Hormone microdosing is an option for trans people who want slower, gradual change to their bodies — here's how it works and the risks involved
- Microdosing hormones is an option for trans people who don't want dramatic changes to their body, but instead want more subtle, gradual change.
- Microdosing involves taking much smaller doses of hormones — about 20 mg per week of testosterone for people who were assigned female at birth and about 1mg of estrogen per day for people who were assigned male at birth.
- Taking testosterone can cause changes like increased muscle mass, more body hair, and less fat around the hips and thighs; whereas microdosing with estrogen can cause breast development, testicle shrinkage, and softer skin.
- This article was medically reviewed by Edward C. Ray, Assistant Professor of Surgery and member of the Transgender Surgery and Health Expert Team at Cedars Sinai in Los Angeles, California.
- Visit Insider's Health Reference library for more advice.
One of the major ways transgender people choose to medically transition is through gender-affirming hormone treatment. Traditionally, hormones are given at doses high enough to help a trans person change their body as much as possible and as fast as possible. But not all trans people want immediate, extreme change. For those who don't, microdosing sex hormones is an option.
Here's how microdosing affects the body and how to access this form of medical transition.
What is hormone microdosing?
Trans people who want to look more stereotypically masculine take testosterone and those who want to look more feminine take estrogen and anti-androgens, which block the effects of testosterone. They can stop treatment when they are happy with the results, though some changes are reversible.
"I have one patient who just wants to be as gender-neutral as possible. We started with a very small amount of testosterone and at a certain point, they were like, 'This is good'," says Zil Goldstein, the associate medical director of Transgender and Gender Non-Binary Health at Callen-Lorde Community Health Center in New York.
Though hormones can be taken through a gel or patch, it's easiest to control dosage through an injection, Goldstein says.
How does microdosing work?
Like all gender-affirming hormone treatment, microdosing involves taking sex hormones regularly to change sex characteristics such as fat distribution, muscle mass, and breast development or clitoris growth.
Microdosing with testosterone
Microdosing works best for trans people who were assigned female at birth because it is easier to get a more subtle result with testosterone. A conventional dose that produces more extreme changes is 50 to 100 mg per week via injection, but people who microdose may take somewhere around 20 mg depending on how their body reacts to the hormones.
Taking testosterone can cause the following changes in the body:
- Less fat at the hips and thighs
- More fat around the stomach
- Increased muscle mass
- Oily skin
- Acne
- More body and facial hair
- Loss of head hair
- Enlarged clitoris
- Increased libido
- Lighter or no period
On high doses of testosterone, changes typically begin to appear after several weeks or months and reach their maximum effect after one to five years. The time to reach desired effects with a low dose varies because everyone on a low dose regimen has different transition goals.
Trans people often continue to take testosterone for the rest of their lives to maintain the reversible effects, though some on a low dose regiment will start and stop treatment to try to maintain a more androgynous figure.
Not all people who microdose testosterone lose their period. People who wish not to menstruate may opt for a birth control method that does not contain estrogen, such as an IUD, to stop menstruation.
Everyone reacts differently to hormones, and some people will never experience all the listed effects. If they do occur, some of the effects of testosterone are permanent, including voice deepening and increased hair growth. Skin changes, fat redistribution, muscle mass increases, increased libido, and skin changes are reversible if treatment stops.
Microdosing with estrogen and anti-androgens
It's harder to microdose with estrogen because even a small amount will cause physical changes like breast growth, Goldstein says. This is why estrogen therapy is also typically combined with the use of anti-androgens, which tamp down the effects of the body's natural testosterone.
This kind of microdosing is more risky because using anti-androgens and only a small amount of estrogen can lead to issues with bone density, which is regulated by sex hormones.
People who wish to conventionally transition will typically take 2 to 4 mg per day of an oral estrogen tablet and work up to 8 mg per day. However, a person who wishes to microdose may take about 1 mg of estrogen per day.
Taking estrogen can cause the following changes in the body:
- Breast development
- More fat at the hips and thighs
- Decreased muscle mass
- Testicle shrinkage
- Erectile dysfunction
- Softer, less oily skin
- Decreased libido
With a low dose testosterone regimen, the amount of time to achieve desired effects varies when taking low doses of estrogen. Trans people may take estrogen for their entire lives or go on and off to maintain a moderate level of reversible effects.
Breast growth is permanent, though skin changes, fat distribution, and muscle mass loss reverse if treatment stops. Restarting estrogen therapy may not achieve the same level of change compared to the first time around, especially when it comes to fat redistribution, because people are more responsive to hormones when they are younger, Goldstein says.
Risks of microdosing
There's not enough research available to be able to say if microdosing poses more or less health risks than traditional doses, besides the fact that improper microdosing with estrogen and anti-androgens can lead to bone decay.
Starting and stopping microdosing to maintain a steady level of reversible changes is not harmful, Goldstein says.
A traditional regimen of testosterone increases the risk of:
- Heart attack
- Headaches and migraines
- Anger and irritability
- Blood clotting
A traditional regimen of estrogen increases the risk of:
- Breast cancer
- Stroke
- Blood clots
- Gallstones
- Heart attack
Access to microdosing hormones
If you're interested in microdosing, bring up the topic with your doctor, who may treat you or refer you to a specialist. But be wary. There is less evidence to show that low doses of hormones lead to mental health benefits, so some healthcare providers aren't supportive of this type of hormone regimen, Goldstein says.
But patients looking to microdose bring this up to their doctor by saying that "they want to go slowly and explore how their body is going to react to hormones, rather than going in and saying, 'I want to microdose.' Because that's not something a provider may necessarily be familiar with," says Goldstein.
Being open and honest about the changes you are hoping for and those you hope to avoid can help your provider better prescribe hormones for you. Goldstein's number one advice is to develop a clear picture of what you want before you speak to your provider, and, when you meet with them, ask how to best achieve those goals.
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