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@ -34,7 +34,7 @@ Once formed, the testes then begin producing a testosterone surge which typicall
If there is an interference in this process then you can end up with the wrong bits, and this is the result of many intersex conditions. Often times this is a partial development, where the external genitalia only partially form, but functional gonads still exist. Sometimes the child comes out with fully functional male or female genitalia, but mismatched gonads. Sometimes the TDF protein fails to release and the fetus grows completely functional female reproductive organs, despite the presence of a Y chromosome.
This is known as Swyer Syndrome, and an unknown number of women may have this condition. In 2015 [an XY woman with Swyer Syndrome who was born without ovaries](https://www.independent.co.uk/news/science/mostly-male-woman-gives-birth-to-twins-in-medical-miracle-10033528.html) successfully carried and gave birth to a child via IVF. Usually Swyer Syndrome results in completely non-functional ovaries, but [in 2008 a woman was found with Swyer Syndrome](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190741/) who had gone through puberty, menstruated normally, and had two unassisted pregnancies. Her condition went undiscovered until her daughter was was found to also have it.
This is known as Swyer Syndrome, and an unknown number of women may have this condition. In 2015 [an XY woman with Swyer Syndrome who was born without ovaries](https://www.independent.co.uk/news/science/mostly-male-woman-gives-birth-to-twins-in-medical-miracle-10033528.html) successfully carried and gave birth to a child via IVF. Usually Swyer Syndrome results in completely non-functional ovaries, but [in 2008 a woman was found with Swyer Syndrome](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190741/) who had gone through puberty, menstruated normally, and had two unassisted pregnancies. Her condition went undiscovered until her daughter was found to also have it.
The fact is, the vast majority of the population has never been tested for genetic karyotype, so we don’t know how common these cases actually are. Where does this come into affect for gender identity? Well, the exact same process that causes the external genitals to differentiate also occurs for the brain.
As we described in the [Causes of Gender Dysphoria](/gdb/causes) section, every human's DNA contains the genetic instructions for both male and female bodies, and which set of instructions gets used is controlled by what hormones your gonads produce. That differentiation occurs entirely based on whether you happen to have an SRY gene which, in the 6-8th week of gestation, kicks off a chain reaction that produces testes instead of ovaries. From that point on, every sexual attribute of the human body (primary and secondary) is a result of the hormones that those gonads produce.
If they produce estrogens (primarily Estradiol) then the genitals form into a vulva, vagina and uterus. If they produce androgens (primarily Testosterone) then the genitals form into a penis and scrotum, shifting the [Skene's gland](https://en.wikipedia.org/wiki/Skene%27s_gland) downward and enlarging it into a prostate. Differentiation ends here until the onset of puberty, 9-10 years later, and we all know what puberty does.
So how does this work? Why do the cells differentiate like this? Well, before we can explain that, first we have to explain the concept of a **Receptor**.
## Hormone Receptors
In simplest terms, a receptor is like the keyed lock ignition on a car (do new car’s still have keyed ignitions?). Every cell in the body has a set of locks which activate different functions within that cell. They’re like switches which signal to the cell that it should activate a different part of its genetic sequence. Each receptor can only accept certain chemical compounds, much like how a lock can only accept certain keys, and different chemicals have different capabilities at turning the key. Some can completely start the car, while others only turn it to Accessory Mode.
The ability for a chemical to fit into a receptor is called **Relational Binding Affinity**, and is measured as percentage of how likely a chemical will bind to a receptor compared to another. So, for example, if Hormone B binds only 10% of the time in relation to Hormone A, then it is said to have a 10% binding affinity. Similarly, the ability for a chemical to turn the key is called *Transactivational Ability*. Compounds which fit into a receptor but don’t do anything are called *Antagonists*, compounds which are able to turn the key are called **Agonists**. If it can only turn the key a tiny bit, it’s called a **Partial Agonist**.
You can think of antagonists like bouncers at a club. They stand in the doorway and prevent anything else from getting through, but don’t enter the club themselves. Most antagonists are referred to as **blockers**. This is different from an **inhibitor**, which is a compound that slows down a chemical reaction, or an *activator*, which speeds up a reaction. In receptors, an inhibitor lowers the ability of the receptor, causing it to respond less effectively to things that bind to the receptor, and an activator increases the ability of the receptor, making it respond stronger, like a booster.
In some cases a hormone can function as an inhibitor or an activator for a different hormone by slowing down or increasing behavior in a cell. For example, progesterone increase cell activity, making cells respond more effectively to estrogens and androgens, and testosterone increases the transaction ability of dopamine receptors, so less dopamine is needed in the brain for the same effect.
## Whats in a Hormone
There are four main kinds of hormones:
- [Amino Acids](https://en.wikipedia.org/wiki/Amino_acid) such as Melatonin which controls sleep, or Thyroxine which regulates the metabolism.
- [Peptides](https://en.wikipedia.org/wiki/Peptide_hormone), like Oxytocin and Insulin, which are collections of Amino Acids.
- [Eicosanoids](https://en.wikipedia.org/wiki/Eicosanoid) that are formed from lipids and fatty acids and predominantly affect the immune system
- [Steroids](https://en.wikipedia.org/wiki/Steroid) are signaling molecules produced by various internal organs in order to pass messages to other organs within the body.
caption="All steroids are formed from cholesterols (top left) and are derived from other steroids. Progestins form into Androgens which form into Estrogens. This is a one-way exchange, and does not reverse, so don't believe it when someone tells you that too much estrogen will turn it into testosterone."
}}</div> }!}
For the purposes of transition, this last category is what we care about the most, as all of the sex hormones are steroids. They fall into seven main categories:
The first three of these are what we care about most when it comes to Hormone Therapy. Note: All human beings, regardless of phenotype, have some of every one of these hormones in their bodies. The ratios are what affect body shape.
### Androgens
There are nearly a dozen different androgens, but the ones we care about the most are [Testosterone](https://en.wikipedia.org/wiki/Testosterone) and [Dihydrotestosterone](https://en.wikipedia.org/wiki/Dihydrotestosterone).
Testosterone is the primary masculinizing hormone for the human body and is produced in the adrenal glands, the testes, and in the ovaries (where it is immediately converted into estrone and estradiol). It tells both muscle and bone cells to grow and in higher concentrations encourages larger muscle mass and thicker skeletal structure. This also means that Testosterone is critical for bone health, as it affects calcium distribution within the skeletal structure. Thus, severe depletion of testosterone can result in osteoperosis and fragile bones. Testosterone also plays a major role in sex drive and libido, encouraging mating behavior within the cerebral cortex.
Dihydrotestosterone (DHT), which is converted from Testosterone in the prostate, skin and liver, plays a major role in the development of the male genitalia during puberty by inducing random erections, and the growth of facial and body hair. Paradoxically, DHT is also what causes male pattern baldness, as it chokes off blood circulation to the follicles on the top of the scalp (sorry, trans guys, it's a double edged sword). DHT binds to androgen receptors ten times more strongly than testosterone, which is why it is critical to eliminate it for feminizing transition.
### Estrogens
There are four estrogens: [Estradiol](https://en.wikipedia.org/wiki/Estradiol), [Estrone](https://en.wikipedia.org/wiki/Estrone), Estriol and Estetrol. The latter two are only produced during pregnancy and are important for fetal health, but have no bearing on transition.
Estradiol is the Feminizing hormone, as it is the primary signaling hormone for growth in the mammary glands (breast tissue), and because it encourages fat deposits in the thighs, hips, butt, chest and arms, while discouraging fat deposits in the abdomen, thus producing a curvier figure. Estradiol also promote increased collagen production, resulting in softer skin and more flexible tendons & ligaments.
Estrone's role in the body has been something of a puzzle in medical research, as it has significantly lower binding affinity compared to estradiol (0.6%) and very low transactivational ability (4%). The hormone doesn't appear to *do* anything, it just sits in the blood stream. However it has a unique ability to convert to and from Estradiol via an enzyme group called [17β-HSD](https://en.wikipedia.org/wiki/17%CE%B2-Hydroxysteroid_dehydrogenase), making it ideally suited to function like an estrogen battery within the body.
New research is starting to suggest that the body may regulate total estradiol levels by releasing HSD17B1 to turn estradiol into estrone, and releasing HSD17B2 to convert it back, however this is very early study. Both enzymes are produced in breast tissue, and may play a role in the presence of cyclical period-like symptoms in estrogenic individuals who do not have ovaries, such as trans women.
{!{ <divclass="gutter"><divclass="card"><divclass="card-body"><h4class="card-title">For Your Information</h4> }!}
**Why aren't AFAB trans people prescribed estrogen blockers alongside testosterone?**
There are two separate sources for estrogens within the female reproductive system. Ovaries contains thousands of follicles, cell structures which produce eggs. The pituitary gland produces luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which encourages the follicles to grow into luteal cells. Theca cells within the follicle produce testosterone, and granulosa cells produce the enzyme [aromatase](https://en.wikipedia.org/wiki/Aromatase), which converts that testosterone into estradiol. This is the first source of estrogen, but it is not the largest source.
Note: This is why PCOS causes ovaries to produce testosterone; the ovarian cysts disrupt the aromatase production, so the testosterone does not get converted.
Two weeks into the period cycle the hypothalamus tells the pituitary gland to produce an LH and FSH spike three to four times stronger than earlier in the cycle. That surge causes the follicles to swell until one pops, releasing an egg, at which point the remains of the follicle become a structure known as the corpus luteum. That corpus luteum then begins to produce progesterone and significantly more estrogens in order to prepare the womb for a fertilized egg. This is the second source.
Taking testosterone causes the hypothalamus to deactivate the genes that initiate this LH and FSH spike, so the follicles never reach maturity, ovulation never occurs, and the corpus luteum is never formed, removing a significant source of estrogen within the ovaries.
*So no, Reddit, it isn't just "because testosterone is stronger", it's because ovaries are a hell of a lot more complex than testes and are easier to disrupt. Please stop spreading this falsehood.*
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### Progestagins
The primary progestogin is [progesterone](https://en.wikipedia.org/wiki/Progesterone), which plays numerous roles in the body and has been found to be [an important component for feminizing hormone therapy](https://academic.oup.com/jcem/article/104/4/1181/5270376).
One of the largest roles that the progestogin receptor plays is in the regulation of gonadal function (ovaries and testies). The hypothalamus is positively *littered* with progestogin receptors and responds strongly to their activation, downregulating the production of [GnRH](https://en.wikipedia.org/wiki/Gonadotropin-releasing_hormone), which then reduces the production of [luteinizing hormone](https://en.wikipedia.org/wiki/Luteinizing_hormone) by the pituitary gland.
LH is what tells the ovaries and testes to produce estrogen and androgens. LH and its sibling hormone [FSH](https://en.wikipedia.org/wiki/Follicle-stimulating_hormone) both play central roles in ovulation, which is another large source of estrogen in ovary-havers. Thus, synthetic progestins, chemicals that fit into progestogin receptors, are often included in birth control in order to prevent ovulation. In AMABs, progestogins are a useful tool for blocking testosterone production.
Another type of cell that is full of progestogin receptors is mammary tissue. Progesterone plays a major role in the growth and maturation of milk ducts within breast tissue. While little formal research has been conducted into progesterone's effect on breast development, anecdotally it has been seen widely across the transfem community to provide significant improvements in breast fullness. Progesterone has also been demonstrated to increase blood flow to breast tissue, and encourages fat deposits in the breasts, both of which increase breast size.
Additionally, progesterone promotes better sleep, improves cardiovascular health, increases ketogenesis (reducing triglycerides), increases metabolic function, and has been found to reduce breast cancer risk.
### Mineralcorticoids
Mineralcorticoids play no role in transition, but they are worth mentioning because of one major hormone: [Aldosterone](https://en.wikipedia.org/wiki/Aldosterone).
Aldosterone is what instructs the kidneys to *stop* extracting water from the blood stream. It is produced by the adrenal glands in order to regulate body hydration. Why is this significant?
Because one drug that is very commonly used in trans hormone therapy is an extremely powerful aldosterone antagonist... Spironolactone. Spiro binds to mineralcorticoid receptors more strongly than aldosterone does, but does not activate the receptor. It just clogs it, preventing the kidneys from receiving the signal to stop extracting water.
This is a compilation of reported medical transition changes collected from testimonials of AMAB trans people taking estrogen based hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.
**Note that this is a list of _possible_ changes. There is no guarantee that every person on feminizing HRT will experience all of these. Your age, genetics, medical history, degree of masculinization from natal puberty, and hormone regimen can all have impacts on results. There is also just a degree of randomness -- every body is different -- and some things can take years to appear.**
### Breast Growth
Despite public perceptions, the majority of transfems do not pursue breast augmentation, as it often isn't necessary (and for many, is not within reach). Every human is born with breast tissue, it simply remains inactive without estrogen to make it grow. Development typically takes 2-5 years, but can continue for more than ten years, just as it does for cisgender women.
Expect aches and pains in the chest, along with lots of tenderness, in the area surrounding and behind the areola. Avoid bumping into anything, as it *will* hurt. Nipples and areolas will become much more sensitive while also becoming larger and darker. You'll want to invest in some sports bras.
This may be accompanied with lactation. Some secretion is normal and can be expected as milk ducts form and open up, so there is no cause for alarm. However, significant discharge without intentional stimulation may be a sign of a prolactin imbalance, so you should tell your doctor if this happens.
### Skin Softening
Testosterone promotes the thickening and toughening of the epidermis, so removing it makes the skin thinner. Additionally, estrogen promotes the production of collagen, which causes skin to become softer more iridescent. Expect to see more varicose veins on your legs. Tattoos that may have faded over time might become bolder and clearer.
The removal of testosterone also causes a severe drop in skin oils, particularly on the face and scalp. This results in a significant reduction of acne and/or dandruff.
### Increased Flexibility
Testosterone causes water retention in ligaments and tendons, rendering them less stretchable. Removing androgens from the body causes the tendons to release those fluids and regain their elasticity.
### Slimmer Hands and Wrists
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As the skin begins to soften and slim down, the hands gradually begin the shrink. Without testosterone, less blood flows to the hands, causing further reduction in tissue sizes. Ring size will drop as fat and fluids move off the fingers. Finger length shortens as ligaments thin and stretch.
### Smaller Feet
Much like hands, the feet also experience changes in shape. Androgens encourage more blood flow to the feet, and encourage water build up in cartilage. Estrogens allow the ligaments in the foot to stretch more. Collectively this causes the arch of the foot to increase, shortening its total length by as much as two centimeters. Many people report a drop of one to two shoe sizes.
### Thinner & Softer Fingernails
Fingernails are made of keratin, and many keratin genes are activated by androgen receptors, thus causing thicker fingernails. The loss of testosterone will make the nails thinner and more prone to breakage.
### Reduced Body Hair
Do not expect a total cessation of body hair, once the follicles are made terminal by DHT they remain that way. However, much like fingernails, hair thickness is an expression of keratin genes activated by androgens. Removing testosterone causes the body hairs to become thinner and lighter. Genetics plays a major role in this, however.
### Changes in Body Temperature Placement
Androgens encourage extra blood flow to extremities, making them warmer. Because of this, women tend to have warmer core temperatures but lower oral and surface level temperatures. You may see your basal body temperature drop to around 97.6.
This unfortunately results in a reduced tolerance to cold, so expect to need to layer clothing more frequently, especially since many buildings [set their thermostats for male comfort levels](https://www.popsci.com/study-finds-gender-bias-office-air-conditioning/).
### Changes in Perspiration Patterns
With the above shift in temperature distribution, this also results in a significant change in how one sweats. Sweat becomes more of a full body experience, as opposed to largely centered on the head and armpits. Underboob sweat becomes a thing.
### Reduction and/or Change of Body Odor
A major component in male body odor is the presence of [the steroid pheromone androstadienone](https://www.sciencedaily.com/releases/2007/09/070916143523.htm) in sweat. Androstadienone is metabolized directly from testosterone, so halting testosterone removes the source. Without it, sweat takes on a much sweeter smell, which is often attributed to feminine odors.
People taking spironolactone may experience a total cessation of any body odor, due to the way the drug alters cortisol uptake within the body.
### Reduced Muscle Mass
Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst body builders. People running on androgens naturally have more muscle mass, particularly in the upper body, without even having to work out. Removing androgens causes that muscle mass to atrophy and makes it harder to gain muscle. This is a major contributor to the feminine shoulder and neck line, as well as the waist line.
With this comes a significant loss in strength. Carrying things becomes more difficult, pickle jars become harder to open.
### Fat Redistribution into Feminine Proportions
Androgens encourage the body to deposit fats into the abdomen, while estrogen encourages the body to deposit fats into the thighs, buttocks, and hips. Switching profiles causes new fats to be deposited according in the estrogen profile, and fats that were stored while on androgens break down. This produces the illusion of fat migration as the shape of the body changes. The waist line shrinks and defines itself below the ribs, and the belly becomes softer and flatter.
Because estrogen deposits weight much lower on the body, and the muscle mass in the upper body is lost, this lowers the center of gravity, which alters one's walking gait. It becomes more natural to cantilever the body with the hips while walking, as opposed to the shoulders.
### Facial Feature Changes
Along with body fat migration, fat in the face also migrates. The neck, chin and jaw line thin out while the lips and upper cheeks puff up. The brow and upper eye lids lift, exposing more of the eyeball. Changes in skin and musculature around the eye can alter the shape of the eyeball, changing focal depth and altering vision clarity. The color of the eyes may also change and become bolder, as testosterone causes the pigmentation in the iris to fade.
This is an extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. Take selfies to compare.
### Changes to Scalp Hair
With the removal of androgens, blood flow to the scalp increases. Follicles that had been lost to male pattern baldness may reactivate, causing some return of the hair line and a filling in of bald spots. Scalp hair becomes thicker and follicles grow stronger, allowing hair to grow to longer lengths.
With this thickening, curliness may become more pronounced, and a change in hair color may also occur. You might find your hair taking on a texture more like your mother's than your father's.
As musculature atrophies, ligament flexibility increases, and weight shifts lower on the body, the orientation of the pelvic bone in relation to the spine and femurs rotates forward. Not by much, only about 10-20 degrees, but enough to cause a change in the alignment of the spine and hips, increasing arch of the back and causing the buttocks to jut out more. The added arch to the back can cause a relative drop in total height, between 1 and 2 inches (2-5cm) depending on pelvic shape.
Note, this is NOT the same as the [hip rotation](https://youtu.be/OROoZzoVwfk?t=12) that occurs in AFAB puberty and during pregnancy. That is the result of migration of bone cells, altering the shape of the pelvic bone itself. **However**, hip rotation *can* occur if the person is young enough to still be within initial puberty, where the body is producing elevated human growth hormone. There have also been examples of hip rotation happening over long periods of time in trans elders. In 2017 an 80 year old trans woman reported on reddit that over the course of her 30 years on HRT, her doctor observed changes in her pelvis consistent with female hip rotation.
### Reduced Tolerance of Caffeine, Alcohol, and/or Psychotropics
Less body mass means less blood to dilute chemicals into. Losing testosterone also means a slower metabolic rate, decreasing the speed at which toxins are reduced from the blood stream. Some anti-androgens also put strain on the liver, further reducing how quickly chemicals are processed.
### Mental Changes
As covered in the [Biochemical Dysphoria]() section, brains can be wired for a certain hormone profile, and running on the wrong profile is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of depersonalization and derealization (DPDR) symptoms within the first two weeks. A mental fog lifts, and it becomes easier to concentrate on complex concepts (assuming you don't also have other mental processing difficulties such as ADHD).
##### ADHD
If you have ADHD, there may be some changes in your symptoms. Androgens amplify [dopamine](https://en.wikipedia.org/wiki/Dopamine) receptor function, so reducing testosterone can reduce the activation potential for dopamine in the brain. Dopamine is a key neurotransmitter in the behavior of [working memory](https://en.wikipedia.org/wiki/Working_memory), the short-term memory of the brain. Less working memory means you become more prone to distractions and have more difficulty maintaining [cognitive load](https://en.wikipedia.org/wiki/Cognitive_load).
The good news is that estradiol prompts the brain to produce MORE dopamine.
There is a known problem with Spironolactone hampering working memory due to it's affects on mineralcorticoids. This can significantly worsen ADHD issues and make it much harder to maintain focus or be aware of your surroundings. I was involved in a car accident in 2017 that I blame on spiro fog.
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##### Emotional Expansion
The alleviation of DPDR almost universally is accompanied with a much broader capacity for emotion and expression. The stoicism and dissociation lifts and emotions land with much greater intensity. Highs are higher and lows are lower. Those who may have been unable to cry, before transition, gain it back, both for sadness and for joy.
Unfortunately this also means that if you had trauma from events earlier in life (and who doesn't), you may start to experience PTSD episodes. This is why it is good (and in some places, required) to have a therapist.
##### Mood Swings
As estrogen levels fluctuate between doses you may experience noticeable and sometimes dramatic shifts in your mood. Unexplained crying happens; PMS rage happens; be ready for it.
##### Appetite
Many people report being unable to eat as much as they could pre-transition. The loss of lean muscle in the arms and shoulders means that the body has a reduced capacity for burning lipids, and as such the fullness sensation occurs earlier.
However, progesterone increases mitochondrial function within the body, boosting metabolic rate. This can cause an increase in appetite as the body attempts to replenish calories burned.
That said, you may find yourself unable to eat *as much* food as you could before. Many report that they become full/satisfied sooner than before.
##### Sleep
Many people report having better sleep patterns after starting HRT. This is likely a factor of the alleviation of DPDR, as it seems to occur in both AMAB and AFAB trans people. That said, initiating progesterone can *significantly* improve sleep, allowing for deeper sleep and more dreaming.
##### Extroversion
It's extremely common for trans people of all types to find themselves much more sociable post-transition. This may not actually be a factor of hormone therapy, however, an simply be a result of no longer having to suppress large portions of their personality.
### Sensory Enhancements
Transgender HRT has [been shown several times](https://academic.oup.com/cercor/article/28/5/1582/3064956) to cause changes in the distribution of gray matter and white matter within the brain for trans people on both forms of HRT. New structures and neuro-pathways are formed as a result of the shift in hormone profiles, and this results in changes of sensory perception. These are some of the changes that have been observed and reported, but it is is not clear if this is a function of the hormones themselves, or a factor of the brain receiving the hormones it is wired for.
- **Improved sense of smell**, especially of other bodies. Human sweat becomes very discernible, even overpowering at times.
- **Improved color perception**. Colors may become bolder, richer.
- **Improved spatial awareness**. Many trans people experience poor proprioception and a tendency towards clumsiness that goes away after starting HRT.
- **Changes in perception of taste**. Certain foods become more or less palatable; Cilantro, for example, may become more or less soapy. Increased tolerance of capsaicin (spicy peppers). Chocolate and wine become more flavorful.
Users of Spironolactone often develop strong cravings for foods high in salt, such as pickles, olives, or potato products. This is because Spiro is a potassium sparing diuretic which causes you to pee out all your sodium. The brain creates cravings to encourage you to replace that sodium.
### Spatial Shift, Reduced Confidence
There is a very frequently reported experience of feeling smaller within the world, even when wearing heels. People taller than you seem to tower over you, and spaces feel larger.
People have also reported a tendency to be less prone to start arguments, an a desire to avoid confrontation rather than create it. Testosterone has been shown to increase a persons sense of confidence, and removing it has the opposite affect.
All genitalia are constructed from the same tissues, they are merely organized differently during gestation. Much of the behavior of these tissues is regulated by the hormones ones body runs on. Skin secretions, textures, sensitivity and erectile behavior are all hormonal expressions. Which means that when you remove androgens and add estrogens, these tissues start acting like they are in the shape of a vulva, even though they aren't.
##### Increased Sensitivity
The skin on the glans and shaft becomes much thinner and fragile, more prone to tearing and irritation, while also becoming *significantly* more sensitive to touch. The entire organ also becomes much more sensitive to pressure, and vibration becomes a better form of stimulation over stroking, which may become painful.
#### Moisture and Feminine Odor
The skin along the shaft begins to secret the same fluids as the vaginal canal, particularly during arousal (yes, trans girls get wet). These fluids encourage the development of the same microbiome that develops within the vaginal canal. The combination of these factors means that odor (and taste) of the penis changes to align more to that of a vulva.
##### Color and Texture Changes
The scrotum is an analog of the outer and inner labia, and softens to take on a softer, more velvety texture, extending down into the perineum. The skin along the perineal raphe (the vertical line where the vulva opening had been before the scrotum formed) will also darken. Some people experience a kind of striping pattern along the scrotum.
##### Fewer Erections
Without free floating testosterone, the levels of [DHT](https://en.wikipedia.org/wiki/Dihydrotestosterone) in the bloodstream drop significantly. DHT plays a major role in the stimulation of random erections during sleep through the enlargement of the prostate, and these erections are what is responsible for the maintenance of the erectile tissue. Without DHT, the prostate shrinks again, and random erections cease (no more morning wood).
However this means that the erectile tissue will begin to atrophy. Prolonged atrophy will result in shrinkage of the entire organ, for better or worse. The shape of the penis changes as this occurs, often becoming more conical. The glans is the first part to shrink and may lose the ability to become rigid. Penetrative sex may become more difficult, and erections themselves may become painful.
This can be countered by regularly inducing erections, but that may become more and more difficult as time goes on.
##### Clear Ejaculate
The majority of the liquid that makes up ejaculate originates in the prostate. It is a completely clear fluid, with a slimy texture. The white color and stickiness that is usually attributed to male ejaculate is caused by semen and seminal fluid from the testicles. The production of both semen and seminal fluid is a product of testicle function, so as the testicles shutdown (either because of anti-androgens or from estrogen dominance), these fluids halt, leaving only the prostate fluid.
Some people lose even that, and stop having any emissions at all during orgasm.
Needless to say, this comes with sterility. Contrary to what some sources report, this is NOT permanent, and many people have been able to restore testicle functionality by halting hormone therapy, either for detransition or for reproductive purposes.
##### Testicle Atrophy
Once the testes have stopped functioning, the cells start to atrophy, shrinking over time. This atrophy may be accompanied with pain, sometimes in the form of a soreness or a dull throbbing sensation, or sometimes as registering as little sparks of pain that travel along the perineal nerve from the testicles down to the rectum.
### Sexual Changes
Initial start of HRT may result in a total loss of sex drive as testosterone levels plummet. This can last 3-12 months, and in some cases doesn't return at all. Starting progesterone often serves as catalyst for its return. If/when sex drive comes back, the new libido [may be a completely different experience](https://curvyandtrans.com/p/5BF1EA/libatious-libidos) that one may not recognize at first.
caption='Source: <ahref=\"https://link.springer.com/article/10.1007/s10508-016-0745-z\">Topography of Human Erogenous Zones</a>'
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The entire body becomes more responsive to touch, and with that unlocks stronger erogenous zones. Breasts, abdomen, inner thighs and neck, in particular, become more arousal inducing.
##### Orgasm
Orgasm changes significantly, both in the way it builds and how it is experienced (see link above), but additionally, if one is lucky, they will gain the ability to become multi-orgasmic with no refractory period. The cost of this is that orgasm may become harder to achieve, and one has to re-learn how to reach it. It also becomes easier to reach with a partner, which may have been the opposite before.
##### Attraction
It is [not at all unheard of](https://www.them.us/story/sexual-attraction-after-transition) for a transgender person to experience a change in their sexual orientation with transition. This is almost always the result of the removal of self-imposed mental barriers, but hormone therapy often plays a role *in* that removal. In most cases this simply involves an expansion of ones attraction, from monosexual to bi/pansexual, but some people also discover that their attraction was largely rooted in self-interest and that their true attraction is reversed.
### Cyclical Period-like Symptoms
Obviously, we do not mean blood flow, that would be ludicrous. Symptoms vary greatly (just as they do in cisgender women) and typically last for 2-4 days, repeating every 26-32 days (though some report experiencing it bi-weekly). This happens independent of medication dosing schedules. The use of a period tracker app like Clue can reveal the pattern.
- Cramping in the intestine and abdominal muscles, ranging from a slight flutter in the gut to strong painful spasms.
- Bloating and water retention
- Gas, diarrhea and other intestinal issues.
- Emotional instability, mood swings and irrational thoughts
No, there have not yet been studies on this yet, but it is reported by far, **far** too many individuals to be an anomaly (including by yours truly), and has been confirmed by multiple people's own doctors. There is also precedent of this happening with cisgender women who have had hysterectomies (I personally know two cisgender women who have cycles but do not menstruate, without any medical intervention).
Running on estrogen and progesterone activates a gene sequence which instructs the hypothalamus to attempt to cycle ovary and uterine behavior just as it does in female assigned individuals, regardless of the absence of ovaries or a uterus. This cycle affects numerous organs and subsystems in the body, causing the release of a variety of different hormones and enzymes that can affect function and even behavior.
A more thorough explanation of this will be coming in a later update to the site.
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# Androgenic Second Puberty 101
## What to expect from Masculinizing HRT
This is a compilation of reported medical transition changes collected from testimonials of AFAB trans people taking testosterone hormone therapy. This information is gathered from social media and chat rooms. Yes, that means this is all anecdotal, but historically, most of transgender medical study is anecdotal because no one wants to fund transgender medical research.
**Note that this is a list of _possible_ changes. There is no guarantee that every person on masculinizing HRT will experience all of these. Your age, genetics, medical history, degree of feminization from natal puberty, and hormone regimen can all have impacts on results. There is also just a degree of randomness -- every body is different -- and some things can take years to appear.**
### Voice Drop
Androgens cause the tissue that comprises the vocal chords to thicken and harden, permanently lowering the pitch of the voice. This is not a very fast change, but is incremental over the first year or two. This does *not* mean that you will automatically become read as having a male voice, however, as pitch is only piece of how people gender voice. Vocal training will be needed to amplify resonance and change speaking style.
Androgens encourage extra blood flow to extremities, making them warmer. Because of this, men have cooler cores but warmer oral and surface level temperatures. You may see your basal body temperature increase. The net result is that you will *feel* warmer, and likely will not be able to layer clothing as much as previously possible. If you live in cold climates, exposing your calves can help to dissipate heat without chilling you too severely.
This change often comes fairly early on; expect night sweats while your system gets used to it.
### Changes in Perspiration
With the above shift in temperature distribution, this also results in a significant change in how one sweats. Sweat will pool on the head, back and armpits. You'll also likely sweat more often, so keep water handy.
### Body Odor
Often onc of the first things to change: sweat and general body odor will become much stronger, especially during exercise. The smell will take on a sour, muskier smell. Tends to even out over time.
### Body Hair, Everywhere
Androgens significantly increase the presence of body hair on the legs, groin, buttocks, chest, back and arms. Hair will grow in thicker, longer and darker. This will likely happen well before facial hair growth, which can take over a year to start. Rogaine / Monoxidil can help with that, but be careful as it is poisonous if ingested, especially to cats.
### Male Pattern Baldness
MPD is caused by [Dihydrotestosterone](https://en.wikipedia.org/wiki/Dihydrotestosterone) (DHT), an androgen which metabolizes from Testosterone. Having more T in your body means more DHT can form, and the gene that contributes to MPD causes the hair follicles on the scalp to receive less blood, choking them out until the follicles die. There will likely be *some* loss of hair line eventually, no matter what, but if there is a history of baldness among the men in your family, then you can expect to see that as well. Again, Rogaine can help with this.
The synthetic androgen [Nandrolone](https://en.wikipedia.org/wiki/Nandrolone) does not metabolize into DHT and may be a viable alternative in place of direct Testosterone if hair loss is a concern. However, DHT is important for genital growth, so this is a double-edged sword.
### Thicker and Oilier Skin
Testosterone promotes the thickening and toughening of the epidermis, causing skin to become coarser. As estrogen levels fall, the body will produce less collagen. This causes the skin to become tougher and drier (especially in the knees and elbows). Veins on the hands, arms, and legs may become more pronounced, but not varicose.
Expect your face and scalp to become oilier. Acne is likely to be a problem, and not just on the face. This tends to be worst immediately after dosing.
### Larger Hands / Feet
Over long periods of time (3-5 years) the hands may become tougher and more calloused. You may need to increase your ring size eventually.
Testosterone also causes ligaments and tendons to retain more water, altering their flexibility. Over time this can result in an increase in foot size as the arch of the foot lowers.
### Thicker and Stronger Nails
Both fingernails and toenails will grow thicker over time as keratin levels rise due to the presence of androgens.
### Increased Muscle Mass
Androgens stimulate muscle growth, which is why anabolic steroids (which are literally testosterone) are so common amongst body builders. The body will naturally gain more muscle without even having to exercise, but *with* exercise there can be substantial gains, particularly in the arms and shoulders. Beware, you won't know your own strength at first.
Added lean muscle in the upper body redefines the shoulder and neck line, creating a more masculine silhouette. It also improves the body's ability to process lipids, making weight loss easier.
### Fat Redistribution
Where estrogen encourages the body to deposit fats into the thighs, buttocks, and hips, androgens encourage the body to deposit fats largely into the abdomen. Starting testosterone will encourage your body to follow the androgen pattern, so you can expect new weight to deposit into your belly, while weight loss will take away from all over. Fat in the breasts, thighs and buttocks will slowly shift away as muscle builds, but this may take a long time.
### Facial Feature Changes
Along with body fat migration, fat in the face also moves. The neck, chin and jaw line will fill out while the lips and upper cheeks shrink. The color of the eyes may also change and become fainter in the long term, as testosterone causes the pigmentation in the iris to fade.
This is and extremely subtle and slow moving process that takes years, and it is easy to think nothing is changing at all. The greatest shifts seem to happen in years 3 and 4. Take selfies to compare.
### Increased Tolerance of Caffeine, Alcohol, and/or Psychotropics
More mass means more blood to dilute chemicals into. Increasing testosterone also means a higher metabolic rate, increasing the speed at which toxins are removed from the blood stream.
### Mental Changes
As covered in the [Biochemical Dysphoria]() section, brains can be wired for a certain hormone profile, and running on the wrong profile is like using a laptop with low batteries or an overheated processor. Starting HRT almost universally results in a cessation of depersonalization and derealization (DPDR) symptoms within the first two weeks. A mental fog lifts, and it becomes easier to concentrate on complex concepts (assuming you don't also have other mental processing difficulties such as ADHD).
##### ADHD
If you have ADHD, there may be some changes in your symptoms. Androgens amplify [dopamine](https://en.wikipedia.org/wiki/Dopamine) receptor function, so increasing testosterone can improve the activation potential for dopamine in the brain. Dopamine is a key neurotransmitter in the behavior of [working memory](https://en.wikipedia.org/wiki/Working_memory), the short-term memory of the brain. More working memory means you may become less prone to distractions and have an easier time maintaining [cognitive load](https://en.wikipedia.org/wiki/Cognitive_load).
*However*, estradiol encourages the production of dopamine, so as estrogen levels fall there will be less dopamine for the brain to work with. Your symptoms worsen, not improve.
##### Emotional Expansion
The alleviation of DPDR almost universally is accompanied with a much broader capacity for emotion and emotional regulation. Emotions become somewhat more controllable and suppressible, less likely to overwhelm on the spot. *Please note: suppressing emotions is a very quick way to develop trauma.*
However, the ability to express them may become reduced. Some people lose the ability to cry after starting on testosterone, but this is *not* a universal experience and may be tied into how strong your T dose is. The reasons behind this aren't well known, although some studies have found that androgens alter function in parts of the brain connected to emotional processing. If you do lose the ability to cry, it may return in time as your brain become more acclimated and you come out of second puberty.
Emotional dis-regulation occurs the most commonly before and immediately after dosing (injections or gel) and results in reduced patience, increased aggression.
##### Increased Appetite / Eating Capacity
You are going to be hungry. Testosterone cranks the body's metabolism up significantly, and increased muscle mass means there is more to feed, so you will burn calories faster.
##### Sleep
Some people report problems with insomnia and having fewer memorable dreams. This is far from a universal, however.
Testosterone is known to induce a strong sense of self-confidence in people. Problems seem less significant, self-esteem is stronger, fewer anxieties. Many people report a tendency to be more prone spark arguments, and more willing to speak out in the face of conflict and self advocate. This does *not* mean more hostile or argumentative, simply that ones tolerance for bullshit is lower.
##### Extroversion
It's extremely common for trans people of all types to find themselves much more sociable post-transition. This may simply be a result of no longer having to suppress large portions of their personality, but the aforementioned confidence also plays a role.
All genitalia are constructed from the same tissues, they are merely organized differently during gestation. Much of the behavior of these tissues is regulated by the hormones ones body runs on. Skin secretions, textures, sensitivity and erectile behavior are all hormonal expressions. Which means that when you add androgens, these tissues start acting like they are in the shape of a penis and scrotum, even when they aren't.
##### Bottom Growth
DHT (mentioned above) plays a critical role in the development of the erectile tissue within the genitals. As DHT levels rise with the increase in Testosterone, this will cause the Skene's Gland (sometimes referred to as the female prostate) to swell. This will induce random erections within the clitoris, causing the erectile tissue to grow. The amount of growth varies from person to person, but 1-3 inches is common.
The clitoral hood and labia will become drier and thicker over time, and the inner labia may also start to grow hair. Self lubrication may reduce substantially, and over time penetration may become painful. Use more lube to avoid tearing and bleeding.
##### Increased Emissions During Climax
With the swelling of the prostate comes more prostate fluid. If you weren't a squirter before, you may become one now.
##### Changes in Sensitivity and Response
Erogenous stimulation may become more focused on the head of the clitoris and in stroking of the shaft.
##### Atrophy
Vaginal and uterine atrophy often happens within the first five years, and a hysterectomy may become necessary. Signs of atrophy include a deep throbbing in the lower abdomen and painful cramping without other period symptoms, particularly following intercourse.
Libido will almost certainly go through the roof for the first year or two, the strongest immediately following dosing. May find yourself more assertive during sex and more prone to being dominant and/or a top.
The "shape" of ones orgasm can change. Rather than a cascade, it strikes like an explosion from the groin.
##### Attraction
Testosterone has been shown to increase arousal from visual stimuli. As such, you may *notice* people of your sexual preference much quicker, especially if you are gynephilic (attracted to the feminine shape).
### Cessation of Menstruation
The increase of androgens within the body causes the hypothalamus to down-regulate production of the hormones which control the ovaries. This will reduce total estrogen available, and may halt ovulation. Without ovulation and with lower FSH levels, the uterus will be less inclined to build up and release a lining, causing the cessation of blood flow.
You may still experience other period symptoms, however, as the hypothalamus can continue to express other aspects of the monthly cycle. This can even continue following a total hysterectomy, although it is not common.
**This does *not* mean that you are infertile, however.** Ovulation can still occur even if you are not menstruating. Additionally, halting testosterone will make the old orbs wake up, they do not die.
@ -42,9 +42,9 @@ Furthermore, no surgeon in the United States will perform a gender altering surg
### Hormonal Transition
**Trans Masculine Hormone Therapy** (female to male sexual characteristics) consists of the introduction of testosterone, usually via intramuscular injection or topical gel. The increase in total gonadal hormones typically causes a cessation of ovulation, which is the source of the majority of estrogen produced in the ovaries.
**Masculinizing Hormone Therapy** (female to male sexual characteristics) consists of the introduction of testosterone, usually via intramuscular injection or topical gel. The increase in total gonadal hormones typically causes a cessation of ovulation, which is the source of the majority of estrogen produced in the ovaries.
**Trans Feminine Hormone Therapy** (male to female sexual characteristics) consists of the introduction of estrogen, typically estradiol, via oral pills, patches, or regular injections (intramuscular or subcutaneous). The use of slow dispensing implants is also becoming more and more common. It is also common practice to prescribe an anti-androgen to block testosterone production or absorption. In the United States this is usually Spironolactone, a blood pressure medication which has a testosterone blocking side-effect. Outside of the US the most common drug is Cyproterone Acetate, an androgen receptor blocker, which is not available in the US. Doctors may also prescribe Bicalutamide, which also blocks androgen receptors. However, some doctors may simply opt to use larger estradiol doses in order to cause the body to halt testosterone production.
**Femininizing Hormone Therapy** (male to female sexual characteristics) consists of the introduction of estrogen, typically estradiol, via oral pills, patches, or regular injections (intramuscular or subcutaneous). The use of slow dispensing implants is also becoming more and more common. It is also common practice to prescribe an anti-androgen to block testosterone production or absorption. In the United States this is usually Spironolactone, a blood pressure medication which has a testosterone blocking side-effect. Outside of the US the most common drug is Cyproterone Acetate, an androgen receptor blocker, which is not available in the US. Doctors may also prescribe Bicalutamide, which also blocks androgen receptors. However, some doctors may simply opt to use larger estradiol doses in order to cause the body to halt testosterone production.
**In adolescents**, puberty blockers may involve the above androgen blockers, or if it is covered by insurance, the use of an antigonadtropin (drug which blocks the hormones that cause the production of estrogen and androgen) such as leuprolide acetate (a shot delivered every few months) or histrelin acetate (an annual implant).
@ -54,7 +54,7 @@ Transgender surgeries are typically divided into three separate categories:
**Bottom Surgery** (modifications to genitals).
- Trans Feminine:
- Femininizing:
- Orchiectomy (removal of the testicles)
- Scrotectomy (removal of scrotal tissue, following orchiectomy)
@ -69,7 +69,7 @@ An additional option for non-binary bottom surgery is genital nullification surg
{!{ </div></div></div> }!}
- Trans Masculine:
- Masculinizing:
- Hysterectomy (removal of uterus and cervix)
- Oophorectomy (removal of one or both ovaries)
@ -81,11 +81,11 @@ An additional option for non-binary bottom surgery is genital nullification surg
**Top Surgery** (modifications to the chest)
- Trans Feminine:
- Feminizing:
- Breast Augmentation via fat transfer or implants.
- Trans Masculine:
- Masculinizing:
- Bilateral Mastectomy (breast tissue removal) with chest reconstruction.
@ -93,7 +93,7 @@ An additional option for non-binary bottom surgery is genital nullification surg
The younger a person is, the less they will need these surgeries, especially if they medically transition prior to the age of 20.
- Trans Feminine:
- Feminizing:
- Forehead recontouring
- Eye socket recontouring
@ -108,7 +108,7 @@ An additional option for non-binary bottom surgery is genital nullification surg
@ -22,7 +22,7 @@ Unfortunately, it is not very common for this to be possible with the cis female
{!{ </div></div></div> }!}
The three most common anti-androgens are **Spironolactone**, **Cyproterone Acetate** and **Bicalutamide**. A fourth method often used is a Gonadotropin-Releasing Hormone (GnRH) argonist, such as **Leuprolide** (Lupron) or **Goserelin** (Zoladex) which works by overloading GnRH receptors until they stop responding.
The three most common anti-androgens are **Spironolactone**, **Cyproterone Acetate** and **Bicalutamide**. A fourth method often used is a Gonadotropin-Releasing Hormone (GnRH) agonist, such as **Leuprolide** (Lupron) or **Goserelin** (Zoladex) which works by overloading GnRH receptors until they stop responding.
### Spironolactone (Brand Name: Aldactone):
@ -32,7 +32,7 @@ Spironolactone (commonly shortened to "spiro") is the most commonly used AA in t
How does spiro work? Well if receptors are locks, spiro is a master key. It fits into a bunch of steroid receptors, androgen, progesterone, and cortisol. For some it binds exceptionally well (aldosterone and dexamethasone), and some just ok (testosterone). For aldosterone it functions as a powerful antagonist, preventing the kidneys from receiving aldosterone from the adrenal glands. Aldosterone slows down kidney function so that body retains water, and spiro blocks that message, causing them to release the water instead.
In androgen and progesterone receptors it is a partial argonist, turning the key just a little bit, just enough to make the radio turn on, but not strongly activating the cell’s response to those chemicals. It is only enough to tell the hypothalamus that there are androgens and progestins present in the blood stream, so it slows down testosterone production.
In androgen and progesterone receptors it is a partial agonist, turning the key just a little bit, just enough to make the radio turn on, but not strongly activating the cell’s response to those chemicals. It is only enough to tell the hypothalamus that there are androgens and progestins present in the blood stream, so it slows down testosterone production.
The other way that spiro works is that it prevents the formation of various enzymes that the body needs in order to produce testosterone. Without these enzymes, the testes and adrenal glands literally cannot form testosterone molecules.
@ -54,7 +54,7 @@ Another common sign of low sodium is muscle spasms and leg cramps (charley-horse
Cyproterone Acetate (commonly shortened to "cypro") is probably the most commonly used transgender anti-androgen outside of the United States, where it was never approved by the FDA for sale to patients. This is mainly because no company has ever found it profitable to undergo the complicated process necessary for FDA approval. Additionally, the the drug has a troublesome history, with early studies finding it connected to high liver cancer risks. It also picked up a stigma of causing blood clots due to its pairing with ethinyl-estradiol in the contraceptive Diane-35.
Cypro works in two ways, first by functioning as a powerful receptor antagonist, competing with testosterone for androgen receptors. Additionally, cypro functions as a mild progesterone argonist with poor transactional ability, just enough to convince the hypothalamus that the body is flush with progesterone and thus reducing hormone production. Unfortunately, this means that cypro competes with progesterone, and can hindering its effectiveness, but it does make it quite affective at lowering testosterone levels in the blood stream.
Cypro works in two ways, first by functioning as a powerful receptor antagonist, competing with testosterone for androgen receptors. Additionally, cypro functions as a mild progesterone agonist with poor transactional ability, just enough to convince the hypothalamus that the body is flush with progesterone and thus reducing hormone production. Unfortunately, this means that cypro competes with progesterone, and can hindering its effectiveness, but it does make it quite affective at lowering testosterone levels in the blood stream.
The common dosage for cypro in trans HRT is 25mg, with a maximum dose of 100mg. Because the drug is so hard on the liver, staying below 50mg is recommended.
@ -80,7 +80,7 @@ The on-label use of Finasteride is for fighting prostate cancer and preventing m
Tip: Insurance companies are more likely to fully cover the cost of the 5mg dose, rather than the 1mg, as the larger dose is usually prescribed for prostate cancer, where the smaller is just for hair loss.
@ -90,9 +90,9 @@ LH causes the production of testosterone in both the testes and the ovaries, but
GnRH Agonists, as the name implies, interface with GnRH receptors on the pituitary gland and trigger a constant stream of LH, which initially causes the testes and ovaries to crank up production. However, because the drug doesn’t pulse, the receptors eventually become overloaded and stop listening, causing LH levels to plummet, and shutting down both testicle and ovarian function.
GnRH Argonists are extremely effective and have very minimal side-effects and are the preferred method for blocking puberty in adolescents of both sexes. Unfortunately, GnRH Argonists are extremely expensive (upwards of $1000 per dose, or more) and are rarely covered by insurance for use in adults.
GnRH Agonists are extremely effective and have very minimal side-effects and are the preferred method for blocking puberty in adolescents of both sexes. Unfortunately, GnRH Agonists are extremely expensive (upwards of $1000 per dose, or more) and are rarely covered by insurance for use in adults.
The three most common GnRH Argonists are Leuprolide Acetate (brand name Lupron), Goserelin (brand name Zoladex), and Histrelin Acetate (brand names Vantas and Supprelin). Leuprolide is a shot delivered every 2-3 months. Goserelin and Histrelin are annual implants, typically placed under the skin of a forearm.
The three most common GnRH Agonists are Leuprolide Acetate (brand name Lupron), Goserelin (brand name Zoladex), and Histrelin Acetate (brand names Vantas and Supprelin). Leuprolide is a shot delivered every 2-3 months. Goserelin and Histrelin are annual implants, typically placed under the skin of a forearm.
title: "Transfeminine HRT - What to Expect When You're Expecting Boobs"
description: From the Bs to the Ds.
classes:
- hrt
siblings:
prev: /hrt/fem/progestins
---
Transfeminine HRT
What to Expect When You're Expecting Boobs
===
This is a compilation of reported medical transition changes collected from testimonials of trans women from various discussion forums and chat rooms. Yes, that means this is all anecdotal, but most of transgender medical care is anecdotal.
**Note that this is a list of _possible_ changes. There is no guarantee that every person on transfeminine hormone replacement therapy will experience all of these. Your age, genetics, medical history, degree of masculinization, and hormone regimen can all have impacts on results, and some things can take years to appear.**
### Changes connected to reduction of Testosterone:
- Reduction in general body odor and change in the smell of ones sweat.
- Many report gaining a sweet smell.
- Users of Spironolacotone may notice a total cessation of body odor entirely.
- Skin softens and becomes thinner.
- Expect varicose veins.
- Reduction in skin oils, causing face and scalp to become drier.
- Significant reduction in acne.
- Thinner and softer finger and toe nails.
- Reduced body hair growth, hairs become thinner and shorter.
- Do not expect total cessation of body hair, you will still likely need some laser treatments.
- Emotional expansion
- Less stoicism and disassociation, and you will regain the ability to cry
- You need Estradiol in order to push this to its fullest
- Reduced muscle mass / harder to gain muscle
- This contributes massively to feminine shoulder and neck line, as well as the waist line.
- Strength diminishes significantly, become unable to open jars.
- Loss of random erections / morning wood
- Failure to regularly give oneself erections can result in atrophy of the tissue, leading to shrinkage.
- Prolonged atrophy can cause painful erections.
- Loss of sex drive, frequently a total loss of libido.
- This returns eventually once the body gets used to running on estrogen, especially with the addition of progesterone, but it will not feel anything like what you're used to.
- Sterility + testicle atrophy
- Testicles shrink in size.
- Atrophy pain is common in the first year. May present as a dull throbbing or as sharp sparks which travel through the genitals.
- Deepening or changes in eye color
- Testosterone causes a fading of iris pigmentation.
- Hairline restoration
- Total reversal of baldness is unlikely, but almost everyone regains some hair line.
- Salt/Pickle cravings
- This is specific to those on Spironolacotone, which is a diuretic that causes you to pee out all your sodium
### Changes attributed to Estradiol:
- Breast growth
- Extreme nipple sensitivity at the onset
- Expect aches and pains in the upper chest
- Nipples will get larger, areolas become more visible
- Fat redistribution into feminine proportions
- Reduction in the waist and upper body, flattening and softening of belly, gains in hips, thighs and upper arms.
- Lower center of gravity
- This results in a change of gait
- Walking with the hips becomes the body's natural movement
- Facial feature changes
- Chin and jaw line will thin out.
- Cheeks and lips will puff up
- Brow and upper eye lids will lift, exposing more of the eyeball.
- Eyelashes will grow thicker and longer
- This is extremely subtle and slow going and it's easy to think nothing is changing at all. Take selfies to compare.
- Changes in tissue around the eye can alter the shape of the eyeball, changing focal depth and altering vision clarity
- Slimmer hands, wrists and feet.
- Ring size will drop as fat moves off the hands and the skin thins, making the fingers thinner
- Finger length will drop as ligaments thin and shift
- Feet shrink both in length and thickness due to ligament and fat changes.
- A drop in two or even three shoe sizes is extremely common.
- [Pelvic tilt](http://en.wikipedia.org/wiki/Pelvic_tilt) causing an increase in curvature of the back and an increase in butt protrusion.
- Potentially a loss of 1-3 inches in height.
- Note: This is NOT the same as the [hip rotation](https://youtu.be/OROoZzoVwfk?t=12) that occurs in AFAB puberty.
- However, that can still happen over very long stretches of time. An 80 year old trans woman reported on reddit last year that over the course of her 30 years on HRT, her doctor observed changes in her pelvis consistent with female hip rotation.
- Improved flexibility due to ligaments stretching
- Scalp hair becomes thicker and follicles grow stronger, allowing hair to grow to longer lengths.
- Hair can also become curlier
- Hair may change color
- Emotional expansion
- Higher highs and lower lows
- Mood swings, random crying
- Crying from joy
- Erogenous zone development
- Multiple. Full body. Female. Orgasms.
- Pelvic orgasm becomes harder to achieve, but stronger in intensity
- Full body orgasm becomes possible, but may be hard to reach without a partner
- Penis and scrotal tissue changes
- Increased sensitivity
- Skin moistening, change in odor (scrotum and penis begin to smell vaginal)
- Coloration changes, particularly along the [perineal raphe](https://en.wikipedia.org/wiki/Perineal_raphe)
- Skin along the shaft and glans thins and becomes more prone to tears/bruising during sex
- Perineum becomes very soft to the touch, velvet like
- Perspiration distribution changes
- Sweating becomes more of a full body experience, less focused on the scalp.
- Underboob sweat will become a thing
- Changes in body temperature placement
- Reduced tolerance of temperature changes
- Women have warmer cores but colder extremities.
- Oral and skin thermometers may show a lower temp (~97.6)
- Improved color perception
- Significantly improved sense of smell, especially of other bodies
- Will be very intense when it first unlocks but then calms down as your brain gets used to it.
- Changes in taste perception
- Many people report cilantro becoming more palatable.
- Chocolate addiction _(Only half kidding)_
### Changes attributed to Progesterone:
- Increased appetite, food cravings
- Progesterone increases mitochondrial function, boosting metabolic rate. That gives you more energy, but it also means you consume calories faster.
- Increased libido / sex drive
- Note, the change in libido may not be immediately obvious, as [estrogenic sex drive feels completely different](https://curvyandtrans.com/p/5BF1EA/libatious-libidos/) from androgenic sex drive..
- Breast fullness and improved breast development
- Progesterone is a critical hormone in the maturation of milk ducts. It also encourages the body to favor breast tissue for fat deposit.
- Improvement of impulse control
- Deeper sleep with potential for much more vivid dreams
### Changes that cannot be specifically attributed to a single component of HRT.
Some of these may simply be the brain getting what it finally wants.
- Drastic reduction in depersonalization / derealization symptoms
- Improved clarity of thought (many reports of improved multitasking)
- Increased chattiness and generally more extroverted
- Less likely to engage in arguments or fights, more likely to attempt to defuse or escape heated situations
- Improved balance & spacial awareness (less bumping into walls or kicking doorways)
- A sense of feeling smaller in the world.
- This is not just because of physical body changes, your perception shifts and you feel actually smaller.
- Reduced tolerance of caffeine and alcohol
- Testosterone increases body mass which increases alcohol tolerance.
- Estrogen slows metabolic rate, decreasing the speed at which toxins are processed.
- Spironolacotone and oral estradiol strain the liver and hinder metabolism of toxins.
- Changes in ADHD symptoms and/or intensity
- For some it improves, for others it gets much worse.
- This is much more likely for users of Spironolactone
- Lactation
- A few drops is to be expected, especially while nipples are being stimulated, and is merely a sign of milk ducts forming properly.
- Significant discharge may be a sign of a dangerous hormone imbalance and should be checked by a doctor.
- Cyclical period symptoms.
- [Yes, for real](https://curvyandtrans.com/p/C4BD87/cycle-dynamics/).
- No menstruation, because there is no uterus, but all other typical period symptoms can manifest in 26-33 day cycles.
- Symptoms vary greatly (just as in cis women) and typically last for 4-5 days. Use of a period tracker can reveal the pattern.
- Cramps in the intestine and abdominal muscles
- Ranges from a slight flutter in the gut, to strong painful spasms
- Bloating, Gas, Diarrhea and other intestinal issues ("period poops")
"full_text":"@salenby @chaoticgaythey The jokes about teenage boys always being horny, well, it's a thing. Not uncontrollably, get yourself in trouble horny, but I'd have sex multi times a day...\n\nAlso, I find I 'notice' women more now, I still mostly prefer men but the ratio has adjusted a bit more towards center.",
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"description":"17 • Read pinned before you follow • 🍄🔪🦎🐌🐛🪐🏳️⚧️ 🏳️🌈 • Gendervague Trans Man • autistic and hypermobile • he/him and bug/bugself • white • singlet",
"full_text":"@salenby @chaoticgaythey Night sweats/being HOT even at normal room temperature. The night sweats went away after a week or two the being constantly warm has not gone away it has just become normal. \n\nYour scent changes, even the smell of your urine. Like I knew that going in, but it was still weird.",
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"full_text":"@salenby Orgasms being different was meantioned and I have to second this.\n\nMy clit now really functions like a small penis.\n\nSo, before I would have these orgasms that could be very intense, yet never satisfying. Now my orgasms are less intense, but it's like, I actually feel I \"finish\".",
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"full_text":"@salenby I know a lot of people have the effect that they can't cry. But honestly, I'm about to cry right now just thinking about crying.\n\nI'm extremely sensitive and emotional now in a way that I didn't allow myself before.\n\nI cry a lot, but it's always tears of joy now.",
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"full_text":"@salenby Nsfw text //\nAlso, ball stank is not a product of balls. It's a product of T. Your junk will smell like balls.\nIf your clit/dick gets bigger, so will your clitoral hood. Congrats, you now have a foreskin. Wash under that guy or you will regret it.",
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"description":"24 butch fan writer/artist/game dev/VA 🌱 creator/host of @willithomestuck 🌱 directing @hsnewgameplus 🌱COMMISSIONS OPEN - SEE PINNED 🌱 icon by @g0atheart",
"description":"They/Them. Embroidery artist and art liker. Full grown adult person who still likes pokemon maybe too much. 18+ since things get a little spicy here sometimes",
"full_text":"@salenby @FoxxyGlamKitty I've been on T for literally a week and a half, and all I will say is that bottom growth and increased libido starts waaaayyyy quicker than you might think.",
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