Learning About Estrogen and Anti-Androgen Hormone Therapy for Gender Affirmation

What is it?

With estrogen and anti-androgen therapy, you take hormones to develop more feminine physical traits. It also suppresses masculine traits. It may be a part of gender affirmation for some people. Hormone therapy can help you change your body to better reflect your gender identity.

How is it done?

Estrogen is given as a pill, a patch placed on your skin, or a shot. You may also take medicines (called anti-androgens) that block the hormone testosterone. Or you may also take a hormone called progestin.

What changes can you expect?

Hormone therapy can cause physical, emotional, and sexual changes. It can be like going through puberty. The changes you experience and how soon they happen can vary.

Physical changes may include:

• Lower sex drive.
• Fewer erections.
• Erections that are less firm.
• Changes in where fat is stored.
• Breast growth.
• Shrinking of testicles.
• Decreased sperm production.
• Less muscle mass.
• Less body hair growth.

Some of these changes will go away if treatment is stopped. Others (like breast growth and shrinking of testicles) are permanent.

Emotional changes are also common. You may find that you feel some emotions differently than you did before taking estrogen. Or you might find that your tastes and interests change.

Many people have a lower sex drive after starting estrogen. Some people have changes in sexual desire or who they're attracted to.

What are the risks?

Estrogen and anti-androgen therapy is safe for most people. But there are some risks. For example, the treatment may make you more likely to get blood clots.

Taking estrogen or anti-androgens may make you infertile. But it may not. So if you have sex with someone who can become pregnant, and you want to prevent a pregnancy, use birth control. If you think you may want to have biological children at some point, talk to your doctor about your options. You may be able to preserve sperm in a sperm bank. It's best to do this before starting estrogen.

Your doctor will monitor you to see if estrogen and anti-androgen therapy is changing your risk for other health issues, such as heart disease, stroke, and breast cancer. You'll be watched closely after you start therapy and then monitored at regular checkups.