Lots is spoken about the use of progesterone in transfeminine people. Does it help with breasts, mood, skin, joints, general wellbeing? Some feel very strongly that it helps, while others are concerned by negative reports they have read in the media and warnings issued by their doctor.
We do know for definite that some types of progesterone have been used in hormonal contraceptive pills that may lead to an increased risk of breast cancer, blood clots, heart disease and strokes.
However, the types of bio-identical and micronised progesterone that should be prescribed for trans women have never been found to cause these issues and the general consensus amongst specialists is that they are likely to be very safe.
Some centres, like the NHS, still adhere to protocols that do not include the option of progesterone for trans people, even on an informed consent basis. This leaves UK-based patients with the only option: to use private services such as GenderGP to try progesterone.
There is very little research to back anything up, but anecdotal reports from trans women suggest that progesterone, given in the right form, is very safe and delivers beneficial results.
Talk to your medical provider and ask them the pros and cons of micronised, bio-identical progesterone.
Best practice suggests that the aim should be to replicate the natural hormone profile of cis women in their trans counterparts. Cis women have progesterone and as such it stands to reason that it should be factored into trans healthcare. More research is needed to provide the necessary evidence but based on anecdotal feedback, some of which is outlined below, we feel that the evidence points to good results with no reports of harm.
Using progesterone as a trans woman
The benefits outlined below rely largely on research conducted in cis women and anecdotal evidence from trans women and healthcare providers. Progesterone may not act in exactly the same way for everyone so it’s important to discuss the potential risks and benefits with your healthcare provider.
Trans women wishing to undergo hormone-driven feminisation therapy currently rely on a cocktail of oestrogen and hormone blocking medication, to prevent the naturally occurring hormone testosterone. However, research shows potential benefit in the addition of progesterone to the mix, in order to more closely reflect the hormone pattern of a cisgender woman.
The available evidence highlights several benefits to using progesterone as part of a gender affirming therapy regime including more rapid feminisation, reduction in male pattern hair growth, oily skin and male sweat/odour patterns, as well as muscle mass being replaced by fat redistribution to the hips and upper thighs, increased breast development and changes in mood/libido.
Studies in cis women have confirmed that using oestrogen together with progesterone significantly increases bone mineral density in the spine, reducing fracture risk.
Progesterone has also been shown to have a positive impact on sleep (in cis men and women) and hot flushes (in cis women). Sleep can be disturbed due to emotional factors, work stress, alcohol excess and relationship issues, all of which may be more common in trans women.
Hot flushes can be triggered by the withdrawal of oestrogen therapy (NB before gender affirmation surgery – oestrogen is stopped to reduce the risk of blood clots associated with surgery and the post-surgical period), therefore giving progesterone throughout the surgical process could improve symptoms and reduce stress.
People on HRT sometimes worry about increased cancer risk The Royal College of General Practitioners released a joint statement with the British Menopause Society addressing a widely publicised review in The Lancet on the increased risk of breast cancer in cis women taking hormone replacement therapy (HRT). This review illustrated a small increased risk of breast cancer when taking HRT (especially combined progesterone and oestrogen), however this aligns with existing National Institute for Health and Care Excellence (NICE) HRT guidelines.
Breast cancer risk in cis women is greater when overweight and or with increased alcohol intake compared to when taking HRT. The review findings are useful in guiding the type and duration of HRT; one must weigh the cancer risk against the benefits to cardiovascular and bone health as described above.
If you think that progesterone could be right for you and you’d like to speak to someone about trying it, please get in touch with a member of the team via our Help Centre.
- Prior, J. (2019). Progesterone Is Important for Transgender Women’s Therapy—Applying Evidence for the Benefits of Progesterone in Ciswomen. The Journal of Clinical Endocrinology & Metabolism, 104(4), pp.1181-1186.
- Deutsch, M. (2019). Overview of feminizing hormone therapy | Transgender Care. [online] Transcare.ucsf.edu. Available at: https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy [Accessed 18 Oct. 2019].