If you’ve searched, ‘how to start transitioning’, you’ve come to the right place. For many trans and non-binary people, starting HRT is a defining moment. It’s the beginning of your transition journey, which may be exciting and challenging at the same time. Hormone therapy may not be right for everyone, but it can give positive gender affirmation for others.
What exactly is gender-affirming hormone therapy?
Everybody has both oestrogen and testosterone, but women have more oestrogen, and men have more testosterone. While the two hormones have quite different effects, their structures are strikingly similar, with only one hydrogen molecule separating them.
HRT has two roles in trans people. One is to stop your body from producing the hormone your ovaries or testicles naturally make. The other is to give you the hormone that is compatible with your gender identity.
Read More from GenderGP:
- Legal recognition of gender shouldn’t require medical diagnosis
- Mature Trans Stories: Transitioning in Older Age
What physical changes can I expect from starting HRT?
Hormones affect the body and the mind, and stopping your hormone production will affect both. The most significant changes to your body with transgender HRT will depend on the gender-affirming hormone therapy for you. The changes will vary, as every person and body is different.
Starting HRT for MTF / AMAB
Oestrogen hormone therapy will create these physical changes in transgender women:
- The breast, nipple, and areola will become larger
- Nipples will become more tender and sensitive
- Perspiration will decrease
- Facial features will soften
- Strength and muscle mass will decrease
- The skin becomes thinner and drier, and pores become smaller
- Body hair will become lighter, softer, and less coarse
- The body begins to redistribute fat to the hips and thighs
- The penis and testes will become drastically smaller
- Sperm production and testosterone levels will decrease
Starting HRT for FTM / AFAB
Testosterone hormone therapy will create these physical changes in transgender men:
- Menstruation stops completely
- The voice deepens
- Perspiration will increase
- Facial features will sharpen
- Strength and muscle mass will increase
- The skin becomes thicker and oilier, with larger pores, and acne-prone
- Body hair will become thicker and darker
- Increased hair growth on the face, chest, back, arms, and legs
- The body begins to redistribute fat to the abdomen
- Depending on age and family history, thinning hair or male pattern baldness may occur
- Clitoral growth and vaginal atrophy
- Testosterone does not prevent pregnancy
What if I’m non-binary and want a middle ground?
We know that everyone needs hormones, and not having any can be harmful to our health. Suppose you prefer a neutral hormone profile. In that case, a lower dose of both hormones may be preferable to completely blocking your natural hormone production and replacing it with the other. It all depends on your identity and what you desire.
Will I go through puberty and experience mood swings?
The benefit of transgender HRT is that the body will align with the person’s authentic gender. These changes are what many trans people have desired for a long time.
However, with that comes all the things we know about puberty: anxiety, mood swings, oily skin, spots, breast buds, stretch marks, body fat shifting, and skin changes!
Due to the adjustments involved with entering a second puberty, some people may experience mood swings. It’s difficult to predict how you will feel until you go through it.
Research studies consistently show that gender-affirming hormones improve mood and mental health for trans people. The bodily changes and gender characteristics help transgender and non-binary people improve their social skills and overall quality of life—while reducing anxiety and depression.
How quickly will changes occur?
Some people want to go slowly and gently and hope that people close to them won’t notice too much. Others want to get there as soon as possible and can’t wait for their body to realign. However, much as with natural puberty, we can’t choose how quickly it goes. We know it doesn’t happen overnight, and we know that it doesn’t take years—but not knowing can be frustrating.
How do I start transitioning and achieve the hormone levels I want?
Your doctor will aim to get your hormone levels as close as possible to what we know is the normal range for your gender identity. It’s worth noting that blood test results for hormones can be temperamental, so it’s important to take a long-term view of the situation.
What health problems might prevent me from receiving this treatment?
In the following situations, your doctor may discourage hormone therapy:
- Difficulty giving informed consent
- Uncontrolled serious medical conditions
- Uncontrolled mental health issues
- Thromboembolic conditions
- Diagnosis or history of hormone-sensitive cancer
- Pregnant or breastfeeding
Is it possible to bridge the gap between how I feel and what I see?
You’ve longed to accept the reflection in the mirror. Starting hormones that validate your gender can be extremely encouraging. Some people fully accept this and can live again. Some will take each day as it comes, amazed by the effects. On the other hand, others may have a more complex relationship with their bodies and fall somewhere in the middle.
Will starting HRT be noticeable to the world?
You don’t have to tell anyone that you’re undergoing hormone therapy until you’re ready. An important part is how you want the rest of the world to see you—and you get to decide.
The hormones work to align your external appearance and internal makeup with your gender identity. Starting HRT is a gradual process that results in changes over time. People may notice something different about you, but they may not be able to pinpoint it. Over time, the world will see you as you authentically are.
What if starting HRT doesn’t feel right for me?
It’s normal to have doubts when stepping into the unknown. Navigating friends, family, colleagues, and people on the street can be challenging and uncomfortable. If things seem to be happening too fast, it may be alarming to you. This is your journey, and you can take things at your own pace. You can start, stop, increase, or reduce your levels of HRT depending on what feels right to you.
How should my level of activity vary, if at all?
Exercise is good for you, but it’s possible that your routine will change. Starting HRT doesn’t affect your body type. However, targeted exercises can enhance your shape by increasing muscle in specific areas—design your new body and life on your terms.
How can I possibly navigate all of this?
Draw on all the support you have around you, and if you need to talk things through with a professional, GenderGP has a wonderful team of specialist counsellors who can help you navigate the journey ahead. Please don’t be afraid to ask for help.
Additionally, support groups offer a safe space to explore your gender and ask any questions you may have. It’s natural for you to want to talk with other people who may be going through the same thing you are. You don’t have to go through this alone, and we’ve put together a list of support groups to help you find one that’s right for you.
What can my family and friends do to help me start my transition?
There’s no right way to come out as transgender or non-binary. Moreover, It’s a very personal decision and is different for everybody. The way you choose to discuss your journey is the right way, and only you can decide what that is.
If it feels right, start by talking to people you feel safe with and trust the most. Share the steps you’re taking to become the person you’re truly meant to be. Also, they should begin using your new name and pronouns.
Support comes in many forms. It’s important to express to your loved ones what you need and what makes you feel comfortable.
What does it mean to be an ally? How do I start transitioning to be an ally?
For far too long, your loved one has felt like a stranger in their own body. It’s a gift that they chose you to be their companion on this journey. That says a lot about you and your character.
Maybe you’re trying to understand what your loved one is experiencing and how to support them best. You don’t have to know everything to respect people and their choices, but you should continue to educate yourself.
You should begin by using your loved one’s preferred pronouns and name. There may be a brief adjustment period where you make a mistake, apologize, and correct yourself. Now is a pivotal point in their life. Your loved one can have the confidence to shine authentically. You can honor this by supporting them by breaking the stigma and choosing to live a life of love and acceptance.
Additional reading on how to be a good ally:
The Human Rights Campaign Coming Out: Living Authentically as Transgender or Non-Binary
National Center for Transgender Equality Supporting the Transgender People in Your Life: A Guide to Being a Good Ally
How do I start HRT now that I’m ready?
You’ll learn how hormone therapy can help you reach your transition goals during an Information Gathering Session with one of our gender specialists.
If hormone therapy is right for you, you’ll receive your first prescription via post or direct from your choice of pharmacy. Alternatively, we can send a treatment summary to your doctor, who will provide you with your prescription.
Every three months, we’ll review your treatment to ensure it’s working for you. Every six months, we recommend a wellbeing review to ensure you’re in tip-top shape. Whether you want to fully medically transition or achieve minor masculinisation or feminisation with microdosing—we can go at the pace that suits you.
It’s important to remember that you’ll need to take hormones for as long as you want the gender-affirming benefits to last. Certain procedures, on the other hand, will result in a reduction in your dosage. We want you to feel confident that your treatment and progress are exactly right for you.