Hormone therapy can help a person’s body align with their gender identity. For many older teens and young adults, it’s an important part of transitioning. It can improve mental health, confidence, body image and overall quality of life.

The type of hormone therapy each person needs depends on their gender identity and desired gender expression.

Feminizing Hormone Therapy

Feminizing hormone therapy makes people look more feminine. It includes estrogen (a sex hormone) with or without androgen blockers (medications that block male sex hormones). It’s appropriate for people assigned male at birth whose bodies don’t match their gender identity. 

What to expect during feminizing hormone therapy
You can take estrogen by pill, with a patch applied to your skin or by injection. Androgen blockers are by pills or injections. After taking prescribed doses for a few months, most people begin to experience some the following changes:

  • Body fat redistribution
  • Breast growth 
  • Decreased muscle mass and strength 
  • Decreased libido 
  • Decreased penile function 
  • Decreased testicular volume 
  • Decreased sperm production 
  • Slowed growth of body and facial hair
  • Softening of skin 

The timing and extent of changes varies widely from person to person. It will likely take two to three years for the hormones to have their full effect. To maintain the changes, you need to keep taking hormone therapy for the rest of your life. 

Masculinizing Hormone Therapy

Masculinizing hormone therapy makes people look more masculine. It involves taking testosterone, a sex hormone that promotes the development of masculine traits and suppresses the production of estrogen (a female sex hormone). It’s appropriate for people assigned female at birth whose bodies don’t match their gender identities.

What to expect during masculinizing hormone therapy
Testosterone can be taken via injection, skin patch or gel. Most people begin to experience the following changes within one to six months of taking their prescribed dose:

  • Body fat redistribution 
  • Clitoral enlargement
  • Deepened voice 
  • Facial and body hair growth 
  • Increased muscle mass and strength
  • Increased skin oiliness 
  • No more periods 
  • Vaginal atrophy 

The timing and extent of changes vary widely from person to person. It may take as many as five years for the hormones to have their full effect. To maintain the changes, you need to keep taking hormone therapy for the rest of your life. 

Is Hormone Therapy the Right Choice? 

Every person is different, so we work closely with each patient to determine whether hormone therapy is the right choice. People who benefit most from hormone therapy usually have: 

  • Persistent, well-documented gender dysphoria or gender incongruence 
  • The capacity to make a fully informed decision and consent to treatment
  • Good, or well-controlled, emotional health

Is Hormone Therapy Safe?  

Most experts, including our team, believe that hormone therapy is a safe choice for transgender older teenagers and young adults, but it can have some side effects. Because research in this area is just beginning, it’s possible that there are other long-term risks we don’t yet know. 

To monitor for possible side effects, we do frequent blood tests to monitor health and check for:

Possible side effects of feminizing hormone therapy

  • Blood clots
  • Gallstones
  • Headaches or migraines
  • Heightened risk of diabetes and heart disease
  • Nausea or vomiting

Possible side effects of masculinizing hormone therapy

  • Headaches or migraines
  • Higher risk of heart attack, heart disease and stroke 
  • Weight gain

At What Age Can You Start Taking Hormone Therapy? 

Current guidelines suggest that around 16 years of age is a good time to start hormone therapy. But every person is different. We work closely with patients and their families to determine what age works best for them. 

Fertility Preservation Options 

Hormone therapy can affect fertility. Because of this, we encourage patients to talk about fertility preservation with our team. 

To preserve their fertility, many of our patients choose to freeze their eggs or bank their sperm before having gender affirmation hormones. We work to create a plan that works for each person. 

Why Choose the Transgender Center for Hormone Therapy 

Leaders in the field: At the Washington University Transgender Center at St. Louis Children’s Hospital, we offer the only multidisciplinary care available to transgender, nonbinary or genderqueer children and adolescents in the St. Louis region.

A supportive environment: We don’t encourage anyone to express a particular identity. Instead, we offer a relaxed, open space where youth are free to talk about their goals with hormone therapy. 

Answers to all your questions: There’s limited research on the long-term effects of hormone therapy for transgender kids and young adults, but we’ll be happy to go over the data that does exist. We’ll talk about what you can expect from hormone therapy and set realistic expectations about what hormones can and can’t do.