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?

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.

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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.

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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.

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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.

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.

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

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?