Help In Strange Places: All About HRT

DISCLAIMER: I am NOT a professional, and am only speaking from my research and personal experience.
Please seek a professional in the topic to get assuredly accurate information.

What is HRT?

  For those who may not know, hormone replacement therapy (HRT) is a type of medical therapy which intends to use various medications to stabilize or alter an individuals hormone levels. The context of use that I am going to talk about is as it applies to transgender individuals.

  If you don't know what being transgender means, you might wanna do some research. For a brief, basic rundown, I suggest this document:

  Understanding Transgender People: The Basics.

  I myself am currently taking HRT as a part of my transition towards a more feminine gender expression, and as such it is what I am more knowledgeable on. I'll be referring to this type of HRT, which changes the body to be more feminine, as MTF HRT, standing for male-to-female hormone replacement therapy.

  MTF is the typical label for things relating to feminine transgender topics, as it is designates someone with the sex of a male transitioning to be more feminine. This is not a great label though, as it places this idea that they were at some point, or still are, male, which of course is just a gender label and may not even be accurate to someone's situation. I will still be using it due to the medical nature of the topic, and it's widespread useage.

How does HRT work? (MTF)

  MTF HRT is typically taken via oral medication, injections, or sometimes patches. Based on my experiences, the oral medications include Estrodial, Spironolactone, and sometimes Progesterone. I'll get in to what each of these do later.

  Prescribed typically by an endocrinologist or other provider (such as a qualified Planned Parenthood doctor in many cases), this form of HRT seeks to decrease production of hormones in the body that result in masculine features and increase those which result in feminine ones. This process can take weeks to have any impact, and years to reach full effect.

  Throughout this time, an individual may regularly return to where they were prescribed their HRT in order to get bloodwork done and to adjust dosages based on what they see fit with guidance from their providor. Many of the changes experienced throughout treatment may vary, and some are reversable while others are not. So, what are these effects?

What does HRT do? (MTF)

  HRT has many effects that take varying amounts of time to become noticable. Many of the typically expected effects include: To get into these, I'll just start down the list, describing when they can be expected to start being noticable (onset), when they will have likely reached their maximum effect (max. effect), and if they will go away if HRT is stopped (reversible?). I will also give a little bit of info about each one and my experiences with them.

  Softer Skin

  As an individual takes MTF HRT, their skin will become softer and less oily. This applies to essentially every part of the body. For me, my acne also cleared up significantly after starting HRT. Interestingly, around my collarbone became the softest first, and I have seen this in others too.

  Body Fat Redistribution

  When taking MTF HRT, the fat in the body will be slowly redistributed, or moved, into different places which can change the apparent shape of the body and certain features. This is a very gradual process, and likely won't be noticed from day-to-day. Some interesting little notes about this, though. In my experiences, this has made my face noticably more feminine and soft looking, especially when compared to pictures pre-HRT. This has also gave me a bit more of a butt than I had before, same with my thighs.

  Decreased Muscle Mass

  Due to having less testosterone in the body, muscle mass may start to decrease as an individual takes MTF HRT. It is very important to note though, that this effect really just depends on how regularly you excersize. With regular working out and staying active, this effect likely won't be noticed. For me, though, I don't go outside or excersize as much as I should, and so I have noticed a fair decrease in strength. Just means I can't open the pickle jar as often, but mostly it's still the same as pre-HRT.

  Breast Growth

  On MTF HRT, over time the body will start to develop breasts. This is one of the irreversible changes of MTF HRT, and should seriosuly be considered for when deciding if and when to start treatment. I know some people who want to start taking HRT, but are not out to their family or friends yet, and this is the biggest thing to consider. The size of the breasts grown is based on genetics, and has nothing to do with the hrt dosages despite what some people want to think (me).

  If Progesterone is added as part of HRT, then it will allow the breasts to develop further, eventually having the same functions of that which a grown cisgender woman's has, like lactation. That won't happen until the later years of development though. In my experiences, the breasts will be particularly tender when first coming in, and after about 6 months to a year, they will start to be less sensitive. (More info on this in the part about sex later) I suggest buying sports bras for the first year or two, as with them constantly growing, it would be a bit of a pain to keep buying bigger bra sizes. Sports bras allow for a bit of leniency when it comes to that, though.

  Reduced Libido (Sex Drive)

  As testosterone is reduced, an individual on MTF HRT may experience a lessered libido. This one is more of a case-by-case basis to my knowledge, as it lowered significantly for me about a few weeks in, and stayed fairly low for about 6 months before coming up a bit to what feels like a healthy, manageable level. Some people may not be bothered by this, others might, but it is important to note reguardless. (More info on this in the part about sex later)

  Decreased Male Sexual Functions

  IMPORTANT: As an individual takes MTF HRT, (under the assumption that they have them) their male sexual functions will decrease, due to the effects of spironolactone and will eventually lead to irreversible infertility. If this is okay with the individual (like with me), then there is no issue. Otherwise, they may want to consider freezing some of their sperm before starting HRT in order to have the option still available later down the line.

  To be more specific, the decrease in sexual function applies to many aspects such as sperm count and production, ability to become erect, decrease in testicle and penis size, and just overall infertility.

  These things are variable in their onset and effect because it is kind of a "use it or lose it type of deal." If an individual does not make use of their male genitalia (via masturbation or sex), then they will suffer the afformentioned decreased function within a few months. (Mileage still varies on this though) Otherwise, it may take longer, though eventually it will. After about 3 months, fertility is not guarunteed to return if HRT is stopped. Again, if this is not an issue with the individual, then they do not need to take any steps to avoid it. (More about this in the part about sex later)

  Thinner And Less Body Hair

  As an individual takes MTF HRT, the production of body hair will slow, and hair that is grown will be thinner and less noticable. I don't think this applies to hair atop the head. Hair that is already grown will not be effected, and it will not completely remove hair from parts of the body. In order to do this, alternative hair removal methods will have to be used, like electrolysis and/or laser hair removal. Notably for me, I have very sensitive skin when it comes to shaving (especially my legs) so having to shave less thick hair, less often makes this less of an issue.

  Reduced Male Pattern Baldness

  Due to the changes in hormones while on MTF HRT, an individual who is experiencing hair loss due to male pattern baldness may have this hair loss slowed greatly, and (I think) essentially stopped. It is important to note that the onset of this reduction is when there will be a slowing of the loss, and that hair that has already been lost will NOT grow back.

  Other, Less Documented Changes

  While HRT in general is not very well documented yet (as is the same with most transgender topics), there are some things that while not officially recognized or noted, are very important to take notice of. These things will be from anecdotes and my own experiences, and are NOT BASED ON PROPER STUDIES. Keep these things in mind, but do not treat them as fact. Some of these include:   To go into these one by one, lets start with hair changes.

  Hair Changes

  Being on MTF HRT, I have noticed my hair is less oily and is kind of easier to manage. I have very long, straight, and fine hair, and I have a lot of it. I do not need to wash it as often as I once did, but this may just be because I use proper hair products now lol. █████████████ has rather curly hair, and in ███ experience being on MTF HRT, ███ hair has become a little more full and somewhat easier to straighten out, and I've noticed it's a little softer. Fairly sure most of these changes are due to the decreased skin oiliness.

  Emotional Changes

  Due to altering hormones, it should be expected that there will be plenty of emotional changes when on MTF HRT. I was told when I started to not expect any emotional changes, but yeahhh they were wrong. This widely varies on the individual, but with hormone fluctuations, mood swings are not uncommon. Additionally, many people (myself somewhat included) who have issues crying for one reason or another have reported being able to cry easier after being on HRT for a while. Sometimes, this even goes so far as to make someone rather emotional where they normally wouldn't be.

  Changes In Sexuality/Romanticity

  Something I have heard of before is that while taking MTF HRT, an individual's sexuality (what gender they are sexualy attracted to) and/or romanticity (what gender they are romantically attracted to) may change slightly. I have no real evidence of this myself, but I have heard of people (who notable were not in relationships at the time of saying) say they they find themselves more attracted to a different gender than they had been pre-HRT.

  Weight Gain

  I have heard many cases of people on MTF HRT experience increases in weight despite no notable changes in diet or excersize. I have also experienced this, but similarly to the decrease in muscle mass, this really just depends on how well you eat and how active you are.

  Again, it is advised that a provider or other qualified professional is asked if there are any questions on this topic, as I do not have any real medical knowledge. I only have my own experiences, what I hear from others, and some rudimentary google searches under my belt. Some things are less based in fact and more in experience, and one of those is sexual experiences.

HRT and Sex

  It is important to note that almost ALL of this information in this section is based on my own personal experiences. I will not be getting descriptive or too personal with any of the info provided here, but of course there will be talk of the act of sex, kinks as a topic, and other things of this nature. My sexual experiences have essentially all been post-HRT, as I started taking it at age 18. Because of this, I won't have too many pre-HRT things to note. Additionally, nearly all of my experiences with other people have been with other pre-bottom surgery transfeminine individuals, which does limit the spectrum of information I can provide.

  Sex And Decreased Male Sexual Functions

  Essentially, as the effects of HRT progress, the penis will become less sensitive to stimulus and will have more difficulty holding an erection. This is normal and should be expected going into any sexual encounter as an individual on MTF HRT. As a result of this desensitization, it takes more effort to reach orgasm, and when it is reached, the decreased sperm production will cause less fluid to be discharged and the pleasureable feeling may not be as strong. This erectile disfunction also makes penetrative sex more difficult to engage with in the position of the penetrator.

  Due to the lack of pleasure upon orgasm, many individuals on MTF HRT choose to engage with more anal sex, in which they experience greature pleasure than they had before HRT. Additionaly, while an orgasm reached via stimulation of the penis may not be as pleasurable, the actual stimulation may be better than the orgasm.

  Sex And Decreased Libido

  On MTF HRT, many individuals may experience a sharp decrease in libido following the first few months on the treatment. This lessened interest in sex may impact relationships in which frequent sex is routine, and should be considered before starting HRT or entering a relationship of a sexual nature. Some individuals may see this sex drive return either in part or in full later on in their transition, but this is on a case-by-case basis.

  The sexual interests, or kinks, of an individual may also vary when on MTF HRT, though this is less commonly spoken of and as such leads me to believe it is not a common thing. Just as with all of this information, it is purely subjective to each person's experience, and may or may not come to be noticed.

  Sex And Breast Growth

  While it may be easy to forget about when thinking, for those on MTF HRT, the breasts developed during the transition are not to be ignored. They can be very sensitive (especially early transition), and certain stimulation to the area can be rather pleasurable. While I do not have much information on the experience of cisgender women and their experiences with sex as it applies to their breasts, I assume it is a similar set of feelings for individuals on MTF HRT with developed breasts.

  Above all, communication is most important when it comes to sexual encounters. Doing things of this nature require lots of trust, and early transition especially requires a lot of communicating to understand the changes your body is undergoing and how to avoid frustrations and get more out of what your body is changing to give you.

Medicines of HRT (MTF)

  All of the information here should be taken with many many MANY grains of salt. Maybe even the whole salt shaker. I am NOT a medical professional. I do NOT know the chemistry and biology of how these medicines change the body. I am only going to give a very brief rundown of what each medicine does.


  Estrodial (or estro for short) is taken in the form of pills or injections, and it is essentially the estrogen hormone suppliment for MTF HRT. It is what causes many of the feminizing effects, and can help to decrease testosterone levels in the body. Pills are typically taken daily and are usually dissolved under the tounge in order to aid in absorbtion into the bloodstream. Injections are typically taken weekly, and are more effecient at delivering the estrogen to the body, though are not recommended if an individual is inexperienced with administering injections to themself. Injections also supress testosterone fairly efficiently, and thus can be taken without the need for spironolactone.

  Dosages vary, but typically start around 1mg twice a day, for 2mg daily, all the way up to 4mg twice a day, for 8mg daily. Dosage is usually decided by the individual taking the HRT with guidance from their provider, with the goal of reaching a stable level similar to that of a cisgender adult woman.


  Spironolactone (or spiro for short) is what's known as an anti-androgen. In function, it helps to lower the levels of testosterone in the body which lets the feminizing effects of MTF HRT take hold better while also reducing some masculine features of the body.


  Progesterone (or prog for short) is another hormone which serves the primary purpose of aiding in further developing the breasts, more than estrodial alone can. This is typicaly not prescribed at the start of an individuals transition, and is saved for when breast growth has already somewhat begun. (Around 6 months is when I started taking this) I've heard its better to take the gel-suspended capsule progesterone rather than the pill type. I think. I've just heard this thrown around and idk what it really means, so again, do your own research and ask a professional.

Cautions to HRT

  While HRT is very beneficial, and is essentially a miracle treatment when it comes to the desires of some transgender people, there are some important health risks to take note of. Many grains of salt here, as again, I highly suggest doing proper research and consulting people more qualified to talk on the topic, but the following are some of the main things to look out for when it comes to MTF HRT:   If any of these become genuine health concerns, I highly recommend visiting a transgender-friendly doctor for a checkup at the very least.


☆ Have a wonderful night ☆