What you can expect

During the procedure

Typically, you'll begin feminizing hormone therapy by taking the diuretic spironolactone (Aldactone) at doses of 100 to 200 milligrams daily. This blocks male sex hormone (androgen) receptors and can suppress testosterone production.

After four to eight weeks, you'll begin taking estrogen to decrease testosterone production and induce feminization. Estrogen can be taken in a variety of methods, including as a pill, by injection or in skin preparations, such as a cream, gel, spray or patch. Don't take estrogen orally, however, if you have a personal or family history of venous thrombosis. Use of gonadotropin-releasing hormone (Gn-RH) analogs to suppress testosterone production might allow you to take lower estrogen doses and wouldn't require the use of spironolactone. However, Gn-RH analogs are more expensive.

Additional therapies might include:

• Progesterone that's been reduced to tiny particles (micronized), which might improve breast development
• Finasteride (Propecia) or topical minoxidil (Rogaine) or both for people prone to male-pattern baldness

Feminizing hormone therapy will begin producing changes in your body within weeks to months. Your timeline might look as follows:

• Decreased libido. This will begin one to three months after starting treatment. The maximum effect will occur within one to two years.
• Decreased spontaneous erections. This will begin one to three months after treatment. The maximum effect will occur within three to six months.
• Slowing of scalp hair loss. This will begin one to three months after treatment. The maximum effect will occur within one to two years.
• Softer, less oily skin. This will begin three to six months after treatment.
• Testicular atrophy. This will begin three to six months after treatment. The maximum effect will occur within two to three years.
• Breast development. This will begin three to six months after treatment. The maximum effect will occur within two to three years.
• Redistribution of body fat. This will begin three to six months after treatment. The maximum effect will occur within two to five years.
• Decreased muscle mass. This will begin three to six months after treatment. The maximum effect will occur within one to two years.
• Decreased facial and body hair growth. This will begin six to 12 months after treatment. The maximum effect will occur within three years.