How long will it take for my hormones to work?

[TanyaG]

The following is summarised from Hembree, Wylie C., et al. "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline." The Journal of Clinical Endocrinology & Metabolism 94, no. 9 (2009): 3132-54.

It lists the changes you can expect, how long they will take to begin and how long it will be before they reach a stable state. There have been lots of questions about this and apart from experience of others here, this is the best guide of which I am aware.

If you are on a testosterone raising regime:

Oily skin/acne: Begins 1-6 months, peak effect after 1-2 years.
Facial and body hair growth: Begins 6-12 months, peaks 5 years or longer.
Scalp hair loss: Begins 6-12 months, peaks 5 years or longer.
Increased muscle mass: Begins 6-12 months, peaks 2-5 years.
Fat redistribution away from hips: Begins 6-12 months, peaks 2-5 years.
You may experience increased sexual desire, though there are no figures about this.
Periods stop: Begins 1-6 months, peaks 1-2 years.
Clitoral enlargement: Begins 1-6 months, peaks 1-2 years.
Shrinkage of vagina: Begins 1-6 months, peaks 1-2 years.
Deeper voice: Begins 1-6 months, peaks 1-2 years.

If you are on an estrogen and testosterone-lowering regime:

Softening of skin: Begins 3-6 months, peak effect unknown timescale.
Decreased hair growth on body: Begins 6-12 months, peaks 3 years or longer (there will be little effect on facial hair.)
Decrease in muscle mass: Begins 3-6 months, peaks after 1-2 years.
Fat redistribution to hips: Begins 3-6 months, peaks at 2-5 years.
Decreased sexual desire: Begins 1-3 months, peak effect unknown.
Decreased spontaneous erections: Begins 3-6 months, peaks 3-6 months.
Decreased sperm production: Unknown when this begins, peaks at 2 years.
Decreased testicular volume: Begins 3-6 months, peak not known.
Breast growth: Begins 3-6 months, peaks after 2-5 years.

[Lori Dee]

If you are on an estrogen and testosterone-lowering regime:

Softening of skin: Begins 3-6 months, peak effect unknown timescale.
Decreased hair growth on body: Begins 6-12 months, peaks 3 years or longer (there will be little effect on facial hair.)
Decrease in muscle mass: Begins 3-6 months, peaks after 1-2 years.
Fat redistribution to hips: Begins 3-6 months, peaks at 2-5 years.
Decreased sexual desire: Begins 1-3 months, peak effect unknown.
Decreased spontaneous erections: Begins 3-6 months, peaks 3-6 months.
Decreased sperm production: Unknown when this begins, peaks at 2 years.
Decreased testicular volume: Begins 3-6 months, peak not known.
Breast growth: Begins 3-6 months, peaks after 2-5 years.

From my own experience, these are fairly accurate, except that the timeline doesn't begin until your hormone levels are into the female range. There are many DIY people going herbal/low-dose route and wondering why they are not experiencing these things.

For me, breast growth didn't begin until after 6 months but then halted for years. My endocrinologist struggled to keep my hormone levels within range and we tried various dosages, brand names, and methods (oral, patches, injections).

Now that my estradiol is high, T is low, and I take progesterone 3 times a day, the girls are starting to fill out again. Everyone's body chemistry is different, so your body may respond differently too. My medical team determined that my body is a "fast metabolizer" in that it processes certain substances faster than others. My estradiol levels were low because my body was processing and eliminating it before it could do its work.

As always, YMMV. 

[ChrissyRyan]

I probably maxed out for body shaping but who knows, I may get another surprise.

[TanyaG]

For me, breast growth didn't begin until after 6 months but then halted for years. My endocrinologist struggled to keep my hormone levels within range and we tried various dosages, brand names, and methods (oral, patches, injections).

This is one of those places where we can add to what is known - if members reply to this thread with their own experiences, then we can help others understand their journey better.

[SoupSarah]

They work as soon as you put them in your body... because, they are hormones.. Oh, I guess you mean when will the effects of HRT finish changing my body? well, anytime between now and say, 10 years.. hmmm, you see - no-one can give YOU a specific time frame that is anything close to reality. You can get averages, you can poll hundreds of people to see what happened to them, but you - you are unique.

You have a unique biology, genetics and cytology - based on your ancestors, living conditions, health and lifestyle. Each one of those factors can effect shaping, growth and changes from HRT in many, many ways..

So, in my opinion, it is best to think my hormones are working now and will continue to work in the future. Whatever changed happen will be for the better and I will be pleased with anything I get.. then get on and live your life and stop worrying about stuff that will be insignificant.

However, interesting point for people with a working pituitary gland - this will work against any hormone treatment you take to balance your body to whatever gonads you were born with until you take enough of the other hormones to overcome the feedback cycles that this gland controls. So, initially, any changes you see when you start your HRT will be temporary and probably fleeting. Just make sure your in it for the long haul - seriously, it takes a cis-female around 5-6 years to fully develop her chest - why would you think it would take you any less time?

[Chelsea]

Ive been on them 7 years with perfect levels and they have done ->-bleeped-<- besides soft skin and no body hair. I am still built exactly like a disgusting man. They do not work for everyone. Biggest joke of my life and I should have pulled the trigger while I had it in my mouth.

[Northern Star Girl]

@Chelsea
Dear Chelsea:

I am so glad to see that you were able to get logged in back here on the Forum...
Since the "big reset" and crash last January 1st I have been eagerly looking for
our previous members as they are able log in again to their member accounts. 

I most certainly recall your earlier time here on the Forum...
   WELCOME BACK

You will most certainly remember me by my previous username  Alaskan Danielle

You were quite fortunate that much of your posting history was recovered prior
to March of 2019.
Count yourself lucky as we have some some members that lost everything... much
data was lost including member accounts, postings, private messaging, etc.

Through what seemed to be endless work, our staff has done a great job in piecing things
together again to very quickly have a fully operational site even though much of the lost
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Please find your way to the following LINKS to read what happened with with the site
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The Forum Administrator
                                        cc: @Lori Dee    @Sarah B

[Allie Jayne]

The simple fact is that those times are averages for the people surveyed, and they are a poor guide. That perfect 'Average' person rarely exists, and most of us fall outside the mean times. We are all different, we start HRT at different times of our lives with different body shapes, genetics, muscle and fat volumes, and abilities to uptake medications. Then we have the myriad of approaches our doctors take, from prescribing doses based on synthetic hormones, to moving to high doses early to supposedly maximise development. Some doctors refuse to prescribe Progesterone, some prescribe it within the first 3 months, and some wait until their patient has reached Tanner stage 3.

From what I have seen in the many trans women I have spoken to, there isn't an ideal dose as each of us reacts differently. This means more is not always better, finding our own 'sweet spot' is preferable, but many doctors run from some organisations recipe rather than find the best for their patient.

So, please take the above timelines with a grain of salt, and don't for a second believe that because "X" had this result, that you will too. Find a doctor who will vary your treatment to find out what is best for you, and run from doctors who have rigid regimens.

Hugs,

Allie

[Lori Dee]

Ive been on them 7 years with perfect levels and they have done ->-bleeped-<- besides soft skin and no body hair. I am still built exactly like a disgusting man. They do not work for everyone. Biggest joke of my life and I should have pulled the trigger while I had it in my mouth.

Hello Chelsea,

Welcome back to Susan's Place. I am sorry to hear that you did not have better results. Part of the problem I had was the specific formulation used by various manufacturers. Obviously, there is a difference between oral, transdermal, and injection formulations. But even within there are differences. I found a difference between the Generic Mylan brand and the Grove patches brand. The paper that comes with the medications has a section on the pharmacokinetics and shows the actual chemical formulas used. The difference was small but apparently, my body could tell the difference.

Now that I have switched to weekly injections, I have noticed a big difference. But there are different formulas here too. I started on estradiol cypionate but had to switch to estradiol valerate due to availability. There is a big difference there too.

I am curious about what types (oral, patches, gels, injections) and brands you have tried over the years. The dosages are not important because your levels are in the normal range.

I am also curious about how much of your appearance has changed over the years. You mentioned skin and body hair, but are you saying you have had no breast development at all? Breast size is determined by genetics, but with hormones in the female range, you should have at least small breast development.

You say you still look like a man, but is that how others see you? Is it possible that you are being overly critical? We are our own worst critics when it comes to appearances. When dressed feminine (hair, makeup, clothes) are you treated as a woman? The reason I am asking is because I am trying to determine how much of this is a self-image issue versus how subtle changes have occurred but just not enough to your satisfaction.

I assume that you have talked with your therapist and prescribing physician about this. Are they open to trying different methods or brands? It took me almost five years to find the right mix, so I understand your frustration. And the issue was not all estradiol either. I started with Spiro, then added Finasteride. After years of taking them, they didn't work. I stopped those and started Eligard (leuprolide) injections every three months plus a daily dose of Casodex (bicalutamide). That allowed things to shift in my favor and I was able to drop the Casodex and just rely on the Eligard injections plus estradiol. But it took many discussions with two endocrinologists and a gynecologist to finally get one to listen to what I was telling them. I showed them the studies that indicate that progesterone should be taken three times a day, not once at bedtime. I told her she had informed consent, so let's try it my way and see what happens. She agreed and I am pleased with my progress again.

I hope your doctors can figure this out for you. Sometimes we have to educate them about what works for us and what doesn't. Please keep in touch and let us know how it is going.

Oh, and welcome back to Susan's Place!

[Sarah B]

Hello Chelsea

As you know by now my name is Sarah B and I would also like to formally, Welcome you back to Susan's Place!

It's good to see that other members of Susan's have also welcomed you as well.

I have been reading your blog and I will finish it very soon.  The last entry from you was around May 2019 and it would be very much appreciated if you can tell us what has happened over the missing years, given that Susan's has lost abut 5 years worth of posts due to the crash and we don't know if you added further posts.  I would appreciate it very much as, I'm always interested in learning something new about new members.

Remember that members of Susan's are here to help, support and more than likely will discuss problems or issues that are similar to yours, so that you can thrive and survive being you, Chelsea.

Best wishes always and please take care, talk, email, PM or post a message to someone.

Once again, Welcome Back to Susan's Place!

Love and Hugs
Sarah B
Global Moderator
@Lori Dee
@Northern Star Girl
@Chelsea

[ChrissyRyan]

I will say it is always nice to see my message "Rx ESTRADIOL is now ready."

That makes me smile.


But I have been told I smile a lot.  So I guess it does not take a lot for me to smile!  But this message does for sure.

[Lilis]

I will say it is always nice to see my message "Rx ESTRADIOL is now ready."

That makes me smile.

Nice, still waiting on mine...

[TanyaG]

Ive been on them 7 years with perfect levels and they have done ->-bleeped-<- besides soft skin and no body hair. I am still built exactly like a disgusting man. They do not work for everyone. Biggest joke of my life and I should have pulled the trigger while I had it in my mouth.

Quite a few people haven't completely got to grips with what Hembree's figures show, Chelsea. The data is based on when patients on hormone treatment began to experience the effects, not on how extensive those effects were. These are different things, which some members who have responded to this thread have conflated.

Once we have gone through puberty, many features of our bodies are fixed, including our bony proportions and other secondary sexual characteristics, such as changes in the larynx. Some features are fixed before that, for example, at birth, if you have a Y chromosome, your nipples will be spaced differently to someone who does not have one.

Other features can be changed, such as skin feel and hair growth (except in the beard area) and breast size. But the later, a big issue for many here, is very dependent on genetics, so someone who comes from a family where women have smaller breasts will very likely have smaller breasts after hormone therapy.

About a third of cis women have an A cup (that's one inch of extra circumference around the fullest part of the breasts compared to the chest) so a large minority of women don't have very noticeable boobs. Women come in all shapes too with few falling into hourglass category. Some of the most compelling women I have known have only been as attractive as they are because they are comfortable with how they are.

The art of happiness is not to wish for an ideal you are not, but to love the ideal that you are. Attractiveness lies mostly within our personalities and our self-confidence, and if you can crack that, you can be whoever you want to be, whatever shape nature has given you.

[Myranda]

From my own experience, these are fairly accurate, except that the timeline doesn't begin until your hormone levels are into the female range. There are many DIY people going herbal/low-dose route and wondering why they are not experiencing these things.

For me, breast growth didn't begin until after 6 months but then halted for years. My endocrinologist struggled to keep my hormone levels within range and we tried various dosages, brand names, and methods (oral, patches, injections).

Now that my estradiol is high, T is low, and I take progesterone 3 times a day, the girls are starting to fill out again. Everyone's body chemistry is different, so your body may respond differently too. My medical team determined that my body is a "fast metabolizer" in that it processes certain substances faster than others. My estradiol levels were low because my body was processing and eliminating it before it could do its work.

As always, YMMV. 

@Lori,  I'm curious as to what the reasoning was behind Progesterone 3x/day?  Is it simply because of your fast metabolism?  Or is there any medical/scientific study about it?  I know there was one several years about about taking it everyday, instead of cycling it monthly.

[Myranda]

Biggest joke of my life and I should have pulled the trigger while I had it in my mouth.

@Chelsea Please do not joke about that!

[Myranda]

I showed them the studies that indicate that progesterone should be taken three times a day, not once at bedtime. I told her she had informed consent, so let's try it my way and see what happens. She agreed and I am pleased with my progress again.

@Lori  Do you have a link to that study?

[Natali400]

👍

[Lori Dee]

@Lori,  I'm curious as to what the reasoning was behind Progesterone 3x/day?  Is it simply because of your fast metabolism?  Or is there any medical/scientific study about it?  I know there was one several years about about taking it everyday, instead of cycling it monthly.

Yes, there was some research into it.

Progesterone is produced by the ovaries 24/7. Not just all of a sudden at bedtime. WPATH guidelines are to mimic the hormone levels of the desired sex. Initially, it was believed that the time the medicine remained in your system was about 18 hours. So taking a dose once every 24 hours makes sense. The reason it was prescribed at night is because some people experience sleepiness or dizziness from taking it. Those are not a problem while you are sleeping.

However, newer forms of assays have determined that oral progesterone is eliminated much more quickly and only remains in the system for 5 - 9 hours. As I explained to my doctor, this means that if I take a dose before bed, when I wake up, I should be ready for another dose. If I don't take regular doses every eight hours, my progesterone levels will not remain in my system long enough to do their job, which is breast development.

The article in Wikipedia explains the details and has a list of references. Scroll down to the section on "Elimination and duration" which says:

Levels of progesterone with oral progesterone have been measured by the unreliable method of IA as remaining elevated for 12 to 24 hours.[1][41] Regardless of the assay method, peak levels of progesterone following a dose of oral progesterone occur after about 1 to 3 hours.[44] The elimination half-life of progesterone in circulation is very short at a range of about 3 to 90 minutes.[14] Previous studies using IA have reported an overestimated elimination half-life of oral progesterone of about 16 to 18 hours.[41] Subsequent, reliable studies using high-performance liquid chromatography–tandem mass spectrometry (HPLC–MS/MS) and similar methods reported elimination half-lives of progesterone with oral progesterone of about 4.6 to 5.2 hours and 9.98 hours when it was taken with food.[7][8] Due to the short half-life and duration of action of oral progesterone, it may be taken in divided doses two or three times per day.[41][62][63]

https://en.wikipedia.org/wiki/Pharmacokinetics_of_progesterone

Since I had been having trouble with my hormone levels for years, my doctors were as frustrated as I was and were willing to explore the causes. I had them read the above article and the referenced sources. They agreed to "try" it. I continue to report great progress so now they are open to this change to the standard protocol.

I wanted to take a dose every 4 hours based on the above report. My doctor's concern was that 400mg per day (total) was above the "recommended dosage". Doctors get nervous when going above that limit. So I asked her what happens to progesterone levels during pregnancy. They increase to very high levels. Higher than the "recommended dosage" would give.

The fear that they have is based upon guidelines from the FDA, which stem from the Women's Health Initiative Study. The problem is in that study they were using synthetic progesterone, not bioidentical progesterone, like Prometrium. If bioidentical progesterone was actually risky, then pregnant women around the world would be routinely diagnosed with cancer, strokes, and blood clots. Since that doesn't happen, exceeding the "recommended dose" poses almost no risk.

They agreed that my logic made sense, but still refused to go that high. So I am at three times per day, but it is working so much better than once a day.