Hormones: are doctors lying to women - or transwomen?

[HeirloomTomato]

What are the real health risks of hormone therapy for transwomen? I'm asking on here because I can't get a clear answer on this from Google or any search engine so I came to the TERF reality-friendly world of mumsnet. Here's an example of what I got when I searched this up:

• Cisgender women: HRT is used for menopausal symptom relief and is typically used for a limited duration and at a lower dose due to potential health risks, especially with long-term use and advancing age.
• Transgender women: HRT is a life-affirming treatment to achieve a feminine hormonal profile, with an individualized approach based on benefits and risks, which are carefully monitored. There is no absolute age restriction for initiating HRT for trans women.

Is this just BS? As a woman in early menopause / perimenopause, it was hard to access HRT even on the lowest dose, and I got dire warnings about not taking HRT for too long, ideally not more than 5 years because of the risk of stroke, blood clots, breast cancer and so on, even though it is helping me a lot.

Yet transwomen seemingly can take hormones for life without any doctor raising objections. So do the risks of HRT not apply to transwomen or are doctors just being dishonest? Or are they being dishonest with biological women about the risks of HRT? Or is no-one being dishonest because the main difference is that transwomen do not have the same risk for cancer due to not having female sex organs?

TL:DR - I am confused by the strictness of HRT protocols for women in menopause compared to the willingness of doctors to prescribe hormone therapy for transwomen and disregard or minimize risks. Unless the risks are just different?

I have no idea but I’m interested to know the answer. Watching and hoping someone more knowledgeable comes along!

I asked chatgpt:

Why Are Women Told HRT Can Be Dangerous Long-Term, but Trans-Identified Males Can Take It Long-Term?
This is a valid and often asked question, and it highlights how medical guidance can seem inconsistent depending on the context. The key differences lie in why HRT is used, the risk profiles, and how benefits are weighed against risks.

1. Different Goals and Contexts of HRT

Women (typically postmenopausal)

• HRT is prescribed primarily to relieve menopausal symptoms like hot flashes, sleep issues, mood swings, and bone loss.
• Usually includes estrogen alone (if the woman has had a hysterectomy) or estrogen + progesterone (if she still has a uterus, to reduce cancer risk).
• HRT is often recommended for short-term use, and doctors aim to use the lowest effective dose due to concerns about:
• Increased risk of breast cancer
• Blood clots
• Stroke
• Heart disease, particularly when started later in life

Trans-Identified Males (transgender women)

• HRT is used as gender-affirming treatment, intended to create and maintain female secondary sex characteristics (e.g. breast development, fat redistribution, body hair reduction).
• Typically includes estrogen, often with anti-androgens to suppress testosterone.
• Treatment is usually lifelong, as stopping HRT would allow masculine traits to return.

1. Risk Profiles Differ

• Age Matters:
• Women usually start HRT in their 50s or 60s, after menopause, when the body is naturally more prone to cardiovascular issues.
• Trans-identified males often start HRT younger, which may reduce some age-related health risks (e.g., lower risk of blood clots or heart problems compared to older adults).
• Organ Differences:
• Women have a uterus and ovaries, which affects how hormones interact — for instance, estrogen alone can raise the risk of uterine cancer unless balanced with progesterone.
• Trans-identified males do not have female reproductive organs, and may or may not have had surgery to remove testicles (orchiectomy), altering the hormonal balance and associated risks.
• Cancer Risk:
• The risk of breast cancer is higher in women using long-term HRT than in trans-identified males, though the latter still carry a higher risk than biological males not on HRT.
• Prostate cancer is also a concern for trans-identified males, albeit lower due to testosterone suppression.

1. Why Risk Is Weighed Differently

• 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.

1. Medical Understanding Is Still Evolving

• The 2002 Women’s Health Initiative study caused widespread concern about HRT risks in women, but subsequent research has found that many of those risks depend on age, health history, and timing.
• Long-term studies on HRT in trans-identified males are still limited, but clinical protocols involve monitoring for risks like blood clots, stroke, and cancers.

Summary GroupPurpose of HRTTypical AgeCommon ConcernsDurationAttitude Toward Risk Women Menopause symptom relief 50+ Breast cancer, heart disease Usually short-term Risk-averse Trans-Identified Males Gender affirmation Often younger Blood clots, stroke, cancer Lifelong Risk accepted due to psychological/identity benefit

MIL is 81 and still taking HRT - they will have to rip it from her cold dead hands basically. I think NICE may have changed the recommendations recently about how long HRT should be taken for…..

No idea - I remember an article about a 90 year old man being given 'gender affirming hormones'.

Hormone medications for women have long been considered with huge suspicion - look at the many cancer scares for contraceptive pills.

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.

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.

Thank goodness for that!

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.

HALLELUJAH

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?

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

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.

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.

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.

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.

I'm asking as a perimenopausal woman who just stared HRT recently after experiencing 3 years of insomnia, night sweats, fatigue, weight gain, mood swings and all kinds of other symptoms and seeing doctors who were going out of their way to avoid prescribing me HRT. Anti-depressants? Sure! Ozempic-type medications? No problem. Birth control? Absolutely. HRT? Weelll... you're not quite 50 yet so maybe not... are your symptoms really that bad? And so on.

Since starting HRT, I am finally sleeping through the night most nights and am not waking up drenched in sweat or dealing with crushing fatigue and struggling to do my job. I can function again. And yet doctors really were wary of prescribing me HRT as if it was a last resort.

Yet for transwomen, it seems like hormones are the first resort, not the last resort. The discrepancy struck me as odd because it makes no scientific sense. The biology of males and female is different but not so different that male-born people can dose themselves up to their eyeballs with oestrogen for decades while female-born people have to take it in the smallest possible dose for the shortest amount of time.

This is another discrepancy that struck me: how can it be safe for transwomen to take such high doses of oestrogen?

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.)

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.

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.

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....

I was wondering about that so I looked it up and found this on the NIH website:

Patches or implants are preferred for transwomen over 40 years of age (although they can be used in younger people) to minimise the risk of venous thromboembolism. Treatment with patches starts with 100 microgram/24 hours titrated up to 400 micrograms. Implants of 50 and 100 mg are available from compounding pharmacies. Generally, 100 mg is inserted for most transwomen, but a supplementary 50 mg implant can be added for patients with a high body mass index.

For context, the estradiol patch I use is a 0.0375mg patch twice a week. Seems like quite a large difference.

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?

@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.

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

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