Some transgender women and transfeminine non-binary people choose to undergo hormone therapy to feminise their bodies and resolve body dysphoria. In most cases, this also has positive effects on physical and mental health.
If you are looking to pursue HRT, it is highly recommended to seek advice from qualified medical professionals to assess your suitability for HRT and better understand its risks and benefits.
Proper medical supervision and regular blood tests are required to ensure your medical safety. Ideally, you should take a blood test before starting HRT to check your baseline hormone levels. This also checks if you have any medical conditions or are on any medication/treatment which may interfere with HRT.
HRT changes your biological profile to that of the sex you are transitioning to, and this includes the respective health risks for each sex. HRT thus also affects blood test results, which should be measured against that of others of that sex.
HRT is well-supported and recommended by medical authorities as the appropriate treatment for transgender people with body dysphoria.
After gonadal removal, HRT is necessary for proper health function, as your body would no longer produce its own sex hormones, and without HRT will result in health problems similar to that experienced at menopause and andropause.
Introduction to feminising hormone therapy
A person’s hormonal profile is dependent on the gonads they were born with; as most people undergoing transfeminine hormone therapy have testes, the clinical goal of the treatment would be to decrease or eliminate the effects of testosterone (T) and dihydrotestosterone (DHT) and increase the level of estrogen in the body so that its feminising effects may take place.
The major forms of feminising hormones in the body are estrogens (primarily estradiol, also known as E2 or E) and progestogens (mainly progesterone, also known as P4 or P). Both of them are responsible for and determine the body’s secondary sex characteristics, much like T in men.
Estrogens are the chief sex hormone used in transfeminine hormone therapy. They cause feminization, which includes breast development, a softening of the skin, a feminine pattern of fat distribution, a widening of the hips, and other physical changes.
Progestogens have no known role in physical feminisation, but perform important functions in the female reproductive system and are essential hormones during pregnancy. Some believe, based on anecdotal evidence, that progestogens have an effect on sexual desire and function in patients undergoing transfeminine HRT, though this has not been well proven.
Anti-androgens (AA) are medicines that reduce or block the effects of androgens like T and DHT. In the context of transfeminine HRT, they are typically prescribed to pre-operational or non-operational patients to suppress endogenous androgen production. AA is not required for post-operative patients who have had their gonads removed.
Sex hormones also affect the brain, influencing cognition, emotions and behaviour. Androgens and estrogens both play roles in regulating sexual desire and arousal.
Obtaining feminising hormone therapy in Singapore
Your doctor will assess your suitability for hormone therapy and discuss the risks and benefits of treatment. Ideally, you’ll first be given baseline laboratory blood tests to determine if you have any concurrent medical issues that may affect your suitability for HRT or your dosage level. This also allows your doctor to know if any future medical concerns are due to HRT or pre-existing conditions.
These tests should be repeated regularly after treatment is initiated to ensure that everything is going fine, after which the frequency can be decreased to about once a year.
Some doctors will recommend starting on a low dose and gradually ramping up to normal dosage levels so as to give your body time to adapt.
Take a look here for more information on how to obtain gender-affirming hormone treatment in Singapore.
Types of transfeminine hormone therapy in Singapore
With the exception of injectables, many routes are available for the administration of estrogen, progesterone and anti-androgens. A table of locally available prescriptions can be found below:
|Type||Brand name||Biochemical name||Route of Administration|
|Estrogen||Estrofem (1mg /2mg)||Estradiol Hemihydrate||Oral/ Sublingual|
|Estrogen||Progynova||Estradiol Valerate||Oral/ Sublingual|
|Anti-androgen||Androcur||Cyproterone acetate (CPA)||Oral|
|Anti-androgen||Spirolon (25mg)||Spironoactone (Spiro)||Oral|
|Progesterone||Oral micronised progesterone||Oral/rectal|
Expected changes from transfeminine hormone therapy
Effects of feminising HRT will often include: breast growth; softening of skin and hair; reduced musculature and strength; fat redistribution to hips and thighs; increase in fat-to-muscle ratio; thinning of facial and body hair; slowed or stopped head hair loss; decrease in size of testicles and genitalia; and a decrease in bone density.
Every person’s body is ultimately different, and expected changes will likely vary significantly between individuals due to factors like genetics, diet and hormone levels as well as HRT regimen and at what age HRT began.
Some potential side effects include erectile dysfunction, loss of ability to ejaculate, loss of libido, infertility, weight gain, mood swings, depression, increased risk of deep vein thrombosis, and an increased risk of breast cancer.
|Breast development||2–6 months||2–3 years||Permanent|
|Reduced and slowed growth of facial and body hair||3–12 months||>3 years||Reversible|
|Cessation and reversal of scalp hair loss||1–3 months||1–2 years||Reversible|
|Softening of skin and decreased skin oiliness and acne||3–6 months||Unknown||Reversible|
|Redistribution of body fat in a feminine pattern||3–6 months||2–5 years||Reversible|
|Decreased muscle mass and strength||3–6 months||1–2 years||Reversible|
|Widening and rounding of the pelvis||Unknown||Unknown||Permanent|
|Changes in mood, emotionality, and behaviour||Immediate||Unknown||Reversible|
|Decreased sex drive and spontaneous erections||1–3 months||3–6 months||Reversible|
|Erectile dysfunction and decreased ejaculate volume||1–3 months||Variable||Reversible|
|Decreased sperm production and infertility||Unknown||>3 years||Mixed|
|Decreased testicular volume||3–6 months||2–3 years||Unknown|
|Voice changes (e.g., decreased pitch/resonance)||None||N/A||N/A|
|Height changes (e.g., decrease)||None||N/A||N/A|
Some effects of a previous masculine puberty cannot be reversed with transfeminine hormone therapy; while facial and body hair can be thinned through transfeminine hormone therapy, permanent removal of facial hair can only occur with laser hair removal and electrolysis.
Skeletal changes – such as widening and rounding of the pelvis or height changes – may not occur after a person’s growth plates close during puberty.
Other effects of a masculine puberty may also be very difficult to reverse without surgical interventions, such as facial feminisation surgery, a tracheal shave, as well as breast augmentation and bottom surgery.
While T may induce a lower vocal pitch in transmasculine HRT patients, E does not have the reverse effect. Voice changes can only be achieved with speech therapy and voice training or surgery.
Notes on fertility
HRT usually but not always results in infertility. There is a very small possibility that you may get someone with a uterus pregnant even when on estrogen; take all necessary precautions. A good rule of thumb would be to assume you can have children unless you have had a vasectomy or orchiectomy.
Loss of fertility may or may not be reversible upon cessation of HRT, depending partly on how long it has been. Some trans people thus choose to bank their sperm or eggs prior to undergoing HRT. Others temporarily pause HRT while they attempt to have a child, with success varying on a case-to-case basis.
Trans women may have to stop HRT for several months in order to attempt to bank their sperm.