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What is oestrogen?

Hormone with many effects including fat redistribution, skin thinning and breast growth.

It's also known as Oestrogen, Estrogen, Estradiol, or 17β-estradiol.

Oestrogen is a component in many hormone-based contraceptives; see contraceptive pill.

What does oestrogen do?

The extent of the effects vary between people. Most people experience these effects:

Occasionally, people experience these effects:

Who can have oestrogen?

  • You need to have had persistent dysphoria, but there is no specific time frame

  • You must have capacity to consent for this treatment

  • If you have significant medical conditions, these need to be “reasonably well-controlled”

  • You usually need to be at least 16

How long does oestrogen last?

Some of the effects of oestrogen (including breast growth) are permanent and start within 2-3 months. Changes may take several years to reach their full effect.

How do I stay safe?

  • 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 safety information on our self-injection page.

  • Attend screening appointments

    If you’re over 50 and have taken oestrogen, you should attend breast screening appointments.

What should I be aware of?

  • Oestrogen is not a contraceptive

    You can still make someone pregnant while taking oestrogen. You can read more about contraceptive options for people taking oestrogen on the FSRH website.

  • Oestrogen use increases your risk of serious medical conditions

Taking oestrogen may increase the risk of thromboembolic disease (problems caused by blood clotting like deep vein thrombosis), prolactinoma, gallstones, and liver problems. These risks can be reduced by regular blood testing, stopping smoking, and maintaining a healthy lifestyle 1. While oestrogen does reduce production of sperm, it does not provide adequate contraception 2 and does not effectively prevent pregnancy.

Is oestrogen right for me?

Oestrogen use can cause many changes to your body and brain. Before you use oestrogen, particularly in combination with an antiandrogen such as GnRH agonists, think about how comfortable you are with:

  • Breast development

    The amount of breast development varies significantly from person to person, can take months to begin, and may not be complete for many years 3.

  • Changes in fat distribution

    Oestrogen can cause an increase in size of hips and buttocks by enlarging skin fat deposits around these areas 1, but this may take up to five years 3, and does not change the shape of the pelvis (hip bones) in adults. Changes in fat distribution may also cause subtle changes to the appearance of your face.

  • Psychological effects

    Oestrogen may have positive effects on your mood. Many transgender women taking oestrogen reporting a calmer mood 1. The exact effects vary from person to person.

  • Changes in arousal

    Oestrogen and antiandrogen therapy can cause changes to sexual arousal, reducing frequency of spontaneous erections 3, and sometimes making it difficult to maintain erections, and can significantly reduce the amount of ejaculate over time down to little or none 4, p.138.

  • Changes in libido

    Oestrogen and antiandrogen therapy can cause changes in interest in sex, often decreased libido 3.

  • Loss of strength

    Oestrogen and antiandrogen therapy often causes a significant reduction in strength and muscle mass 3.

  • Infertility

    Oestrogen and antiandrogen therapy can reduce sperm quality 4, p.138 and may eventually cause infertility.

  • Other effects

    Oestrogen therapy can also have a number of other effects including changes in skin softness, skin appearance, and body odour.

Some effects of oestrogen are permanent or not easily reversed. You might want some of the effects of oestrogen, but not all of them, which may mean oestrogen is not the right option for you. You can talk to your gender clinician if you would like to further discuss the possible effects and whether any can be reduced or avoided.

What else might I want?

Oestrogen has no effect on the voice, and patients who wish to make changes to their voice should instead consider speech therapy.

In combination with oestrogen therapy, most people will also wish for testosterone to be reduced. Some endocrinologists may use high doses of oestrogen for testosterone suppression 5, p.12, although this is often unsuccessful and commonly a lower dose of oestrogen in combination with antiandrogens (in the UK, normally GnRH agonists) is the most common approach for testosterone suppression 6, p.170.

How do I get oestrogen?

Most people get oestrogen using the UK system for gender medicine. Read our step-by-step guide to getting medical support for information about using that system. Some people also choose to access hormones without a medical diagnosis.

For oestrogen therapy to begin, it is required that any other significant medical or mental health issues are “reasonably well controlled” 7, p.24. This means that a medical professional is currently helping or has helped you manage the condition.

What kinds are there?

  • Weekly or twice-weekly patches

    Evorel costs around £10 for a 2-4 weeks supply

  • Daily use gel

    Oestrogel costs around £10 for a 2-8 weeks supply

  • Daily pills

    Progynova costs around £10 for a 1-4 weeks supply

Oestrogen is commonly available in oral (pill or tablet) form, transdermal patches (patches that are stuck to the skin), and gels applied to the skin1, p.237. It is very rarely available as an implant, although these are not commonly used. Oestrogen injections are not available in the UK.

There are several different variants of oestrogen available. The two main variants used in the UK are oestradiol valerate (as pills) and oestradiol hemihydrate (as pills, patches, and gel). In the past, ethinylestradiol and conjugated equine oestrogens were used, but these are now avoided because they have a much higher risk of blood clots 8 and are not detectable in normal blood tests.

How much will it cost?

If you have received a formal diagnosis, the NHS will normally provide funding for oestrogen therapy and treatment with GnRH agonists. Oestrogen therapy is not usually provided to under-18s on the NHS, with the effects of hormones during puberty being stopped by GnRH agonists until the age of 18 when oestrogen therapy can be commenced. Some services may additionally provide oestrogen to selected 16 and 17 year old people 9.

Under some circumstances, it may be possible to get hormone therapy from the NHS without a diagnosis.

You do not have to pay the full cost of medication you are prescribed on the NHS. You are not asked to pay anything at all in Northern Ireland, Scotland and Wales. In England, people are asked to pay a small charge for each item on their prescriptions. There are ways you can reduce or avoid this cost, which you can read about on the NHS website.

You can find detailed information about costs for hormone therapy from private gender services on our Private Fees page.


  1. 1.
    Seal, Leighton J (2017) “Hormone Treatment for Transgender Adults,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 227–249. Link
  2. 2.
    FSRH Clinical Effectiveness Unit (2017) “Contraceptive Choices and Sexual Health for Transgender and Non-binary People.” Link
  3. 3.
    Hembree, Wylie C, Cohen-Kettenis, Peggy, Delemarre-Van De Waal, Henriette A, Gooren, Louis J, et al. (2009) “Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.” The Journal of Clinical Endocrinology & Metabolism, 94(9), pp. 3132–3154. Link
  4. 4.
    Adeleye, Amanda J, Reid, Garrett, Kao, Chia-Ning, Mok-Lin, Evelyn and Smith, James F (2019) “Semen parameters among transgender women with a history of hormonal treatment.” Urology, 124, pp. 136–141. Link
  5. 5.
    Devon Partnership NHS Trust (2017) “PG12 Pharmacological Treatment of Gender Dysphoria.” Link
  6. 6.
    Seal, Leighton J (2007) “The practical management of hormonal treatment in adults with gender dysphoria,” in Barrett, J. (ed.), Transsexual and other disorders of gender identity: A practical guide to management, Radcliffe Publishing, pp. 157–190. Link
  7. 7.
    Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link
  8. 8.
    Toorians, AWFT, Thomassen, MCLGD, Zweegman, S, Magdeleyns, EJP, et al. (2003) “Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people.” The Journal of Clinical Endocrinology & Metabolism, 88(12), pp. 5723–5729. Link
  9. 9.
    NHS England Specialised Commissioning Team (2016) “Clinical Commissioning Policy: Prescribing of Cross-Sex Hormones as part of the Gender Identity Development Service for Children and Adolescents.” Link

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