Hormones: are doctors lying to women - or transwomen?

I think men who take wrong sex hormones know they are risking their health because access to follow up care is a talking point on reddit.

If they 'diy' or use private suppliers often their GP wants nothing to do with monitoring their hormones levels.

If there are no real health side effects, why the need for regular monitoring, why are GP reluctant to get involved and why are these men so worked up missing tests?

Because it has a cost to the NHS so women have to fight but men get whatever they want. No-one really sees transwomen as women or they wouldn't be getting hair removal; breast implants; HRT etc on the NHS

Yes, when I was prescribed it I was told there was no reason I couldn’t take it basically forever and that there were actually significant benefits in doing so.

And this was the answer to long term complication risks. It includes irreversible fertility, but this is glossed over in the summary.

Unsurprisingly then, the AI answer depends on the question you ask it. But the information can still be used selectively. Now who might want to do that?

❤️
Cardiovascular System

• Increased risk of blood clots (VTE)
• Especially with oral estrogen (e.g. ethinylestradiol), though transdermal estrogen carries lower risk.
• Stroke and heart attack (MI)
• Data are mixed, but risk may be slightly elevated, especially in smokers or older individuals.
• Lipid profile changes
• Estrogen can raise HDL (good cholesterol) but also triglycerides. Cardiovascular risk needs regular assessment.

🧠
Mental Health and Cognitive Function

• Mood changes
• Many people report emotional benefits, but some may experience increased anxiety or depression, especially during early stages or dose adjustments.
• Neurocognitive effects
• Long-term impact on cognition is not fully known; estrogen has complex interactions with brain function.

🧬
Cancer Risks

• Breast cancer
• Risk appears to be lower than in cisgender women but higher than in cis men. Screening is recommended after 5+ years of hormone exposure.
• Prostate cancer
• Still possible, although risk may be reduced due to androgen suppression. Prostate monitoring should continue unless surgically removed.
• Liver tumors (rare)
• Particularly with certain synthetic estrogens or long-term high-dose therapy.

🩸
Endocrine and Metabolic

• Insulin sensitivity
• Estrogen may reduce insulin sensitivity slightly; type 2 diabetes risk could increase over time in predisposed individuals.
• Bone health
• Estrogen helps maintain bone density, but inadequate dosing or stopping therapy can lead to osteoporosis. Regular bone density scans (DEXA) are advised.
• Weight gain & fat redistribution
• Often seen as desirable feminizing changes, but can contribute to long-term metabolic risk.

🧪
Reproductive and Sexual Health

• Infertility
• Often irreversible. Sperm production declines significantly and may not recover even if hormones are stopped.
• Libido and sexual function
• Decreased libido and erectile function are common. These effects can be permanent, though this varies.

🧠
Pituitary and Hormonal

• Hyperprolactinemia
• Elevated prolactin from estrogen use may rarely lead to prolactinomas (benign pituitary tumors). Monitoring is essential if symptoms arise (e.g. headaches, vision changes, galactorrhea).

🧍‍♀️
Other Concerns

• Gallbladder disease
• Estrogen slightly increases risk of gallstones.
• Skin changes
• Thinner, softer skin and reduced oiliness; can predispose to dryness or irritation.
• Muscle mass and strength
• Gradual decline, which may affect physical capacity or balance in older age.

📅
Ongoing Monitoring Is Key

Most long-term risks can be mitigated with:

• Regular blood tests (lipids, liver function, hormones, glucose)
• DEXA scans (for bone density)
• Cancer screening (breast, prostate)
• Lifestyle support (smoking cessation, exercise, weight management)

✅ Summary

Long-term hormone therapy is generally safe with proper medical oversight, but:

• Cardiovascular disease, bone health, cancer risk, and infertility are the primary long-term concerns.
• Risk varies based on age, lifestyle, dose/form of hormones, and personal/family history.
• Transdermal estrogen and avoiding smoking significantly reduce some of the most serious risks.

It’s important in my view not to talk about males taking female hormones as HRT. They aren’t replacing any hormones, their aim is to acquire female characteristics.

I’ve just asked CGPT about contraindications

⚠️
Absolute Contraindications
(Do
not
use)

1. History of hormone-sensitive cancer (especially prostate cancer or certain types of breast cancer).
2. History of thromboembolic disease (e.g. deep vein thrombosis [DVT], pulmonary embolism) not on anticoagulation.
3. Severe liver dysfunction (especially with synthetic estrogens like ethinylestradiol).
4. Allergy or hypersensitivity to the hormone formulation (rare).
5. Uncontrolled hypertension or significant cardiovascular disease, especially if untreated.
6. Pregnancy (though not applicable to most assigned males at birth, it’s listed formally in medication leaflets).

⚠️
Relative Contraindications / Cautions

These are not outright prohibitions, but require careful monitoring or specialist input:

1. Personal or family history of thromboembolism

• Estrogen increases the risk of blood clots.
• Transdermal estrogen (patch or gel) may be preferred over oral in high-risk individuals.

2. Obesity (BMI > 30)

• Increases risk of venous thromboembolism and cardiovascular disease.
• Still possible to proceed, but with risk mitigation.

2. Smoking (especially age >35)

• Increases cardiovascular risk. Smoking cessation is strongly encouraged.

3. Hyperprolactinemia or pituitary issues

• Estrogen can raise prolactin levels, so existing abnormalities need evaluation.

3. Liver disease or gallbladder disease

• Estrogen is metabolized by the liver and can increase gallstone risk.

3. Mental health conditions

• Not a contraindication, but close support may be needed. Hormonal changes can impact mood.

3. Fertility concerns

• Estrogen and anti-androgens reduce sperm production, often irreversibly. Fertility preservation (e.g. sperm banking) should be discussed before starting.

🧪
Monitoring is Critical

Regular blood tests and physical assessments are recommended:

• Baseline and ongoing:
• Liver function tests
• Lipid profile
• Prolactin
• Oestradiol and testosterone levels
• Full blood count
• Renal function
• Other considerations:
• Bone density scans (especially if on hormone therapy long-term or if therapy is interrupted)
• Mammography as per female screening guidelines after several years of exposure
• Mental health and psychosocial support

@HeirloomTomato I think that is a mistake. The abbreviation 'mg' means milligrams, but has been has read as micrograms. The traditional abbreviation for microgrames is the greek lower case mu with a g, but standard keyboards don't have the mu symbol. Failing a mu, the abbreviation is 'mcg'.

0.375mg = 375mcg

For context, one pump of Oestrogel (I am on 3/day) is 750mcg, ie twice the strength of your patch.

Men can get oestrogen implants? Why can't I get an oestrogen implant? Why do I have to faff around with gels and patches causing skin irritation, with supply issues, with repeat prescription requests and visits to the pharmacy because the GP won't prescribe more than 6w supply at a time? I've been on for medically necessary HRT 15y. Like a PP's relative, they will prise my HRT from my cold, dead hands. Unlike other posters, my GP is supportive of me taking a medication that benefits my health and reduces my overall cost to the NHS. So why can't I have my HRT as an implant? Why are such implants wasted on men?

There was that panorama programme on about women and how they were being privately prescribed really high doses (against recommendations) because there were a bunch of doctors who thought this was a good idea despite medical evidence - and isn't safe. And it was causing a pile of issues... Basically these were doctors who had 'gone rogue'.

When it comes to trans medicalisation, I think we can say there's reasons to believe there's a sizeable culture of 'rogue prescribing' going out there.

The difference? Despite all the issues with women's health care, there's still a degree of scrutiny and accountability out there. I will go as far as to say, this isn't the case for trans people and the lack of oversight going on into trans health care is a scandal that will blow up in time. It's a ticking time bomb....

Does anyone know how high a dose they're taking?

The other thing that strikes me is there will be a lack of data about effects ranging over 40 to 50 years. So there may be some warnings that they don't get because there's not been a chance to do studies yet.

that said, with any other treatment that's not got a long history, you tend to be told don't you - a doctor will say to you that nobody knows what the potential long-term effects are. But maybe trans people get told this in consultation.

That was what I had heard - I thought they'd said they'd overstated the long term risks for women. And that the benefits of continuing HRT might be beneficial for some women anyway because the benefits in other areas outweighed the small risk in others.

And from what I've seen the risks of heart problems for transwomen have been massively downplayed.

But yes I do think there's a difference in how women and men have effectively been treated with there being an overly risk adverse and not considering the fuller picture for women that prevents access to medication but there's a much bigger acceptance of higher risk for men and there's isn't this attitude of almost treating women as too fragile for HRT.

For women, HRT is viewed as optional symptom relief — so physicians often approach it cautiously, especially if there's a strong family or personal history of cancer or cardiovascular disease.
• For trans-identified males, HRT is considered medically necessary for gender affirmation and mental health. The benefits are considered more fundamental to identity and well-being, and therefore, risks may be more acceptable in the context of informed consent.

Optional? Yes, HRT is optional for both women and men. Medically necessary? No, HRT is no more medically necessary for men than facial electrolysis or eyeliner tattoo. HRT is only necessary for menopausal women because it helps prevent osteoporosis.

As for the benefit to women's mental health being unimportant ('optional'), is it unimportant to enable women to be economically active? Is it unimportant to reduce or avoid severe depression in women? Or is it more important to create lifelong male patients? Clearly, once a woman has shrivelled up into an old prune, she longer has the right to identify as a woman, or have that sense of herself supported with a healthy body. Unlike certain men.

(Chill, Jelly, it's only Chat GPT.)

It’s much more likely that doctors are discussing risks with both categories of patients, and TIMs are still choosing to take the hormones 🤷🏻‍♀️ I’m a GP and have one or two patients who are being prescribed cross-sex hormones by specialists, so I receive letters every time they’re reviewed in clinic; these always spell out the specific risks of hormonal treatment, and confirm that those risks have been discussed with the patient.

The view on the risks of HRT in women has changed significantly in recent years as it is now known that the risk of breast cancer is only a tiny increased risk. It was thought to be a much bigger risk previously. As such there is now less concern about women using HRT in the longer term if it helps with symptom control (which can be extensive and severely life limiting), particularly as HRT reduces the risk of osteoporosis (which I believe about 60% of women are likely to get without HRT after menopause) and there is some evidence that it has cardiovascular benefits also.

Only oral (tablets) HRT has the increased risk of blood clots. The vast majority of women are therefore offered transdermal HRT in the first instance.

The increase risk of uterine cancer is offset by the adequate use of progesterone which is standard practice when prescribing HRT in women who are still menstruating. Along with monitoring of symptoms such as mid cycle bleeding (which may indicate build up of womb lining and that therefore a change is needed in HRT dose/progesterone).

I don’t think anyone is deliberately being dishonest with women about the risks, although anecdotally some doctors don’t seem to have kept up with the changes so may still be quoting some of the things you outline in the OP. It seems now.the thinking is the HRT is relatively low risk for women and can provide lots of longer term health benefits potentially.

Yes it absolutely has. I came on to say this. It used to be short duration as there was a study showed it increased breast cancer risk but the study was flawed and subsequent research has disputed this.

Women in general are used to hearing the truth, like the word "no" or cons/risks.
As someone perimenopausal on HRT, I was pleased to hear the risks and that I was relatively low based on lifestyle/known genetics.
People suffering from mental health disorders may feel desperate for a solution and those with dysphoria have been set up to expect medication (rather than counselling). The TRAs are a scary group and it's safer not to draw their attention.

They're lying to transwomen @HeirloomTomato. Studies have shown that they are at increased risk of stroke, cardiovascular disease, hypertension, heart disease and breast cancer, to name but a few risks.
Oh and because men are given a much higher dose than women the risks are exponentially larger than for women who take hrt.
All of that doesn't include the damage done to their bodies by blocking/removing their natural testosterone which their bodies actually need and no cross sex hormones doesn't fix that either

I have a feeling this was covered in one of the recent reviews. Maybe the one the government commissioned from Alice Sullivan, Google will find it.

I'm always struck by how many young people at trans events have walking sticks etc. Possibly more sick or disabled people Id as trans, I think it likely but also you need your correct sex hormones to build strong bones through puberty and early adulthood.

There just isn't enough data to draw a conclusion.

Are you asking because you're considering hrt or are supporting a man who wants cross sex hormones?

HALLELUJAH

I’d agree with you it is confusing a bit like puberty blockers original purpose is a short term deferral of puberty bring up trans and yes you can stay on them till adulthood.

I think the idea is that trans people are so vulnerable and at risk of suicide that they must be affirmed and treated at every juncture.

It seems to me like the risk levels are being balanced out differently. For women it’s about risks of in five years if you take this will your outcome be worse overall in which case maybe you should suffer through. For trans people treatment seems to be balanced out with death. This treatment will cause sterility, osteoporosis and shorten your life span but if we fail to affirm you then you will commit suicide so it’s all worth it attitude.

I think if your starting point is it’s this or death it skews a prescribing perspective.

Thank goodness for that!

I've often wondered why thrush treatment is so hard to get hold of when you're over 60. I've concluded that the medical profession infantilises women, and doesn't trust us to know when a treatment isn't working for us.
When all the evidence shows that we know full well, we just can't get our voices heard.
But strangely, thinking you aren't the same sex as your body seems to open the magic medical box, the usual caveats no longer apply. And I have no idea why that is.

I think you've probably got different doctors with different ideas. There was a big HRT=Cancer scare about 20 years ago. While that has largely been debunked by later studies, there is still a tiny increased cancer risk. However, most women will be treated by GPs, who can be slow to change their ways. Transwomen will be treated by specialists and (despite the general view here that they are hiding in every toilet) there are probably too few transwomen for a meaningful study of the cancer risk to them.