Estrogen

Changes Caused By Estrogen

Physical


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Emotional Changes


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Sexual Changes


Reproductive Changes


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Treatment


Now let’s talk about treatments. Cross gender hormone therapy for transwomen may include three different kinds of medicines: estrogen, testosterone blockers and progesterones.

Estogen

Estrogen is the hormone responsible for most female characteristics. It causes the physical changes of transition and many of the emotional changes. Estrogen may be given as a pill, by injection, or by a number of skin preparations such as a cream, gel, spray or a patch.

Pills are convenient, cheap and effective, but are less safe if you smoke or are older than 35. Patches can be very effective and safe, but they need to be worn at all times. They could also irritate your skin.

Many transwomen are interested in estrogen through injection. estrogen injections tend to cause very high and fluctuating estrogen levels which can cause mood swings, weight gain, hot flashes, anxiety or migraines. Additionally, little is known about the effects of these high levels over the long term. If injections are used, it should be at a low dose and with an understanding that there may be uncomfortable side effects, and that switching off of injections to other forms may cause mood swings or hot flashes.

Contrary to what many may have heard, you can achieve the maximum effect of your transition with relatively small doses of estrogen. Taking high doses does not necessarily make changes happen quicker it could, however, endanger your health. And after you’ve had genital surgery or orchiectomy—removal of the testicles—your estrogen dose will be lowered. Without your testicles you need less estrogen to maintain your feminine characteristics and overall health

Testosterone Blockers

There are a number of medicines that can block testosterone and they fall into two categories. Those that block the action of testosterone in your body and those that prevent the production of it.

Spironolactone

The blocker most commonly used, spironolactone, can cause you to urinate excessively and feel dizzy or lightheaded, especially when you first start taking it. It’s important to drink plenty of fluids with this medication. Because spironolactone can be dangerous for people with kidney problems and because it interacts with some blood pressure medicines, it’s essential you share with your doctor your full medical history and the names of all the medications you’re taking. A rare but potentially dangerous side effect of spironolactone is a large increase in the production of potassium, which could cause your heart to stop, so while on this medication you should have your potassium levels checked periodically.

Finasteride & Dutasteride

Finasteride and dutasteride are medicines which prevent the production of dihydro-testosterone, a specific form of testosterone that has action on the skin, hair, and prostate. These medicines are weaker testosterone blockers than spironolactone but have few side effects, and are useful for those who can not tolerate spironolactone. It is unclear if there is any added benefit to taking one of these medicines at the same time as spironolactone.

Progesterone

Though it’s commonly believed to have a number of benefits, including: improved mood and libido, enhanced energy, and better breast development and body fat redistribution, there is very little scientific evidence to support these claims. Nevertheless, some transwomen say they experience some or all of these benefits from progesterone. Progesterone may be taken as a pill or applied as a cream.

The risk of things like blood clots, strokes and cancer are minimal, but may be elevated.

We believe your risk of prostate cancer will go down but we can’t be sure, so you should follow standard testing guidelines for someone your age.

Your risk of breast cancer may increase slightly, but you’ll still be at less of a risk than a non-transgender female. When you’ve been on hormones for at least 2-3 years, it is recommended you begin breast cancer screenings depending on your age and risk factors after discussion with your doctor.

Since there is not a lot of research on the use of estrogen in transwomen, there may be other risks that we won’t know about, especially for those who have used estrogen for many years

FAQs About Estrogen


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What is the process for getting onto estrogen?
The first visit is always a consultation you won't get estrogen day one. It's a process. Many doctor's offices require a letter from another doctor's office but usually from a mental health provider.
Second appointment is usually blood work and you have to fast to allow for accurate results.
Third appointment they call you back and discuss your results.
Fourth appointment. They teach you how to inject yourself or schedule your first dose. Congratulations!
After this you are on your own. You need to schedule appointments to continue to check your estrogen levels and to make sure that your transition is going smoothly.
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Not everyone passes right away.
While passing is not an all or nothing game, not everyone passes as soon as they start socially or medically transitioning. It's okay for it to take time and for you to choose the pace of your transition. Passing does not always need to be the end goal.
There is no such thing as a standard dose of estrogen.
Your dose of estrogen is based off your lab work. Your provider knows what estrogen levels are safe for you, but you can always talk to them about adjusting your dose.
“Stealth” isn’t an all or nothing.
Some people can be out to friends while they are stealth at work or at home. You are not being deceptive by not being out to the world. Your safety comes before anything else.
You can change your name again.
You may find a name that fits better after you thought you had one. Not everyone will be patient with you always changing your name but finding a name that you find fits you is important.
Your body fat does shift.
Starting estrogen is great. You gain more curves. You lose more fat. Your body fat shifts around a bit. Just check with your medical provider to make sure you are staying healthy.
There is nothing wrong with detransitioning.
There is a stigma in the world about detransitioning. That it's wrong or that you transitioned for the attention. Some may say that transitioning was a phase or that you were lying. This is simply untrue and it is a stereotype we should break down. Not everyone can afford nor wants to stay on hormones for their entire lives. Transitioning is a personal experience, gender is not static and therefore your transition should not need to be a static or linear one either.
What changes are permanent?
Breast development, enlargement of nipples and areolas, and stretch marks are some of the permanent changes that occur on estrogen. The degree of how far each of these develops depends on the individual.
What changes are reversible?
After stopping estrogen and anti-androgen your libido will return, your fat will move back towards more masculine shape, your muscle will start to redevelop, your skin will thicken and become rougher, body hair will start to grow faster and thicker, and your gonads will begin to grow again.
Will I stop growing facial hair?
No, your face will continue to grow hair. This hair with estrogen will stop being as thick and will grow much slower. Many people turn to laser hair removal for their faces and other areas. For those who cannot afford laser hair removal, shaving and covering up with makeup is an option. Check out the makeup section for some tips.
Will my skin become softer?
Yes, your skin will become softer and thinner. So, you may start to see spider veins and get cut more easily.
Will my eyesight change?
Some transwomen have reported having slight changes in their eye sight. Most agree that it is from the dryness of their eyes from starting hormones.
Will I grow breast?
You will start to have fat move to your pectoral region creating the form of breast. Everyone has a different time line for how long this process will take. It is okay and totally normal for one breast to grow slightly faster than the other.
Will my body shape change?
Fat will move around your body and you will start to lose muscle mass. This can create a more feminine appearance and shape. Love your curves. For some who start estrogen these curves can appear much faster than for others. Be patient.
I am worried about depression will hormones help?
Hormones can cause mood changes, depression being one of the other factors that can occur after starting hormones. It is best to talk with a therapist and your doctor to make sure that these are addressed especially if you have a family history of mental health concerns.
Should I preserve my gametes?
It is an option that should be considered before starting hormones. Though there is not much research on transwoman and their ability to reproduce after hormones, it is best to keep options open. If you want to be the non-gestational mom, you can breast feed your child.
Can I breast feed a child?
Yes, there is little research on how transwoman nourishing children but transwomen have breast fed their children and it is important for this to be understood. Transwoman can induce lactation with birth control. It is best to do this under the guidance of a medical professional. Seek out a reproductive endocrinologist in your area.
Will my voice change on estrogen?
No, unlike testosterone which thickens your vocal cords, estrogen has no effect on your voice. If you are looking to change your voice, consider voice training lessons. EVA MTF is a good option for individuals who do not want to leave their home though it can still be quite pricy.
What forms of estrogen are there?
Oral | Sublingually : it can be swallowed or dissolved under the tongue. This is often the cheapest form.
Intramuscular : delivered as an injection that goes deep into the muscle tissue. This requires injection training and many who use intramuscular injections report feeling moody towards the end of their injection cycle.
Transdermal : estrogen patches are generally considered lowest risk. They are usually applied twice a week. They are the most expensive option if you don’t have medical insurance coverage for them.
What health conditions make hormone replacement therapy an unfit option for me?
Deep Vein Thrombosis, estrogen-sensitive cancers and allergies to estrogen are a few of the reasons a physician may be reluctant to prescribe estrogen for you. If you feel that they are denying you hormones because of your transgender status check your state laws and see what protections, they offer for transgender people in healthcare.
Is estrogen all I need to transition?
No, you will likely also be prescribed anti-androgens as a part of your transition.
What kind of blood test will need to be done?
Your physician will do blood test every couple of months in the beginning to make sure you are staying healthy. They will check potassium levels, lipids (cholesterol and triglycerides, and estrogen/testosterone levels.)
Can I develop breast cancer?
There are no large studies of breast cancer in transwomen, but so far it does not appear that transwomen are at a high risk for breast cancer.
How soon can I expect results?
See the chart below.
This looks like a long process is there any way to speed up hormone changes?
No, hormone replacement therapy is a lot like a second puberty. It takes a while for all the changes to take place.
How will hormones change after I have surgery?
Top surgery for people assigned male at birth does not affect hormones. The dose of estrogen does change when the testes are removed and most physicians stop prescribing anti-androgens or reduce the dose.
Effect Expected Onset Expected Maximum Effect
Body Fat Redistribution 3-6 months 2-5 years
Decreased Muscle Mass 3-6 months 1-2 years
Softening of Skin 3-6 months Unknown
Decreased Libido 1-3 months 1-2 years
Decreased Spontaneous Erections 1-3 months 3-6 months
Sexual Dysfunction Variable Variable
Breast Growth 3-6 months 2-3 years
Decreased Testicular Size 3-6 months 2-3 years
Decreased Sperm Production variable variable
Thinning of Body/Facial Hair 6-12 months >3 years
Male Pattern Baldness No Regrowth 1-3 months 1-2 years

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