Intro to HRT

Hormone replacement therapy, or HRT, is a relatively common medical treatment used in many contexts. Despite what many may think, this is not a new or experimental practice, nor is it exclusive to transgender individuals. Hormone replacement therapy has been used for over half a century, starting its use in the 1960s and becoming widely popular in treating menopause in AFAB (assigned female at birth) patients.

In this page, we will cover how HRT can be used in transgender or non-binary patents for gender affirmation. Certain hormones and medications can help feminize or masculinize even someone who has gone through an undesirable puberty.

This website is intended to be a resource for AMAB transgender individuals.

What can HRT do for me?

For AMAB transgender individuals who desire female secondary sex characteristics, estradiol hormone therapy is the most common practice: Lowering one's testosterone level and raising one's estradiol (AKA E2, the most biologically active estrogen) levels, targeting that of an average cisgender woman. Transfeminine HRT can also involve many other medications, such as progestogens or antiandrogens. This results in the feminization of the body. You will see changes such as healthier skin, female fat redistribution throughout your body, and breast growth.

Below is a chart outlining most of the common changes from HRT:

Effect	Permanence	Expected Onset	Maximum effect
Body fat redistribution	Reversible	1-2 months	2-5 years
Decreased muscle mass	Reversible	1-2 months	1-1.5 years
Decreased skin oil	Reversible	1-2 months	1-1.5 years
Skin softening	Reversible	1-2 months	1-2 years
Decreased libido	Reversible	days-weeks	weeks-months
Decreased random erections	Reversible	days-weeks	weeks-months
Erectile Dysfunction*	Reversible	days-weeks	weeks-months
Breast Development	Irreversible	2-6 weeks	2-6 years
Decreased testicular volume	Variable	1-3 months	2-3 years
Decreased sperm production	Variable	2-6 weeks	1-3 years
Decreased semen volume	Veriable	2-6 weeks	1-3 years
Slowing of body & facial hair growth**	Reversible	1-3 months	6 months-1 year
Voice changes***	N/A	none	none
Reversal of male pattern hair loss****	Reversible	1-3 months	1-2 years

*: Most individuals do not experience erectile dysfunction.

**: HRT will slow down body and facial hair growth, only laser/electrolysis can stop it entirely.

***: Transfeminine HRT does not cause an effect on an individual's vocal folds.

****: Male pattern hair loss can be prevented with HRT, but reversal of hair loss is rare.

So, what should I take, and how much?

Again, the goal with transfem HRT is to bring your hormone levels, most notably for feminization being estradiol and testosterone, from your current male range, to that of a healthy cisgender woman. On top of this, there are some medications and other hormones we will cover, progestogens, antiandrogens and other niche or specific medications such as hair loss treatments or more experimental methods for feminization.

Before we talk about specific medications, you need to have a basic understanding of the target hormone levels. For feminization to be effective, you should be within the level a premenopausal female would be:

100-200 pg/ml estradiol & <50 ng/dl testosterone.

Blood tests are the only effective way to measure these levels and are extremely important in minimizing the risks of HRT and maximizing its effectiveness. We will talk about how to try and manage being in a situation where you cannot access bloodwork but highly recommend it.