Gender-affirming hormone treatment with feminizing effects

Effect	Onset	Maximum
Redistribution of body fat	3 to 6 months	2 to 3 years
Decrease in muscle mass and strength	3 to 6 months	1 to 2 years
Softening of skin/decreased oiliness	3 to 6 months	Unknown
Decreased sexual desire	1 to 3 months	3 to 6 months
Decreased spontaneous erections	1 to 3 months	3 to 6 months
Male sexual dysfunction	Variable	Variable
Breast growth	3 to 6 months	2 to 3 years
Decreased testicular volume	3 to 6 months	2 to 3 years
Decreased sperm production	Unknown	>3 years
Decreased terminal hair growth	6 to 12 months	>3 years*
Scalp hair	Variable	—^¶
Voice changes	None	—^Δ

* Complete removal of male sexual hair requires electrolysis or laser treatment or both.

¶ Familial scalp hair loss may occur if estrogens are stopped.

Δ Treatment by speech pathologists for voice training is most effective.

Reproduced from: Hembree W, Cohen-Kettenis P, Gooren L. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102(11):3869-3903. By permission of Oxford University Press on behalf of the Endocrine Society. Copyright © 2017 Oxford University Press. Available at: https://www.endocrine.org/guidelines-and-clinical-practice/clinical-practice-guidelines/gender-dysphoria-gender-incongruence.

Graphic 54189 Version 16.0