Transgender hormones: women and transfeminine

Many transgender people take hormones as part of a gender transition. Trans people must think about their reproductive options before they start hormones. Hormones can change their bodies so they can’t ever make children.

In the case of hormones, talk to your healthcare provider about your goals. You can start and stop hormones if you want to try them for a while. Some people try them for a few weeks or a few months to see how they feel. You can stop and restart anytime, but it’s a good idea to do it under a doctor’s care.

Below is a suggested feminizing hormone regimen for transgender women (aka male to female, MTF) and transfeminine people.


Anti-androgen or testosterone blocker

Blocks masculinizing hormones for those who have not had orchiectomy, either by itself or as part of a vaginoplasty. Also helpful for reducing hair loss and improving effectiveness of feminizing hormones.

Oral option:

  • Spironolactone   100 – 200 mg/day (up to 400 mg)
  • Cyproterone acetate   50–100 mg/day

Under the skin option:

  • GnRH agonists   3.75 mg subcutaneous monthly

Estrogen (estradiol and others)

Oral option:

  • Oral conjugated estrogens   2.5–7.5mg/day
  • Oral 17-beta estradiol   2–6mg/day

Injected option: (aka parenterally, i.m., intramuscular, or subcutaneous)

  • Estradiol valerate   5–20mg i.m./2 weeks  or cypionate  2–10mg i.m./week

Transdermal option:

  • Estradiol patch    0.1–0.4mg/2X week

Monitoring for transgender women (MTF) on hormone therapy:

  • Monitor for feminizing and adverse effects every 3 months for first year and then every 6– 12 months.
  • Monitor serum testosterone and estradiol at follow-up visits with a practical target in the female range (testosterone 30 – 100 ng/dl; E2 <200 pg/ml).
  • Monitor prolactin and triglycerides before start- ing hormones and at follow-up visits.
  • Monitor potassium levels if the patient is taking spironolactone.
  • BMD screening before starting hormones for patients at risk for osteoporosis. Otherwise, start screening at age 60 or earlier if sex hormone levels are consistently low.
  • MTF patients should be screened for breast and prostate cancer appropriately.

Where to get hormones

This information is for adults. For younger people, see how to get hormones as a minor.

From your doctor

  • Most people get hormones from their healthcare provider. Tell them you want to start hormones. They will probably give you a physical exam that includes blood tests. In some cases, they may ask you to take other steps before prescribing them, like speak with a therapist.

From a clinic

Online (less recommended)

  • Some people order hormones online from foreign pharmacies.
  • This can be an option for those who do not want others to know about hormone use.
  • Buying and importing prescription drugs without a prescription is probably against the law where you live.
  • Because it is against the law, you might lose the money you paid:
    • No delivery sent
    • Fake drugs sent
    • Drugs seized by police at the border

From someone you know (not recommended)

  • This used to be common, but there are cheaper and safer ways now. If you do not have insurance or can’t afford going to the doctor, it’s better to go to a clinic.

References

Gardner IH, Safer JD (2013). Progress on the road to better medical care for transgender patients. Current Opinion in Endocrinology, Diabetes and Obesity. 2013 Dec;20(6):553-8. https://doi.org/10.1097/01.med.0000436188.95351.4d