Risks

Talk to your doctor about the changes in your body and any concerns you might have. Complications of feminizing hormone therapy might include:

• A blood clot in a deep vein (deep vein thrombosis) or in a lung (pulmonary embolism)
• High triglycerides, a type of fat (lipid) in your blood
• Weight gain
• Infertility
• High potassium (hyperkalemia)
• High blood pressure (hypertension)
• Type 2 diabetes
• Cardiovascular disease
• Excessive prolactin in your blood (hyperprolactinemia)
• Nipple discharge
• Stroke
• Increased risk of breast cancer compared to men whose gender identity and expression matches the stereotypical societal characteristics related to their sex assigned at birth (cisgender men)

Your fertility

Because feminizing hormone therapy might reduce your fertility, you'll need to make decisions about future childbearing before starting treatment. The risk of permanent infertility increases with long-term use of hormones, especially when hormone therapy is initiated before puberty. Even after stopping hormone therapy, testicular function might not recover sufficiently to ensure conception without reproductive technology assistance.

If you want to have biological children, talk to your doctor about freezing your sperm (sperm cryopreservation) before beginning feminizing hormone therapy.

Other side effects of estrogen use in trans women include reduced libido, erectile function and ejaculation. Erectile function might improve with the use of oral medications such as sildenafil (Viagra) or tadalafil (Adcirca, Cialis).