Hormone therapy

Content warning: Some sections of this page use anatomical terms for body parts. Some sections discuss sexual activity, needles, injections, and blood. Some sections briefly mention periods, pregnancy, and infertility.

Sex hormones are natural chemicals that everyone has in their body. These hormones – particularly oestrogen and testosterone – affect how your body develops over time and are responsible for the changes that happen during puberty and adulthood that are related to gender.

Hormone therapy is using medication to change the amount of sex hormones in your body or how your body reacts to them. This can help you make your body more masculine, more feminine, or slow down changes that are currently happening.

You might also hear words like ‘gender-affirming hormone therapy’ (GAHT), ‘hormone replacement therapy’ (HRT), or just ‘hormones’ used to describe these medications.

If you’re having hormone therapy to make your body more masculine (masculinising hormone therapy), hormone therapy usually involves taking testosterone. Occasionally, a GnRH agonist might also be used to reduce the amount of oestrogen produced by your body.

If you’re having hormone therapy to make your body more feminine (feminising hormone therapy), hormone therapy will normally involve taking oestrogen. This is often (but not always) used together with an anti-androgen (on the NHS, normally a GnRH agonist) to reduce the amount of testosterone produced by your body. Some people also take progesterone as part of feminising hormone therapy, but this isn’t part of the current NHS treatment protocols.

Some other medications often get used by people as part of medical transition too: 

Contraceptive medications can be helpful if:

Topical oestrogen cream can be helpful if:

  • you are experiencing vaginal dryness, or vaginal atrophy (thin skin in the vagina that tears easily)

Eflornithine (Vaniqa cream) can be useful if:

  • you have unwanted facial hair, and you want to slow down how quickly it grows so you need to shave less – this is sometimes used by people who can’t have permanent facial hair removal

Finasteride or dutasteride can be helpful if:

  • your body produces testosterone, and you want to slow down body hair or facial hair growth
  • your body produces testosterone, and you want to stop male pattern baldness
  • you’re taking testosterone, and you want to stop male pattern baldness

Minoxidil can be helpful if:

  • your body produces testosterone, and you want to slow down body hair or facial hair growth
  • your body produces testosterone, and you want to stop male pattern baldness
  • you’re taking testosterone, and you want to stop male pattern baldness

Some people are sure that hormones are the right thing for them. You might have known for a long time that you want to start hormone therapy. However, it’s really common not to be sure about whether hormones are what you want, and to need to take some time to figure it out. You don’t need to be sure about whether you want hormones or not before you ask for a referral to an NHS gender service.

It’s totally fine to decide that hormones aren’t the right thing for you – lots of people do this. You might feel it’s not something you need, that there are effects from the hormones you don’t want (like balding, chest growth, or voice changes), or that it’s not the right time for you at the moment.

Lots of people do find hormones really help them – and there’s lots of medical studies that have shown that hormones help people who want them.

If you’re not sure whether you want to take hormones, you might want to consider these questions:

  • Would learning more about your options help you to make a decision? Hormones have lots of effects on your body and emotions, and there’s a lot to learn to understand your choices fully. In the next section, What should I expect from taking hormones?, you can read more about it.

  • Do you understand the risks of hormone therapy? You can read more about some of these risks, and how they can be reduced, on our Blood Tests page. You’ll be able to discuss these risks more in your appointment with a gender service.

  • Could you talk to someone who has taken hormones already? They might be able to talk to you about their experiences and how they found it. This might help you think about what it would be like, or give you a chance to ask questions. If you don’t know anyone who has taken hormones yet, you could look on our Sources of Support page for support groups, peer support services, and peer-run helplines.

  • Could you talk to a counsellor? A counsellor could help you talk about your situation, suggest things you might want to consider, or signpost you to other support. You can find links to sources of mental health support on our Sources of Support page.

  • Could you keep track of how you’re feeling? Some people find it helpful to keep a journal of how they feel about their body and about the idea of starting hormone therapy. Do you feel the same every day about the effects that hormones might have? Do your feelings about your body, or how other people treat you, change over time?

  • Could you work out what it might be like? It can be helpful to experiment with temporary things that might be similar to the effects of hormones. For example – if you’re thinking about starting masculinising hormone therapy, would it help to try using makeup to add the impression of beard shadow and see how that feels? If you’re considering feminising hormone therapy, would it help to try padding a bra and see how that makes you feel?

More questions that might help you make a decision are:

  • What would be the effect on my life if I didn’t take hormones?
  • What would improve in my life if I did take hormones? What would it let me do?
  • How could I tell if I wanted to stop? If it did turn out to feel wrong, and I wanted to stop, how would I deal with that?
  • Would taking hormones right now put me in an unsafe situation?
  • Do I need to be 100% certain? Would it even be possible to be 100% certain?

You might find it helpful to talk your your answers to these questions with a friend or counsellor.

Different people experience different things when they start hormones. Some of the changes might be ones you don’t want. You can’t normally pick and choose what effects you do and don’t get from hormone therapy.

However, there’s some common effects that happen to most people. 

If you’re making a decision about whether to start taking hormones or not, remember that:

  • You might find only some of these things happen for you – that might be something you want. You can’t predict which of the effects you’ll get.
  • Some of these changes are permanent and are difficult or impossible to reverse. You might want that too!

The changes that most people see over time from hormones are:

  • Body shape: Where your body stores fat may change over time while you are on hormones. If you’re using masculinising hormone therapy, you may find you start to have more fat on your stomach and less on your hips and buttocks. If you’re using feminising hormone therapy, you may find you start to have more fat on your hips or buttocks. You may find that you need to buy new clothes to fit your body better. There might also be some subtle changes to your face shape as fat is redistributed.

  • Fertility: Hormone therapy may make you infertile over time. Some people are able to pause their hormones to have children who are genetically related to them, but there are no guarantees. Some people use fertility preservation to store eggs or sperm that they can use later to have children – you can read about this in much more detail on our Fertility Preservation page.

  • Mood or emotions: The changes to your moods and emotions from hormone therapy can be difficult to handle initially. You might find your body reacts to emotions differently – for example, some people find it much harder to cry, or much easier to cry, after they start hormone therapy. Some people find that their emotions become much more intense and difficult to handle. If you’re finding these changes difficult to handle, or you find it difficult to recognise what emotions you’re feeling, you may find it useful to talk to a counsellor.

  • Gender dysphoria: Gender dysphoria is a feeling of discomfort many trans people describe around gendered aspects of their body or how people treat them in gendered ways. Many people find that hormone therapy can help reduce their gender dysphoria. 

  • Libido: Some people find that they are less interested in sex or masturbation than they used to be, and some people find that they are much, much more interested in these things. Some people find that they’re interested in doing sexual activities they weren’t before, or in having sex with people they wouldn’t have been attracted to before. If you’re finding this difficult, and want help, speaking to a psychosexual counsellor could be helpful.

  • Existing health conditions: Some people find that their existing health conditions, like PCOS, migraines, or hair loss, become more or less severe when they start hormones. Tell your gender clinic about your existing physical health conditions so that you can discuss these things with you and plan how you can manage the changes.

  • How other people treat you: When the changes from hormone therapy become apparent to other people, some of those people start to treat you differently. These differences in how you are treated by other people can be quite dramatic. You might find different people find you attractive sexually or romantically, that people take your opinions or emotions more seriously (or less), and some people might even be less comfortable being around you than they were before. Some people even find it affects their relationship with a romantic partner.

  • How other people around you are treated: You might find other people in your life start to be treated differently too. For example, if you have a partner, they may start to be perceived by others as ‘straight’ rather than ‘gay’, or vice versa. You may find that your family members are treated in ways they don’t want to be. For example, people might start asking them lots of questions about you and your future plans, or even stop talking to them completely.

  • Medical risks: Hormone therapy can increase your risks of some medical conditions, and decrease your risk of others. It’s important you understand these risks before you start hormone therapy. The person who prescribes you hormones will discuss these risks with you in detail before you start taking hormones. Some of these risks are quite serious.

Both feminising and masculinising hormones have extra effects that you should know about too.

Masculinising hormones

There are some additional changes that are specific to testosterone:

  • Physical strength: The size of your muscles can increase, particularly if you are weight training while you are taking testosterone. Some people find that they are stronger in other ways, like feeling able to recover more quickly from exertion, build muscle more quickly, or generally feeling more energetic. You may find that your increased muscle mass means your shoulders get broader.

  • Acne and skin: Lots of people taking testosterone find their skin gets oily and some people experience acne. This may mean you have to learn how to adapt your skincare routine – you may need to wash more regularly than you’re used to. If the acne continues, speak to your GP for advice.

  • Body hair: Many people who take testosterone are happy to grow hair in places they didn’t have it before, like on their chest or stomach, and darker thicker body hair in places they already had it. Thick body hair can start growing in places you don’t expect or want, such as your back, shoulders, ears, nose, buttocks, or around your anus.

  • Facial hair: You can expect that you will have increased facial hair, which may be enough to grow a mustache or beard. This can start quickly but take a long time to get thick – for some people, this may take years or decades, or may not grow at all.

  • Head hair: Many people experience male pattern baldness on testosterone. The amount of hair loss can range from significant balding through to thinning of head hair or changes in hairline shape. If hair is thinning and you don’t want it to, hair loss treatments are available – finasteride and minoxidil. NHS guidance suggests that finasteride should not be prescribed by NHS GPs for male pattern baldness, as this is considered an ‘aesthetic’ treatment, so most NHS GPs will not prescribe finasteride to trans people for hair loss. However, many people get finasteride by booking a consultation with a paid GP service instead – for example, at Boots, Lloyds Pharmacy, Superdrug, Well Pharmacy, or at a local pharmacy. You can buy minoxidil (often branded as “Rogaine”, “Regaine”, or “Loniten”) without a prescription “over the counter”. These medications can have side-effects of their own so it’s important to read about these before you start either of them. It’s particularly important to read the safety information for minoxidil as this may be harmful to some pets. Don’t forget to let the person prescribing your hormone therapy and your GP know if you’re starting either of these medications.

  • Body odour: Lots of people find how they smell changes, and your smell might get much stronger. This may mean you have to change your hygiene habits and shower or bathe more frequently. This change can happen quickly.

  • Genital changes: Most people find that their clitoris gets significantly bigger. This may mean you have to change how you wash yourself. It can also be very sensitive until you get used to it, which can be inconvenient and annoying. You might also start to experience “spontaneous erections” – erections of your clitoris that happen for seemingly no reason.

  • Vaginal changes: Over time, the skin around your vagina (your vulva) and in your vagina can become thinner (atrophy). You might find that the skin becomes uncomfortably dry, delicate, or itchy during everyday life, that it stings when you pee, or that it makes penetrative vaginal sex painful or difficult. If you’re experiencing some of these symptoms, you can talk to your GP or gender clinician about topical oestrogen cream, which can help reduce this symptom. 

  • Menstruation: Menstruation (periods) normally stops after a few months of taking testosterone, but if not, you might want to use a different form of testosterone or take additional medications like GnRH agonists. Talk to the person who is prescribing your testosterone if your periods haven’t stopped and you would like them to.

  • Voice: This change can start quite quickly and for some people it’s quite a dramatic and very noticeable change. You may find that you go through a period of your voice ‘breaking’, where you become a little ‘squeaky’. Some people don’t have much of a change in their voice, or it takes a long time for it to happen. Speech therapy is available to all trans people on the NHS, so if you’re unhappy with the changes you’ve experienced, you can ask about this option.

Feminising hormones

There are some changes that are specific to feminising hormone therapy:

  • Breast growth: The amount of breast growth varies from person to person, can take months to begin, and may not be complete for many years. Your breasts may grow differently shaped to how you expect, and one may be bigger than the other. You may find that your breasts are very sensitive initially while they are growing. Some people find that they aren’t happy with their breast size even after several years of hormone therapy. If you’re unhappy with your breast size, it’s possible to have breast augmentation or breast reduction surgery, but the NHS rarely funds these surgeries so it’s likely you’d need to pay for it yourself.

  • Skin changes: Many people who take oestrogen say that their skin has become softer.

  • Acne: Hormone changes can cause acne to reduce significantly for some people.

  • Genital changes: You may find that your genitals become smaller in size over time. Some people find their testicles reduce in size significantly.

  • Erections: Most people find they stop having “spontaneous erections” (erections happening for no clear reason). Some people taking feminising hormone therapy lose the ability to maintain an erection for very long, or stop being able to have an erection at all. For many people, not having erections is something they want, but some people starting hormones want to keep being able to have an erection. Some people who want to keep the ability to have an erection find that when they start hormone therapy, and feel more comfortable in their body, having erections becomes less important to them. Psychosexual counselling (specialist counselling about your sex life) can help you feel more comfortable with your body and with sex, which can help some people to get ‘turned on’ and have erections more easily. Working with a psychosexual counselling can also help you find ways of having sex that you can enjoy without needing an erection. Some people use a type of medications called PDE5 inhibitors, like sildenafil (“Viagra”) or tadalafil (“Cialis”), which can help to give you an erection by increasing blood flow into your genitals, but these medications don’t affect how interested in sex or “turned on” you are.

  • Orgasm: Many people describe that orgasm starts to feel different to them after starting feminising hormone therapy, that the amount of semen they produce reduces (sometimes down to almost nothing), and that the appearance of the semen changes a lot. There’s very little research into this area, and what does exist focuses mainly on people’s fertility, so it’s difficult for us to give you good information on exactly what to expect.

  • Physical strength: Without testosterone in your system, you’ll probably lose strength and muscle mass over time. This change can be significant, and you may find that you are not able to lift or carry as much as before. You may find you need to ask people to help you do physical things you could do on your own before.

Some of the effects of hormones can happen very quickly – for some people, within a few weeks or months. Some people try a low dose at first to slow down how quickly the changes happen – this is called microdosing. This can help you get an idea of whether hormones are right for you or not before too many changes happen. However, if you are microdosing you can’t know for sure which changes you’re going to get, or what order they will happen in. If you stay on a low dose for a long time, you’ll probably get most or all of the same changes you would from a full dose.

Most people decide to continue taking hormones for the rest of their lives.

You might need to pause taking hormones for a while. This could be because:

  • you need to have a medical treatment that requires you to do it, like some fertility or surgical treatments
  • you’re having supply issues with your hormones
  • you’re not in a situation where it’s safe for you to take hormones
  • you want time to think about whether you want to continue taking hormones or not
  • you are trying to get pregnant or have found out that you’re pregnant

Sometimes, people decide that they want to stop taking hormones completely. This might be because:

  • they are happy with the changes that have happened so far but don’t want any more to happen
  • they like many of the changes that are happening but are finding the side-effects of the hormone therapy difficult to handle
  • they’ve decided they no longer want some of the changes that are happening
  • they’ve realised that it just isn’t the right thing for them

Very occasionally, people need to stop taking hormones because of serious medical issues.

It’s not unusual to change your mind about exactly what you want: unless you’ve tried something yourself, it’s really difficult to know for certain whether you really want it or not. If you do decide to stop hormone therapy , but still feel you are trans, that’s fine – that doesn’t make you any less valid as a trans person.

What happens if I pause or stop hormone therapy?

There’s a lack of medical research into this, which means we can only talk about what we’d normally expect to happen.

Some changes from hormone therapy are mostly permanent and normally remain even if you stop or pause your hormone therapy. These include:

  • growth of your breast tissue (people taking oestrogen)
  • body hair, facial hair, and clitoris growth (people taking testosterone)
  • changes to your voice (people taking testosterone)
  • hair loss

If you’ve not had surgery to remove testes or ovaries) and you’re not taking GnRH medications (“blockers”), stopping hormone therapy might mean:

  • your body fat distribution slowly changes back to how it used to be
  • changes to your moods, emotions, and libido
  • changes to your body odour
  • you have increased feelings of gender dysphoria
  • Restarting menstruation (periods) for people with a uterus.

If you decide to restart your previous hormone therapy, these things are likely to go back to how they were when you were previously taking hormones.

If you’ve had surgery to remove testes or ovaries, or you’re taking GnRH medications and don’t want to stop taking them, the situation is more complex. If you’re in this situation, it’s advisable to talk to a specialist endocrinologist about your situation. In brief, you have three choices:

  • masculinising hormone therapy
  • feminising hormone therapy
  • doing nothing: this may have implications for your emotional and physical health, such as osteoporosis (thinning of the bones) or increased risks of heart problems, and will need to be discussed carefully with a specialist endocrinologist to manage these risks.

Hormones are prescription medications. If you’ve not been on any prescribed medications before, it can be a bit confusing understanding how to get your hormones. It’s worth reading the advice for your area on how prescriptions work:

These resources explain how to order your medications and how to order more before you run out.

If your medication is an injection, you’ll normally need this to be injected for you. If your medication has been prescribed by the NHS, your GP surgery should do this for you. You may need to book an appointment with a nurse at the GP surgery for your injections. Normally you will have to order your prescription, pick it up from the pharmacy and then take it to the appointment with you.

If your prescription is a ‘private prescription’, you can take it to a normal pharmacy as if it was an NHS prescription, but you’ll have to pay full price for the medication.

NHS prescriptions are free for most people in Scotland, Wales, and Northern Ireland.

In England, people are asked to pay a small charge for each item on their NHS prescriptions. There are ways you can reduce or avoid this cost, which you can read about on the NHS website. If you do need to pay for your prescriptions, you may be able to reduce how much your hormones cost you by getting an NHS Prescription Prepayment Certificate (PPC) – this could save you a lot of money. There is also a lower cost Prepayment Certificate for oestrogen hormone therapy which you can use specifically for oestrogen.

You can find more information about the cost of private prescriptions on our Private Care page.

Sometimes pharmacies aren’t able to provide people with their hormones because of shortages or supply issues. They will tell you whether or not they will be able to order your medication or not. 

Being prepared for shortages

Make sure that you’re prepared for problems with your hormone supply. It’s wise to make sure you order your next repeat prescription before you run out of your medication or a couple of weeks before your injection is due. Add a recurring reminder event to your calendar to make sure you don’t forget to order your repeat prescription or pick up your medications. If this is difficult for you, ask someone else to help you remember. You may be able to have the medication delivered to you using an online pharmacy using services like Boots Online Pharmacy or Pharmacy2U – but this only works for some types of medications.

Handling supply issues

If your pharmacy isn’t able to get your hormones for you, what you need to do will depend on your situation.

If you’re not going to run out soon, you can ask your pharmacy to contact you when they have your medicines in stock again.

If you need your medications very soon, you can ask for the pharmacy to ‘release’ your prescription, which means you are able to take your prescription to a different pharmacy instead. You may find that a different pharmacy is able to get your medications as they have different suppliers. You can check to see if your medications are available in a nearby pharmacy – by phoning, by going into the pharmacy, or using an online tool like the Boots pharmacy stock checker.

If you are not able to find any pharmacies stocking your medication, you can:

  • Check whether information about the shortage has been published on the website for your gender clinic. There’s information you can show your GP or pharmacist about what to do on our Prescribing page. Gender clinics often publish new advice for patients and GPs during a shortage, so don’t forget to check their website. 
  • Talk to your GP or gender clinic about whether a different form of your hormone might be better. For example, they might be able to switch you from testosterone injections to gel, or from oestrogen pills to patches, until the supply problem is resolved.
  • Check whether a Serious Shortage Protocol (SSP) has been published for your medication – this tells pharmacies to switch you to an alternative option. You can check the lists of SSPs for England and Wales, Scotland, or Northern Ireland to find out if there is an SSP for the medication you’re looking for and how your pharmacist is meant to be supporting you.

If you’re experiencing any unwanted or unexpected side effects from your hormone therapy, tell your GP and the person who is prescribing your medication.

Some rare side-effects of hormone therapy can be quite serious. Hormone therapy can increase your risk of cardiovascular problems (problems with your heart and blood vessels) and liver problems. It’s not possible to avoid all risk, but proper blood testing can help reduce the risk as much as possible. If you’re experiencing something you weren’t expecting, tell a medical professional.

If the side-effects you’re experiencing are less serious, it’s still worth talking to a medical professional about them, as they may be able to offer you help. For example, lots of people find it difficult to adjust to changes in how they feel or process emotions when they start hormone therapy. If you talk to a medical professional about it, they might be able to refer you to support, like a counselling or psychology service.

Hormones come in many different forms. The formulations that are prescribed in the UK are all equally effective, and none work faster than others, but some might be more convenient for you.

Oestrogen is normally prescribed in the UK as:

  • Weekly or twice-weekly patches that are stuck to the skin (also called ‘transdermal patches). Brands available in the UK include Evorel and Estradot.
  • Daily use gel applied to the skin (normally arms or thigh). Brands available in the UK include Oestrogel.
  • Daily pills (also called ‘oral oestrogen’). Brands available in the UK include Progynova.

Sometimes a spray form of oestrogen will be prescribed (the Lenzetto brand is available in the UK). Oestrogen injections are not available on prescription in the UK. 

You might hear oestrogen referred to as ‘estrogen’ (the common US English spelling). The specific type of oestrogen that’s prescribed for trans people can also be called ‘estradiol’ or ‘oestradiol’.

Testosterone is normally prescribed in the UK as injections or as gels applied to the skin. The types available are: 

  • Short-acting injections that last around 2-4 weeks. Brands available in the UK include Sustanon. Some NHS services avoid using these injections on a long term basis to reduce the risk of polycythaemia, a common complication.
  • Long-acting injections that last around 3 months. Brands available in the UK include Nebido. You might also see this called ‘testosterone undecanoate’. 
  • Daily use gel that you apply to your skin. Brands available in the UK include Testogel and Tostran.

GnRH agonists are normally prescribed in the UK as injections. The types available are: 

  • Monthly injections like Prostap 3.75mg
  • Three-monthly injections like Prostap 3 11.25mg or Decapeptyl SR 11.25mg
  • Six-monthly injections like Decapeptyl SR 22.5mg

GnRH agonist nasal spray is occasionally prescribed, with brands like Synarel or Suprefact available in the UK.

Your clinician should help you to pick a formulation that is right for you.

If you’re having side-effects from a particular formulation, or you’d find it easier to take a different formulation, you could ask the person prescribing them if you can change to a different form (for example, moving to testosterone gel instead of testosterone injections).

You might want to try a different form of testosterone because:

  • You’re experiencing pain, discomfort, or swelling after injections.
  • Gel is causing you skin irritation, dry skin, or unwanted hair growth.
  • You’re finding it difficult to schedule, remember, or attend appointments for your injections.
  • You want to have your injections less frequently.
  • It’s difficult for you to find the time to apply gel, and to wait for it to absorb, before you swim, bathe, or shower.
  • You don’t want the risk of someone else accidentally touching skin you’ve put gel on.
  • You feel better with more consistent blood hormone level than you can achieve with injections.

You might want to try a different form of oestrogen because:

  • Gel is causing you skin irritation or dry skin.
  • You’re finding it difficult to remember to take your pills every day at the right times.
  • You find that patches are not sticking to your skin properly.
  • It’s difficult for you to find the time to apply gel, and to wait for it to absorb, before you swim, bathe, or shower.
  • You don’t want the risk of someone else accidentally touching skin you’ve put gel on.
  • You’ve been advised by a medical professional to try gel or patches instead of pills based on your blood test results.

Hormone pills are usually only for oestrogen and progesterone. Testosterone isn’t given in pill form in the UK. The pills are usually small – smaller than a typical paracetamol tablet. 

If you’ve been given pills, you’ll normally be asked to take them at least once every day. You might even be asked to take several pills each day. Some people like to take the pills spread out through the day and find this makes them feel better – you could discuss this with your gender clinic.

Some people who take pills find their hormone levels are low, even with a high dosage. If that happens to you, you can ask the person who is prescribing your medications to switch you to gel or patches instead.

It’s difficult to remember to take your pills every day, particularly if you’re taking them at different times of day. Some things that can help you to remember are:

  • Alarms to remind you to take your pills.
  • Leaving your pills somewhere you’ll find them during your existing daily routine. Could you put them on the table where you normally eat your breakfast?
  • Combining taking your pills into other parts of your routine that you already manage to do every day – like taking your pills just before you brush your teeth.
  • Getting someone else to remind you as part of their daily routine.
  • Dosette boxes – these are boxes with compartments for each day of the week that you can put your pills into.

If you’re still finding it difficult to remember to take your pills, you could ask the person prescribing your medication if you could switch to gel or patches, as this might be easier for you.

Hormone patches are normally only used in feminising hormone therapy as a way of taking oestrogen. The patches are small pieces of plastic which stick to your skin – they feel a bit like a waterproof plaster. You might be asked to wear more than one patch at once.

Oestrogen patches are worn for several days at a time. You’ll need to replace them regularly (normally twice a week). It can be hard to remember when to replace your patches because you don’t have to do it every day. It might help you to set a recurring event in your calendar to tell you when to take your old patch off and put a new patch on.

Removing all the adhesive (sticky glue) from your skin after taking a patch off can be difficult for some people. If you’re having this problem, medical adhesive remover wipes (e.g. “Zoff” wipes) or baby oil can be helpful to remove all of the left over glue.

Some people find that their patches fall off early. You can just apply a new patch if this happens. If you’re finding you have regular problems with patches not sticking properly, try:

  • pressing down on the patch firmly for ten seconds after applying it
  • making sure the skin has been washed before applying patches
  • making sure the skin is properly dry before applying patches
  • moving the patches to a different area of your body as the patches may be being rubbed by clothing or stretched by skin movement – remember to follow instructions about where the patch can be placed (normally not above your belly button).
  • ask the person prescribing your medication about trying a different brand of patches –  different brands have different sizes and types of adhesives so may stick better to your skin. If you’re still having problems, they could switch you to a different formulation like gel.

Some people find that the patches irritate their skin. If this happens, speak to the person prescribing your hormones – they could try you on a different brand of patch which might irritate your skin less, or could switch you to an alternative formulation like gel or pills.

When you have blood tests for your hormone levels, you should be given specific instructions about when to apply your patches before the test.

Hormone gels come in pump bottles (or sometimes sachets). The pump gives you a specific amount of gel in each pump. Some brands of gel come with an ‘applicator’ you can use to avoid getting gel on your hands.

You’ll need to put hormone gel on your skin once every day. Think about how to fit this into your daily routine, as you’ll need to do it when your skin is dry, and not shower or have a bath for a certain amount of time (often more than an hour) afterwards. You might find it helpful to set a reminder alarm on your phone to remind you when to put your gel on.

To apply the gel: 

  1. Make sure there’s no naked flames (e.g. candles) around you.
  2. Make sure the skin you’re putting the gel onto is clean, dry, healthy, and isn’t damaged or broken.
  3. If you’re using a pump for the first time, make sure that it’s been prepared properly. The pump will come with instructions on how to do this.
  4. Put the correct amount of gel onto your fingers (unless your gel came with an applicator).
  5. Spread the gel onto the area you’ve been asked to put the gel on. Don’t rub it in. Make sure the gel is a thin and even layer.
  6. Wash your hands with soap and water.
  7. If you’re using a pump, make sure you follow any instructions about storage (e.g. replacing a stopper, or cleaning the applicator).
  8. Wait for the gel to dry in the air.
  9. Put clothes on that cover the whole skin area that you’ve put the gel on.

It’s possible for gel that you’ve put on your body to transfer to other people if they touch or rub against you. This can be particularly difficult to avoid if you have young children. Once the gel has dried, you should make sure you always put clothes on if there is any risk that you could accidentally touch that part of your skin against anything or anyone else. Make sure your clothes cover the whole skin area that you’ve put the gel on. Make sure you wash your hands thoroughly with soap to get rid of any gel that’s on them – they aren’t covered by your clothes and you’re more likely to touch other people with them. If you think that the gel might have touched someone else’s skin, tell them to wash the area carefully with soap and water. There will be more information about avoiding transfer to other people in the instructions that come with your medications.

Some people find the gel irritates their skin. If this happens, speak to the person prescribing your hormones – they could try you on a different brand of gel which might irritate your skin less, or could switch you to an alternative to gel.

Hormone gels normally contain lots of alcohol. If you find being around this smell difficult or upsetting, you may want to avoid applying the gel to your upper arms, chest, or shoulders. The smell should become much less noticeable once the gel has dried.

When you have blood tests for your hormone levels, you should be given specific instructions about when to apply your gel before the test. On the day of your blood test, avoid applying gel to the arm you’ll have blood taken from, as this helps to avoid accidental contamination of the blood sample.

Injections are often used in masculinising hormone therapy as a way of taking testosterone, and in feminising hormone therapy as a way of administering GnRH agonists (blockers).

If you’re having an injection, it’s important to check the ingredients of what’s being injected into you, even when it has been prescribed by a doctor. Some hormone injections contain ingredients that aren’t suitable for people who have allergies to peanuts or soya.

Injections aren’t normally very painful – they are often described as a ‘sharp scratch’ or uncomfortable – but can be sore for a while afterwards. 

If you’re afraid of injections, there’s some practical advice on overcoming needle phobia.

The injections are normally done into your thigh or buttock. You may be given a choice of whether the injection is performed with you standing or lying down, depending on what is most comfortable for you. The injections will normally alternate between sides of your body each time you have an injection done (e.g. into your left buttock, and then into your right buttock).

If your injections are prescribed for you by an NHS gender clinic, someone at your local GP surgery should be able to perform the injections for you. This normally means you need to book a nurse’s appointment for the injection.

If you’d prefer, some injections can be done by you, or a friend or family member at home. You might want to inject at home:

  • Because it’s more convenient
  • Because you’re more comfortable in your own home than a doctor’s office or clinic
  • Because you’re taking an extended trip away where you won’t have easy access to a clinic
  • Because you can’t find a clinician in your area who will perform the injection
  • If you’re already self-injecting other medicines

You or the person making the injection will need to be trained to perform the injection. You can read more about how injections at home work in the next section, Injecting hormones at home.

If you’ve been told by the person prescribing your medication that you can inject at home, you should have been offered training in how to do the injection. If you’ve bought your own medications, and are planning to inject them, you may want to try asking your GP surgery if they would be willing to offer you training as a form of harm reduction. If you’re unable to get advice from a professional, you could contact an organisation or group that provides harm reduction guidance (you can find details of these on our Sources of Support page), or read guidance written by NHS clinicians (for example, this Harm Reduction Advice for Self Sourcing Hormones produced by the Edinburgh Steroid Clinic).

If you’re injecting at home, you will normally need:

  • Sterile, unused needles of the correct sizes (needle thicknesses are known as gauges)
  • Sterile, unused syringes
  • Pre-injection swabs
  • Disposable gloves
  • A sharps bin
  • Gauze or cotton wool

You may be able to have these prescribed to you. You can also buy these from your local pharmacy or online medical suppliers. If you’re buying medical supplies online, use a reputable medical supplier registered with the MHRA to make sure your supplies are safe.

You should learn how to safely inject your medication, including the correct gauge (size) of needles to use, and which injection site to use. You can find guidance for:

  • Sustanon: There are useful instructions about safely self-injecting testosterone entantate or Sustanon on the Leeds GIS website.

  • Nebido: There’s information published by the manufacturer about how to inject Nebido. Nebido can be significantly more difficult to inject than Sustanon. These instructions are intended for professionals, so if you are able, ask a professional for advice.

  • Oestrogen: There’s no official guidance on injecting oestrogen produced by a UK organisation we’re aware of, as it’s not dispensed by pharmacies in the UK. Be aware that if you’ve found instructions online for injecting oestrogen, they might either be for intramuscular (IM) injection or for subcutaneous (subQ) injection, and these use different types of injection sites and needle sizes. There are very clear instructions for performing an intramuscular injection in this resource for medical professionals. The resource is intended for professionals, so if you are able, ask a professional for advice.

  • Prostap: The manufacturer has produced detailed instructions on injecting Prostap (see “Method of Administration“) and a video on how to inject Prostap. Prostap is injected differently to most other injections. These instructions are intended for professionals, so if you are able, ask a professional for advice.

  • Decapeptyl: The manufacturer says this medication is not suitable for home injection. It is particularly difficult to administer correctly, so consider an alternative medication, or ask your GP surgery if they would be willing to perform the injection for you.

It’s very important that you do not re-use needles, syringes, or pre-injection swabs.

Used needles should be put into a dedicated sharps bin. This is a special type of bin for objects like needles and scalpels that makes it easier to dispose of them safely. You can find more information about how to use a sharps bin on the NHS England website. You can bring the sharps bin to a needle exchange programme, certain pharmacies, or your local council may offer a collection service. Make sure the bin is properly sealed before you try to take it anywhere.

There are medical risks involved with taking hormone therapy. You’ll be given important instructions to follow by the person prescribing your hormones that will help reduce these risks.

Testosterone

Some things that may help reduce the risks of taking testosterone are:

  • Get regular blood tests: Testosterone use can cause serious medical conditions. To reduce your risk level, use testosterone under medical supervision with regular blood testing – you can learn more about blood tests and how to get them on our Blood Testing page.

  • Learn about sleep apnoea symptoms: Testosterone users are more likely to have sleep apnoea. Learn about the symptoms to watch out for, and if you sleep in a room with someone else, you may wish to tell them too.

  • Use safe injection practices: If you use injections and these aren’t being performed for you by a nurse or doctor, read the safety information in the Injecting Hormones At Home section.

  • Stop smoking: Smoking is harmful to your health, and some medical studies suggest there are further increased risks of health problems if you’re smoking and having hormone therapy. We know that the majority of people who are smoking or vaping would like to stop. If you want help to stop, you can talk to your GP, or contact stop smoking services directly yourself. Read how to get help with smoking or vaping on the NHS Stop Smoking Services page. 

  • Contraception: While testosterone can affect your fertility, it isn’t a contraceptive. People on testosterone can still get pregnant. Testosterone can have serious effects on a growing foetus, so it’s important you think about your options for contraception carefully. There’s a detailed guide to trans people’s options for contraception in this leaflet from the Leeds Gender Identity Service.

  • Sexual health: If you’re sexually active, or you think you might be in the future, you should learn about your options for looking after your sexual health. You can read more in this guide from Terrence Higgins Trust, including information about PreP and PeP, or find more resources about sexual health on our Patient Information Resources page.

Oestrogen

Some things that may help reduce the risks of taking oestrogen are:

  • Get regular blood tests: Oestrogen use can cause serious medical conditions. To reduce your risk level, use oestrogen under medical supervision with regular blood testing.

  • Use safe injection practices: If you use injections and these aren’t being performed for you by a nurse or doctor, read the Injecting Hormones At Home section.

  • Attend screening appointments: If you’re over 50, have taken oestrogen, and have breasts, you should attend breast screening appointments. You can read more about making sure you get the right screening appointments on our Updating Medical Records page.

  • Stop smoking: Smoking is harmful to your health, and some medical studies suggest there are further increased risks of serious health problems if you’re smoking and having hormone therapy. We know that the majority of people who are smoking or vaping would like to stop. If you want help to stop, you can talk to your GP, or contact stop smoking services directly yourself. Read how to get help with smoking or vaping on the NHS Stop Smoking Services page. 

  • Contraception: While feminising hormone therapy can affect your fertility, it isn’t a contraceptive, and people taking feminising hormone therapy may still be able to make someone pregnant. There’s a detailed guide to trans people’s options for contraception in this leaflet from the Leeds Gender Identity Service.

  • Sexual health: If you’re sexually active, or you think you might be in the future, you should learn about your options for looking after your sexual health. You can read more in this guide from Terrence Higgins Trust, including information about PreP and PeP, or find more resources about sexual health on our Patient Information Resources page.

GnRH agonists

Some things that may help reduce the risks of taking GnRH agnoists are:

  • Attending screening appointments: If you have taken GnRH agonists for some time, your doctor may recommend you attend bone density (DEXA) scans. These help check if you’re developing osteoporosis.

  • Get regular blood tests: These medications can sometimes have side effects or cause other medical conditions to get worse. To reduce your risk level, use GnRH agonists under medical supervision with regular blood testing.

At the moment, international guidelines and NHS guidelines don’t recommend using progesterone. 

Some trans people say that taking progesterone helps their breast growth, mood, or have other beneficial effects. There’s really not been enough research in this area to say whether it’s useful at this point – currently there are some medical studies underway in the UK and in other countries to investigate this question. 

Many people transition without using progesterone and are happy with the changes they experience. However, we understand that some people aren’t happy with the changes they’ve had from their hormone treatment so far, and would like to try adding progesterone.

There are risks of serious medical conditions associated with progesterone use in cisgender women, and these risks might affect trans people taking progesterone too. There might be additional risks from taking progesterone as part of feminising hormone therapy, and these risks aren’t well understood yet. 

If you’re taking progesterone, the simplest way to reduce your risk level is regular blood testing and medical supervision. Working with a medical professional can also help you determine the correct dosage and formulation of progesterone to minimise risk as much as possible and avoid any unwanted side effects.

If you want to access progesterone under medical supervision in the UK:

  • Some private gender clinics will prescribe progesterone for patients who ask for this service.
  • Some NHS gender clinics have offered progesterone to a very small number of patients as part of a clinical trial.

If you’re leaving the UK for more than three months, or will be away when your injection is due, it’s important to ask for advice from your gender clinic about your situation well in advance of travelling. NHS prescribers can normally only provide a three month supply of medications, and are not responsible for your care after that point, so you may need to find a health service in the country you are travelling to which is able to prescribe your medication for you.

It can be a lot more complicated to travel outside the United Kingdom with your medications than you might expect. 

It’s important that you:

  1. Make sure it’s legal to take your medications into or out of all the countries you are visiting
  2. Make sure you know the local rules around your medications in all the countries you’re visiting
  3. Make sure you’ve planned ahead in detail if you take an injected medication

The next few sections explain how to do this.

If you’re a trans person travelling outside of the UK, you should also read these very important government advice pages about travel to other countries:

Is it legal to take my medications into or out of the country?

The medications used in hormone therapy are not legal to take into or out of many countries. If you don’t follow the rules about what you’re allowed to take into other countries, there could be very serious legal consequences, which could include time in prison.

You’ll need to check that it’s legal for you to take all of your medications into (and out of) all of the countries you are visiting. Make sure you do this before you book any travel or accommodation. This applies to all medications you take or are planning to take with you, not just medications for hormone therapy. If you need to make a transfer (like catching a connecting flight), make sure you also check your medications are legal to take into and out of each country you’re transferring through.

To check whether it’s legal to take your medications into or out of a country, search the government websites of the country for information about travelling with prescription medication. This information may be in another language, or written in complex legal language. If you’re not sure you understand the rules, look for contact details on the website, and use email or phone to ask questions. 

If you’re unable to find information this way, you can also contact the embassy or consulate of the country directly to get advice on travel. You can find contact details for embassies and consulates on the Foreign embassies in the UK page on GOV.UK 

You can use these pages for guidance about the UK rules:

Are there local rules around travelling with my medication?

Even if it’s legal to travel to a country with your medication, many countries will still require you to follow rules when you do it. 

These rules might include:

  • Travelling with the medications in your hand luggage.
  • Keeping the medications in their original packaging as given to you by the pharmacy that dispensed them.
  • Bringing a copy of the prescription for the medication with you, or an official letter from the person who prescribed the medication.
  • Getting the prescription or other documents translated into the local language.
  • Only bringing a limited amount of your medication with you.
  • Applying for a licence to bring the medication into the country. 

These rules are different for each country, so it’s important to check exactly what is required for each country you will be travelling to.

If you’re planning on travelling by plane, and your medication is in liquid or gel form, there might be extra rules about taking your medications with you. You will need to check the information for all countries you are planning on flying to or from. The rules for flying to and from the UK are on the GOV.UK website. If you’re not sure, contact your airline for advice. 

If your medications haven’t been prescribed by a medical professional (because you bought them yourself) you might not have all the documents that a country’s rules say you need. In this situation, there are very serious risks involved with taking the medication with you, so consider whether to stop taking your medication while you’re outside of the UK.

Planning for travel if you’re having injections

If you’re taking an injected mediation, it’s really important to plan ahead of time for trips outside the UK.

You’ve got a number of different options to consider:

  • The easiest approach to use is to schedule your injections so you’re not being injected while you’ll be away. You may find this easier if you’re receiving a medication formulation that lasts for a longer time (e.g. Nebido for testosterone, or 3 or 6 month formulations of GnRH agonists). You can ask the person prescribing your medication if they would be willing to switch you to one of these formulations if you’re not already taking them.
  • Another possibility is to ask your prescriber to switch you to an alternative formulation of your medications temporarily. Your prescriber may be able to give you up to a three-month supply of gel, patches, or pills.
  • For some forms of medications, you can learn how to inject your own medication. See the Injecting Hormones At Home section for more information about learning how to do this. If you’re planning to inject yourself, and you’re taking injection equipment like needles with you, research the rules on taking these into any countries you are visiting. For most countries, you will need to keep the needles in the same place as your medication, and to have a doctor’s letter explaining your need for the needles.
  • If you definitely need to receive an injection while you are outside of the UK, and you’re not able to inject it yourself, you could contact a private medical service in the country to ask them to perform the injection for you. Before you leave the UK, contact the private medical service to arrange the injection, and make sure to ask what documents or medical supplies you need to bring with you. GPs can normally provide supporting letters confirming the medication or injecting equipment you’ve been prescribed, although they may charge for this service, and you may need to do this well in advance of your travel.

You can read more about masculinising hormone therapy in these places:

You can read more about feminising hormone therapy in these places:

Community voices

On hormone therapy:

  • “Ask friends and family if they notice changes, especially those you don’t see every day, as the changes are gradual so you might not notice at first but others will.”
  • “Take pictures, even if you hate pictures, you won’t notice the smaller changes until you look back on them.”
  • “It is good to ask yourself if the pros of taking hormone therapy outweigh the cons.”
  • “Emotions! The first few months it takes some adjustment to feel a bit more in control. They surprised me. The rest has gone as I thought it would. It’s astonishing to see and experience the flexibility of the human body.”
  • “Important to not compare yourself to other people on hormones. We’re all different and genetics plays a huge part in the outcomes.”
  • “You may end up feeling like a teenager again and that can feel very disconnective if you are an adult. Remember to be kind to yourself and keep a track of how you’re thinking and feeling. Understand that often any discomfort will pass and if not, you can always reach out for support or help either from a practitioner at the GIC like the psychologist or the endocrine team, or your GP”

On masculinising hormone therapy:

  • “I wish I’d known how much better I’d feel, how much energy and confidence it gave me. It’s also worth being aware of some of its effects, for example I hadn’t really considered that as I have a family history of male pattern baldness that it would begin to affect me.”
  • “The most significant thing I wished I had known before I started are about the sexual side of things. I was aware that the clitoris would grow. But I was not aware of the possibility of vaginal atrophy. As time progressed I started to have pain during sex which was confusing for a period of time. It would have been useful to know about this beforehand.”
  • “injections are not that bad. I no longer have a phobia of needles because I can associate them positively with my transition.”
  • “If you’re on Nebido, warming it in your hand will definitely help. Make sure you keep the dates your injections are due in your calender and set reminders so you have enough time to book appointments and order prescriptions.”
  • “After a nebido injection, your legs may very well ache, walking (if you are able) is a good way to help the injection settle and stop your legs aching!”
  • “I was very concerned about ruining my singing voice before taking them. I’ve definitely had a number of years with it not in a good state, but it’s only been bad for that long because I completely stopped singing for a long time. I recently started taking (non-trans-specific) singing lessons and it’s improving far faster than I’d anticipated.”

On feminising hormone therapy:

  • “Get a pill box if you take anything orally. I wish I’d got one at the start since I started to forget as the months went by like any medication.”
  • “I wish someone had told me that breasts develop unequally, so it’s normal to have one larger than the other!”
  • “Use the medication mechanism that’s good for you, when I was in hospital for COVID, they put me on patches, but I don’t like them, the adhesive irritates my skin and they fall off!”
  • “Try your best to create a good routine with hormones taking them the same time of day so you are less likely to forget and cause hormone fluctuations. Accept that it will likely change your brain chemistry as well as physical attributes and there is a lot to adjust to.”
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Parts of this page are based on information originally posted on genderkit.org.uk with permission.

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A disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended for information purposes only. It is not a substitute for medical advice, diagnosis or treatment from a medical professional. It is not a substitute for advice from a legal professional. We strongly suggest you consult a healthcare professional or legal professional for specific advice about your situation. TransActual do not advocate or recommend the purchase of any specific product and we do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of insurance and legal services.

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