Hormone Replacement Therapy (HRT)

Hormones are chemical messengers produced by one part of the body to tell cells in another part of the body how to function, when to grow, when to divide, and when to die. They regulate many functions, including growth, sex drive, hunger, thirst, digestion, metabolism, fat burning and storage, blood sugar and cholesterol levels, and reproduction.

The requirements for hormone replacement therapy (HRT) can vary immeasurably. Typically, a certain amount of psychological counseling is required, along with a period of time in the Real Life Experience (RLE) of the desired gender role.

Hormone replacement therapy (HRT) for GRS patients replaces the hormones naturally occurring in their bodies with those of the other sex. However, not all cases GRS patients endure hormone replacement therapy (HRT). It cannot undo the changes produced by the first natural occurring adolescence.

Specifics of bone shape transform throughout life; bones becoming heavier and more deeply sculptured under the influence of testosterone. Changes include:


Pelvis in females tends to be wider than in males and tilted forward; the pelvis in males tends to be more circular and tilted upwards.


Male hands and feet tend to be larger than female hands and feet in persons of equal height.


Females tend to have smaller heads than males of the same height.


Female ribcages tend to be narrower than those of males in the same height.

Facial changes develop gradually over time, and tend to increase with age. Changes include:


Males tend to develop heavier bony brows than females.


Female cheeks tend to be fuller and more rounded. Under the influence of estrogen, fat is deposited beneath the skin and overall facial and body contours become softer.


The tip of the nasal bone tend to grow more in males than females, creating a larger (longer or wider) nose.


The jaw in males tends to grow wider and more deeply sculptured than in females.


At puberty, the bones and cartilage of the voice box tend to enlarge less in females than males. In some males, the larynx becomes perceptible as a bony “Adam’s Apple.”


Females tend to have thicker, fleshier lips than males of the same size.

MTF Therapy Options

MTF Hormonal Therapy

Male to female hormonal reassignment of gender is based on the ability of medications to effect de-masculinization by blocking production and action of Androgens (testosterone) and to effect feminization. Typically MTF hormone therapy involves estrogen, medication to block testosterone, or a combination of the two.

“Feminizing” hormone therapy has important psychological benefits as it draws the mind and body closer together to ease gender dysphoria and can help MTF patients in Mexico feel confident about their bodies.

Estrogen Therapy

Estrogen is the principal hormone used for feminization. Numerous classes of estrogens have been used for gender reassignment.

Common Prescribed estrogens used for reassignment of gender include: Conjugated Estrogens (Premarin), Ethinyl Estradiol (Estinyl), 17 Beta Estradiol (Estradiol), Estrogen Transdermal (Estroderm, Climara), and Estradiol Valerate – Injection.

Anti-Androgen Therapy

Antiandrogen drugs can be prescribed alone for MTF patients who want to reduce “masculine” characteristics for a more androgynous presence, as it’s less “feminizing” than estrogen.

Several classes of medications will specifically or nonspecifically decrease testosterone to normal or lower than normal female levels: GnRH analogues, Cyproterone, Testosterone Inhibitors, High Dose Estrogens, Progesterone, and Spironolactone. It may be used alone but is usually used in combination with Estrogens.

Progesterone Therapy

Progesterone therapy is used to supplement estrogen if estrogen isn’t working even at the maximum dose or as a replacement for estrogen if there are concerns about estrogen’s side effects or health risks.

Medroxyprogesterone is not a routine part of hormonal reassignment regimens but may be used in the following situations:

As adjunct for patients on maximum estrogen doses with unsatisfactory effects.

In patients intolerant of other drugs.

Risks and Side Effects of HRT

The medications taken in hormone therapy are managed by the liver; therefore there is a possibility that taking hormones over a long period of time can put strain on the liver, possibly leading to liver disease.

It is generally recommended that MTFs taking feminizing hormone therapy get their liver enzyme levels checked periodically to monitor liver health.


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