Estrogen and the Transgender Woman -Transgender Universe

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

Estrogen and the Transgender Woman - Transgender UniverseHormone 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
  • Adam’s Apple: Estrogen will not reduce the size of an Adam’s 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
  • One’s 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


Women (> 18 years old)
Follicular Phase 30-120
Ovulatory Peak 130-370
Luteal Phase 70-250
Post-Menopausal 15-60
Male 15-60



Females 6 – 86 0.1 – 1.2
Males 270 – 1100 2.4 – 12




Hormone Replacement Therapy can have many great benefits for male to female patients when administered correctly. It can have a positive affect on one’s 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 it’s 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.

  • ocean hunter

    Great to reinforce common knowledge but entirely useless as all transsexual women know this. Suggestion: Something to actually help us would be nice please…like how can we who are less fortunate get assistance with surgery ? Jim Collins foundation is not available for some of us due to it’s restricted acceptance of US surgeons who ALL offer a very outdated surgical technique ! Go figure America even treats transsexual women with contempt ! . Still puzzled how Jim Collins and the insurance community work so cooperatively to restrict surgery to US surgeons especially since Thailand offers better results for half the price ! Considering the mission to help people it makes absolutely no sense that they would not use the limited resources to cover twice the amount of us that suffer from this genetic birth defect !

    • Daniel Burke

      I just need to point out 1 issue with your response. The surgical technique used in America is “outdated” but that is due to Americas tendency to be reluctant in approving new medical procedures without proper and extensive research and study. In the long run surgical techniques are more effective in America once approved because of the slow pace of approval. In countries elsewhere there is far less regulation on new surgical and medical practices leading in many cases to underdevelopment in the practice. In my case this would be surgical and medical procedures to treat spinal injuries which has even less research being preformed than trans research. Overseas there are many emerging medical procedures to treat spinal injuries and a number and have been shown to be detrimental to the patient due to the lack of research done prior to the introduction of the technique or procedure. This is also the case with the new medical and surgical procedures used to treat transgender patients. In the long run medical procedures used to treat these individuals will be more efficient, successful, and better understood by American physicians because they were tested out and had flaws revealed in the testing ground that is overseas medical practices.

      • Ellen Faye Harvey

        Very good points, but In the case of genital surgery for M2F’s, the techniques used in the first class clinics in Thailand are very, very good. I do believe that this was the reference point in contrasting the US vs. overseas. There are butcher shops everywhere. I did choose Bangkok for both results and costs. For me, and many others it is a good choice. They have so much practice and honing. My gynecologist told me I had the best looking surgery she had ever seen and the average doctor would never know I wasn’t a natal female. (I blushed). I used Dr. Preecha’s clinic.

    • Ocean Hunter,

      Thank you for reading and replying. It is encouraging to hear transgender individuals such as yourself are educated in your own care. However, there are other transgender individuals first learning about themselves, and this information is priceless to them as they move forward with their care.

      Also, I never viewed my GRS surgical procedure as outdated and can personally attest to the success of the American GRS surgical process. I flew to California for 14 days, and I cannot imagine my total cost(airfare, hotel stay, surgery, et cetera) had I gone to Thailand. I had zero complications, zero pain -yes absolutely ZERO pain- and was up walking around my hospital floor 1 day post surgery.

      While there, I met a lovely girl who flew in from Australia for her GRS. She had a minor complication and had to extend her stay. This proved a hardship for her. A caveat, if traveling, especially overseas, for surgery.

      Here is a list of health care providers covering GRS(updated 8-1-2015):

      Wish you all the best and a bright New Year!
      mir, irini, peace, amn,

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