6 main body changes induced by MtF HRT

Posted on October 16, 2018 by Aaricia

The impact of Hormone Replacement Therapy on the Male-to-Female body varies greatly from person to person, and it is therefore wise to stay realistic. But there are six significant effects that are generally quite common!

6 main body changes induced by MtF HRT

Illustration by Katja Tetzlaff, 2015. Ktetzlaff.com

Breast development

  • Within the first few months of hormone therapy, the tissue behind the nipple will start to develop. The area around the nipple will get more sensitive and tender, and the nipples themselves will probably feel sore, just like they do in adolescent females.
  • It usually takes 2 years for the breast growth to reach its maximum size. There is no saying how much growth there may be, and growth is not comparable to that of adolescent females. In some there might not be any growth, in which case some may opt for MtF breast augmentation procedures.


  • The skin will become much softer, more translucent and less rough.

Fat distribution

  • Over a time of typically 1 to 2 years, the existing body fat will redistribute itself into a typically feminine pattern.
  • The body will begin to burn the fat located in the waist, shoulders and back.
  • The majority of the fat will migrate to the hips, thighs and buttocks, which may result in a smaller waist and larger hips.
  • There is a tendency for fat to centralize in the stomach for men, and this may diminish.

Sexuality and genitals

  • The testes will get much smaller in size and it is likely that the size of the penis diminishes. The production of sperm and testosterone will also reduce greatly.
  • Sexual function will decrease, but it is hard to say to which extent performance will be affected.
  • In some cases erections will no longer be possible, in others they may. On average the erections will become less frequent and less long. However! It is important to remember that the ability to orgasm does not depend on any of these factors!

Body hair

  • The normal process of scalp hair loss in men is stopped.
  • Body hair will become thinner, lighter, softer and less coarse.
  • The hair on the arms, legs, chest, abdomen and shoulders will greatly lessen over the years, and in some instances it might disappear completely.
  • Beard hair that is present at the start of HRT will remain, and can only be removed completely with electrolysis hair removal.

Muscle mass

  • Depending on the amount of muscle mass in a person, there may be a slow decline in the bulky upper body appearance.
  • The existing muscles will become weaker.


Are there any side effects to Hormone replacement therapy?

Yes. Possible side effects of HRT in trans women may include fatigue, lethargy and long-term infertility. One will most likely also discover an increase in emotionality. Other than that, the risk of thrombosis (blood clots) will increase, especially in smokers.


Bear in mind:

While one might like to see the effects of HRT sooner rather than later…

  • Every body is different! In some people these effects may remain absent, and in some they may be more pronounced.
  • It takes time, sometimes a lot of time, for effects to become visible, in some more so than in others. So try to be patient with your body!


How long will it be until I see the development of my breasts?

In general, you will start to notice breast development between three and six months after starting with HRT. After two years they will have reached their maximum natural size. However, in some people there may not be any growth at all. Read more about the effects of HRT on the MtF body.

When does fat redistribution start when taking HRT?

You will be able to really start noticing changes from about 6 months onward after having started HRT. In some people it may take longer before they start seeing changes.

Should I wait with FFS until I have taken hormones long enough?

The hormones will have their effect on the soft tissues of your face: the fat will redistribute and the muscles will atrophy a bit. Also the facial hair will diminish and hair to the scalp will become denser and thicker. All this will make your face look softer and more feminine.
Dr van de Ven will try to make your face as feminine as possible and there is no negative effect to your face becoming even more feminine after your FFS due to the hormones. Those last changes will be very subtle. Therefore Dr van de Ven does not see a reason to postpone FFS if you have only started taking hormones recently.

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.

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