Feminizing Hormone Therapy

Our gender-affirming care providers can help you determine if feminizing hormone therapy — using estrogen to halt and decrease testosterone — is right for you.

Our gender-affirming care providers can help you determine if feminizing hormone therapy — using estrogen to halt and decrease testosterone — is right for you.

What to Expect: Feminizing Hormone Therapy

Our gender-affirming care team specializes in providing feminizing hormones for male to female transition, or mtf. Feminizing hormones therapy includes using estrogen and anti-androgen (anti-masculinizing) hormones to develop feminine characteristics.

A number of different specialists at Rush offer feminizing hormone therapy. Affirm: The Rush Center for Gender, Sexuality and Reproductive Health can help you find the right provider for you. And your provider will help you understand what to expect with feminizing hormone therapy. 

Estrogen Therapy Effects

Estrogen and anti-androgen work by halting testosterone production, lowering testosterone levels and increasing estrogen.

This allows your body to develop feminine characteristics. These are some of the physical changes you can expect with estrogen therapy:


  • Decrease in facial and body hair
  • Decrease in male pattern baldness


  • Softer skin
  • Decrease in acne


  • Permanent increase in breast tissue

Reproductive system and sexual health

  • Fewer penile erections
  • Decreased prostate size
  • Lowered sperm count and quality
  • Decreased sexual desire

Body mass

  • Decrease in lean body mass
  • Increase in fat mass
  • Increase in visceral fat

Depending on your goals and expectations, estrogen and anti-androgen therapy alone may help you achieve the feminizing characteristics you desire.

If you’re looking for additional gender-affirming care, Rush offers other nonsurgical gender-affirming therapies and gender affirmation surgery. Your provider can connect you with the right specialist for your needs and goals. 

Types of Feminizing Hormone Therapy

There are several ways to take estrogen:

  • Estrogen patches or transdermal
  • Oral medications
  • Intramuscular or subcutaneous injections, using a needle to inject estradiol into your muscle or beneath your skin

To decrease your testosterone levels, you can take anti-androgen therapy the following ways:

  • Oral medication (spironolactone)
  • Intramuscular injection of gonadotropin releasing hormone

Your provider will discuss the best method for estrogen and anti-androgen therapy for you.

Estrogen Risks

Estrogen therapy is safe and effective if you have regular follow-ups with your provider.

There is a growing amount of research looking at the safety of estrogen in transgender and gender non-conforming people. This is what current research has shown:

  • Bone health: Hormones play an important role in maintaining the strength of your bones and preventing osteoporosis. While more research is needed, studies show there is no significant bone density loss in transgender people on estrogen therapy. If you’ve had your testicles removed, you may lose bone density if you stop taking estrogen therapy.
  • Heart health: Studies vary when it comes to estrogen and heart health. Some reports show no risk to heart health. And others find an increased risk of heart attack or stroke for transgender people on estrogen therapy. Talk to your provider if you have underlying risk factors (e.g., personal or family history, smoking).
  • Blood clots: While overall risk is low, estrogen can increase your risk for blood clots. Talk to your provider if you have a personal or family history of blood clots or if you smoke. Your provider may recommend specific formulations of estrogen if you have any risk factors.
  • Cancer: While more research is needed, there is currently no evidence that estrogen therapy increases your risk for cancer. However, talk to your doctor if you have a family history of breast cancer, ovarian cancer or prostate cancer.

Follow-up Care

Seeing your provider regularly after starting hormone therapy is an important part of your care.

In the first year after you start hormone therapy, you will follow-up with your provider every three months. At your appointments, you and your provider will discuss your progress, questions or concerns, and your overall health.

Depending on your needs and goals, your provider may order additional lab tests or adjust your medications. They can also refer you to other specialists like gender-affirming surgeons, behavioral health specialists and others.

Estrogen therapy and puberty

We also work with transgender youth to provide hormone therapy.

If identified early, we can provide puberty blockers, also called hormone blockers, to suppress puberty. And you can start estrogen therapy when puberty is naturally expected.

If you are transitioning after puberty, you can start estrogen and anti-androgen therapy immediately.

Family planning and estrogen

You can still start or grow your family when you are on or starting feminizing hormone therapy. Your provider can discuss your options with you and connect you to affirming fertility services at Rush.