Feminizing GAHT Information
Feminizing hormone therapy (also known as estrogen-based GAHT) is commonly undertaken by transfeminine or non-binary people aiming to look and feel more feminine, it involves the administration of estrogen usually in combination with a testosterone blocking antiandrogen and occasionally progesterone [1].
Effects
The effects of combined estrogen and antiandrogen hormone therapy (does not include potential effects of progesterone). Keep in mind that effect strength and onset can vary greatly between individuals, consider this table as an approximate guide only.
| Effect | Expected Onset | Expected Maximum Onset |
|---|---|---|
| Redistribution of body fat | 3–6 months | 2–5 years |
| Decrease in muscle mass and strength | 3-6 months | 1-2 years |
| Softening of skin/decreased oiliness | 3-6 months* | Unknown |
| Decreased sexual desire | 1-3 months | Unknown |
| Decreased spontaneous erections | 1-3 months | 3-6 months |
| Decreased sperm production | Unknown | 2 years |
| Breast growth | 3-6 months | 2-5 years |
| Decreased testicular volume | 3-6 months | Variable |
| Thinning and slowed growth of body and facial hair* | 6-12 months | >3 years |
| Increased scalp hair** | Variable | Variable |
| Voice changes*** | None | None |
| *Complete removal of hair requires laser treatment [2]. | ||
| **Familial scalp hair loss may occur if estrogen is stopped [2]. | ||
| ***Voice and speech therapy may be available [2]. | ||
Table adapted from Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 [3].
Learn more about the effects of estrogen-based GAHT here.
Side Effects/Risks
(Does not include potential side effects of progesterone).
| Risk Level | Side Effect |
|---|---|
| Likely increased risk | Venous thromboembolism* |
| Infertility* | |
| Hypertriglyceridemia | |
| Weight gain | |
| likely increased risk with presence of additional risk factors | Cardiovascular disease |
| Cerebrovascular disease | |
| Gallstones | |
| Possible increased risk | Erectile dysfunction |
| Possible increased risk with presence of additional risk factors | Type 2 diabetes |
| Low bone mass/osteoporosis | |
| Hyperprolactinemia | |
| No increased risk or inconclusive | Breast and prostate cancer |
| *Shown to be clinically significant. Highest risk of venous thromboembolism if aged >40 years and most common within the first two years [2]. | |
Table adapted from Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 [3].
Hormone Regimes
Always consult a medical professional before starting GAHT.
The following table is based of New Zealand and international standards and is only meant to inform the audience of what to expect before a medical consultation about GAHT. Dosages and prescriptions should always be discussed with a medical professional, as the information presented here is only a broad overview and the full depth of facts and information about certain medicines may not be present here.
| Medication | Standard Starting Dose | Maximum (Usual Maintenance) Dose | Notes |
|---|---|---|---|
| Antiandrogens | |||
| Cyproterone | 25-50mg orally daily | 25-50mg orally daily | May have a likely increased risk for meningioma with presence of additional risk factors. One significant study shows that a 10mg daily dosage is equally effective at lowering testosterone while showing fewer side effects [4]. |
| Spironolactone | 50-100mg orally daily | 100-200mg orally daily | May have a likely increased risk for polyuria/dehydration with presence of additional risk factors and a likely increased risk of hyperkalemia [3]. |
| Estrogens | |||
| Estradiol valerate | 1mg orally daily | 2-4mg (max 6mg) orally daily | Has a likely increased risk of venous thromboembolism, especially if aged >40 years old. |
| Estradiol patch | 25mcg transdermal application twice weekly | 100-200mcg transdermal application twice weekly | Lower risk of venous thromboembolism than oral formulations. |
Table adapted from Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa New Zealand [2].
Citations
- [1] Sudhakar D, Huang Z, Zietkowski M, Powell N, Fisher AR. 2022 Nov 20. Feminizing gender‐affirming hormone therapy for the transgender and gender diverse population: An overview of treatment modality, monitoring, and risks. Neurourology and Urodynamics. doi:https://doi.org/10.1002/nau.25097.
- [2] Oliphant J, Veale J, Macdonald J, Carroll R, Johnson R, Harte M, Stephenson C, Bullock J. 2018. Guidelines for gender affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa New Zealand. researchcommonswaikatoacnz. https://hdl.handle.net/10289/12160.
- [3] Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, et al. 2022. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health. 23(S1):S1–S259. doi:https://doi.org/10.1080/26895269.2022.2100644. https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644.
- [4] Kuijpers SME, Wiepjes CM, Conemans EB, Fisher AD, Guy T, Martin den Heijer. 2021. Toward a Lowest Effective Dose of Cyproterone Acetate in Trans Women: Results From the ENIGI Study. The Journal of Clinical Endocrinology and Metabolism. 106(10):e3936–e3945. doi:https://doi.org/10.1210/clinem/dgab427.