Transgender hormones: women and transfeminine

Many people take hormones as part of a gender transition. They 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.

These are what experts say are good hormones to take for people who want to feminize how they look, like transgender women (aka male to female, MTF), transfeminine people, and other gender diverse people.


Anti-androgen or testosterone blocker

This drug blocks masculinizing hormones for those who have not had orchiectomy, either by itself or as part of bottom surgery like vaginoplasty or vulvoplasty. It can also help slow hair loss and make feminizing hormones work better.

Oral option – pills you swallow

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

Under the skin option – a small pellet of drugs that stays under your skin

  • GnRH agonists: 3.75 mg subcutaneous monthly

Estrogen (estradiol and others)

Oral option – pills you swallow

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

Injected option – drugs put in through your skin with a needle (parenterally, i.m., intramuscular, or subcutaneous)

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

Transdermal option – a sticky patch that sends drugs through your skin

  • Estradiol patch: 0.1–0.4mg/2X week

Things your doctor will watch for:

  • 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.
  • 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. You will have to sign something that says you give informed consent.

From a clinic

  • Many larger cities have clinics that serve our community. See the resources section for options near you.
  • Planned Parenthood offers hormones for our community at many locations and is throughout the US: (plannedparenthood.org/health-center)

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 their 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 taken 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 not afford to go to the doctor, it is 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