Gender Affirming Procedures

HRT Timeline And Effects: Hormone Replacement Therapy Information

Medically transitioning from male to female can be a surgical or non-surgical process. Surgical procedures include MTF top surgery, MTF bottom surgery, and FFS (facial feminization surgery). The primary non-surgical option for transgender women or non-binary transfeminine patients is known as hormone replacement therapy. HRT is an effective solution that also treats menopausal symptoms in cisgender women and can help with several medical conditions.

Some individuals may wish to undergo a combination therapy that involves surgical procedures and HRT. Doctors recommend pursuing HRT for a year before opting for surgery. Under the guidance of an excellent medical team and a highly skilled surgeon specializing in transgender patient care, patients can achieve a complete, permanent physical alteration that they feel better aligns with their gender identity.

What Hormones Are Involved In HRT?

For individuals assigned male at birth who struggle with gender dysphoria, HRT can be a viable option. Hormone replacement therapy starts with medicine aimed at blocking the androgen–or testosterone–receptors. This stage will accomplish changes to the male hormone and its effects on the body.

The next step is the introduction of the estrogen hormone to the body. Four to eight weeks after beginning anti-androgen medicine, patients will start taking estrogen. This hormone will further decrease the body’s production of testosterone. It will also initiate physical changes that usually occur during female puberty.

What Physical Changes Occur With HRT?

The effects and timeline of hormone replacement therapy can vary for each person. In addition to other physical effects, the initial use of androgen blockers and estrogen can cause patients to experience many changes. Generally, this is a breakdown of what patients can expect.

1 To 3 Months After Therapy Begins

  • Hair loss due to male pattern baldness slowing before stopping altogether 
  • Lower sex drive

3 To 6 Months

  • A less oily complexion and generally thinner skin
  • Body fat redistribution, such as increased fat near the hips and thighs
  • Facial features will develop a round, feminine look
  • Increased breast growth
  • Decreased testicle size

6 to 12 Months

  • Facial and body hair will thin and grow more slowly

Patients may notice changes as soon as one month after starting HRT. Maximum effects, however, usually occur two to three years after therapy begins.


There are several ways to accomplish medical transitioning. MTF body surgeries and facial feminization surgeries are the most popular choices among transgender patients who choose medical transitioning. Hormone replacement therapy is a non-surgical alternative option to these procedures. HRT will produce physical changes in patients, such as stopping hair loss, decreasing body hair, face shape alteration, a drier complexion, and thinner skin. Other effects include new breast growth, increasing body fat near the thighs and hips, and changes in sex drive.

While most of the effects of HRT are reversible, some are permanent. The best time for patients to seek hormone replacement therapy, male-to-female cosmetic procedures, or facial feminization surgery as a means to transition is under the advice of a mental health professional. Their guidance will help ensure patients choose the treatment that is best for them.