The Effects of HRT (pt 1)

Welcome back to Queering the Narrative!

This week, I wanted to do something slightly different and talk about hormone replacement therapy, or HRT. There’s a lot of confusion about the effects of HRT, especially outside the trans community, which can lead to some fundamental misunderstandings as to how trans bodies function and how they might look.

In live-action media, there’s an easy solution to this: hire trans actors. In animated, drawn, or written work, however, it’s helpful to understand what is and is not feasible -- or acceptable -- as far as descriptions of trans bodies go.

Please note, however, that I am not a medical professional. Much of the information I’m giving here is based on my own experience, research, and anecdotal evidence gathered from trans folx in a variety of mediums. This is not a definitive list of effects of HRT. 

In fact, a defining factor of HRT is that you do not get to choose the effects. Some things happen more or less quickly at certain doses, but there’s no way for your character to pick and choose the effects of HRT on their body.

What is HRT?

HRT a medical procedure in which a person takes exogenous (from outside the body) hormones to replace the ones their body makes naturally. There are many different ways to take HRT -- pills, patches, gels, injections -- but generally speaking those will be delivery methods for one of the following medications:

Estradiol tablets, a common form of estrogen HRT

Estrogen, the “female” sex hormone, which folx take in order to achieve “feminizing” effects. Sometimes referred to as “E” in the trans community (not to be confused with the party drug!)

Testosterone, the “male” sex hormone, which folx take to achieve “masculinizing” effects. Usually referred to as “T” in the trans community. “Microdosing” -- in the trans community -- refers to using small or infrequent doses of T to achieve intermediate changes.

Testosterone Blockers, medications which block the effects of testosterone, often used by trans women to offset the effect of their endogenous (produced within the body) testosterone, because testosterone is a tough mother fucker. Usually referred to as “T-blockers,” the standard medication in the U.S. is spironolactone, and cyproterone acetate in the rest of the world. T-blockers are not required for trans women, though they are the standard. Used without estrogen, they also do have “moderate” feminizing effects.

Progesterone, another “female” sex hormone, which is thought by some to intensify feminizing effects, including promoting fuller breast development. Sometimes taken alongside estrogen, but rarely if ever on its own.

Related to HRT are “puberty blockers,” medications which can be given to gender expansive teens and children to delay or interrupt the onset of puberty, giving them more time to thoroughly examine and consider their gender identities. These medications are extremely well studied and safe, and the effects of puberty blockers are completely reversible.

Feminizing effects

So, what sort of effects might your trans character expect from feminizing hormone replacement therapy, in the form of some combination of estrogen, progesterone, and/or t-blockers?

Note that, of all of these, only breast development is irreversible -- if someone goes off HRT, the only change that will be permanently retained are the breasts. The changes are listed in roughly the order they might occur, but many happen simultaneously.

Skin softens and becomes less oily

This is usually the first change that trans women notice, and also leads to less acne, which is AWESOME.

Body hair thins, softens, and lightens

However, it usually does not go away entirely, and facial hair tends to stick around, though it may grow more slowly. Many trans women pursue hair removal treatments such as laser or electrolysis to rectify this fact.

Body odor changes 

You tend to have less noticeable body odor.

Fat redistribution

Generally, fat will begin to accumulate on your hips, thighs, breast and butt instead of on your gut and waist. This change is gradual and does not move existing fat. This might also change your character’s face shape slightly, giving them chubbier cheeks or a less dramatic jawline, and can also cause their waist to narrow.

Halts or prevents “Male Pattern Baldness”

Yep! Stops it right in its tracks! Baldness treatment that comes with a free pair of tits!

(I’m serious -- this form of baldness is directly connected to testosterone, and replacing that hormone stops the process!)

Breast development

This is a gradual process that takes months to years but is most dramatic (and painful) after a few months of HRT. Their nipples will also get a bit larger and sometimes change color.

Breast development depends on the age they started HRT, their family history, and their medication levels. A lot of trans women don’t end up with very large breasts without surgical intervention, but it’s not impossible!

If they’ve already undergone a testosterone puberty, then they likely have a broader chest, meaning that even if they develop a fair amount of breast tissue their breasts may still look proportionately smaller

Changes in sexual function

I’m not going to delve into this -- I recommend avoiding fixation on trans peoples’ genitals -- but, yes, at certain doses of HRT, there is a change in overall genital function. I will say, however, in case it’s unclear: HRT can NOT cause a penis to transmogrify into any other sort of genitals. That requires bottom surgery.

What CAN’T feminizing HRT do?

Feminizing HRT can do nothing about your bone structure -- once your bones are fused, that’s that. This is why some trans women have broader chests, shoulders, and jaws and narrower hips than cis women, as those bone structure changes occurred during their first puberty

It also won’t change your voice. Some trans women and non-binary folx undergo “voice training” to make their voices higher or more feminine, but the resting pitch of your voice won’t change on its own.

Hair follicles will persist, even if the hair changes color or structure. With the exception of facial hair (mentioned above), this isn’t particularly noticeable for other body hair -- that usually changes to vellus hair (the soft, colorless hair all over your body) or else thins to the point that it’ll look the same as any cis women with slightly above-average body hair.

Note that all these things will only persist if the trans woman in question underwent a testosterone puberty and developed these secondary sex characteristics as a result of that.

That’s it for this week! This went a little long, so I’ll be back next week to talk about masculinizing effects of HRT, and possibly touch on some intermediate effects of HRT non-binary individuals might pursue.

Until then stay safe, stay healthy, and keep writing!