We spoke to trans and gender diverse young people about their experience of feminising and masculinising hormone therapy. Feminising hormone therapy involves the prescription of oestrogen, often alongside hormone [testosterone] blockers. Masculinising hormone therapy is the prescription of testosterone, usually on its own.
In this section, you can find young people’s experiences about:
- Making the decision to start hormone therapy;
- Feminising hormone therapy;
- Describing effects and changes
- Masculinising hormone therapy
You can read about the different ways the people we interviewed have accessed hormone therapy (see Experiences of Gender Identity Clinics (GIC) and Experiences of private healthcare).Describing effects and changes
Making the decision to start hormone therapy
Factors that affect decision-making about starting hormone therapy include: weighing-up side effects, and the expectations of what hormones could do physically and mentally. Patrick said that hormones are not ‘a magic cure or at least they weren’t a magic cure for me’. He said ‘it wasn’t a magic fix for everything, it was a slow process’. Begam spoke about how she was ‘scared because of the side effects.’ She had ‘done a bit of the research’ and decided she was going to ‘take it slowly, if it’s not going well, I’ll always consult with my consultant’.
Young people shared some of the concerns they had about hormone therapy. Cas who identifies as asexual (Experiences of sexuality and relationships) was concerned about ‘an increase in sex drive [on testosterone therapy], which isn’t really what I want’. Hair loss was a concern for some of the trans and gender diverse young people considering masculinising therapy. Theo said, ‘it’s very scary. I’m worried about my hair falling out. I’m worried about my voice sounding like my dad and I’m worried about looking like my dad. It is scary.’ For the young people who were concerned about hair loss, PJ mentioned using Minoxidil [licensed medication for the treatment of hair loss] ‘which helps grow hair on the head and body’.
Bay talks about their apprehension when starting hormone therapy and says it’s okay to still have doubts.
Jacob weighs up the expectations of what hormone therapy can and can’t do.
Erion shares his excitement for starting masculinising hormone therapy it’s going to be amazing.
For non-binary young people we interviewed, the decision-making process was complicated further. Non-binary people were sometimes stuck between wanting some of the effects of hormone therapy but not others. Anderson said they’ve ‘been prescribed a low dose [testosterone] gel’ however they’re ‘not that keen’. They said ‘I don’t want to be hairy, I think I’m quite cute you know. I enjoy my little face. And I sing, that’s a big factor’.
Ari states they don’t want all the effects and obviously you can’t pick and choose’ and that’s holding me back.
A says a lot of trans resources are catered more towards binary trans people. I was on my own and had to work it out for myself.
Feminising hormone therapy
Oestrogen comes in various forms. It is most often prescribed as tablets, patches, or topical gel. Hormone blockers or Gonadotropin-Releasing Hormone (GnRH) analogues can be prescribed alongside (usually as a three-monthly injection) to reduce testosterone but this is not always the case. More information can be found in standards of care on Wpath.org.
People talked about the different ways they took oestrogen. Sophie took ‘tablets orally once a day.’ Talking about patches, A said ‘you just get a sticky patch usually’ and ‘you take two a week’ and ‘usually people stick it on their thigh or on their bum’. Jessica uses ‘Estrogel (estradiol) [a topical gel], which is like a gel and have to rub it on my arms’. Similarly, Kat used ‘two sachets of Sandrena (estradiol) [a topical gel] per day, which I rub on my skin’.
Summer explains how she takes oestrogen in 2mg tablets and the experience of hormone blockers alongside.
People on feminising hormone therapy (oestrogen and hormone blockers) described many different changes they experienced. Some young people described a change in smell. Freya said, ‘The first thing [she noticed] was like musk smelt different.’ The young people we interviewed also mentioned body hair. Freya said feminising hormone therapy ‘really slows hair growth down.’ Michelle said, ‘Body hair in places vanished’. Whereas for Tori it was ‘softness of my hair, all over my body.’ She says it became ‘finer’ and ‘grew less’. Jessica said she also felt ‘maybe a slight increase in the tenderness of my skin’. Sophie added that ‘very initially’ that she ‘would suddenly get very warm’ and described it as ‘like hot flushes’.
Shash describes the physical and emotional changes she experienced with feminising hormone therapy.
A key change during feminising hormone therapy was the beginning and development of breasts. A said that ‘less than a month in I started noticing like the first signs of breast growth.’ Jessica said it felt ‘mostly like tenderness in the breasts and it hurts to touch’. Sophie and Sally agreed and said ‘you probably start noticing like breast tenderness first’. However, Sally went on to say ‘my [breast development] was not great at the beginning and then as I’ve gone on, they’re more like bigger.’
Cassie said, ‘Early-stage breast development is like mosquito bites’. Michelle confirmed and said it ‘took about eighteen months for the breasts to grow in.’ Even years down the line Tori commented that after eight years on hormone therapy she ‘noticed that the itchiness has come back again, so I know that they’re probably going to grow a bit more again.’ A said ‘I wished the breast development would happen faster but the whole process takes like two years to stabilise’.
Young people also told us about changes in mood. Sally said she felt ‘a bit more calm’ and even that her ‘memory’s gotten better, I’m a bit sharper’. For Jaz it was ‘an intensely creative period of my life… feeling good about my body and my self-image, for like the first time in my life’. Cassie agreed and felt ‘I like how my body is developing.’ She said ‘I think this is probably what puberty’s supposed to feel like, the first time.’ She concluded ‘I’m immeasurably more comfortable in my body and continue to be so.’ Michelle said, ‘A load of problems I didn’t know were problems vanished within like a year.’
Sally talks about the changes she experienced on feminising hormone therapy in detail.
Masculinising hormone therapy
Testosterone also comes in different forms. It is most often prescribed either in the form of two types of injection: short acting (prescribed every 2-4 weeks) and long acting (prescribed every 6-15 weeks). It is also prescribed as topical gel. More information can be found in standards of care on Wpath.org.
The trans and gender diverse young people we spoke to described the ways they were prescribed testosterone. Jay said he took testosterone gel ‘in sachets’ and he puts it on his shoulders. M described ‘vials of Sustanon (testosterone) [short acting injection]. However, they said they would get ‘massive bruising’ which was ‘quite painful’ so they ‘switched to gel’. H also first started with Sustanon (testosterone) but got ‘changed over to Nebido (testosterone) [longer acting injection] because for me it was a bit more convenient’.
Rahul describes his experience of intramuscular injections of testosterone [short acting] and how he came to that decision.
Bay ‘was prescribed Testogel (testosterone) [topical gel]’. They said ‘I wanted to go on gel rather than injections’. Declan said he was prescribed Tostran (testosterone) [topical gel] ‘in a bottle’. He ‘would put four pumps’ into his hand. He said that ‘at the time I was having really sensitive skin so I couldn’t put it on my shoulder as they wanted me to, so I put it on my thigh instead. He continued ‘when my skin got less sensitive I put it on my arms again.’ Following that he was prescribed Testogel (testosterone) ‘two pumps on my shoulder every day’.
Patrick describes administering Nebido [a long acting testosterone injection]
Reuben discussed the side effects of hormones with their clinician.
Describing the changes
People on masculinising hormone therapy [testosterone] went through a number of different changes on their journey. Declan said that one of the first things to change was his smell, with his boyfriend telling him he smelled differently. People also noticed changes to their skin. CJ had ‘teenage acne’ at 32, which I really didn’t enjoy.’
Some of the young people experienced changes in mood. Jay said, ‘the first thing’ he noticed was ‘emotional changes’. Alistair described the first three months of taking testosterone as ‘a bit of a roller coaster… mood swinging, very irrational, very hungry, very sleepy.’ Loges felt ‘more anger than usual.’ H and Henry all described feeling more ‘irritable’. However, Jay said he ‘felt a lot calmer’.
Voice changes were often seen as positive. M said that their voice changing was the ‘best thing’. Declan remembered his ‘voice was dropping but it was really squeaky and my boyfriend would just make fun of me and every time it squeaks’. Whereas Jay said the changes to his voice ‘started after maybe a month’.
Body and facial hair changes were also discussed. Henry stated they experienced facial and body hair growth at around six months. He said, ‘for a long time I didn’t want to shave it off because I was like, “Oh my gosh this is my first beard,” but then I realised I did look like a … twelve-year-old boy’.
Rahul describes the effects of testosterone and how the changes felt a very exciting period of time.
Jack describes his experience of being on testogel and describes the changes in detail.
The trans and gender diverse young people on masculinising hormone therapy also described changes to their body and weight distribution. Henry said, ‘One of the clinicians at the gender clinic who had seen me the year before, said, “Your body shape has changed”. H noticed his shoulders ‘have broadened out’. Declan spoke about how he ‘gained a lot of weight since I’ve started testosterone’. He said ‘I gain muscle really fast because I play rugby… I did nothing [before] and now my legs are really strong which I quite like’. He added ‘I was in the gym for a bit and had arm muscles which I’ve never had.’ Jay said that when he was the gym, ‘I could exercise for longer and I could lift a bit more without getting tired’. M said ‘I think my facial structure’s changing a bit’.
Some of the young people on masculinising hormone therapy talked about experiencing ‘bottom’ or ‘lower growth’, which is growth of the clitoris. Some young people described it as one of the first changes they recognised.
June says that he felt a lot more connected in terms of what I actually wanna be achieving with life’ on hormone therapy.
People also talked about less positive changes. Patrick said he experienced ‘irregular periods’. H said he experienced ‘aches and pains’. His ‘legs and my back and stuff would always ache’. Sometimes changes were too slow for some young people. Max said he had ‘not really noticed many changes in six months’ and doesn’t expect to ‘see a massive amount of changes until I’m close to two years’. Declan ‘I didn’t really see any changes [until] after three months’. He did not feel like he had any ‘dramatic transformations’. However, just being on hormone therapy Patrick said he felt a ‘change in confidence, just knowing that something is happening’.