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Estrogen for Feminizing Hormone Therapy: What You Need To Know

Feminizing hormone therapy is a complex cocktail of medications that work together to support the social and physical transition from male to female. No two transitions are exactly the same, meaning that each individual will have different needs when it comes to their hormone therapy. However, one thing remains constant – estrogen! This post breaks down everything you need to know about estrogen for feminizing hormone therapy.

What is estrogen for hormone therapy?

Estrogen is a sex hormone that is produced in both men and women, but in different amounts. Women have higher levels of estrogen, which leads them to develop secondary sex characteristics during puberty such as breasts, wider hips, increased fat storage, and thicker skin. Men have lower levels of estrogen, but still enough to support their sexual function and overall health. When it comes to hormone therapy, estrogen is the primary hormone used for feminizing hormone therapy. Estrogen is typically delivered in the form of pills, patches, gels, or creams, which are then metabolized by the liver into estrogen. This process takes two to three weeks (with patches), or one to two hours (with creams). The estrogen metabolized by the liver then travels through the blood, stimulates specific estrogen receptors in the body, and triggers changes as a result.

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How does estrogen support feminizing hormone therapy?

Estrogen plays a huge role in helping shape the transition from male to female. There are many ways that estrogen can support feminizing hormone therapy and help create the desired changes. – Builds breast tissue – Since estrogen is high in breast tissue, it’s the perfect hormone for building breast tissue in trans women. – Stimulates smooth, soft skin – Along with estrogen, androgens break down collagen and elastin, which are two key proteins found in skin. During feminizing hormone therapy, estrogen also increases the amount of skin cells, meaning more collagen and elastin can be broken down and replaced with smooth skin. – Redistributes body fat – Since estrogen increases fat storage, it makes sense that trans women on estrogen therapy would store more fat on their hips, thighs, and breasts. – Stimulates hair growth – Estrogen stimulates hair growth, but can also make hair fall out. This is why people who have a higher level of estrogen often experience hair thinning. – Changes in mood, energy, and libido – Typically, estrogen has a positive effect on mood, energy, and libido.

Estrogen and body changes during feminizing hormone therapy

  • Body fat redistribution. Estrogen increases fat storage, which leads to a redistribution of fat from the abdominal area to the hips, thighs, and breasts.
  • Increased body fat. Along with increased fat storage, estrogen also leads to an increase in body fat.
  • Hair thinning or loss. Estrogen encourages hair growth, but also makes hair fall out.
  • Lower muscle mass. Since estrogen keeps muscle mass low, estrogen therapy can lead to a decrease in muscle mass.
  • Less frequent and reduced sperm production. Since estrogen reduces testosterone, sperm production decreases. As a result, many trans women stop producing sperm.
  • Mood swings. A lot of trans women experience mood swings when they first start estrogen therapy. These mood swings typically disappear within a few months.
  • Nausea. Some trans women experience nausea when first starting estrogen therapy.
  • Nipple sensitivity. Many trans women experience sensitivity in their nipples.
  • Skin softening. Estrogen encourages skin cells to break down and replace themselves with smooth, soft skin.
  • Water retention. Estrogen encourages water retention, which leads to swelling in the hands, feet, and ankles.

Dosage and timing of estrogen during HRT

  • Your dosage will depend on your age, health conditions, and goals for HRT.
  • Dosages for estrogen therapy are typically between 0.25 mg to 1 mg.
  • Dosage timing varies depending on the method of delivery. For estrogen pills and patches, you take one pill or patch per day.
  • For creams and gels, you apply them once or twice a day.
  • Once you know the correct dosage, you can then schedule your estrogen therapy.
  • The standard estrogen therapy schedule is to take estrogen every day.
  • A two-week break every three months is also a common method. This is especially useful for people who experience side effects or don’t want to take estrogen every day.

Mixed Estrogens

While most trans women take estrogen alone, some may take both estrogen and testosterone inhibitors (AI) to stop testosterone from breaking down estrogen. These are known as mixed estrogens, and many trans women prefer to take both a testosterone inhibitor and estrogen to prolong their HRT. The main benefit to taking both a testosterone inhibitor and estrogen is that it extends the length of your HRT by reducing the amount of estrogen you take each day. For example, if you take 0.25 mg of estrogen a day and 0.25 mg of an AI, you will experience the same estrogen effects as someone who takes 0.5 mg of estrogen alone. While taking both estrogen and an AI is safe, it doesn’t offer any additional benefits over taking estrogen alone.

Transdermal Estrogen Patch (Estrogen Patch)

The transdermal estrogen patch is a small, thin patch that adheres to your skin and releases estrogen into your body throughout the day. The patch contains estrogen and a small amount of an AI to prevent your body from breaking down estrogen. The patch is applied once a day, with most people keeping it on their back, stomach, or thigh. The patch takes two to three weeks to fully dissolve, but can be removed any time before then. The estrogen patch is a popular method among trans women who wish to have greater control over the timing and amount of estrogen in their body. While the patch adheres to your skin, the rest of your body functions as normal.

Vaginal Estrogen Gel (Vaginal Estrogen Therapy)

Vaginal estrogen therapy is a method of delivering estrogen through a vaginal cream, gel, or liquid. The estrogen is applied to the inside of the vagina and absorbed into your body through the vaginal wall. The amount of estrogen absorbed varies from person to person and is completely individualized. You can also choose to apply the gel to the outside of your vagina, but this isn’t recommended for long-term use. Since the estrogen is absorbed through the vaginal wall, it’s a great choice for trans women who are experiencing menopause. This is because estrogen that is absorbed through the vagina travels to the uterine tissue and ovaries.


Estrogen is the main hormone used for feminizing hormone therapy, and it comes in many forms. The standard dosage is between 0.25 mg to 1 mg, and you can apply it one of three ways: pills, patches, or creams. The transdermal estrogen patch takes two to three weeks to fully dissolve, while the vaginal estrogen gel is applied once a day. Once you know the correct dosage, you can then schedule your estrogen therapy.

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