HRT for Beginners
What is HRT?
Hormone Replacement Therapy uses prescribed hormones to help a person’s body align more closely with their gender identity. It can bring physical changes, ease gender dysphoria, and improve mental well-being. Not everyone who is transgender or nonbinary chooses HRT — and that’s completely valid.
Masculinizing HRT (Testosterone)
Purpose:
Deepens the voice (permanent)
Increases facial and body hair (permanent)
Increases muscle mass
Redistributes body fat toward the abdomen
Stops menstruation
Changes skin texture and oil production
Methods:
Injections – Intramuscular or subcutaneous, weekly or biweekly
Topical gels/creams – Applied daily to skin
Patches – Worn on skin, changed daily or every few days
Pellets – Implanted under skin, lasting several months (less common)
Typical Timeline:
1–3 months: Increased libido, oilier skin, voice starts to drop
3–6 months: Fat redistribution, menstrual cycle stops
6–12 months: Facial/body hair growth, muscle increase
1–5 years: Full facial hair development, final voice drop
Risks & Considerations:
May increase red blood cell count (polycythemia)
Possible cholesterol changes and heart health concerns
Acne and oily skin
Fertility changes (may be permanent)
Regular bloodwork is essential
Feminizing HRT (Estrogen + Anti-Androgens)
Purpose:
Breast development (permanent)
Softer, thinner skin
Fat redistribution to hips, thighs, buttocks
Decreased muscle mass
Reduction of facial/body hair over time
Slows or stops male-pattern baldness progression
Estrogen Methods:
Pills (oral tablets) – Swallowed
Sublingual tablets – Dissolved under the tongue
Patches – Applied to skin, changed every few days
Injections – Weekly to monthly
Gels/creams – Applied daily to skin
Anti-Androgen Methods (to reduce testosterone):
Spironolactone – Oral, common in the U.S.
Cyproterone acetate – Common outside the U.S.
GnRH agonists – Injections that suppress testosterone production
Typical Timeline:
1–3 months: Softer skin, reduced libido, breast buds
3–6 months: Fat redistribution, decreased muscle mass
6–12 months: Breast growth, body hair reduction
1–5 years: Breast development complete, body changes stabilize
Risks & Considerations:
Increased risk of blood clots (especially for smokers or those with clotting disorders)
Possible changes in liver health and cholesterol
Some effects are permanent (breast growth)
Fertility changes (may be permanent)
Regular bloodwork is essential
Nonbinary & Low-Dose HRT Options
Microdosing testosterone or estrogen for subtle changes
Goal-based combinations – tailoring dose and medication type to focus on specific desired effects
Mix-and-match approaches – e.g., low-dose testosterone with estrogen blockers, or low-dose estrogen without full suppression of testosterone
Can be useful for androgynous goals, softening or enhancing certain traits without full typical “masc” or “fem” changes