The evaluation might include:. You might also need a behavioral health evaluation by a provider with expertise in transgender health. The evaluation might assess:. Adolescents younger than age 18, accompanied by their parents or guardians, also should see doctors and behavioral health providers with expertise in pediatric transgender health to discuss the risks of hormone therapy, as well as the impact and possible complications of gender transition in that age group.
Typically, you'll begin feminizing hormone therapy by taking the diuretic spironolactone Aldactone at doses of to milligrams daily. This blocks male sex hormone androgen receptors and can suppress testosterone production. After four to eight weeks, you'll begin taking estrogen to decrease testosterone production and induce feminization. Estrogen can be taken in a variety of methods, including as a pill, by injection or in skin preparations, such as a cream, gel, spray or patch.
Don't take estrogen orally, however, if you have a personal or family history of venous thrombosis. Use of gonadotropin-releasing hormone Gn-RH analogs to suppress testosterone production might allow you to take lower estrogen doses and wouldn't require the use of spironolactone. However, Gn-RH analogs are more expensive. Feminizing hormone therapy will begin producing changes in your body within weeks to months. Your timeline might look as follows:. During your first year of feminizing hormone therapy, you'll need to see your doctor approximately every three months for checkups, as well as anytime you make changes to your hormone regimen.
Your doctor will:. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Feminizing hormone therapy care at Mayo Clinic. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version. This content does not have an Arabic version. Overview Feminizing hormone therapy is used to induce physical changes in your body caused by female hormones during puberty secondary sex characteristics to promote the matching of your gender identity and your body gender congruence.
One animal study from demonstrated that a flaxseed-rich diet was able to reduce ovarian cancer severity and frequency in hens. More human research is still needed. Sesame seeds are another dietary source of phytoestrogens. Another animal study from investigated the impact of soybean and sesame oils on rats with estrogen deficiency. The researchers found that a 2-month diet supplemented with these oils was able to improve bone health markers.
This research suggests a positive estrogen-like effect of both sesame and soy seeds, although further human research is needed. B vitamins play an important role in the creation and activation of estrogen in the body. Low levels of these vitamins can lead to reduced levels of estrogen.
In one study , researchers compared levels of certain B vitamins to breast cancer risk in premenopausal women. Results indicated that higher levels of vitamins B-2 and B-6 were associated with a lower risk of breast cancer, which may be due to the impact of these vitamins on estrogen metabolism. Vitamin D functions as a hormone in the body. One study explains that both vitamin D and estrogen work together to reduce the risk of cardiovascular disease.
The link between these hormones is due to the role that vitamin D plays in estrogen synthesis. This indicates a potential benefit of vitamin D supplementation in low estrogen levels. Boron is a trace mineral that has a variety of roles in the body. Boron is also necessary for the metabolism of the sex hormones testosterone and estrogen.
Researchers believe that boron influences estrogen receptors by allowing the body to more easily use the estrogen available. DHEA , or dehydroepiandrosterone, is a naturally occurring hormone that can be converted to estrogen and testosterone. Within the body, DHEA is first converted to androgens and then further converted to estrogens. One study also found that DHEA may be able to provide similar benefits in the body as estrogen.
Black cohosh is a traditional Native American herb that has historically been used to treat a variety of conditions, including menopause and menstrual issues. Researchers believe that black cohosh also contains certain compounds that stimulate estrogen receptors. Although more research is still needed, this may suggest a possible benefit of black cohosh supplements when estrogen is low. In one study , researchers reviewed the available literature for the Vitex species, which includes chasteberry.
They found that it was able to exhibit estrogenic effects at the dosages of 0. Evening primrose oil EPO is a traditional herbal remedy that contains high levels of omega-6 fatty acids, making it a popular supplement for conditions such as PMS and menopause. However, one study found that of over 2, women that used EPO after discontinuing hormone replacement therapy, reported EPO as useful for controlling the symptoms of low estrogen with menopause.
Red clover is an herbal supplement that contains a handful of plant compounds called isoflavones that may act like estrogen in the body.
These isoflavones include:. One review study examined the impact of red clover on hot flashes and hormone levels in women. The researchers found four studies that showed a significant increase in estrogen levels with red clover supplements. Dong quai is a traditional Chinese medicine commonly taken for the symptoms of menopause. Like the other herbal supplements above, dong quai contains compounds that function as phytoestrogens.
In one study , researchers examined the possible estrogenic compounds in 17 popular herbal supplements. They found two possible compounds in dong quai that exhibit estrogenic activity. After meeting a few transgender women at the famed music and arts festival, Andrea decided to pursue her own transition.
But when she sought out feminizing hormones through clinics around her home in Philadelphia, she ran into lengthy waiting lists and high costs. So she decided to experiment on her own. She ordered Estradiol, a commonly prescribed form of estrogen, and Spironolactone, a testosterone blocker traditionally prescribed to transgender women, from an online pharmacy without a prescription.
With a lack of transgender-related services across the country, as well as discrimination from medical professionals and insurance companies, many transgender patients are conducting their own hormone replacement therapy, a regiment of medications meant to help them develop some of the secondary sexual characteristics of their gender identity. Because of the legal questions around these practices, we agreed not to identify the full names of some individuals we spoke to for this story.
For Andrea, the do-it-yourself method was only a stepping-stone towards a doctor-managed approach. But she may return to DIY to retain the independence and control it gave her, she says. Without insurance coverage to affordably and legally pursue a transition, however, Adam ended up ordering hormones for a number of months, and monitored the results through close observation of lab results and online research into the side effects of the different hormones.
Estradiol and Spironolactone are the most popular drugs for transgender women to increase estrogen and decrease testosterone, respectively, which help develop softer skin, feminine fat distribution in the face and body, and breasts. Transgender men are typically prescribed Depo-Testosterone, regular consumption of which helps them develop muscle, body hair, and a deeper voice.
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