Primary Care & Adult Gender-Affirming Hormones

Every person’s body is unique, and hormones will impact each person differently. Although there are typical changes experienced on estrogen and/or androgen or testosterone blockers, actual changes differ from person to person and are influenced by factors such as age, genetics, and your overall state of health.

The changes you will experience with hormones will develop over the course of months and years, with some changes happening before others.

It is important for you to think about what your short- and long-term goals are, and to discuss them with your provider. Your provider will work with you to develop the best approach for you. If your goals change or evolve, talk with your provider to navigate next steps. You can work with your healthcare team to alter your dose, change its form, or completely stop hormones - your care team is available to provide ongoing support and guidance.

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Every person experiences changes differently, and you may or may not experience the following changes. Typically, most changes are expected to occur in the first two years of taking adult gender-affirming hormones.

Physical Changes

The physical changes experienced depend on whether you are taking estrogen alone, a testosterone blocker alone, or a combination. Here are some changes you can expect:

• Breast growth (typically no larger than an A cup or small B cup)
• Softer, less oily skin/softening of the skin (smaller pores; less oily; drier)
• Thinning or slowed hair growth on face and body (hormones cannot make your hair go away. If your facial and/or body hair causes you dysphoria or discomfort, you may want to consider laser hair removal or electrolysis)
• Feminizing body fat redistribution to hips and thighs
• Decreased muscle mass (and strength)
• Change in the smell of your sweat, odor patterns, and urine
• Slowing or stopping of hair loss on head if taking DHT blocker (bald areas will not regrow; you may choose to use wigs or hair pieces, or consider hair transplants or other procedures)
  • Although hormones may slow down or stop baldness, there is no way to reverse baldness; however, there are many methods that can be used to combat balding such as the use of partial testosterone blockers, products that promote hair growth, and hair transplantation—talk with your provider to navigate which option is best for you.

Estrogen does not impact the pitch of your voice. If you desire changing the pitch of your voice and/or your speech patterns, you may want to consider vocal training through Temple’s voice therapy program.

Emotional Changes

Some people experience little or no changes in their emotional states, whereas others may experience changes in the way they are interacting and functioning socially and/or emotionally. Remember, you are going through a second puberty and puberty can carry a lot of emotions. For people who experience changes in their emotional states, these changes will likely settle down over a period of time. 

Sexual Changes 

• Possible decreased sex drive
• Impact on erections:
  • Decreased spontaneous erections
  • Less firm erections
  • Inability to keep or get an erection
    Note: There are medications that can address this. Ask your provider which may work for you.

Reproductive Changes

Speak with your medical providers about how estrogen, progesterone, and testosterone blockers affect fertility and reproductive functioning. It is important that you know your fertility preservation options, whether you are just starting hormones or are working with Temple to continue your care. Your fertility and family planning desires are important, and we are here to connect you with the resources you need.

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There are reversible and irreversible changes that occur when taking estrogen or blockers. The reversibility of changes depends on how long you have been on hormones, the type of hormones, and your body.

Talk to your primary care provider about your goals and questions.

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Estrogen and testosterone blockers come with their own benefits and risks. You can work with your provider to discuss your options and balance the potential benefits and risks.

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At Temple, we work with you to individualize your care based on your specific needs. Speak with your team about which form of estrogen, testosterone blocker, and/or combination could work best for you. Your provider can help you understand options like low-dose or microdosing and average hormone dosing.

Forms of Estrogen and Androgen Blockers at Temple

• Estrogen
  • Injectable
  • Pill
  • Transdermal: patch, cream, gel, spray
• Androgen blockers / testosterone blockers
  • Pill
• Progesterone
  • Pill

As you learn more about your body and experience changes with hormones, you can modify or stop to best fit your needs. Always consult your provider before making changes.

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Every person’s body is unique, and hormones will impact each person differently. Although there are typical changes experienced on testosterone, actual changes differ from person to person and are influenced by factors such as age, genetics, and your overall state of health.

The changes you will experience from a low, medium, or high dose or testosterone will develop over the course of months or years.

It is important for you to think about what your short- and long-term goals are and to discuss them with your provider. Knowing and discussing your needs will help your provider determine the best approach for you. If your goals change or evolve, talk with your provider to navigate next steps. You can work with your healthcare team to alter your dose, change its form, or completely stop hormones - your care team is available to provide ongoing support and guidance.

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Every person experiences changes differently. You may or may not experience the following changes. Typically, most changes are expected to occur in the first two years of taking hormones.

Physical Changes

• Voice deepening
• Development of facial hair
• Increased body hair
• Body fat redistribution, away from hips and thighs
• Increased muscle mass
• Bottom growth/clitoris growth (~1-4 cm)
• Changes to monthly bleeding/periods/menstruation
• Change in sweat, odor, and urine
• Possible hairline recession or partial balding (“male”-pattern balding)
• Increased skin oiliness/acne

Emotional Changes

Some people experience little or no changes in their emotional states, whereas others may experience changes in the way they are interacting and functioning socially and/or emotionally. For people who experience changes in their emotional states, these changes will likely settle down over a period of time. 

Sexual Changes

• Increased libido or sex drive
• Front hole dryness/vaginal dryness

Reproductive Changes

Speak with your medical providers about how testosterone affects fertility. It is important that you know your fertility preservation options, whether you are just starting testosterone or are working with Temple to continue your care. Your fertility and family planning desires are important, and we are here to connect you with the resources you need.

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There are reversible and irreversible changes that occur when taking testosterone. The reversibility of changes depends on how long you have been on testosterone and on your body. Current research suggests that voice changes, facial and body hair growth, bottom/clitoral growth, and baldness are not reversible, whereas changes in your monthly bleeding and body fat distribution are reversible.

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Testosterone use comes with benefits and risks. You can work with your provider to discuss your options and balance the potential benefits and risks.

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At Temple, we work with you to individualize your dosing based on your specific needs. Speak with your provider about which form of testosterone will work best for you. Your provider can help you understand options like low-dose or microdosing, average, and high-dose options.

As you learn more about your body and experience changes on testosterone, you can modify or stop using hormones to best fit your needs. Always consult your physician before making changes.

Forms of Testosterone Offered at Temple

• Injection (subcutaneous or intramuscular)
• Gel (topical)

Note: Some forms of testosterone are covered by insurance, whereas others may not be—discuss your coverage with your provider.

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