This morning I was walking across a hospital lobby when I saw a lovely young woman walk through the doors. She was quite tall, fashionably dressed, with platinum blond hair. I wish I was that tall and/ or blond, I thought, and went on my way. I was two feet away from her before I realized with a start that this was one of our transgender patients. I hadn’t seen her for a few months, and in that interval she had started hormone treatment. She looked confident, cheerful, and beautiful.

Biological males who are transgender can physically transition to being young women and not only find significant improvement in their mental health, but also a new pleasure in being in their own skin. Society tends to think of a MTF transgender person as looking like “a man in a dress”- which is a fine option for MTFs who wish to appear that way. But MTF people who want to “pass”, or appear fully female to an outside observer, may have that option as well.

MTF teens and their families may opt for starting pubertal suppression. This offers the opportunity for the patient’s features and body to develop in the most traditionally feminine manner possible. An MTF teen who has had pubertal suppression and then hormone therapy may have features and a body shape indistinguishable from that of a female-born patient (as well as not having to deal with persistent facial hair or a deep voice.)

One of the hormones used for MTF patients is estrogen. Let’s examine some of the physical changes of estrogen on a biologically male body:

  • Skin: On average, women have softer skin than men, and MTF patients usually notice their skin is changing texture after they start hormones.
  • Body Fat: MTF patients will see their body fat redistribute to a more “feminine” pattern, accumulating around the hips and buttocks instead of the belly.
  • Body Hair: If facial and body hair are already present, growth may slow and change, but the hair will not go away completely. This is one of the reasons why pubertal suppression can be desirable; that way, typically male facial and body hair won’t occur in the first place.
  • Erections: An MTF patient will find that erections diminish or disappear soon after taking hormone therapy. Sperm production will be decreased, as well. If your teen may want to have a biological child, it’s important to look into sperm banking before treatment is started.
  • Breast Growth: It takes 1-2 years, but eventually MTF patients on hormones will experience breast growth, and possibly nipple growth as well
  • Testicular size: Over time, the testicles will shrink.

These changes are not permanent, and will go away if hormone therapy is stopped, with the exception of breast growth and a decrease in sperm production that may result in infertility.

It should also be noted that long-term estrogen therapy may increase the risk of certain cancers, such as breast cancer. Unfortunately, we don’t have enough research on transgender health to know more information.

MTF patients need to keep taking estrogen for as long as they want its feminizing effects on the body. For most transgender patients, the inconvenience of a lifetime medication is far outweighed by the joy of living in a body that is closer to expressing who they are inside.