What to Expect When You’re Expecting Boobs

This is a compilation of reported medical transition changes collected from testimonials of trans women from various discussion forums and chat rooms, backed up by my own experiences and medical research.

Note that this is a list of possible changes. There is no guarantee that a person on hormone replacement therapy will experience all of these. Your age, genetics, medical history, degree of masculinization, and hormone regimen can all have impacts on results, and some things can take years to appear.

Changes connected to reduction of Testosterone:

  • Reduction in general body odor and change in the smell of ones sweat.

    • Many report gaining a sweet smell.
    • Users of Spironolacotone may notice a total cessation of body odor entirely.

  • Skin softens and becomes thinner.

    • Expect varicose veins.
    • Tattoos from pre-transition may become bolder and more colorful.

  • Reduction in skin oils, causing face and scalp to become drier.

    • Significant reduction in acne.
    • Reduction or even cessation of dandruff flaking

  • Thinner and softer finger and toe nails.

  • Reduced body hair growth, hairs become thinner and shorter.

    • Do not expect total cessation of body hair, you will still likely need some laser treatments.

  • Emotional expansion

    • Less stoicism and disassociation, and you will regain the ability to cry
    • Increased mirth in response to comedy and humor
    • You need Estradiol in order to push this to its fullest

  • Reduced muscle mass / harder to gain muscle

    • This contributes massively to feminine shoulder and neck line, as well as the waist line.
    • Strength diminishes significantly, become unable to open jars.

  • Increase flexibility

    • Testosterone causes ligaments to retain water, reducing mobility.

  • Loss of random erections / morning wood

    • Failure to regularly give oneself erections can result in atrophy of the tissue, leading to shrinkage.
    • Prolonged atrophy will result in changes to musculature and erectile function. Pelvic floor response may shift to be centered more around the perineum than the based of the penis.
    • This may result in some urination incontinence as the body becomes less accustomed to the length of the urethra.

  • Loss of sex drive, frequently a total loss of libido.

    • This returns eventually once the body gets used to running on estrogen, especially with the addition of progesterone, but it will not feel anything like what you’re used to (see below).

  • Sterility + testicle atrophy

    • Testicles shrink in size.
    • Atrophy pain is common in the first year. May present as a dull throbbing or as sharp sparks which travel through the genitals.

  • Deepening or changes in eye color

    • Testosterone causes a fading of iris pigmentation.

  • Hairline restoration

    • Total reversal of baldness is unlikely, but almost everyone regains some hair line.

  • Salt/Pickle cravings

    • This is specific to those on Spironolacotone, which is a diuretic that causes you to pee out all your sodium

Changes attributed to Estradiol:

  • Breast growth

    • Extreme nipple sensitivity at the onset
    • Expect aches and pains in the upper chest
    • Nipples will get larger, areolas become more visible

  • Fat redistribution into feminine proportions

    • Reduction in the waist and upper body, flattening and softening of belly, gains in hips, thighs and upper arms.
    • Lower center of gravity
      • This results in a change of gait
      • Walking with the hips becomes the body’s natural movement

  • Facial feature changes

    • Chin and jaw line will thin out.
    • Cheeks and lips will puff up
    • Brow and upper eye lids will lift, exposing more of the eyeball.
    • Eyelashes will grow thicker and longer
    • This is extremely subtle and slow going and it’s easy to think nothing is changing at all. Take selfies to compare.
    • Changes in tissue around the eye can alter the shape of the eyeball, changing focal depth and altering vision clarity

  • Freckles.

    • Estradiol alters behavior of melanocytes, the cells in the skin that produce melanin in response to UV light. This change causes melanin to cluster in higher quantities, resulting in spots with extra pigmentation.

  • Slimmer hands, wrists and feet.

    • Ring size will drop as fat moves off the hands and the skin thins, making the fingers thinner
    • Finger length will drop as ligaments thin and shift
    • Feet shrink both in length and thickness due to ligament and fat changes.
      • A drop in two or even three shoe sizes is extremely common.

  • Pelvic tilt causing an increase in curvature of the back and an increase in butt protrusion.

    • Potentially a loss of 1-3 inches in height.
    • Note: This is NOT the same as the hip rotation that occurs in AFAB puberty.
      • However, that can still happen over very long stretches of time. An 80 year old trans woman reported on reddit last year that over the course of her 30 years on HRT, her doctor observed changes in her pelvis consistent with female hip rotation.

  • Scalp hair becomes thicker and follicles grow stronger, allowing hair to grow to longer lengths.

    • Hair can also become curlier
    • Hair may change color

  • Emotional expansion

    • Higher highs and lower lows
    • Mood swings, random crying
    • Crying from joy

  • Erogenous zone development

  • Multiple. Full body. Female. Orgasms.

    • Pelvic orgasm becomes harder to achieve, but stronger in intensity
    • Full body orgasm becomes achievable, but may be hard to reach without a partner

  • Penis and scrotal tissue changes

    • Increased sensitivity
    • Skin moistening, change in odor (scrotum and penis begin to smell vaginal)
    • Coloration changes, particularly along the perineal raphe
    • Skin along the shaft and glans thins and becomes more prone to tears/bruising during sex
    • Perineum becomes very soft to the touch, velvet like

  • Perspiration distribution changes

    • Sweating becomes more of a full body experience, less focused on the scalp.
    • Underboob sweat will become a thing

  • Changes in body temperature placement

    • Reduced tolerance of temperature changes
    • Women have warmer cores but colder extremities.
    • Oral and skin thermometers may show a lower temp (~97.6)

  • Improved color perception

  • Significantly improved sense of smell, especially of other bodies

    • Will be very intense when it first unlocks but then calms down as your brain gets used to it.

  • Changes in taste perception

    • Many people report cilantro becoming more palatable.
    • Wine becomes more flavorful.
    • Chocolate addiction.

Changes attributed to Progesterone:

  • Increased appetite, food cravings

    • Progesterone increases mitochondrial function, boosting metabolic rate. That gives you more energy, but it also means you consume calories faster.

  • Increased libido / sex drive

  • Breast fullness and improved breast development

    • Progesterone is a critical hormone in the maturation of milk ducts. It also encourages the body to favor breast tissue for fat deposit.

  • Improvement of impulse control

  • Deeper sleep with potential for much more vivid dreams

Changes that cannot be specifically attributed to a single component of HRT.

Some of these may simply be the brain getting what it finally wants.

  • Drastic reduction in depersonalization / derealization symptoms

  • Improved clarity of thought (many reports of improved multitasking)

  • Increased chattiness and generally more extroverted

  • Less likely to engage in arguments or fights, more likely to attempt to defuse or escape heated situations

  • Improved balance & spacial awareness (less bumping into walls or kicking doorways)

  • A sense of feeling smaller in the world.

    • This is not just because of physical body changes, your perception shifts and you feel actually smaller.

  • Reduced tolerance of caffeine and alcohol

    • Testosterone increases body mass which increases alcohol tolerance.
    • Estrogen slows metabolic rate, decreasing the speed at which toxins are processed.
    • Spironolacotone and oral estradiol strain the liver and hinder metabolism of toxins.

  • Changes in ADHD symptoms and/or intensity

    • For some it improves, for others it gets much worse.
    • This is much more likely for users of Spironolactone

  • Changes in hair color or texture.

    • Estradiol makes hair follicles stronger.
    • Removing testosterone reduces DHT metabolism, increasing bloodflow to the scalp.

  • New libido and sexual response.

    • Desire becomes more situational than visual (testosterone encourages response to visual stimuli).
    • Desire becomes more controllable. When the drive hits, it is easier to just ignore it.
    • Desire may be experienced more in the chest than in the groin.
    • Desire felt in the groin may shift to be felt deeper, near the perineum rather than in the penis.
    • Flexing of the pelvic floor becomes erogenous

  • Lactation

    • A few drops is to be expected, especially while nipples are being stimulated, and is merely a sign of milk ducts forming properly.
    • Anything more than that may be a sign of a dangerous hormone imbalance and should be checked by a doctor.

  • Cyclical period symptoms.

    • Yes, for real.
    • No menstruation, because there is no uterus, but all other typical period symptoms can manifest in 26-30 day cycles.
    • Symptoms vary greatly (just as in cis women) and typically last for 4-5 days. Use of a period tracker can reveal the pattern.
      • Cramps in the intestine and abdominal muscles
        • Range from a slight flutter in the gut, to strong painful spasms
      • Bloating, Gas, Diarrhea and other intestinal issues (“period shits”)
      • Emotional instability and irrational thoughts
        • Heightened depression and Dysmorphia
        • Increased dysphoria
        • Irritability (PMS)
      • Muscle aches and pains
      • Breast engorgement and nipple tenderness
      • Fatigue
      • Appetite changes

  • Significant increase in distrust of men.

  • Communism

Ok, those last two might be more social than hormonal…

Photo credit: Wikihow, distributed as CC BY-NC-SA 3.0, altered for size and illustration