For transgender women, hormone replacement therapy (HRT) is often one of the most important milestones in their transition. Generally HRT consists of blocking the male sex hormone testosterone and adding the female sex hormone estrogen and sometimes progesterone. Estrogen is in a lot of cases, the most transforming aspect of your transition and will go a long way towards easing dysphoria and allowing the transgender woman to feel a little more comfortable in her skin. Of course, the female secondary sex characteristics brought about by estrogen can make passing easier. However, estrogen does have its limitations and can be variable depending on your genetics. Let’s take a closer look at estrogen and examine what it can and can’t do as well as look at exactly how it does what it does in your body.
Lets start off by talking a little bit about what happens in your body when estrogen is introduced into your body. Initially the estrogen enters your bloodstream and begins to circulate throughout your body. I know a lot of transgender women get very concerned about the liver removing estrogen from the bloodstream and yes it does remove some but it really is nothing to worry about. The reason for that is that a lot of the estrogen will diffuse across your body’s cell membranes and enter your individual cells. Once in your cells, they will then bind to estrogen receptors. By binding to these receptors, it tells the DNA to begin expressing specific genes that would not get expressed without the presence of estrogen. These genes will code for the expression of the female secondary sex characteristics. Once the estrogen is in your cells, the liver no longer plays a role and it is not diminishing your dosage.
What Estrogen Does
- Soften the skin
- Decrease muscle mass
- Increase body fat and redistribute the fat into a more female pattern
- Decrease sex drive and reduce/eliminate good morning erections
- Decrease ability to make sperm and eventually lead to sterility
- Nipple and Breast growth
- Slow growth of body and facial hair
- slow or stop male pattern baldness
The changes mentioned above do take time and can vary greatly from person to person based on numerous factors. Genetics plays a huge role in the entire process. For example, if all the women in your family have small breasts, you are almost certain to have small ones too. Also the number of estrogen receptors in your cells can also play a role in how fast changes occur. In the case of breasts, it can easily take up to two years to reach your maximum growth. Estrogen will also act as an anti-androgen to some degree.
- Change your voice nor change size of your Adam’s apple
- Stop facial hair growth
- Grow back hair lost due to male pattern baldness
- Change size of bones
Even though estrogen won’t change your Adam’s apple of the bone structure in your face, the fat redistribution can, in some cases, help draw less attention to those areas. However, if you are really concerned about those areas, you will need surgery to change them to a more feminine configuration. A tracheal shave and facial feminization surgery (FFS) can do amazing things. The downside is that FFS is very expensive and not everyone is able to afford it readily.
Possible Risks of Taking Estrogen
- Increases the chances for blood clots (smoking amplifies the risk greatly)
- Long term use could effect liver function
- Increased risk of gallstones
- Increased risk of heart disease
- Can increase blood pressure
- Can increase the risk of breast cancer if it runs in your family, you are overweight, or you have been taking it for more than 5 years
These risks are pretty serious and they can certainly happen. However, if you take care of yourself the odds go way down and chances are you will not see any of these conditions. Smoking is definitely something you simply should not do on HRT and some doctors will refuse to put a patient on HRT if they smoke or they may put them on a very small dosage. Eating healthy is another thing that cannot be stressed enough in its importance. Proper nutrition will not only make you healthier, it can help your overall appearance with your transition. Sometimes too much fat can hide all of your new curves.
One benefit of estrogen that I did not hit on above is the psychological aspect of being on HRT. It can have a huge positive effect on your whole outlook. I know that I use to feel really good about myself knowing that I had estrogen molecules floating around my bloodstream and doing what Nature should have been doing. I still do think about that from time to time and it still makes me happy.