03 9457 4445

Providing a specialist Endocrinology service to every corner of Australia.


Transgender (or trans) is a broad term and includes people with binary and non-binary genders. Improving the health and well-being of people who are trans is critical and A/Prof Cheung strives to provide patient-centred, individualised and affirming care. Each person has individual goals and gender affirming hormone therapy is one option which an endocrinologist (hormone specialist) can assist with. A/Prof Cheung highly recommends accessing mental health support from your GP and mental health professional during transition, as well as exploring other community support networks with a peer navigator.

A/Prof Cheung also leads a trans health research group at The University of Melbourne and useful health resources and information about trans-related research can be found here www.transresearch.org.au

Gender Affirming Hormone Therapy

Gender affirming hormone therapy (sometimes known as Hormone Replacement Therapy or HRT) is an important aspect of affirming one’s gender for some individuals. Gender affirming hormones can allow some physical characteristics to align with a person’s gender and by doing so, improve dysphoria and psychological functioning. The decision to embark upon hormonal treatment is a shared-decision between an individual and their treating doctor, made with a clear understanding of the potential benefits and expected effects, weighed against the potential risks and side-effects of treatment.

As everybody’s goals are different, each person’s transition and treatment may be different. In general, different doses of testosterone therapy are used in masculinising hormone therapy, and estrogens (+/- testosterone blockers) are used in feminising hormone therapy. A/Prof Cheung has published an Australian Position Statement on the Hormonal Management of Trans Adults published in the Medical Journal of Australia which has been endorsed by the Royal Australasian College of Physicians, Endocrine Society of Australia and Australian Professional Association for Trans Health. Although care is broadly based on these clinical guidelines, care is flexible and is tailored to the needs of each individual.

What can I expect from hormone therapy?

Hormonal therapy can change physical characteristics to more closely align with a person’s gender, however, effects are gradual and vary from person to person. Most changes take 1 to 2 years to take full effect and are highly variable. Below are some tables that describe expected effects and expected time course of masculinising (testosterone) hormones and feminising (estrogen) hormones. See this great news article about options for testosterone therapy here.

Effects And Expected Time Course of Masculinising Hormones

Effects Expected onset Expected maximum effect
Skin oiliness/acne 1-6 months 1-2 years
Facial/Body hair growth 3-6 months 3-5 years
Scalp hair loss >12 months Variable
Increased muscle mass/strength 6-12 months 2-5 years
Body fat redistribution 3-6 months 2-5 years
Cessation of menses 2-6 months n/a
Clitoral enlargement 3-6 months 1-2 Years
Vaginal atrophy 3-6 months 1-2 Years
Deepened voice 3-12 months 1-2 Years

Effects And Expected Time Course Of Feminising Hormones

Effect Expected onset Expected maximum effect
Body fat redistribution 3-6 months 2-5 years
Decreased muscle mass/strength 3-6 months 1-2 years
Softening of skin/decreased oiliness 3-6 months unknown
Decreased libido 1-3 months 1-2 years
Decreased spontaneous erections 1-3 months 3-6 months
Male sexual dysfunction variable variable
Breast Growth 3-6 months 2-3 Years
Deceased testicular volume 3-6 months 2-3 Years
Deceased Sperm Protection variable variable
Thinning and slowed growth of body and facial hair 6-12 months > 3 year
Male pattern baldness No growth, Loss stops 1-3 Months 1-2 year

Hormone therapy may not lead to all of the desired effects for an individual and there are many other ways that a person may affirm their gender. These options include laser hair removal, speech pathology to change voice, hair transplants, trachea shave, voice surgery, facial feminisation surgery, breast augmentation surgery, chest reconstruction surgery or genital surgery. Service providers can be found here.

Risks and Side-Effects of Gender Affirming Hormone Treatment

All medications carry some risks and each person’s risk varies depending on factors such as their medical conditions, the dose, route, genetics and family history, and smoking status. Below is a table summarizing potential risks associated with hormone therapy.

Bolded Items Are Clinically Significant

Risk Level Feminising hormones Masculinising hormones
Likely increased risk Venous thromboembolic disese (blood clots) Polycythemia (thick blood)
Gallstones Weight gain
Elevated liver enzymes Acne
Weight gain Androgenic alopecia (balding)
Hypertriglyceridemia Sleep apnea
Likely increased risk with presence of additional risk factors Cardiovascular disease
Possible increased risk Hyperprolactinemia Elevated liver enzymes
Prolactinoma Hyperlipidemia
Possible increased risk with presence of additional risk factors Type 2 diabetes Destabilisation of certain psychiatric conditions
Cardiovascular disease
Type 2 diabetes
No increased risk or inconclusive Breast cancer Loss of bone density
Breast cancer
Cervical cancer
Ovarian cancer
Uterine cancer

Other useful links

Some useful links for people <18 years of age