Feminizing Hormone Therapy: How Does It Affect and What Changes Can I Expect?

Feminizing hormone therapy, also known as cross-sex hormone therapy, involves the administration of estrogens along with medications that reduce the effects of testosterone. There are two main reasons for this: to block the action of testosterone and to promote the development of female secondary sex characteristics.

Hormone treatment can begin at various stages in a trans woman’s life—during adolescence (preceded or accompanied by puberty blockers), in young adulthood, or later in life. In all cases, it is crucial that the treatment be supervised by a medical team experienced in trans healthcare to ensure the woman’s safety, adjust treatment when necessary, and provide personalized follow-up.

Before starting hormone therapy, you’ll need to undergo certain tests and medical evaluations to ensure your health status is adequate.

Physical changes do not happen immediately. Over time, as feminizing hormone therapy progresses, various changes become noticeable. Not all changes appear at the same time, and results vary from person to person. Generally, changes may become noticeable between one month and two years of treatment. The most common effects of feminizing hormone therapy include:

Libido typically decreases due to feminizing hormone therapy. Erections and ejaculations become less frequent. The testicles also shrink in size.

Fat begins to accumulate more around the hips, buttocks, and thighs, while decreasing in the abdomen and shoulders. This redistribution can soften the body’s silhouette and bring it closer to a typically feminine pattern.

The skin becomes thinner and softer, less oily, and with smaller pores.

Hair loss slows down. Body hair density progressively decreases, although it does not disappear completely. Scalp hair may become finer and silkier.

The nipples and breasts begin to develop gradually—a process that can take two to three years. Not all women develop the same breast volume. In such cases, breast augmentation surgery is an option for trans women.

Other effects include a slight reduction in muscle mass, decreased physical strength, and changes in body odor.

However, some features are not affected by hormone therapy. The voice does not feminize it requires speech therapy or voice surgery if a change is desired. Bone structure in the face and body is not altered. For this reason, if hormone therapy begins in adulthood, achieving more typically feminine features may require facial feminization surgery, body feminization surgery, or aesthetic treatments.

In some cases, hormone therapy can also bring emotional benefits. Many trans women report greater emotional stability after starting treatment, along with improved psychological and emotional well-being. It can also enhance quality of life, as one’s gender identity becomes more visibly reflected in the body.

One of the most important consequences of feminizing hormone therapy is the progressive loss of fertility. Over time, sperm production significantly decreases or stops altogether. Therefore, if there is a desire to have biological children in the future, it is crucial to consider gamete preservation before starting treatment.

When a trans girl has access to an early diagnosis and a specialized team, she may, if she wishes, start treatment with puberty blockers before the onset of puberty. These medications temporarily halt unwanted pubertal changes, providing time until the person is older and mature enough to decide whether to begin estrogen therapy.

This approach, endorsed by clinical guidelines such as those from WPATH and the Endocrine Society, has many benefits: it reduces dysphoria, prevents the development of male secondary sex characteristics (such as an Adam’s apple, body hair, or a deep voice), and facilitates a smoother transition in adulthood.

When hormone therapy begins after the use of blockers, the physical changes may be more pronounced and complete. In contrast, if estrogen therapy starts after male puberty has been completed, some effects are no longer reversible (like voice pitch or certain bone proportions), though others may still improve over time.

This is a sensitive and deeply personal topic that must be approached with respect for the individual’s identity and pace of development, always with professional and family support.

Beyond physical changes, hormone therapy has a profound impact on how one relates to the world. Many trans women experience greater social recognition, reduction of dysphoria, and a fuller sense of identity.

However, challenges may also arise in work, social, educational, or even family settings. Adequate emotional support can help prevent more complex situations.

Feminizing hormone therapy is much more than a medical treatment. For many trans women, it represents a first step toward affirmation and self-connection. There is no single valid way to transition, and not all trans women choose to undergo feminizing hormone therapy.