Male-to-female (MTF) hormone therapy, or estrogen hormone therapy, can cause a person to experience physical, emotional, sexual, and reproductive changes.

Some transgender people transition with the help of medical procedures, such as estrogen hormone therapy. This can help the body develop “feminine” physical characteristics. It can also help to suppress “masculine” physical traits.

This article will replace the term MTF hormones with estrogen hormone therapy. This is because MTF terminology is binary and exclusionary. Not everyone who uses estrogen-based hormone therapy may identify as male or have the goal of becoming female.

This article looks at what changes a person can expect and how long these changes take when undergoing estrogen hormone therapy.

A person who may be undergoing estrogen hormone therapy sitting on the floor and wearing a floral dress while holding roller skates.Share on Pinterest
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Estrogen hormone therapy involves an individual assigned male at birth taking the hormone estrogen to develop certain “feminine” characteristics.

Estrogen stops the pituitary gland from forming gonadotropin, which reduces androgen production. Androgens are a group of hormones that help with reproductive development, among other things.

Reducing the number of androgens in the body helps a person transition by encouraging changes in fat distribution, breast development, and male pattern hair growth.

Doctors may also prescribe other anti-androgen drugs to help the transitioning process.

Learn more about estrogen here.

A person may not notice significant changes when starting estrogen hormone therapy. The timeline varies, and some people may see more significant changes than others.

People may notice more changes if they use anti-androgen therapy alongside estrogen therapy.

Estrogen hormone therapy can cause physical changes.

Changes to the skin

The University of California (UCSF) note that estrogen hormone therapy can cause:

  • the skin to become dry or thin
  • the pores to become smaller
  • less oil production

Additionally, a person may become more prone to cuts or bruising and perceive temperature and pain differently.

Breast development

A person undergoing estrogen hormone therapy might notice small buds developing underneath the nipples. This can be painful but will typically resolve over several months.

Breast development will vary between people. The breasts can vary in size and shape and may be uneven. However, most people can expect to develop an “A” cup or perhaps a small “B” cup.

The UCSF note that people should wait for approximately 1 year before considering breast augmentation surgery.

Fat redistribution

A person can expect fat to collect around their hips and thighs. Muscle mass and strength will decrease.

Additionally, arms and legs will appear smoother. This is because the fat below the skin becomes thicker.

As the fat under the skin increases and moves, the eyes and face may take on a more “feminine” appearance.

Hair growth

Facial hair, and hair on the chest, arms, and back, will grow at a slower rate. However, it will not stop growing entirely.

Additionally, the rate of baldness may slow down or stop.

Other physical changes

A person may notice minor changes in shoe size or height.

It is important to note that estrogen hormone therapy will not affect a person’s voice.

When will these physical changes occur?

According to a 2017 article, a person can expect a decrease in sexual desire and function within 1–3 months. However, these changes can take 3–6 years to reach their maximum effect.

After 3–6 months, a person can expect:

  • a decrease in muscle mass
  • softer skin
  • redistribution of body fat
  • breast growth
  • testicles will shrink

It may take 2-3 years for these changes to reach their full extent.

A 2016 systematic review found that estrogen hormone therapy positively affects the emotional and mental health of transgender individuals.

People may experience:

The UCSF state that a person may notice that they experience a wider range of emotions. They may also develop different tastes and interests. These emotional changes should settle.

During this time, some people might find it helpful to talk to a mental health professional to help explore and understand these new emotions and thoughts.

Once a person starts taking estrogen hormone therapy, they may begin to experience erectile dysfunction and fewer erections. However, a person will still be able to reach orgasm.

If a person is concerned about maintaining an erection, they can talk with a healthcare professional about taking medications, such as Viagra (sildenafil).

A person’s testicles will also shrink to approximately less than half their original size. This can occur 3–6 months after beginning estrogen hormone therapy.

Although there is a decrease in testicle volume, the amount of scrotal skin does not change. If a person decides to undergo gender-affirming surgery, the surgeon will use the scrotal skin to create the labia majora.

Anecdotally, some transgender women note that their orgasms feel different once they begin estrogen hormone therapy. Some state that their orgasms become “full-body orgasms” rather than being centered on their genitals.

Studies have investigated the effect of estrogen hormone therapy on the reproductive system. However, the results are not clear.

A 2019 systematic review notes that in some cases, estrogen hormone therapy causes infertility, whereas, in others, it does not.

In most cases, people regain fertility once they stop taking the hormones. However, there is some evidence that the longer a person takes estrogen hormone therapy, the less likely they are to have fertile sperm.

People may take into account several considerations before deciding to use estrogen hormone therapy.

Health considerations

A 2016 systematic review suggests that transgender women may have an increased risk of heart disease and bone loss.

Estrogen hormone therapy may increase the risk of bone loss due to the use of anti-androgens other than estrogen.

Doctors may recommend bone screening procedures, especially if a person is at high risk, to monitor the effects the hormones have on the bones.

One type of estrogen, ethinyl estradiol, can lead to an increase in the risk of cardiovascular disease. Doctors are less likely to prescribe this form of estrogen due to the risks.

Additionally, transgender women who have diabetes may be more likely to increase the risk of cardiovascular disease while undergoing estrogen hormone therapy.

Reproduction considerations

While the research does not suggest that infertility due to estrogen hormone therapy is irreversible, some people may find fertility procedures beneficial.

A 2019 systematic review notes that there are procedures that adult transgender women can undergo to preserve sperm.

Transgender women who have not undergone an orchiectomy, which is removing the testicles, can use a sperm bank to preserve their sperm.

The UCSF note that using a sperm bank can cost $2,000–$3,000.

A 2016 article notes that doctors used to prescribe ethinyl estradiol, a form of estrogen. However, it is more likely that doctors will prescribe different forms of estrogen, as ethinyl estradiol can cause an increase in the chance of cardiovascular disease and deep venous thrombosis.

Research suggests that people over the age of 40 metabolize estrogen better through transdermal application than other options. So, doctors are likely to recommend transdermal application of estrogen, such as patches.

The following table describes the different types and dosages of estrogen and anti-androgen that a person may take:

ApplicationTypeDoses in milligrams (mg)
OralEstradiol2–8 mg daily
Shot Estradiol valerate20–40 mg every 2 weeks
TransdermalEstradiol0.1–0.4 mg twice weekly
Anti-androgensProgesterone

Medroxyprogesterone acetate

Leuprolide


Histrelin implant

Spironolactone

Finasteride
100–2000 mg daily

2.5–10mg daily

3.75–7.5 mg shot every month

50 mg every 12 months

100–200 mg daily

1.5 mg daily

If a person decides to transition, it is essential to receive estrogen hormone therapy from healthcare professionals.

Buying and taking hormones from other sources carries many risks, such as poor quality of drugs, improper doses, and possible harm.

In order to start the process, a person must discuss their options with a healthcare professional.

Transcaresite has a directory of trans-friendly medical professionals. If an individual’s healthcare insurance covers the cost of transitioning, it is important to check that the healthcare professional a person chooses is in their insurance network.

The World Professional Association for Transgender Health recommends healthcare professionals and individuals undergo several steps before starting estrogen hormone therapy.

These include:

  1. assessing a person for and diagnosing gender dysphoria
  2. educating an individual on the different treatment options available
  3. assessing, diagnosing, and treating any mental health conditions
  4. assessing eligibility and referring a person for hormone therapy

The GLMA is the national LGBTQI+ medical association that also has provider listings for trans-affirming care.

A healthcare professional will ask a person about their history of the following:

  • psychiatric, including any mental health conditions
  • social, such as social support and legal history
  • family, such as a history of psychiatric illnesses, suicides, and substance use
  • developmental, such as education level and any history of trauma
  • any instances of substance use

A doctor will also ask a person about their medical history as some people are at increased risk for cardiovascular complications, blood clots, and other potential risks.

It is crucial to ask a doctor any questions a person has about estrogen hormone therapy. It is necessary to understand the risks and benefits and to discuss fertility options and the possibility of surgery in the future.

Preparation before taking hormones

Before starting estrogen hormone therapy, it is important to gain as much information as possible. So always discuss the risks and side effects that hormone therapy may cause with a healthcare professional.

It is also essential that a person manages their expectations of when they will begin to see changes. Some people can take hormones for over a year before seeing any noticeable changes.

A person’s healthcare provider may ask people to come back for health checks regularly to ensure they are taking the correct medication dosage.

The cost of estrogen hormone therapy can vary according to a range of factors. These include the type of hormones a person takes and how they use them.

A person wanting to transition must check that their health insurance covers the costs.

People must also check that the healthcare professional or medical center that their doctor has referred them to are in their insurance network.

There are several other gender-affirming procedures that people can opt for.

Puberty blockers

Young people who are transgender and have not begun, or are in the process of puberty, may find puberty blockers beneficial.

These medicines stop the body from producing sex hormones, such as testosterone and estrogen, and prevent the body from developing secondary sex characteristics.

These medicines are reversible.

Gender-affirming surgery

Some people may decide to have gender-affirming surgery. According to the United Kingdom’s National Health Service (NHS), these surgical procedures include:

  • orchiectomy, the removal of the testicles
  • penectomy, the removal of the penis
  • vaginoplasty, the construction of the vagina
  • vulvoplasty, the construction of the vulva
  • clitoroplasty, the construction of the clitoris
  • facial surgery
  • hair transplants

Other surgeries include breast augmentation, facial surgery, voice surgery, liposuction, and thyroid cartilage reduction.

It is important to contact a doctor if a person decides to transition. A person must also have regular health checks to ensure that they are taking the correct medication dosage.

Some people may need additional health checks, such as if they are at a higher risk of bone loss or cardiovascular disease.

Estrogen hormone therapy is a longer-term process that can help people develop physical characteristics to alleviate their gender dysphoria.

There are multiple ways to take hormone therapy, and some people may find better results when taking additional anti-androgens alongside estrogen.

It can take some time for people to notice physical and emotional changes while taking estrogen hormone therapy. Some people may see these changes within months, whereas others may only notice changes after a year.

It is important to receive estrogen hormone therapy from a healthcare professional. Sourcing estrogen and anti-androgens online can carry many risks. A healthcare professional can ensure that a person takes the correct dosage of their medication and treat any additional health conditions.