Breast development w/o nipple or areola development?

[Asche]

I've been on HRT (estradiol) for 8 years, and have developed breasts, as expected.  However, I notice that the nipples and areolas look like they did before I started, and not like most (?) cis women's.

Has anyone heard of this?  Is there some additional hormones I should be/should have been taking?

[Lori Dee]

The same with me. I was always told that the areolas are part of the skin, so they would enlarge as the breast enlarges, but I haven't seen that. I just assumed that due to my hormone levels only recently being in the "normal" range that the breasts are not done growing yet.

[Allie Jayne]

Firstly, everyone is different, and our reactions to hormones are different, so you can't read someone else's experience with hormones and believe the same will happen to you. Some people have more rapid development at lower Estrogen doses, some need higher, and some different doses at different times, while many of us get little development due to many factors including age, genetics, metabolism, available receptors, and the skill of your doctor.

Generally, estrogen will lower testosterone and support breast development. This happens in stages called Tanner Stages. When Tanner Stage 3 is reached, the breast will be basically formed, but it is not yet mature. Time may mature breasts. Many trans people and doctors will introduce Progesterone at this stage as it is the hormone which prepares breasts for feeding. Again, this varies greatly for everyone. The maturation can take the form of rounding out the breast, and developing typically larger nipples and areoles. Some doctors with little trans medicine experience will recommend starting Progesterone early in the HRT journey, but this risks stunting potential development. Once the breast tissues are matured, they can stop growing, so if you start Progesterone before Tanner stage 3 is achieved, breasts may mature before full development.

Some people have great results from Progesterone, some people have small changes, but most will not see visible changes, and this wild variation in effectiveness is why most professional medical bodies don't support the use of Progesterone in trans medicine. Depending on your individual biology and medical history, Progesterone can be low risk, and many say they get other effects from it like better moods, better sleep, and some improved fat distrubution on face and body.

I tried it for a couple of years, and worked with my doctor to try different doses and methods of application, but aside of some growth to my nipples, the only other affect was draining my money. This is something to talk to your doctor about, and if they don't seem to have experience with Progesterone in trans medicine, it's maybe time to find a better experienced doctor. It's your life, you deserve the best care available to get the best outcomes possible, so you deserve to have the best people treating you!

Hugs,

Allie

[Lori Dee]

I have had success with Progesterone, but only after I talked with my doctor about it. Progesterone is produced by the ovaries, the same as estrogen. That happens 24/7, not just once at night. I showed her some recent studies and she agreed to let me take it three times a day. Like you, I have some nipple enlargement, but the most noticeable outcome is the rounding you mention. The breasts become more shapely. I told my doctor I want melons, not bananas. 

So far, there has been no increase in measurable size, just a better shape. So I am hopeful that they are still growing and that will increase the areolas as well. If not, there is always tattooing. The same technique they use for permanent make-up. We will see what happens.

[Nadine Spirit]

I really think that nipple development, as all bits, is specific to each person. For me, they were the very first thing that changed. My areolas grew as well as the nipples themselves. I really didn't get a whole lot of breast development though. I first used patches, and after 2 years I switched to pellet implants. I also started taking progesterone at the 2 year mark also. No one thing really caused any significant change as they just sort of changed along the way. My wife and I look at them now and just marvel at how very different they are.

However, they are very different than my wife's. Mine are much more clearly defined in color and shape. Hers are very spread out and very pale in color. So, with my limited experience, I think everyone's nips are different. Some are large, some are small, and some are in-between. So with us trans-fems we should see variations as well.
 

[Lilis]

If not, there is always tattooing. The same technique they use for permanent make-up. We will see what happens.

What about "Nipple-Areola Complex (NAC) augmentation"?

Which is a procedure designed to enhance the size, shape, or prominence of the nipple and areola.

My doctor saids this can be done for aesthetic reasons or to achieve a more typically feminine appearance in trans women.

I was talking about this with her not to long ago in our last session. I am considering to add progesterone soon. But, now what I've read here I'm thinking to probably wait a couple of years.

[Lori Dee]

I was talking about this with her not to long ago in our last session. I am considering to add progesterone soon. But, now what I've read here I'm thinking to probably wait a couple of years.

As Kelly said, everyone's body is going to be different.

What people forget, including medical providers, is that the ovaries produce both estrogen and progesterone cyclically every month. So, why wait? Why only take one dose at bedtime? Ovaries in cis women don't wait. They don't only secrete at night. It doesn't make sense.

This is what I told my gynecologist. I said Let's just step back for a moment and use our heads. WPATH guidelines say we aim to achieve hormone levels equal to those found in cis gender women. So, let's start there. Female Reproductive Biology 101. Everything we do should mimic what the ovaries do. Let's go further. Forget that I am transgender. I am a woman without ovaries or a uterus. How will you get my hormone levels where they need to be? How will you mimic ovarian secretion into the blood stream?

The problem is that the medications we are given were not designed for transgender medicine. They were designed to treat women who were experiencing menopause. As I explained to my doctor, no matter my age, I am not going through menopause. I am trying to start puberty. That is where my hormone levels should be.

Sorry, Asche. I drifted off topic.

[Sarah B]

Hi Everyone

Breast development on hormone replacement therapy (HRT) varies significantly from person to person due to factors such as age, genetics, metabolism, hormone levels and medical care.  Estrogen (estradiol) is the primary hormone responsible for breast growth, progressing through Tanner Stages.  By Tanner Stage 3, breasts are mostly formed but not fully matured and some individuals introduce progesterone at this point.

The role of progesterone in breast development remains unclear.  Some report benefits such as nipple and areola growth or improved breast shape while others see little to no effect.  The science is not settled on this issue and results vary from person to person.

Some individuals might want to improve the look of their breasts with Nipple Areola Complex (NAC) augmentation.  This method enhances the size, shape or prominence of the nipple and areola and there is nothing unusual about considering it.

From personal experience, I have had breasts for 36 years and my nipples have remained about the same size.  My areola's are noticeably larger but fainter in color.  I have long understood that every woman's breasts develop differently based on multiple factors.  During my HRT I was on Premarin and Depo Provera and never took progesterone. 

I am content with what I have and never worried about my breasts at any time.  I was too busy working and knew from the beginning that they would take time to grow.  I basically have a C cup size just one less than my mum's.  The only issue I have is with my left breast mainly when I swim as it tends to pop out to the side.  To manage this I usually wear two bathers if they are old.  If I were to have any surgery it would be solely to correct this issue and enhance cleavage.

The key takeaway is that breast, nipple and areola development on HRT is highly individual.  Consulting with an experienced doctor is essential to determine the best approach for your personal goals and health needs.

So is there anything to worry about, no not really.

Best Wishes Always
Sarah B
Global Moderator

[Allie Jayne]

As Kelly said, everyone's body is going to be different.

What people forget, including medical providers, is that the ovaries produce both estrogen and progesterone cyclically every month. So, why wait? Why only take one dose at bedtime? Ovaries in cis women don't wait. They don't only secrete at night. It doesn't make sense.
The problem is that the medications we are given were not designed for transgender medicine. They were designed to treat women who were experiencing menopause. As I explained to my doctor, no matter my age, I am not going through menopause. I am trying to start puberty. That is where my hormone levels should be.

Sorry, Asche. I drifted off topic.

Bioidentical Progesterone has a half life of about 18 hours, so some doctors will recommend taking twice per day, but one of the side effects of oral administration is sleepiness, and this is why the recommendation to take at night. (there is some legal liability in taking drugs which make you sleepy during the day when you need to be fully awake). There have been studies about mimicking the female cycle and there was no advantage found. There have been anecdotal accounts that it makes a difference, but the medicos won't rely on non scientific opinion.

You are right to mention that none of these drugs have been passed by the FDA for trans medicine, and that all of the research which developed these drugs was on cis people. Trans people have significantly different needs, and until specific research and approvals are carried out, we are using these drugs 'off label' and this is why it is so important to find doctors with lots of trans medicine experience.

Hugs,

Allie