Estrogen and the Transgender Woman

Mila Madison

Testosterone and estrogen are the hormones associated with gender. The average male, female and everyone in between have bodies that run on and need both. Today we are going to explore estrogen and the effects of it on the transgender female. Please note before we proceed that if you are currently undergoing or thinking of undergoing hormone replacement therapy with estrogen that we strongly recommend you do so under the care of a physician. There can be many dangers and health risks if estrogen is not administered and monitored properly.

es·tro·gen (pronounced ˈestrəjən) noun

Any of a group of steroid hormones that promote the development and maintenance of female characteristics of the body. Such hormones are also produced artificially for use in oral contraceptives or to treat menopausal and menstrual disorders.

Hormone Replacement Therapy (HRT) and estrogen

Hormone Replacement Therapy with estrogen is the process of administering the hormone to male to female transgender patients in order to induce and maintain the development of female secondary sex characteristics. Though estrogen cannot reverse the effects of puberty, HRT with estrogen can help develop female characteristics and make a patient look more like the female gender they identify with. It causes significant social and psychological changes while affecting your mood, energy, appearance and overall health. Though not a full cure it is very effective at treating patients with gender dysphoria. Estrogen can be administered by injections, pills, patches and sub-dermal pellet implants.

Physical changes associated with estrogen

There are many changes that occur when taking estrogen. Some are permanent and some are reversible.

Permanent changes

  • Breast development
  • Enlarged nipples and areolae
  • Stretch marks (for some)

Reversible changes

  • Redistribution of body fat
  • Reduced muscle development
  • Decreased libido
  • Changes in the texture of the skin
  • Significantly reduced and lightened body hair
  • Ocular changes the lens of the eyes changes in curvature
  • Reduced gonadal gonads size
  • Less prominence of veins
  • Possible hair growth in balding areas
  • Eyebrow hair becomes less bushy or scattered

What estrogen cannot change

  • Facial Hair: Though there are slight changes estrogen will not remove facial hair
  • Voice: The voice will not change without training
  • Adams Apple: Estrogen will not reduce the size of an Adams Apple
  • Hips: The width of the hips are not affected in individuals who are past puberty
  • Brow: Estrogen will not reduce the size of brow ridges

Changes to the face (over time)

  • Cheeks: The face can become fuller and more rounded

Other known changes

  • The prostate shrinks
  • The bladder shrinks
  • The line that runs down the underside of the penis and down the middle of the scrotum darkens
  • Minor water retention is likely.

The affects on bone structure

Both testosterone and estrogen are needed for healthy bone and to prevent osteoporosis. Estrogen is the predominant sex hormone that slows bone loss. The hips will rotate slightly forward due to changes in the tendons so hip discomfort is not uncommon. If estrogen therapy is conducted prior to the pelvis ossification that occurs around the age of 25, the pelvic outlet and inlet open slightly. This widening will also widen the femora as they are connected to the pelvis. The pelvis will still have some masculine characteristics by default but the end result will be wider hips than a normal male and closer to a cis female.

Fat redistribution

The body will now tend to accumulate new adipose tissue (fat) in a typically female pattern. This includes the hips, thighs, rear, pubis, upper arms, and breasts.

Metabolic risks associated with estrogen

  • Estrogen therapy causes decreased insulin sensitivity which places transgender women at increased risk of developing type II diabetes
  • Ones metabolism slows down and one tends to gain weight, lose energy, need more sleep, and become cold more easily. Due to androgen deprivation a loss of muscle tone, a slower metabolism, and physical weakness becomes more evident. Building muscle will take twice as much work than before. However, the addition of a progestogen may increase energy although an increase in appetite may be seen as well.

Possible mental risks associated with estrogen

  • Mood changes can occur including the development of depression
  • Migraines can be made worse or unmasked by estrogen therapy
  • Estrogens can induce the development of prolactinomas, which is why prolactin levels should periodically be monitored in transgender women.

Typical hormone levels in females and males


Hormone Replacement Therapy can have many great benefits for male to female patients when administered correctly. It can have a positive affect on ones mental state and the changes that occur to the body are often positive for those who identify as female. In addition to estrogen many male to female transgender patients also take an anti-androgen to reduce the production of testosterone. Some patients also take progestogens, though there is much debate whether its use has any benefits. Again we highly recommend you see a medical professional such as an Endocrinologist who has experience treating transgender patients if you are taking or considering taking estrogen.


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