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3 Types of Feminizing Hormone Therapy for Transgender Women

Beginning feminizing hormone therapy is an exciting and important stage in a transgender woman’s transition, as she takes another important step toward becoming her authentic self. But starting feminizing hormone therapy can also be very technical – and more than a little bit confusing.

Certified SottoPelle physicians have helped thousands of transgender individuals across the United States and around the world align their sexual characteristics with their true gender identity, using natural and safe bioidentical hormones.

Feminizing hormone therapy primarily consists of three different kinds of therapy: estrogen, testosterone blockers, and progesterone. In this article the hormone replacement experts at SottoPelle explain these three different types of feminizing hormones, to help you understand this important phase of your journey toward gender confirmation.

Feminizing Estrogen Therapy for Transgender Women

Estrogen is well known as the primary “female” hormone. It is responsible for regulating many of the physical and emotional changes experienced during transition. Estrogen is responsible for the body’s development of typically female traits, including breast tissue growth, decreased muscle mass, and a reduction in hair on the face and body.

The results of a transgender woman’s estrogen therapy will vary depending on factors such as genetics, age, body type, overall health, and any underlying conditions. Typically, women who begin estrogen treatments in their 40s or 50s will experience somewhat less dramatic changes than adolescents or younger adults undergoing feminizing estrogen therapy.

It is important to understand that once a person is within the normal range of estrogen levels, taking higher doses will not bring about more dramatic results. And, in fact, doses of estrogen that are too high may lead to complications. Just like giving cisgender women extra estrogen will not result in more exaggerated feminine features, above-normal estrogen levels will not make your transition happen faster or more dramatically.

Previously, feminizing estrogen therapy was given as a pill, by injection, or using a skin preparation such as a gel, cream, spray or a patch. These methods have now been replaced by time-released bioidentical estrogen pellets which offer several advantages over older delivery methods.

Hormone pills are inconvenient, requiring you to remember them daily. They are also less safe for women who smoke or are older than age 35. Patches need to be worn at all times – and are not only unsightly but can fall off. And in some women, they cause skin irritation. Gels, creams and sprays are messy making them inconvenient as well.

Estrogen injections are probably the worst hormone delivery system because they cause very high and wildly fluctuating estrogen levels that can cause mood swings, weight gain, hot flashes, anxiety and migraines.

HRT pellets, however, only require insertion a few times a year! The area is numbed first, so there is no pain. And a single 5-minute pellet insertion treatment can last several months. Additional hormone pellets are time-released – so they constantly and consistently release bioidentical hormones over several months as the body need them, without “roller coaster” ups and downs.

Blood tests for estradiol (which is the most important estrogen in the body) should be performed periodically to ensure your hormone replacement therapy is achieving optimal – but not excessive – estrogen levels.

Feminizing Progesterone Therapy for Transgender Women

Progesterone, a hormone that is naturally present in cisgender women, primarily maintains the uterine lining and supports pregnancy. Progesterone’s role in other female functions, however, is contested and controversial. Some medical providers believe that progesterone improves mood, increases sex drive, improves energy, and enhances breast development and body fat redistribution – but the science behind this is still somewhat uncertain.

However, progesterone is more well accepted as a useful partial blocker of testosterone production. Progesterone may be especially useful in feminizing hormone therapy in cases where other testosterone blockers cannot be used or have proven to be ineffective.

Progesterone replacement therapy should be used conservatively as it can sometimes cause mood swings, anxiety, depression, irritability, and weight gain. Generally, progesterone is added to a feminization hormone regimen only after the patient’s hormone levels have been stabilized during the initial startup period taking estrogen and testosterone.

Feminizing Testosterone Blockers for Transgender Women

While many transgender patients immediately think of estrogen therapy, the primary predictor of feminizing effects is actually the lack of testosterone rather than increased levels of estrogen.

Testosterone blockers – also known as anti-androgens – can reduce the male sex hormones (“androgens’) that cause male or masculine features. There are a number of medications that your provider can prescribe to block testosterone.

Spironolactone is the most common anti-androgen medicine used feminizing hormone therapy. Spironolactone works by blocking the production and the actions of testosterone. While spironolactone is widely used, safe and well tolerated by most women, it can have side effects for some people. Excessive urination, dizziness, and very rarely elevated potassium levels can occur. Your physician will monitor your blood testosterone level while taking spironolactone to help ensure that proper levels are being achieved.

If spironolactone is not appropriate or well tolerated, gonadotropin-releasing hormone (GnRH) analogs (such as leuprolide / Lupron), may be used. This therapy causes the pituitary gland to shut down the signals being sent to your testicles that tell them to make testosterone. Spironolactone can be very effective and well tolerated, but can be expensive, and not all insurance plans cover it.

Finasteride and dutasteride are alternative medicines that prevent the production of a specific form of testosterone called dihydrotestosterone, that effects the skin, hair, and prostate. These are a weaker class of testosterone blockers than spironolactone but also have few side effects. So they can be useful for transgender women who cannot use spironolactone or GnRH analogs.

Feminizing Hormone Therapy for Transgender Women

More information about the effects of feminizing hormone therapy is covered in our article HERE. Once you have discussed your hormone therapy options and risks, the next step is deciding with your provider which approach is best for you.

SottoPelle has been helping transgender women live as their true and authentic selves with bio-identical hormone replacement therapy since the mid 1990’s. This natural approach, is more identical to the body’s own hormone delivery system, leading to more effective results, with fewer side-effects and risks than synthetic hormones. And, SottoPelle long-lasting, time-released, subdermal pellets more consistently and conveniently deliver hormone therapy than oral medications.

Talk to your physician about SottoPelle hormone therapy to help you on your unique and personal gender confirming journey. Or find a physician in your area who is SottoPelle certified using our Physician Finder HERE.

IMPORTANT DISCLAIMER: This article is provided as general information only and is not intended to be used as medical advice. While the benefits of hormone replacement are well documented through clinical research, we are not representing that hormone therapy is a “cure” for any disease. Only your treating physician can determine if hormone replacement may be a beneficial part of your healthcare regimen, based on your age, overall health, risk factors, and lifestyle.

Transgender Feminizing Hormone Therapy: 323.986.5100