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What Physical Changes to Expect on Estrogen Hormone Replacement Therapy, Explained by FOLX

Though each and everybody responds differently to estrogen hormone replacement therapy, there are some general expectations to have about how estrogen impacts the body. What are they? Read on to learn more about estrogen HRT for transgender and non-binary people.

Body showing physical changes of estrogen HRT

Looking for the testosterone version of this article? Click here to learn about the physical changes of testosterone hormone replacement therapy.

The individual effects of estrogen HRT (alongside anti-androgens like spironolactone or progesterone, if also taken) are going to be different depending on the person. While there are some general changes that you can expect, how fast or to what degree these changes take place will vary from body to body. Generally, lower doses of estrogen correlate to slower or more gradual changes, and higher doses are associated with faster changes. We know that many people’s first question is what changes to their body they can expect to see on estrogen HRT. With that in mind, we’ve mapped out a generalized timeline for the secondary sex characteristics you might see and when.

Hormone replacement therapy of any kind isn’t one-size-fits-all.

With that said, there are some common changes you can expect from estrogen replacement therapy. What are the main or most common changes expected with estrogen GAHT/HRT?

  • Breast growth
  • Softening of the skin
  • Thinning or slowed hair growth on face and body
  • Body fat redistribution to hips and thighs
  • Decreased muscle mass and strength
  • Changes in libido (sex drive) and sexual function
  • Decreased spontaneous erections*
  • Decreased sperm production/reduced fertility
  • Decreased testicular volume (By 25-50%) after being on estradiol long-term 
  • Reducing hair loss on head if also taking DHT blocker

**Adding anti-androgens such as spironolactone or progesterone may also help with hair, skin, and breast and body changes. 

The only permanent change with the use of estrogen over time is breast tissue. This starts in the first 3 months with the development of “breast buds” and continues over the next two to three years. With the different routes and dosages of estrogen, there are ways to find the one that fits best for you and your goals. Check out this general timeline of what changes you can expect to see when on estrogen.

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    Will estrogen impact my mood?

    Hormones affect how we feel and experience the world and our bodies. Gender affirming hormones generally improve mood and lead to people feeling better in their heads, hearts and bodies. There are common, patriarchal misconceptions that estrogen makes women experience mood swings. One (or more) of the following adjectives are often used to describe people on their menstrual periods: moody, crazy, hysterical, out-of-control, or unstable. Unfortunately, this list isn’t exhaustive. However, none of these are true about anybody with more estrogen than testosterone in their bodies.

    For many trans femmes and other gender-variant people, introducing estrogen into their bodies allows people to truly feel their feelings in a body that feels more like home to them, especially during the first year. This can manifest in a variety of ways, including feeling like your moods are bigger or more expansive. Estrogen mood changes can also look like an improved emotional and mental health because gender-affirming hormone therapy (GAHT) can greatly alleviate gender dysphoria, affirm gender identity, and improve your overall quality of life.

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    Does estrogen change your voice?

    Although trans men and other gender-variant people on testosterone hormone replacement therapy are highly likely to experience a deepened voice with a lower pitch, unfortunately, the reversed scenario of voice changes isn’t plausible for those on estradiol/estrogen hormone therapy. Simply put: no, estrogen cannot change your voice.

    If you were assigned male at birth and weren’t on hormone blockers as a teenager, testosterone would have thickened your vocal cords, which deepened your voice. With that said, if altering your voice is important to you, voice feminization can be achieved through voice therapy and/or surgery. Transgender voice therapy (or voice training that can help you work towards a more feminine voice) is a booming field with a growing number of trans competent experts.

    Does estrogen change your face?

    Yes, broader physical changes of hormone replacement therapy—particularly muscle loss, body fat redistribution, reduced oil secretions, thinner facial hair, and softer skin—can all show up on the face. The shape of your face can change slightly. For instance, fat can migrate to your cheeks for a more feminized shape.

    If you want more facial feminizing changes than estradiol provides, you can seek facial feminization surgery and/or electrolysis of hair removal to reduce facial hair and/or body hair. Although FOLX doesn't provide  these procedures, we encourage you to seek out transgender competent healthcare providers and speak to your clinician for referrals or further resources.

    For those interested in getting started with FOLX for estrogen GAHT, the process begins here! For existing FOLX members with estrogen-related questions, please schedule time with a clinician. For those who have more questions, read up on estrogen gender-affirming hormone therapy here and feel free to reach out to us at support@folxhealth.com.