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FAQ: What Happens To Your Body On Hormones

FAQ: Quick question about being trans and going on hormones. I’m switching high schools this year, and I think I want to go on hormones over the summer so that people just know me there as a girl so they don’t misgender me. If I started going on hormones now, how long would it take for me to notice a change?

This is the most common question that we get when people ask about hormones – which makes sense! Going on hormones is supposed to change your body and it can be pretty scary when you don’t know what kinds of changes to expect. A lot of the resources online are designed for medical professionals and they can be hard to understand if you’re not a clinician. For this post, we’ve adapted a couple of images from the Rainbow Health Network’s pages on Feminizing and Masculinizing Hormone Therapy. (Even though this question is asking about feminizing hormones, we’re going to include info on masculinizing hormones as well, just because we get asked about that a lot too.) Check the Resources section at the bottom of this post for links to those pages and more!

****A Quick Affirmation About Hormone Therapy****
  • While some trans people choose to go through hormone therapy to better align their bodies with their gender identity, this is not something that all trans people need to do. Your gender identity is whatever you say it is, no matter if you’re on hormones, have had surgery, aren’t doing any medical interventions, or whatever!
  • If people are interested in exploring gender transitioning and haven’t gone through puberty yet, you can talk to your doctor about going on Puberty Blockers. These prevent your body from going through changes brought on by the introduction of hormones like estrogen or testosterone during puberty. For some people, this prevents their body from causing them distress for not aligning with their gender identity. Puberty Blockers are considered very safe overall, and their effects are fully reversible. If you decide to stop taking them, your body will go through puberty just the way it would have if you hadn’t take puberty blockers at all. Check in with your clinician if you’re interested in starting Puberty Blockers.

Feminizing Hormone Therapy (FHT)

The goal of feminizing hormone therapy is to reduce some of the effects of testosterone (like coarse body/facial hair), and to start developing things like breasts and hips. This requires taking an anti-androgen (a type of drug meant to block testosterone), and to start taking estrogen, usually by injection. To get started on feminizing hormone therapy, you’ll need to check in with a clinician to get a prescription for the hormones and to help figure out what the right dosages are for you and your body.

You’ll start noticing different physical changes at different times. The image below lays out some of the expected effects of FHT, and roughly when you can start expecting them.

For example, you may start noticing decreased strength or muscle mass 3-6 months after starting FHT. It’s expected to level out at about the 2 year mark. (If you continue experiencing decreases after the 2 year mark, it maybe be unrelated to FHT and you might want to check in with your doctor.) Decreases in strength/muscle mass is a reversible effect, and so you could notice increases in those areas if you stopped FHT.

Other reversible changes include where and how much hair a person has, body fat redistribution, and softening of skin/decreased oiliness. Irreversible changes, like breast growth, are permanent and will not go away if you stop FHT. Variable changes are ones that may be reversible, but that’s based on a number of factors. These could include decreases in testicular volume, sex drive/libido, erections, and sperm production.

Now, how the extent and timeline of these effects is going to be different for everyone. Most of these changes don’t start until 3-6 months of FHT, but even then a lot of it will vary. Check the image below for more info on these timelines.

Masculinizing Hormone Therapy (MHT)

The goal of masculinizing hormone therapy is to encourage your body to do things like develop body hair, deepen a person’s voice, and change muscle mass and distribution. This requires taking testosterone, usually by injection. To get started on masculinizing hormone therapy, you’ll need to check in with a clinician to get a prescription for the hormones and to help figure out what the right dosages are for you and your body.

You’ll start noticing different physical changes at different times. The image below lays out some of the expected effects of MHT, and roughly when you can start expecting them.

For example, you may start noticing facial and body hair growth 3-6 months after starting MHT. It’s expected to level out at about the 5 year mark. Facial and body hair growth is an irreversible effect, so you might still keep some of that hair if you stopped MHT.

Other irreversible changes include scalp hair loss, clitoral enlargement, a deepened voice, and infertility. Most of the other changes are reversible, including skin oiliness/acne, increased muscle mass/strength, vaginal atrophy, and cessation of menses/not having a period anymore. Body fat redistribution is a variable change, as that can also be based on other factors.

Now, how the extent and timeline of these effects is going to be different for everyone. Most of these changes don’t start until 3-12 months of MHT, but even then a lot of it will vary. Check the image below for more info on these timelines.

What to Expect

To bring it back to the question at the top of this post, even if the person started hormone therapy today, they wouldn’t start noticing most changes for 3-6 months, and by then school will have already started. These changes will keep happening throughout the year, and likely into the next year and the next.

This isn’t to say that this summer is a bad time to start hormone therapy. Most people’s bodies change a lot during high school. People are going through puberty, lots of growth spurts, etc. Even as adults, our bodies change as we age, as we change our diets or do different things for exercise. Being around new people can be a great fresh start if you’re looking to be free from people’s old impressions of you.

But it might also help to adjust expectations of how hormones will impact being misgendered. Frustratingly, it happens to people all the time. If you have stereotypically “masculine” features or characteristics, hormones aren’t necessarily going to completely change how people perceive your gender.

Another thing to keep in mind about having a fresh start with new people is that you can do things like wear all new clothes or share hobbies or interests you may have kept hidden from people at your old school. There are lots of things people can do to present their gender, including lots of non-hormonal options.

But even if you dress or talk or act in a more stereotypically “feminine” way, people might still misgender you. And that sucks.

****A Quick Note About Passing****
  • In the context of gender, passing is when a transgender person is generally perceived as cisgender. This often involves a mixture of physical gender cues (like hair style or clothing) and certain behaviours that tend to be culturally associated with a particular gender.
  • Many people find the idea of passing complicated, and we’ll cover this more in depth in future blog post.

If you want to learn more about your new school’s supports for trans students but don’t want to out yourself to any staff or other students as trans, consider calling ahead to ask. (You don’t have to identify yourself beyond saying that you’re an interested student or parent, and they’ll probably answer your questions.) Ask if they have any trans positive policies, specific resources, clubs (like a Queer Straight Alliance), or even teachers who identify as trans that you can go to if you need support. For example, the Toronto District School Board has their Guidelines for the Accommodation of Transgender and Gender Independent/Non-Conforming Students and Staff on their website [Link]. Maybe this policy (or policies like this) are available at the school you go to.

Resources

If you have questions about this topic, feel free to contact one of our peer educators. [Link]