This article is part of a series on the impacts of hormone replacement therapy (HRT), designed to help our clients (and others!) prepare for possible changes they may experience as they begin their hormone journeys.
When preparing for hormonal transition, many people are eager for physical changes to take place rapidly- understandably so. But it's important to remember that the extent of these changes and the rate at which the changes take place depend on many factors. These factors include your genetics, the age when you start taking hormones, and your overall state of health.
Hormone therapy causes a second puberty, and puberty normally takes years for the full effects to be seen. Taking higher doses of hormones will not necessarily bring about faster changes, but it could endanger your health. And because everyone is different, your medicines or dosages may be different from your friends, content creators on TikTok, or people posting online.
What physical changes should I expect, and when will they start?
Initially, your skin may become a bit drier and thinner. In fact, you may bruise easily in the first few weeks of your hormonal transition.
Your body odor may change, with many people finding that they sweat less. When you touch things, they may “feel different” and you may perceive pain and temperature differently.
Within a few weeks, you may develop small “buds” beneath your nipples. These may be slightly painful, especially to the touch. The right and left sides may be uneven, which is normal; your growth will even out over time.
Most transgender women who begin hormone therapy after puberty can only expect to develop an “A” cup or perhaps a small “B” cup, even after years of hormone therapy. However, it is still a good idea to wait until you have been on hormones for at least a year before pursuing breast augmentation surgery, so your surgeon knows what your natural growth will be.
Your body will begin to redistribute your weight. Fat may gather around your hips and thighs a bit more than before, although hormones typically do not have a significant effect on the fat in your abdomen (your belly). Overall, your weight may fluctuate once you begin hormone therapy, depending on your diet, lifestyle, genetics, and pre-existing muscle mass.
The muscles in your arms and legs will become less defined, and you can expect your muscle strength to decrease.
As the fat under the skin increases and shifts, your eyes and face may develop a softer appearance. Because it can take two or more years for these changes to develop fully, delaying facial feminization surgery is a good idea until you have been on hormone therapy for at least one year. What won’t change is your bone structure, including the bones of your face, hips, arms, hands, legs, and feet.
Body hair usually does not go away altogether, but the hair on your chest, back, and arms will decrease in thickness and grow at a slower rate. All cisgender women have body hair, but some people on estrogen pursue permanent hair removal using electrolysis or laser treatment.
Your facial hair may thin a bit and grow slower, but it will rarely go away entirely without electrolysis or laser treatments. If you have had any scalp balding, hormone therapy will usually stop it; however, the extent to which it will grow back is variable.
Some people may notice minor changes in shoe size or body height. This is not due to bone changes but changes in the ligaments and muscles of your feet and spinal column.
Feminizing hormone therapy does not have any effect on voice pitch or tone. If you want to modify your speaking voice, you should consult with a speech and language specialist who has expertise in this area.
