Hormone Replacement Therapy (HRT) for Sissies in the U.S.A.


Are you at the point in your sissy journey where you’re starting to consider Hormone Replacement Therapy (HRT)? Or just looking to learn more about potential next steps? If so, this guide is for you!

I’m here to tell you all the about the process so that you can make informed decisions and ultimately live your best life, whatever that may look like 🙂

What is Hormone Replacement Therapy?

Let’s start what with the basics.

HRT is the process of changing the hormone balances within the body to resemble those of the alternate sex. For sissies, this makes it so that our male hormones (testosterone) decreases and our female hormones (estrogen) increases, which leads to feminizing effects.

Simply put, your body will begin to look more feminine the longer you’re on hormones.

What Changes are Possible with Hormones?

Here is a list of all the things that can be changed / influenced with hormones:

changes that are commented as “semi-permanent” are maintained on hormones or until sexual reassignment surgery (SRS) is done. “permanent” tags are permanent and will remain even after stopping hormones, and would require medical intervention such as surgeries to undo. Should you wish to stop HRT, the semi-permanent changes would take an equal amount of time to undo.

  • Fat Redistribution (semi-permanent)
    • Changes begin around 3 months and take up to 5 years for full effects to be noticed
    • Your body fat will redistribute so that you will get more fat around the hips/butt/thighs rather than the midsection.
  • Reduced Muscle (semi-permanent)
    • Changes begin around 3 months and take up to 2 years for full effects
    • You’ll likely loose some of your muscle mass
  • Softer Skin (semi-permanent)
    • Changes begin around 3 months and take up to 5 years for full effects
    • The thickness of your skin will lessen which will make your skin softer and thinner.
    • You may notice that you also bruise easier due to the thinner skin
  • Lower Libido (semi-permanent)
    • Changes begin around 1 month and take up to 2 years for full effects
    • This varies person by person, but being on hormones will likely lessen your libido or change your sexual tendencies a bit
    • Some people have naturally higher sex drives than others, so this will likely be something that you have to keep an eye on
    • You can talk with your Medical Professional to adjust dosages if this is an undesired effect.
  • Reduced Erections (semi-permanent)
    • Changes begin around 1 month and take up to 6 months for full effects
    • This is one of the quickest effects that you will begin to notice since your testosterone levels will be rapidly decreasing
    • This is another topic you can talk to your Medical Professional about if it’s an undesirable effect
  • Breast Growth (permanent)
    • Changes begin around 3 months and take up to 3 years for maximum effects
    • You will begin to grow breast tissue and develop breasts as your estrogen levels reach the desired levels
    • Doctor’s will usually say you will likely end up a cup size or two smaller than your sister / mother, which will give you an idea about where you can get to naturally.
    • Progesterone can also help increase this, but you want to make sure you raise estrogen too quickly or you may end up with tuberous tits and not a balanced shape
  • Testicle Shrinking (semi-permanent)
    • Around 3 months through 3 years, you will begin to notice your testicle sizes shrink.
    • Your testicles will shrink as much as 50% since testosterone is being blocked in the body
  • Body Hair Thinning
    • Changes in body hair thickness will begin to change around 6 months and take up to 5 years to take full effect
    • Existing body hair won’t vanish without medical treatments (i.e. laser hair removal or electrolysis)

What changes aren’t possible with hormones?

Sadly there are things that aren’t possible to change with hormones.

These include:

  • Voice
    • Hormones won’t naturally raise your voice pitch, resonance, or speech patterns.
  • Height / Bone Structure
    • Hormones won’t make you shorter or make your hands/feet smaller
    • If you lose weight, you may notice slight changes in shoe size, but the underlying bone structure doesn’t change
  • Hair Loss / Male Pattern Baldness
    • Depending on when you start hormones, existing hair line recession typically doesn’t improve.
    • Hormone will pause / stop the male pattern baldness and won’t worsen the current state of your hair
    • hair treatments and surgeries are possible to change the hairline, but are expensive

How do you go about getting on hormones?

Depending on where you live, the availability of hormones and the ages you can begin HRT vary, but assuming you’re of legal age and reading this, the process generally follows this:

Step 1: Get a Letter of Readiness from a qualified therapist

Most doctors and endocrinologists will ask that you get a letter of readiness from a qualified therapist prior to beginning hormone replacement therapy. This involves explaining your current mental state, what your feeling in terms of wanting to transition, how long you’ve feeling this way, and making sure you understand the implications of this change. They also want to make sure you have a good support system for the road ahead.

from my experience talking with multiple therapists, most therapists will feel comfortable writing a letter after a few sessions, and want to support you on your journey.

i would also be upfront with the therapist and ask if they would be comfortable writing such a letter during the initial session, since that makes the intent clear and they will also let you know if this is something than can or can’t do.

For example, online services like betterhelp often won’t write such a letter since there’s no in person dynamic, and it’s more anonymous.

Once the therapist has written a letter of readiness, and is prepared to fax it to your medical professional, you’re able to move onto the next step.

Step 2: Schedule an appointment with gender affirming care medical professionals

Now that you have the pre-requisites met, you can begin working on getting hormones.

In order to find medical practitioners that are willing to prescribe hormones, I would first talk with your primary care doctor to see if there is anyone in your current health network that can help you on this journey.

They may refer you to an endocrinologist or a specialty clinic that will be able to prescribe the hormones. You can also reach out to your insurance and they may be able to locate a doctor within your care network.

Step 3: Get blood work done and make sure that you’re general health is good for hormones

For your initial appointment with your endocrinologist or doctor, they will take some blood work to check your current levels and organ function.

Assuming the general tests come back clean, they will then look at your current testosterone and estrogen levels and prescribe an initial dose.

Step 4: Starting Hormones and choosing a med type

There are a few different types of HRT available, and it’s up to you and your doctor to determine which one is most appropriate for you.

Some people say injections are the best way to go for best results, however some doctors say that constant and consistent dosages with patches / oral tablets are better for mood and changes.

Hormone TypeLevel of RiskCostFrequencyLevels over Time
Oral TabletsHigh (Risk of Blood Clots)CheapestTwice DailyStable / Constant
PatchesLowMedium24/7 – Swapping out patches periodicallyStable / Constant
InjectionsMediumMediumOnce WeeklyHigh Spike then levels off

There’s a website called Transfeminine Science that has some fun reading if you want to see some science and research around how levels and dosages impact your body.

Step 5: Follow Up Appointments & More Bloodwork & Dosage Adjustments

Once you’re on hormones, you’ll typically have blood work done every 6 weeks to monitor your levels and make sure your organ health remains healthy.

The doctor will adjust the dosages to get you to the levels that are appropriate to achieve the desired results.

What is it like on hormones?

I know a lot of you girlies probably are hoping that upon taking hormones, things will feel dramatically different immediately, but unfortunately it takes a bit of time to begin noticing results 🙂

When I began hormones, and the levels ramped up to where they were supposed to be, I started to feel more emotional and my feelings were heightened. I noticed i cried and my empathy went into overdrive, but I’ve also always been a bit like that.

Overtime i began to notice those changes that I described in the previous section , and started to become more androgenous and i was ecstatic after getting called miss and ma’am after a while. It took me a long time to train my voice to get it where I wanted it though.

I also had a harder time to orgasm quickly, and my erections weren’t as strong as they used to be, but i found other ways to pleasure myself if you catch my drift 🍑😉


Can i self medicate?

I know everyone is in a different spot and medical care isn’t always possible, but I can’t in good conscious recommend that people attempt to self medicate and go through this journey on your own.

There are so many things to consider, and taking dosages that are too high can be damaging to your organs and lead to very serious medical problems.

What about those breast enhancement pills? do those work?

I’ve tried those before when I was exploring feminization and unfortunately those don’t do much for sissies and are more of a gimmic.

Without anti-androgens (testosterone suppressants), the increase in estrogen will just get converted to testosterone in our body and won’t achieve the desired effects.

In a lot of cases, you will just be wasting money that could be spent on other feminization surgeries or sissy fun.

Does eating more foods that boost estrogen help at all?

You may have come across articles or guides that talk about consuming foods that help boost estrogen, or foods that are rich in phytoestrogens (i.e. soy), but without testosterone suppressants it really won’t do any good.

In addition, those levels are so small that you would have to consume an insane amount of those foods to come close to a very low dose of HRT, and it wouldn’t be as effective without the combination of anti-androgens and estrogens.

Are doctors going to judge me? or what should i look for?

For transgender care, doctors that follow WPATH (world professional association for transgender health) standards will look out for you and provide quality care for trans individuals.

This is something that your therapist is going to reference in your letter of readiness as well.

See the current Standards of Care document for more information.

If the doctors and medical professionals are familiar with this, and specialize in gender affirming care, you should have a good experience 🙂

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