are for you, it is very normal to want to take your time. Some people make decisions by doing lots of research on the effects of E or T. Other people prefer to talk to folks who have already tried these medications. You may find that Plume’s support groups, which offer a safe and judgment-free space to talk about your feelings regarding GAHT, are a good option for you.
It is also very common to feel overwhelmed by the idea of transitioning, period. Transitioning can feel like a huge project. There are social, physical, and psychological aspects to consider. Some people delay or wait to begin hormones because it feels like too much to manage. That is completely fine—it’s your transition, and you should be able to transition on your own terms. Taking it slow gives you the time to experiment with your gender expression. You can also lessen or stop hormone therapy if you realize it’s not for you or it’s not the right time.
The important thing is that you never feel pressured to make a decision about hormones if you are unsure. It is your transition and your body. Gender transition goals, gender euphoria, and gender dysphoria are different for everyone. That’s why it’s so important to take the time to understand your own desires.
Making choices that will make you most comfortable over time will help you navigate your gender journey at your own pace. There is no rush to fit in with a certain idea about gender identity. For many of us who have used hormones for years, we know that transitioning is a process of self-awakening that is never “finished.” Don’t be surprised if your gender expression and identity shift throughout your lifetime. You are allowed to stop, take a breath, and ponder, before you go at your very own pace.
Aleena Ortiz (he/she/they) is an independent world traveler, freelance writer, and contract book reviewer at Foreword Magazine. They obtained a Bachelor of Arts in Religion with a focus on Buddhism, Daoism, and Shintō at Reed College in May 2021. Eager to explore fictive worlds with respect to cultural sensitivity and the complexities of human emotion, he has published over 1 million words online over the last decade. Aleena strives to create space for nuanced understanding of historically underrepresented groups through her analyses of media and in fiction writing.
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.
