DIY Hormone
Replacement Therapy:
Harm Reduction Guide
What Is Hormone
Replacement Therapy?
HRT is a medical treatment by which sex hormones (testosterone,
estrogen, and progesterone) are supplemented and/or changed by the
use of hormones or hormone blockers. HRT has a variety of uses and is
often used for cisgender folks who are experiencing a decreased
hormone level often due to aging and hormone sensitive cancers. Here
we will be talking about HRT as it is used by Trans and gender expansive
folks.
The information in this booklet is NOT medical advice. This
information is compiled from the life experience of Trans folks
receiving Hormone treatment either under the supervision of a doctor
or self-managed (often called self-medding), online resources from
health clinics serving Trans folks, and physicians who have answered
our questions about HRT. Thank you to all those who supported us in
compiling this and answering our questions
The Expected Effects of Testosterone Therapy
Effect Expected onset Expected maximum effect
Skin oiliness/acne Reversible 1–6 months 1–2 years
Facial/body hair growth Irreversible 3–6 month 3–5 years Variable
Scalp hair loss Irreversible >12 months
Body fat redistribution Reversible 3–6 months 2-5 Years
Cessation of menses Reversible 2–6 months 1–2 years
Clitoral enlargement Irreversible 3–6 months 1–2 years
Vaginal atrophy Reversible 3–6 months
Deepened voice Irreversible 3–12 months 1–2 years
The Risks and Possible Side Effects of Testosterone Therapy
• Possible loss of fertility; you may not be able to get • Possible changes in cholesterol, higher blood pressure and other
pregnant after being on testosterone therapy for some time; changes to the body that might lead to an increased risk of
how long this might take to be a permanent effect is cardiovascular disease (heart attacks, strokes and blockages in the
unknown. Some persons choose to harvest and bank eggs arteries).
before starting on testosterone therapy.
• Possible changes in the body that might increase the risk of developing
• Testosterone is not reliable birth control, however. Even if diabetes.
your periods stop, you could get pregnant; if you are having
• Increased appetite and increased weight gain from both muscle and
penetrative sex with a natal male partner, you should discuss
fat.
using some form of birth control with your medical provider.
• Increased risk of sleep apnea (breathing problems while you are
• If you do get pregnant while taking testosterone, the high
sleeping).
levels of testosterone in your system may cause harm and
even death to the developing fetus • Possible abnormalities in blood tests for the liver; possible worsening
of damage to the liver from other causes.
• Other effects of testosterone on the ovaries and on
developing eggs are not fully known. • An increase in the hemoglobin and hematocrit (the number of red blood
cells); if this increases to levels higher than is normal in males, it may
• Some trans men, after being on testosterone for a number
cause problems with circulation, such as blood clots, strokes and heart
of months, may develop pelvic pain; often this will go away
attacks.
after some time, but it may persist; the cause of this is not
known • Weakening of tendons and increased risk of injury.
• The lining of the cervix and walls of the vagina may become • Possible worsening or triggering of headaches and migraines.
more dry and fragile; this may cause irritation and
• Possible increase in frustration, irritability or anger ; possible increased
discomfort; it also may make you more susceptible to
aggression and worsened impulse control.
sexually transmitted infections and HIV if you have
unprotected penetrative sex • Possible worsening of bipolar disorder, schizophrenia and psychotic
disorders or other unstable moods,
• Increased sweating.
From Fenway Informed Consent Model for Masculinizing Hormone Therapy
The Expected Effects of Feminizing Hormone Therapy
Effect Expected onset Expected maximum effect
Body fat redistribution Reversible 3–6 months 2–5 years
Decreased muscle mass/
Reversible 3–6 month 1-2 years
strength
Softening of skin/
Reversible 3-6 months Unknown
decreased oiliness
Decreased libido Reversible 1-3 months 1-2 years
Decreased spontaneous erections Reversible 1-3 months 3-6 months
Breast growth Irreversible 2–6 months 2-3 years
Likely
Decreased testicular volume 3–6 months 2-3 years
Irreversible
Thinning and slowed growth of Reversible 6-12 months >3 years
body and facial hair
Male pattern baldness Reversible Loss stops 1–3 months 1–2 years
The Risks and Possible Side Effects of Estrogen Therapy
Brain structures respond differently to testosterone and estrogen and current medical science does not fully
understand these responses. Taking estrogen therapy may have long-term effects on the functioning or structure of
the brain that are impossible to predict.
Loss of fertility (unable to get someone pregnant). Even after stopping hormone therapy, may not come back. How
long and whether this becomes permanent is difficult to predict. Some people choose to bank some of their sperm
before starting hormone therapy.
Possible increased risk of developing blood clots. Risks are uncertain overall, with higher risks in those with a family
or personal risk of blood clots, and those using high doses of or some forms of estrogen (i.e., Premarin). Other
research shows lower risks with other forms of estrogen (patches). Additional increased risks occur if you smoke,
are exposed to, or use tobacco while taking estrogen therapy.
Risks include developing blood clots in the legs or arms
(DVT); blood clots in the lungs (pulmonary embolus); blood clots in the arteries, including the arteries of the brain.
Blood clots to the lungs, heart, or brain could result in death.
Possible increased risk of developing cardiovascular disease, a heart attack, or stroke. This risk may be higher if you
use tobacco products, are over age 45, or already have high blood pressure, high cholesterol, diabetes, or a family
history of cardiovascular disease, and if you have low physical activity.
Possible increase in blood pressure requiring treatment with medication.
Possible increased risk of developing diabetes. Limited research found an increase in insulin resistance in trans-
feminine people taking estrogen therapy. The effect of hormone therapy on the risks of developing or management
of diabetes remains unclear.
* from Fenway Healths Informed Consent Form for Feminizing Hormone Therapy
The Risks and Possible Side Effects of Estrogen Therapy Cont.
Possible nausea and vomiting, especially when starting on estrogen therapy
Possible increased risk of gallbladder disease and gallstones
Estrogen may lead to liver inflammation and/or contribute to existing liver damage
May cause or worsen headaches and migraines. Migraine headaches have a clear hormonal element. Estrogen
may increase the intensity or frequency of migraines.
May cause elevated levels of prolactin (a hormone made by the pituitary gland); a few persons on estrogen for
hormone therapy have developed prolactinomas, a benign tumor of the pituitary gland that can cause headaches
and problems with vision and cause other hormone problems
The effect of starting estrogen therapy on mental health conditions is unknown. Some people may feel their
mental health and social comfort increases and others may feel it declines. There is no clear evidence that
estrogen therapy is directly responsible for causing or making worse any mental health conditions. If you have a
history of depression, anxiety, or other mental health diagnoses.
Risks of breast cancer are unclear. The risk may be higher than in non-transgender men and lower than in non-
transgender women. Risk factors include family and genetic history of breast cancer, length of time on estrogen
therapy, age when starting estrogen therapy, and exposure to progesterone.
The Risks and Possible Side Effects of Androgen Blockers (Spironolactone)
Increased urine production and needing to urinate (i.e., pee) more frequently; possible changes in kidney
function
A drop in blood pressure and feeling lightheaded, especially when standing up from sitting or lying down
Increased thirst
Increase in the potassium in the blood and in your body; this can lead to muscle weakness, nerve problems
and dangerous heart arrhythmias (irregular heart rhythm)
If used without estrogen therapy, androgen blockers may cause hot flashes and low mood or energy.
Long-term use of androgen blockers to block fully testosterone without additional hormone therapy may
result in bone loss.
* from Fenway Healths Informed Consent Form for Feminizing Hormone Therapy
Drugs Used for Hormone Replacement Therapy
Estradiol (17-beta estradiol): Bioidentical form of estrogen. Administered via trans-dermal
patch, oral or sublingual tablet, or injection.
Progesterone: Progesterone is sometimes used to aid in breast development for trans
feminine people, or to stop the menstrual cycle for people who have dysphoria due to
menstruation but do not desire masculinization.
Testosterone: Hormone that causes masculinization. Commonly administered via injection,
trans-dermal gel, trans-dermal patch, or trans-dermal cream.
Anti-androgens: Used to suppress testosterone production to
minimize associated secondary sexual characteristics
Spironolactone: Most common anti-androgen used in the U.S., Spironolactone is a potassium
sparing diuretic, which in higher doses also has direct anti-androgen receptor activity as well
as a suppressive effect on testosterone synthesis (from UCSF Center for Excellence in
Transgender Health). It’s recommended that you eat a low potassium diet on spironolactone.
5-alpha reductase inhibitors (finasteride and dutasteride): Finasteride prevents the
conversion of testosterone to dihydrotestosterone (DHT) in the body. DHT is many times
more potent than testosterone, and is responsible for many of testosterones’ effects on the
body. Finasteride is often prescribed for the treatment of male pattern baldness. Dutasteride
works in a similar way but has been known to have more dramatic feminizing effects.
IF POSSIBLE
USE
BIOIDENTICAL
HORMONES,
AND TRY TO
AVOID
SYNTHETIC
HORMONES.
DOSING
Start with initial low dose (dosing range recommendations on the next page) and wait 6
months to see if there are visible changes. If there are, then stay on that dose. If there are
no visible changes you can then increase to the next highest dosing recommendation.
When you have a dose that is producing consistent physical changes going to a higher
dose won’t bring about faster changes or increased changes and will increase your
risk of negative side effects.
It’s important if you’re using trans-dermal testosterone or estrogen (gel or cream) that
you don’t expose others to it. The best way to do this is to apply it somewhere others
aren’t likely to come into contact with, especially before it dries.
If at all possible, get
blood work done!
Ideally get your blood work done every 6 months. Making
sure your hormone levels aren’t too high and are holding
steady will greatly reduce risks associated with HRT
You can ask your general practitioner for blood work. You can
also get it done at a local lab through www.privatemdlabs.com
under “Gender Reassignment Testing”
Masculinizing Hormone Dosage Recommendations
From The Center for Excellence in Transgender Health
Androgen Initial - low dose Initial-typical Maximum-typical Comment
Testosterone For 2 wk dosing,
20 mg/week IM/SQ 50mg/week IM/SQ 100mg/week IM/SQ
Cypionatea double each dose
Testosterone For 2 wk dosing,
20 mg/week IM/SQ 50mg/week IM/SQ 100mg/week IM/SQ
Enthanate double each dose
Testosterone May come in pump,
12.5-25 mg Daily 50mg Daily 100mg Daily
topical gel 1% packets, or tubes
Testosterone May come in pump,
20.25mg Daily 40.5 - 60.75mg Daily 103.25mg Daily
topical gel 1.62% packets, or tubes
Testosterone 10mg 50mg 100mg
cream
Testosterone 90-120mg Daily Comes in pump only,
30mg Daily 60mg Daily
axillary gel 2% one pump = 30mg
Testosterone 1-2mg Daily 4mg Daily 8mg Daily Patches come in
patch 2mg and 4mg size.
Feminizing Hormone Dosage Recommendations
from The Center for Excellence in Transgender Health
Hormone Initial - low dose Initial-typical Maximum-typical Comment
Estradiol oral if >2mg recommend divided
sublingual 1mg/day 2-4mg/day 8mg/day bid dosing
Max single patch dose
available is 100mcg.
Estradiol Frequency of change is
transdermal 50mcg 100mcg 100-400 mcg brand/product dependent.
More than 2 patches at a
time may be cumbersome
for patients
May divide dose into weekly
Estradiol valerate
<20mg IM q 2 wk 20mg IM q 2 wk 40mg IM q 2wk injections for cyclical
IMa
symptoms
May divide dose into weekly
Estradiol <2mg q 2wk 2mg IM q 2 wk 5mg IM q 2 wk injections for cyclical
cypionate IM symptoms
Hormone Initial - low dose Initial-typical Maximum-typical Comment
Spironolactone 25mg Daily 50mg bid 200mg bid
Finasteride 1mg Daily 5mg Daily
Dutasteride 0.5mg Daily
*Bid dosing means taking it twice (two times) a day
Hormone Initial - low dose Initial-typical Maximum-typical Comment
Medroxyprogesterone 2.5mg Once 5-10mg Once
acetate (Provera) daily at bedtime daily at bedtime
Micronized 100-200mg Once
progesterone daily at bedtime
Safe Injection Information
Use this link for Harlam
United Safe Hormone
Injection Information
https://www.harlemunited.org/self-
inject-hormones-how-to-instructions/
RESOURCES
Kentucky Health Justice Network - Trans Health Program
kentuckyhealthjusticenetwork.org/trans-health
transhealth@khjn.org
Kentucky Needle Exchange Locations
kyhrc.org/needle-exchange-program/
The Transgender Law Center
transgenderlawcenter.org/legalin
National Center for Transgender Equality - Health Coverage Guide
transequality.org/health-coverage-guide
Trans Lifeline
(877) 565-8860 - www.translifeline.org/
