What’s the Timeline for Trans Women and Transfeminine People Medically Transitioning?

Medical transitioning is a personal journey that differs from one person to the next. There’s no “right” way to transition or timeline to follow.

Whether you medically transition (and how you transition) is entirely up to you. Your individual timeline for transitioning depends on a lot of factors, including:

• your personal goals
• your anatomy and overall health
• whether you have access to the gender affirming care you want

Still, if you’re medically transitioning — or considering transitioning — you might find it helpful to have a rough timeline so you know what to expect.

Some medical procedures, such as surgeries and laser hair removal, produce almost immediate changes. Other kinds of gender affirming care, like hormone therapy, can take months or even years to produce the results you’re looking for.

When it comes to medical transitioning, you have a few different surgical and nonsurgical options.

The kinds of gender affirming care you choose will typically depend on what you’d need to feel that your gender presentation matches your gender identity, which is called gender congruence.

Americans see their primary care doctors less often than they did a decade ago. Adults under 65 made nearly 25% fewer visits to primary care providers in 2016 than they did in 2018, according to National Public Radio. In the same time period, the number of adults who went at least a year without visiting a primary care provider increased from 38% to 46%.

Trans women and transfeminine people may opt for:

• hormone blockers (also called puberty blockers), which can prevent the start of puberty for pre-pubescent adolescents
• anti-androgen medications, which lower levels of testosterone in the body and are often combined with estrogen hormone therapy
• hormone replacement treatment (HRT), specifically estrogen hormone therapy, which can produce changes in body fat distribution and skin
• laser hair removal, which can slow the growth of body and facial hair
• voice training, which can include gender affirming speech therapy
• surgical options, which can include breast augmentation, vaginoplasty, orchiectomy, and facial feminization surgery

Many trans people do not medically transition. Some choose not to while others have difficulty accessing gender affirming care.

Out of trans people who medically transition, not all will opt for every medical transition option. For example, someone may choose hormone replacement therapy but not surgery.

Change	Produced by	Onset of changes	Maximum effect
body fat redistribution	hormone therapy	3–6 months	2–5 years
breast growth	hormone therapy	3–6 months	2–3 years
changes in speech	vocal therapy	1–3 sessions	variable
changes in speech	vocal surgery	immediate	immediate
decreased muscle mass	hormone therapy	3–6 months	1–2 years
decreased libido	hormone therapy	1–3 months	1–2 years
decreased spontaneous erections	hormone therapy	1–3 months	3–6 months
decreased testicular volume	hormone therapy	3–6 months	2–3 years
hair loss decreases	hormone therapy	1–3 months	1–2 years
male sexual dysfunction	hormone therapy	variable	variable
softening of skin/decreased oiliness	hormone therapy	3–6 months	variable
thinning body/facial hair	hormone therapy	6–12 months	>3 years
thinning body/facial hair	laser hair removal	1–3 sessions	8–10 sessions, depending on location and thickness of hair

Three kinds of hormone medications are available to trans women and transfeminine people:

• puberty blockers
• anti-androgen medications
• estrogen hormone therapy

Anti-androgen medications are usually combined with estrogen hormone therapy.

Puberty blockers work quickly as they have an almost immediate effect on hormones. They’re typically given to pre-pubescent adolescents, so the effects won’t be immediately noticeable. You just won’t go through puberty when you typically would.

However, the effects of puberty blockers are reversible, and puberty can continue once you stop taking the medication.

With anti-androgen and estrogen therapy, you might notice changes as little as 1 month after starting medication. The maximum effects take place within a couple of years — in other words, after about 5 years, it’s unlikely that you’ll experience more changes. However, hormone therapy is usually necessary to maintain those changes.

Many trans women and transfeminine people look for ways to reduce facial and body hair. Although HRT also reduces and thins hair on the face and body, it can take 6 to 12 months to produce noticeable results.

In the interim, there are a few ways to remove hair, including shaving, waxing, tweezing, or using hair removal creams.

However, laser hair removal is one of the most popular options as it can thin your hair and possibly stop hair growth. As such, it is part of many people’s medical transition journeys.

Laser hair removal is a procedure usually done by a dermatologist. During the procedure, concentrated beams of light target hair follicles and destroy unwanted hairs. You can get laser hair removal done on your face and body.

Although you’ll probably notice slight hair thinning after a single session, you’ll usually need between six and eight sessions to remove hair fully. The effects of laser hair removal can last a long time.

While your hair may return, it usually grows back thinner and sparsely, making it easier to maintain smooth skin by waxing or shaving.

For trans women and transfeminine people, HRT will not affect your voice. As such, you might opt for voice therapy. Also known as voice training, this involves working with a qualified speech therapist to change the sound of your speech.

Voice therapy can help you change your voice so it’s more in line with your identity, which can reduce gender dysphoria.

Voice training can help you change:

• intonation
• resonance
• pitch
• volume
• speech patterns
• nonverbal communication, such as eye contact and gestures

It’s difficult to say how long voice therapy takes to work. The duration of voice training depends on your transition goals, which will be unique to you. In general, you can expect to need several sessions over a few months.

It’ll take time to implement and practice what you learn in voice therapy, and you’ll need to practice what you learn in your sessions at home. Sessions can teach you techniques you can use immediately, and you can expect to notice a difference after a few sessions.

Many gender affirming surgery options are available to trans women and transfeminine people.

Surgical options for gender affirming care can include:

• Breast augmentation: Although HRT can stimulate the growth of breast tissue, this growth is limited and can take several months to produce a noticeable effect. As such, some people might opt for breast augmentation, which involves inserting implants or fat into the chest to create a fuller bust.
• Vaginoplasty: During this procedure, surgeons construct a vagina. The most common type of vaginoplasty is the penile inversion procedure, which involves using penile tissue to form the vaginal lining.
• Orchiectomy: An orchiectomy involves the removal of one or both testicles. It reduces testosterone levels. An orchiectomy is often done alongside a vaginoplasty, although it can also be done on its own.
• Voice feminization surgery: Voice feminization surgery is done to change the pitch of one’s voice. During surgery, a laryngologist will operate on your vocal cords to change the length, size, or tightness. This makes your voice more high-pitched.
• Facial surgeries: A variety of plastic surgery procedures can be used to change your face shape. For example, you might opt for a facelift, Botox injections, or adjustments to your jawline and browbone. This is often called facial feminization surgery.

These surgical options produce immediate results, although you’ll often need days or weeks to see the full difference as you’ll need to recover from surgery.

However, accessing surgery in the first place can be where the difficulty lies. Depending on your location, you might be on a waiting list for several months.

Every trans person is different, and your medical transition — if you opt to transition medically — will be unique to your individual goals and experiences.

Whether you choose to transition medically or socially, several surgical and nonsurgical options can help you more comfortable in your body.

Sian Ferguson is a freelance health and cannabis writer based in Cape Town, South Africa. She’s passionate about empowering readers to take care of their mental and physical health through science-based, empathetically delivered information.

Last medically reviewed on March 13, 2023