MtF hormones for transgender women

MtF hormones for transgender women

Prof. Dr. Luc Van Gaal – Professor in Endocrinology, Diabetic and Metabolic Diseases at the UZA (University Hospital Antwerp)


For many, MtF hormones (also called hormone replacement therapy or HRT) is one of the first steps in the transition. If the patient is a transgender woman, she is given female hormones while at the same time reducing the production of male hormones. For transgender men, it is exactly the opposite. It is possible to start with hormone treatment via 2pass Clinic.

Prof Dr Van Gaal will guide you and follow-up on you. During the first year there will be follow-up appointments quarterly, and biannually during the second year of the hormone treatment. After a gender reassignment surgery (SRS), there usually is an annual follow-up consultation.

In many cases, hormone preparations will be reimbursed by your health insurance. This usually happens after approval of your doctor and after submission of a statement from a psychologist and an endocrinologist.

Below you will find more information about hormone therapy, the types of hormones, and their effects.

Who should receive MtF hormones?

MtF hormones is a major therapy. Before the endocrinologist (hormone specialist) prescribes hormones, it is first determined whether genetic dysfunction actually occurs. In addition, you have to answer some questions about your health and you may have to undergo a short medical examination.

MtF hormones is not recommended for  transgender women with untreated high blood pressure, who have a thrombosis (blood clot) or cerebral hemorrhage, or who are known to be at risk of thrombosis, and transgender women with severe liver disease.

In addition, you must be at least 16 years old. People below 16 years of age cannot get puberty inhibitors. These inhibit the development of gender characteristics. There are conditions attached to this.

Are you considering gender-change surgery (sexual reassignment surgery)? During the operation, the testicles are removed. This eliminates the source of testosterone production. After surgery, only estrogens are necessary.

Types of hormones

For MtF hormones of transgender women, two types are used:

  • Natural hormones, such as estradiol.  
  • Synthetic hormones, for example ethinyl estradiol.

The main difference between these species is that synthetic hormones are much stronger. They give faster results, but also have more side effects.

It is possible to buy hormone preparations for trans women via the Internet. We do not recommend that. Self-medication increases the risk of health damage, side effects and other unwanted effects. In addition, the quality of products sold through the Internet is not guaranteed.

What does MtF hormones do?

MtF hormones inhibit the production of the male hormone testosterone in transgender women. This is achieved with anti-androgens such as cyproterone acetate. To this is added estrogens, which are provided both in tablet form and in patches. A number of male gender characteristics gradually disappear into the background.

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Effects of anti-androgens:

  • Decline of libido
  • Reduction of testicles
  • Reduction of body hair  
  • The normal process of hair loss in men is stopped   
  • Weakening of muscles  
  • Possible side effects include fatigue, lethargy and long-term infertility.  

Effects of estrogens:

  • Breast growth
  • Fat is distributed differently across the body (more around the hips)
  • Skin becomes softer  
  • Increasing emotionality  
  • Increased risk of thrombosis (especially in smokers).

People respond differently to MtF hormones In some people, the effects are more pronounced or may present quicker than in others. This is normal.

What do MtF hormones not do?

MtF hormones ensure that you feminize sooner. However, there are cases where hormones have little or no effect.

  • Although body hair will slowly decrease, male beard growth is not affected at all, or is only slightly affected. People who need to get rid of beard growth will therefore need laser treatment or electrolysis hair removal.
  • Also, the voice does not change through hormone treatment. You can only feminize your voice through speech therapy and in some cases by surgery.
  • Breast forming is stimulated by female hormones. This requires patience. It may take up to two years to reach the final size. Many transgender women are not fully satisfied with the result obtained after two years of treatment. In such cases, breast enlargement can be chosen.
  • The skeleton and the body length are not changed by hormone treatment. Male features of the facial bones (strong jaw and chin, forehead bossing) can be altered by facial feminization surgery.

MtF hormones and fertility

MtF hormones affect your fertility. If you are treated with hormones for a long time, there is a strong possibility you will not be able to produce any more children. Do you nevertheless want a child in the future? Trans-gender women can freeze seed cells before hormone treatment. The endocrinologist can tell you more about this.

Follow-up during MtF hormones

In the first year there are quarterly controls by the endocrinologist;  in the second year of hormone treatment, semi-annually. After gender-adjusting operations, follow-ups are often done annually.

Re-reimbursement of MtF hormones

In most cases, your health insurance will reimburse you for hormone preparations. This usually happens after approval by the physician and after submitting a statement from the psychologist and endocrinologist.

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