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What Happens When You Stop Taking Hormone Therapy During Male-To-Female Transition?

Taking hormone replacement therapy or HRT is a very important step in a trans person's life. Even if there are health risk factors involved, the positive impact on one's self-esteem is worth gambling for. A biological male who wants to become a woman will risk it all just to see breasts, full hips, and a feminine face staring back at him in the mirror. Then there are the psychological benefits - being on hormones can bring the mind and body closer together, helping trans people feel better about their bodies and ease their feelings of gender dysphoria.

If you're thinking of taking the plunge towards transitioning or maybe you have already started but thinking of stopping the hormones for whatever reason, it's important to know the permanent and reversible changes of feminizing hormone therapy so you can make a more informed decision whether to start or stop. 

Purpose of Feminizing Hormone Therapy

Feminizing hormone therapy is given to individuals who want to transition from male to female. The process involves taking estrogen, progesterone, and testosterone blocker. These hormones can be taken orally, absorbed through the skin via topical cream or transdermal patch, or via injection. This is also applicable to masculinizing hormone therapy, which involves testosterone therapy.

Young transgenders who are still about or already undergoing puberty will be given puberty blockers to prevent the onset of male development.

The effects of the hormones will take some time to show, both physical and otherwise. Some changes are permanent while some can be reversed once you stop taking the hormones. The extent of the changes will depend on several factors, such as genetics and the length of time the hormones are taken.

Why Some Trans Women Stopped Taking Feminizing Hormone Therapy

Stopping hormones once you have started doesn't necessarily mean you regret transitioning. Although yes, there are trans women who do regret their decision to transition, there are lots of them who had to stop because of personal or medical reasons. Taking hormones as a transgender woman does come with a lot of risks, such as blood clots (including venous thromboembolism), heart or cardiovascular disease, and potential liver damage. There are trans women who went off hormones for a period of time because they wanted kids. Taking time off hormones can make it easier for them to conceive.

There's also the money factor. Needless to say, transitioning is a very expensive process and transgender individuals who plan to go through it should be prepared to spend...A LOT. Even without the more advanced stages of gender reassignment surgery, facial feminization surgery, and breast augmentation, hormone therapy alone already costs thousands of dollars a year and you definitely have to take it longer than that.

Permanent Changes in Feminizing Hormone Therapy

First, here are the permanent changes of estrogen therapy and the time expected for the changes to become visible. These changes would still stick even if you stopped taking your hormones.

  • Breast development and nipple/areola enlargement - it will take several years for your breasts to reach their full size and these will remain even if you stop taking estrogen. If you continue with the hormones, you might have a milky discharge from your nipples. If this happens, you have to tell your doctor about it because it might be caused by estrogen or something else. There might be an increased risk for breast cancer, as to what degree is uncertain. Having breasts means taking care of them just like a natural-born female would. You have to take annual breast exams and regular mammograms when you reach a certain age.
  • Widening and rounding of the pelvis - widening of the hip bones is part of a woman's pubertal process and estrogens cause the pelvis to widen as part of sexual differentiation. Females have wider hips generally for childbirth. After puberty, a woman's hips get generally wider than her shoulders.

Reversible Changes in Feminizing Hormone Therapy

Now, what about the changes that will revert once you stop taking your estrogen hormone therapy? The majority of the changes that happen during therapy are indeed reversible which is something you should keep in mind if you're planning to lay off estrogen treatment, temporarily or permanently.

  • Thinning/slowed the growth of facial/body hair - taking estrogen means less body hair, which will become less noticeable and will grow more slowly. It will not stop growing completely even if you take your hormones for a long time. When you stop taking the estrogen, your body hair will come back with a vengeance.
  • Cessation/reversal of male-pattern scalp hair loss - balding, which is a common male problem, will slow down when you take estrogen. Your balding will slow within one to three months and the full effect will be seen after one or two years. Balding will resume once you get off the hormone treatment. You may lose your hair faster than if you hadn't taken hormones.
  • Softening of skin/decreased oiliness and acne - hormones make your skin as soft and smooth as a woman's also with less acne and oiliness. Your skin will return to its original male condition when you stop your hormones.
  • Redistribution of body fat in a feminine pattern - during therapy, you will notice less fat on your abdomen and more on your hip, butt, and thighs, just like in a biological woman. Going off therapy means you're more likely again to gain weight in the gut.
  • Decreased muscle mass/strength - trans women on hormones will notice muscle and strength loss in their upper body, which is something you will regain when you stop your therapy.
  • Changes in mood, emotionality, and behavior - as hormone levels increase, so do emotional changes such as depression, anxiety, suicidal thoughts, or a worsening of existing mental health issues. This is one of the prominent risks of feminizing hormone therapy. You will notice these wild emotional zigzags taper down when you quit your hormones.
  • Decreased sex drive - as a trans woman undergoing therapy, you will notice having less interest in sex as compared to a biological man. Your ability to make sperm will decrease, thus taking your fertility down with it. When you stop therapy, your sexual appetites will come back to the same level as a biological male's.
  • Decreased spontaneous/morning erections - Your morning erections may not be as much as before and you may have a harder time ejaculating when you masturbate. Speaking of which, being on therapy will make you want to masturbate rather than have sex.

What Will NOT Change Even If You Take Feminizing Hormone Therapy

It's best to set expectations as early as possible and become aware of what transgender hormone therapy can and cannot change. First, let's start with the physical ones. Hormone therapy will not turn your penis into a vagina or transform your sex chromosomes. Your present bone structure will remain as is even though your features may soften as you transition. Body hair will lessen but will not completely go away. You will have the same height and voice pitch even after years of hormones. Your Adam's apple will stay put as well.

This is why transitioning goes beyond hormone therapy. If you wish to go further, you will need to take surgery to make your face look more feminine, to have larger breasts, and to have your penis transformed into a vagina.

Second, therapy will not change your body image. Yes, seeing yourself look more womanly will definitely give a stratospheric boost to your self-esteem and confidence, but it cannot eliminate your gender dysphoria issues completely. This is where counseling comes in and all those who wish to transition are required to seek psychological help.

Lastly, society will not really bend the way you want it to just because you look more like a woman. Not all people will readily accept you and this is something you have to learn to accept. Professional and peer counseling will help you with this. It's vital to seek support from people and communities who accept transgender people unconditionally. You may feel lonely and alone at first, but your outlook will eventually improve once you find people who will love you just the way you are.

Preventing Medical Complications of Feminizing Hormone Medications

It's possible to get the most benefits and minimize the risks of feminizing hormone therapy so you can rest easy during your transitioning. There are lots of ways to make hormone therapy as safe and effective as possible for the transgender patient. With the help of your doctor, making the decision to undergo therapy will become a more informed decision.

  • Be informed - listen well when your doctor discusses how hormones work and what to expect while you're having it. Keep in mind the possible side effects and risks to make you more in charge of your health.
  • Stop smoking - smoking is not good for anyone, especially for someone who is under hormone therapy. It increases the risks involved and your doctor might prefer to keep your estrogen levels low if you're a smoker. Lower estrogen means lesser or slower feminizing effects. Your doctor can also help you quit smoking if you can't at least cut down dramatically.
  • Do not self-medicate - everything you take should be approved by your doctor. Get a clearance first if you want to start, change, or stop the doses of any of your prescription medicine. A lot of trans women take it upon themselves to self-medicate and take higher doses than they should. This increases your health risks and can slow down the feminizing changes that you signed up for in the first place.

Getting a doctor whom you can trust in this delicate process is key in making your transitioning as safe and comfortable as possible. Let the excellent medical professionals at Revitalize You MD take care of your hormone therapy needs. 

We are a trusted name not just in hormones for transgender adults, but also in helping the menopausal woman deal with issues such as menopause symptoms (including hot flashes, vaginal dryness, and vaginal bleeding). We help pre and postmenopausal women deal with the menopause experience with menopausal hormone therapy.

Call us to make your appointment so we can discuss what we can do for you in your feminizing journey.

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