For gender-nonconforming people, getting medical care can be an uphill battle. In the U. On top of that, there's not nearly enough information out there about reproductive health for trans and nonbinary people. But regardless of how you identify, you deserve medical practitioners who respect your gender identity and understand your specific needs, one of which may be birth control. Depending on your anatomy and whether you're on hormone therapy, your decisions about birth control may require some considerations that you never learned about.
These changes are permanent and are not affected by HRT. Endocrine treatment of transsexual persons: extensive personal experience. Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. Absolute contraindications — those that can cause life-threatening complications, and in which feminizing hormone therapy should never be used — include histories of estrogen-sensitive cancer e. Transgender hormone therapy of the male-to-female Provara transgender type, also known as feminizing hormone therapyis hormone therapy and sex reassignment therapy to change the secondary Provara transgender characteristics of transgender people from masculine or androgynous to feminine. Flutamide [c].
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I loved my children, though, and chose the basement instead of being alone and broke. I am still capable of erections and orgasms, although Provara transgender as frequently or as spontaneously as in my younger transgneder. Then you can enjoy a long and healthy life as the woman that you are. They do so as an alternate of second choice to prescribed hormones. Depo Provera? Drinking is ok but you may have to reduce your intake. Or is there a doctor who can get me a prescription? Someone please help i was on depo provera for 3 months? Please seek out a proper Dr. Again, I settled on natural products transgenedr of synthetic prescription products partly to Suasage lovers my anonymity and partly because I was afraid of the side effects of synthetic drugs. Printer-Friendly Option. Are most women bi? Laugh at husband premature ejaculation the care of a Doctor. Used for female disorders as it helps Provara transgender balance female hormones.
Many transgender men and women seek hormone therapy as part of the transition process.
- Chat or rant, adult content, spam, insulting other members, show more.
- Very recently, the world's social climate has progressed enough to the point where people who identify as a different gender from which they were biologically born have been able to publicly and openly live the way they want and need to live.
- Chat or rant, adult content, spam, insulting other members, show more.
- It is a widely held social belief that gender is a binary concept and that there are only two sexes: male and female.
- Disclaimer: This information is given for general purposes only and is not warranted or guaranteed or construed as medical advice.
Many transgender men and women seek hormone therapy as part of the transition process. Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features.
Guidelines exist to help providers choose appropriate candidates for hormone therapy, and act as a framework for choosing treatment regimens and managing surveillance in these patients.
Cross-sex hormone therapy has been shown to have positive physical and psychological effects on the transitioning individual and is considered a mainstay treatment for many patients. Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy.
Transgender individuals experience discord between their self-identified gender and biological sex. Transgender men are individuals who were assigned female at birth but identify as men, and transgender women are individuals who were assigned male at birth but identify as women.
While research in this area is sparse, the current evidence points toward a biologic etiology for transgenderism. These data come from studies examining children with congenital genitourinary anomalies who were assigned gender at birth 1 , 2 , as well as postmortem cadaveric studies 3.
Estimation of prevalence of transgenderism has historically been challenging. The most recent estimates in the United States have been reported from survey studies, and range from 0.
The number of transgender individuals seeking cross-sex hormone therapy has risen over the years 6. The administration of exogenous virilizing hormones is considered medically necessary for many transgender individuals 7.
Many transgender men seek therapy for virilization and the mainstay treatment is exogenous testosterone. Transgender women desire suppression of androgenic effects and often use anti-androgen therapy with feminizing exogenous estrogens. The purpose of this review is to present updates on the current hormonal regimens used by transgender patients, to discuss the safety and efficacy of these treatments, and to provide a summary of the current data that exist on both their short- and long-term effects.
Both the World Professional Association for Transgender Health WPATH and the Endocrine Society have created transgender-specific guidelines to help serve as a framework for providers caring for gender minority patients. These guidelines are mostly based on clinical experience from experts in the field. Guidelines for hormone therapy in transgender men are mostly extrapolations from recommendations that currently exist for the treatment of hypogonadal natal men and estrogen therapy for transgender women is loosely based on treatments used for postmenopausal women.
This test required patients to live full-time as their self-affirmed gender for a predetermined period of time usually 12 months before starting cross-sex hormones. The recommendation was intended to help patients transition socially. As a result, the updated guidelines do not require this step, and instead, the societies recommend that patients transition socially and with medical therapy at the same time 7 , 8.
WPATH recommends that hormone therapy should be initiated once psychosocial assessment has been completed, the patient has been determined to be an appropriate candidate for therapy, and informed consent reviewing the risks and benefits of starting therapy has been obtained. Per WPATH, a referral is required by a qualified mental health professional, unless the prescribing provider is qualified in this type of assessment. This fourth criterion can sometimes be the most challenging to interpret.
Many patients may have concurrent mood disorders related to their gender dysphoria, and experienced providers may have success alleviating the severity of these symptoms by allowing the patient to begin the medical transition process.
Later in this review I discuss the effects hormones have on quality of life and perception of personal well-being. This is a key concept and should be considered when patients are being evaluated for hormone therapy initiation. Patients with comorbid psychiatric conditions should be closely monitored and mental health support remains paramount for these patients.
Testosterone therapy is used to suppress female secondary sex characteristics and masculinize transgender men. The therapy used resembles hormone replacement regimens used to treat natal men with hypogonadism and most of the preparations are testosterone esters. Current formulations for testosterone are presented in Table 1. These are usually administered weekly, but if higher doses are needed to reach adequate physiologic levels, the dosing interval can be extended to every 10 to 14 days.
Before a patient is started on testosterone, a baseline hematocrit and lipid profile should be obtained, as these indices will change over time. In addition, if a patient is at significant risk for osteoporosis, a baseline bone mineral density should be obtained 9. Most providers start testosterone therapy with half the anticipated dose needed to reach maximum virilization in a patient. Studies exist looking at dose-response with regard to virilization once testosterone is initiated.
Nakamura et al. Therefore, while higher doses may achieve desirable effects sooner, the risks associated with fast titration need to be assessed, and patients should be aware that testosterone effects eventually become the same over the intermediate-term.
Once implanted, the pellets slowly release testosterone for a long-acting androgenic effect. They are approved for the treatment of primary hypogonadism and hypogonadotropic hypogonadism. Our group recommends that patients first be started on an alternative form of testosterone until maximum virilization is achieved and maintenance dosing is then necessary. Patients may then be transitioned to the implanted pellets. The number of pellets to be implanted depends upon the minimal daily requirements of testosterone needed to reach physiologic levels.
Each pellet is cylindrical in shape and contains 75 mg of testosterone and six pellets may be implanted with each pass of the insertion device that is provided with the kits. Two pellets should be inserted for every 25 mg of parenteral testosterone needed weekly. The pellets are placed in a fatty area under the skin.
Most commonly, the upper gluteal region or hip is used as a site for implantation. The effects of the pellets may last up to 6 months, but most patients require re-implantation every 3 to 4 months. Hormone therapy for transgender women is intended to feminize patients by changing fat distribution, inducing breast formation, and reducing male pattern hair growth Estrogens are the mainstay therapy for trans female patients.
Through a negative feedback loop, exogenous therapy suppresses gonadotropin secretion from the pituitary gland, leading to a reduction in androgen production Estrogen alone is often not enough to achieve desirable androgen suppression, and adjunctive anti-androgenic therapy is also usually necessary.
Ethinyl estradiol used to be the mainstay of most estrogen-directed therapies. This is no longer the case, as clinical evidence has showed a strong relationship between ethinyl estradiol and the incidence of deep venous thrombosis As a result, there are strong recommendations against the use of ethinyl estradiol in transgender patients 8.
See Table 2 for dosing recommendations. No studies have examined the efficacy of the different formulations specific to transgender hormone management. After the age of 40, transdermal formulations are recommended as they bypass first pass metabolism and seem to be associated with better metabolic profiles There are no unanimous recommendations for the use of anti-androgens.
Options are also listed in Table 2. Spironolactone is one of the most common medications used to suppress endogenous testosterone in trans female patients. The biggest risk associated with spironolactone is hyperkalemia, and this should be closely monitored. GnRH agonists can be very expensive, and are not always a good option for patients. Progestins are used by some providers, but should be used with caution as there is a theoretical risk of breast cancer associated with long-term exogenous progesterone use Many trans men seek maximum virilization, while others desire suppression of their natal secondary sex characteristics only.
Within three months of initiating testosterone therapy, the following can be expected: cessation of menses amenorrhea , increased facial and body hair, skin changes and increased acne, changes in fat distribution and increases in muscle mass, and increased libido 11 , Later effects include deepening of the voice, atrophy of the vaginal epithelium, and increased clitoral size.
Male pattern hair loss also can occur over time as a result of androgenic interaction with pilosebaceous units in the skin Some patients find this favorable as it may be considered masculinizing. However, patients should be made aware of the potential side effects on sexual functioning that can be associated with these medications, and they should be counseled that no data exist on the use of these medications in transgender men In most female-to-male patients unless testosterone is administered during the peri-pubertal period , there is some degree of feminization that has taken place that cannot be reversed with exogenous testosterone.
As a result, many transgender men are shorter, have some degree of feminine subcutaneous fat distribution, and often have broader hips than biologic males The following changes are expected after estrogen is initiated: breast growth, increased body fat, slowed growth of body and facial hair, decreased testicular size and erectile function. The extent of these changes and the time interval for maximum change varies across patients and may take up to 18 to 24 months to occur. Use of anti-androgenic therapy as an adjunct helps to achieve maximum change.
Longitudinal studies also show positive effects on sexual function and mood 16 , There is biologic evidence that may explain this. Kranz et al. SERT expression has been shown to be reduced in individuals with major depression These types of data are preliminary, but do point to the important role of hormone therapy in patients who suffer from gender dysphoria. Hormone therapy may even have a positive effect on physiologic stress as well. Colizzi et al. They found that after starting cross-sex hormones, both perceived stress and cortisol were significantly reduced.
This finding also has important implications for treatment. Patients on testosterone should be monitored every 3 months for one year and then every 6 to 12 months thereafter. Hormones should be carefully monitored to avoid a prolonged hypogonadal state if dosing is too low, which can lead to significant losses in bone mineral density; and to avoid exposures to supraphysiologic levels, which could have significant physiologic and metabolic effects Sex steroids—testosterone and estradiol—are necessary to maintain bone health in men and women, respectively.
They are responsible for bone growth and turnover, and hypogonadal states in both males and females can result in clinically significant bone loss. Testosterone has a direct role in bone health maintenance, but the steroid is also aromatized peripherally to estradiol, which has a very important role as well Testosterone also has an important role in increasing muscle mass, which further helps with bone health preservation.
Studies have looked at bone health in transgender men on long-term testosterone therapy. Exogenous testosterone appears to have an anabolic effect on cortical bone and when dosed at physiologic levels, is adequate enough to avoid issues with bone demineralization in transgender patients Transgender women may be at higher risk for bone loss despite estrogen use This is likely a result of anti-androgen use, and therefore, providers should consider stopping anti-androgen therapy if and when patients undergo orchiectomy with or without genital confirmation surgery.
Screening for bone loss should be performed per the guidelines for the general population, unless a patient has baseline low bone mineral density, or is at risk for osteoporosis tobacco use, alcohol abuse, previous fractures, eating disorder, family history of osteoporosis. Patients at risk should be screened sooner and more regularly. It is not clear whether use of exogenous testosterone increases the risk of cardiovascular disease in transgender men.
Alexis was an actress, too, certainly one of the first prominent transgender people on screen. Libs who believe there is no such thing as gender: Have you ever heard of David Reimer? GLAAD president Neil Giuliano called King's participation an "unprecedented opportunity for a community that is underrepresented on television. Evidence must be slim or quackery at most. It would be unfair to her to deprive her of your sexual performance unless it is mutually agreeable. The recommended dosage is 2 capsules per day, so the resulting daily dosage was:. One of the effects that I did not anticipate of the Provara was the feminizing effects.
Provara transgender. Lana and Lilly Wachowski
Are you sure you want to delete this answer? Yes No. Answers Relevance. Rating Newest Oldest. Add a comment. If you want to take progesterone, you should be taking micronized progesterone Brand name, Prometrium in the US The dosage range is mg daily, depending on how it effects you.
Depo provera is a progestin. Why would you be taking that? Normal HRT consists of estrogen and a androgen blocker. I highly recommend you go to a doctor who HAS experience treated transwomen. Provera Transgender. I would like to ask the same question as the person above. Existing questions. Depo provera injection continuous bleeding for months? Depo Provera 3 month shot?
More questions. Depo Provera? Someone please help i was on depo provera for 3 months? Answer Questions Are gays and lesbians will go to hell? If Straight women have sex with women they are still straight. Cycrin , generic brand of Provara. This has been the most important drug in my regimen. By reducing my testosterone level, it allowed the estrogen in my body to begin its work. For a while, I added Rejuvex , an herbal menopausal supplement for women. It contains:.
The reason I chose this one was because of the raw glandular powders which seemed to be a missing compound for me. They have two excellent products, Evanesce and Feminol. Evanesce's primary purpose is to reduce the testosterone level, but I was already doing that with the Provara, so I used just the Feminol which provided glandular concentrates and increase estrogen levels.
The recommended dosage is 2 capsules per day, so the resulting daily dosage was:. Dong Quai GPH, 0. The black cohosh contains natural estrogen. For the first two or three weeks, I took 4 capsules per day, until I found that I was able to supplement the glandular intake with another cheaper and more powerful source, Raw female Ovarian and Uterus Glandular Concentrate with Synergistic Complex by Natural Sources, Long Beach, CA According to the label on the bottle, Raw tissue concentrates are made from toxin-free lyophilized glands imported from animals grazed in rangeland free of pesticides, growth hormones, antibiotics or chemical additives.
Special sustained release formulation ensures maximum intestinal availability. At the recommended dosage of two per day during meals, the daily intake was:. Damiana is considered by many to be an aphrodisiac; useful to increase the sperm count in men and to strengthen the egg in women. It helps to restore the natural sexual capacities and functions, especially for the exhausted body.
Damiana works as a stimulating nerve tonic used for debility, depression, and lethargy. Used for female disorders as it helps to balance female hormones. This herb has a diverse reputation including use by the Aztecs; the herb tea is an effective aphrodisiac which increases and stimulates energy and sexual appetite.
DAMIANA is an herb used for increasing sexual powers, restoring hormonal balances, and as a natural yet powerful aphrodisiac, stimulant and tonic. I went back to the recommended dosage of two Feminol per day since the Raw glandular product was providing my glandular requirements. The next step taken at the same time was to increase my estrogen intake. I had read about taking birth control pills for the estrogen, but decided to do more research.
Every legitimate medical report that I could find about it said that there was not enough estrogen in current birth control pills to affect feminization of men. The only place I found reference to successful feminization with birth control pills was in some fiction stories in the transgendered boards.
Again, I settled on natural products instead of synthetic prescription products partly to maintain my anonymity and partly because I was afraid of the side effects of synthetic drugs. I researched estrogen and discovered phytoestrogen, a naturally occurring estrogen compound in plants that is used to herbally supplement estrogen therapy in women.
All in a natural self-emulsifying delivery system. Although not required for feminization, Super Blue-Green Algae by Cell-Tech has become an integral part of my transformation. A human body requires a multitude of trace elements, proteins and enzymes and, if any of them are missing, it results in less-than-efficient bodily functions.
Super Blue-Green Algae provides these trace elements in a natural form that is easy for the body to assimilate. It makes up for anything that I lack in my normal diet. Using Super Blue-Green Algae will produce positive effects in your general health. Nugest Wild Yam Extract for the natural estrogen and progesterone. The results have been gradual but noticeable. You should remember that it takes an adolescent female years to develop full breasts and full hips, and accelerated results within a few months are generally not possible with men.
This is particularly true because the male body must continually fight the levels of testosterone that is being produced. This is why it is so important to reduce the testosterone levels or any type of hormonal therapy conventional or herbal will not work. I have not had any ill side effects, although I have gained about 10 pounds since I started on Provara. I try to be very aware of any changes in my body and read everything I can on the drugs and herbs that I use.
For me, even my reduced libido is not an unpleasant side effect. In fact, I have to say that it has improved my marriage. My personal sex life has stabilized. I am still capable of erections and orgasms, although not as frequently or as spontaneously as in my younger days. I am satisfied with less sex from my spouse and so is she.
My moods are more stable and my temper is under control, so we get along much better. My breasts and hips have enlarged somewhat, most noticeably my breasts which are much more sensitive. My wife has noticed my enlarged breasts but I have convinced her that has more to do with my middle-aged body going through changes and my increased body weight.
I am more self-conscious about going without a shirt now, but they are not abnormally large for a male. I haven't decided how big I will let them grow and when I will stop with this herbal hormonal replacement therapy. For now, I am pleased with the results and look forward to more changes. I will keep you updated on the results as they develop.
Herbal TS March 6, Thank you also for reminding people in our community that the changes will come gradually! I would like to offer one bit of additional information. Evanesce, while it stresses testosterone suppression, is also full of a wonderful synergistic blend of phytoestrogenic herbs! Many people have had significant breast development on just Evanesce alone! I think your web site is a very good composite of information form many sources -- you have done a GREAT job of putting this all together!
What an incredible site on herbal hormones. Most excellent Sounds to me like you've settled into the perfect cutomized blend for your chemistry and lifestyle. I like the way you stress supervision uder the care of a trained medical professional.
I believe truly also that therapy, counseling and personal genetic tailoring to all drugs be foremost in the role of transformation. I wish at this time I could afford it all! You say that the hormones can be natural, but the Provara drug is needed to reduce the male hormones Does anyone out there in Cyberspace know of something?
I went to your page and thought it was very interesting. I have thought about going on hormones, but do not want to use anything dangerous and do not want to go to a doctor for any treatment at this time. Is there a way to get Provara without a prescription?
Or is there a doctor who can get me a prescription? How do you get yours? All medications should be taken under a doctor's supervision and self-administration of drugs like Provara can be dangerous. I "personally" think most herbal hormones are a waste of consumer finances. Your page proved interesting and educating. I still wouldn't take herbal hormones, however I will definitely add your link to my website. You did a good job, it was detailed enough to provide people solid information. I stopped by your site last night and gave it a read.
Mmmmm, information I haven't run across yet. I guess a hell of a lot safer than my brief trial with hormones oops, I guess I should've had a prescription for those J. The effects are stunning to say the very least.
A breast growth of one cup size in 2. Even with "real" hormones they say projected breast growth starts around months, so I thought that I can go well past the swimsuit season before I need to do any real changes, but no.
I am already conspicuous when walking on T-shirt for my overall body size they are still small, though.
Transgender hormone therapy of the male-to-female MTF type, also known as feminizing hormone therapy , is hormone therapy and sex reassignment therapy to change the secondary sexual characteristics of transgender people from masculine or androgynous to feminine.
Some intersex people also take this form of therapy, according to their personal needs and preferences. The purpose of the therapy is to cause the development of the secondary sex characteristics of the desired sex , such as breasts and a feminine pattern of hair , fat , and muscle distribution.
It cannot undo many of the changes produced by naturally occurring puberty , which may necessitate surgery and other treatments to reverse see below. The medications used for the MTF therapy include estrogens , antiandrogens , progestogens , and gonadotropin-releasing hormone modulators GnRH modulators. While the therapy cannot undo the effects of a person's first puberty , developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria , and can help the person to "pass" or be seen as the gender they identify with.
Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc.
The goal of the therapy is to provide patients with a more satisfying body that is more congruent with their gender identity. Many physicians operate by the World Professional Association of Transgender Health WPATH Standards of Care SoC model and require psychotherapy and a letter of recommendation from a psychotherapist in order for a transgender person to obtain hormone therapy.
The accessibility of transgender hormone therapy differs throughout the world and throughout individual countries. Some medical conditions may be a reason to not to take feminizing hormone therapy because of the harm it could cause to the individual.
Such interfering factors are described in medicine as contraindications. Absolute contraindications — those that can cause life-threatening complications, and in which feminizing hormone therapy should never be used — include histories of estrogen-sensitive cancer e.
Relative contraindications — in which the benefits of HRT may outweigh the risks, but caution should be used — include:. As dosages increase, risks increase as well. Therefore, patients with relative contraindications may start at low dosages and increase gradually. A variety of different sex-hormonal medications are used in feminizing hormone therapy for transgender women. Estrogens are the major sex hormones in women, and are responsible for the development and maintenance of feminine secondary sexual characteristics, such as breasts, wide hips, and a feminine pattern of fat distribution.
In addition to producing feminization, estrogens have antigonadotropic effects and suppress gonadal sex hormone production. Prior to orchiectomy surgical removal of the gonads or sex reassignment surgery , the doses of estrogens used in transgender women are often higher than replacement doses used in cisgender women. Antiandrogens are medications that prevent the effects of androgens in the body. Antiandrogens that directly block the androgen receptor are known as androgen receptor antagonists or blockers, while antiandrogens that inhibit the enzymatic biosynthesis of androgens are known as androgen synthesis inhibitors and antiandrogens that suppress androgen production in the gonads are known as antigonadotropins.
Steroidal antiandrogens are antiandrogens that resemble steroid hormones like testosterone and progesterone in chemical structure.
Spironolactone is an antimineralocorticoid antagonist of the mineralocorticoid receptor and potassium-sparing diuretic , which is mainly used to treat high blood pressure , edema , high aldosterone levels , and low potassium levels caused by other diuretics , among other uses. Cyproterone acetate is an antiandrogen and progestin which is used in the treatment of numerous androgen-dependent conditions and is also used as a progestogen in birth control pills. Medroxyprogesterone acetate is a progestin that is related to cyproterone acetate and is sometimes used as an alternative to it.
Numerous other progestogens and by extension antigonadotropins have been used to suppress testosterone levels in men and are likely useful for such purposes in transgender women as well. Nonsteroidal antiandrogens are antiandrogens which are nonsteroidal and hence unrelated to steroid hormones in terms of chemical structure. The nonsteroidal antiandrogens that have been used in transgender women include the first-generation medications flutamide Eulexin , nilutamide Anandron, Nilandron , and bicalutamide Casodex.
GnRH modulators are powerful antigonadotropins and hence functional antiandrogens. GnRH modulators are highly effective for testosterone suppression in transgender women and have few or no side effects when sex hormone deficiency is avoided with concomitant estrogen therapy. But they are under patent protection and, as with other GnRH modulators, are very expensive at present.
In adolescents of either sex with relevant indicators, GnRH modulators can be used to stop undesired pubertal changes for a period without inducing any changes toward the sex with which the patient currently identifies.
There is considerable controversy over the earliest age at which it is clinically, morally, and legally safe to use GnRH modulators, and for how long.
The sixth edition of the World Professional Association for Transgender Health 's Standards of Care permit it from Tanner stage 2 but do not allow the addition of hormones until age 16, which could be five or more years later. Sex steroids have important functions in addition to their role in puberty, and some skeletal changes such as increased height that may be considered masculine are not hindered by GnRH modulators.
Progesterone , a progestogen , is the other of the two major sex hormones in women. There are two types of progestogens: progesterone, which is the natural and bioidentical hormone in the body; and progestins , which are synthetic progestogens. Clinical research on the use of progestogens in transgender women is very limited. Progestogens have some antiestrogenic effects in the breasts, for instance decreasing expression of the estrogen receptor and increasing expression of estrogen- metabolizing enzymes ,     and for this reason, have been used to treat breast pain and benign breast disorders.
In terms of the effects of progestogens on sex drive, one study assessed the use of dydrogesterone to improve sexual desire in transgender women and found no benefit. Progestogens can have adverse effects. Progesterone is most commonly taken orally. Galactogogues such as the peripherally selective D 2 receptor antagonist and prolactin releaser domperidone can be used to induce lactation in transgender women who wish to breastfeed.
Many of the medications used in feminizing hormone therapy, such as estradiol , cyproterone acetate , and bicalutamide , are substrates of CYP3A4 and other cytochrome P enzymes. As a result, inducers of CYP3A4 and other cytochrome P enzymes, such as carbamazepine , phenobarbital , phenytoin , rifampin , rifampicin , and St.
John's wort , among others, may decrease circulating levels of these medications and thereby decrease their effects. Conversely, inhibitors of CYP3A4 and other cytochrome P enzymes, such as cimetidine , clotrimazole , grapefruit juice , itraconazole , ketoconazole , and ritonavir , among others, may increase circulating levels of these medications and thereby increase their effects. The concomitant use of a cytochrome P inducer or inhibitor with feminizing hormone therapy may necessitate medication dosage adjustments.
The spectrum of effects of hormone therapy in transgender women depend on the specific medications and dosages used. In any case, the main effects of hormone therapy in transgender women are feminization and demasculinization , and are as follows:.
Maximum effects vary widely depending on genetics , body habitus , age , and status of gonad removal. Generally, older individuals with intact gonads may have less feminization overall. Temporary hair removal can be achieved with shaving , epilating , waxing , and other methods.
Breast , nipple , and areolar development varies considerably depending on genetics, body composition, age of HRT initiation, and many other factors. Development can take a couple years to nearly a decade for some. However, many transgender women report there is often a "stall" in breast growth during transition, or significant breast asymmetry. Transgender women on HRT often experience less breast development than cisgender women especially if started after young adulthood.
For this reason, many seek breast augmentation. Transgender patients opting for breast reduction are rare. Shoulder width and the size of the rib cage also play a role in the perceivable size of the breasts; both are usually larger in transgender women, causing the breasts to appear proportionally smaller. Thus, when a transgender woman opts to have breast augmentation, the implants used tend to be larger than those used by cisgender women.
In clinical trials , cisgender women have used stem cells from fat to regrow their breasts after mastectomies. This could someday eliminate the need for implants for transgender women. In transgender women on HRT, as in cisgender women during puberty, breast ducts and Cooper's ligaments develop under the influence of estrogen. Progesterone causes the milk sacs mammary alveoli to develop, and with the right stimuli, a transgender woman may lactate. Additionally, HRT often makes the nipples more sensitive to stimulation.
The uppermost layer of skin, the stratum corneum , becomes thinner and more translucent. Spider veins may appear or be more noticeable as a result. Collagen decreases, and tactile sensation increases. The skin becomes softer,  more susceptible to tearing and irritation from scratching or shaving, and slightly lighter in color because of a slight decrease in melanin.
Sebaceous gland activity which is triggered by androgens lessens, reducing oil production on the skin and scalp. Consequently, the skin becomes less prone to acne. It also becomes drier, and lotions or oils may be necessary. Many apocrine glands — a type of sweat gland — become inactive, and body odor decreases. Remaining body odor becomes less metallic, sharp, or acrid, and more sweet and musky. As subcutaneous fat accumulates,  dimpling, or cellulite , becomes more apparent on the thighs and buttocks.
Stretch marks striae distensae may appear on the skin in these areas. Susceptibility to sunburn increases, possibly because the skin is thinner and less pigmented. Antiandrogens affect existing facial hair only slightly; patients may see slower growth and some reduction in density and coverage.
Patients taking antiandrogens tend to have better results with electrolysis and laser hair removal than those who are not. Body hair on the chest, shoulders, back, abdomen, buttocks, thighs, tops of hands, and tops of feet turns, over time, from terminal "normal" hairs to tiny, blonde vellus hairs.
Arm, perianal, and perineal hair is reduced but may not turn to vellus hair on the latter two regions some cisgender women also have hair in these areas. Underarm hair changes slightly in texture and length, and pubic hair becomes more typically female in pattern. Lower leg hair becomes less dense. All of these changes depend to some degree on genetics. Head hair may change slightly in texture, curl, and color. This is especially likely with hair growth from previously bald areas.
The lens of the eye changes in curvature. Because oil prevents the tear film from evaporating, this change may cause dry eyes. The distribution of adipose fat tissue changes slowly over months and years. HRT causes the body to accumulate new fat in a typically feminine pattern, including in the hips, thighs, buttocks, pubis, upper arms, and breasts. Fat on the hips, thighs, and buttocks has a higher concentration of omega-3 fatty acids and is meant to be used for lactation.
The body begins to burn old adipose tissue in the waist, shoulders, and back, making those areas smaller. Subcutaneous fat increases in the cheeks and lips , making the face appear rounder, with slightly less emphasis on the jaw as the lower portion of the cheeks fills in. HRT causes a reduction in muscle mass and distribution towards female proportions. Male-to-female hormone therapy causes the hips to rotate slightly forward because of changes in the tendons.
Hip discomfort is common. This can cause a reduction in total body height.