HRT is typically considered safe, but there are some risks to be aware of. Talk with your doctor to find out if it’s right for you.

We all have estrogen and testosterone in our systems, but HRT affects the amounts and the subsequent changes that those hormones make.

Hormone replacement therapy (HRT) is a type of gender-affirming and overall healthcare for people of all genders and sexes. While it can be common for some people, is it safe for everyone?

Let’s look at the risks associated with HRT and what the research says about safety.

Yes! Generally, medical professionals consider HRT to be safe.

For trans people, research shows that “cross-sex hormones” are safe over the short and medium term.

A 30-year cardiovascular study found similar mortality rates between trans participants and a comparison group.

A 2012 paper affirms these findings, stating that long-term use (longer than 10 years) of HRT is safe. There’s also no increase in death or cancer rates due to HRT for transgender people, according to a 2015 review of research.

For those experiencing menopause, medical professionals recommend HRT to lessen the unpleasant symptoms that accompany them. Typically, the benefits outweigh the risks, and it’s safe with a doctor’s supervision. Check out our easy guides to learn more about using HRT postmenopause.

For cisgender men who want to be on HRT (or TRT, testosterone replacement therapy), some risks may outweigh the benefits. However, as long as you’re in regular conversations with your healthcare team, there typically isn’t cause for concern.

Potential risks for females on estrogen-based HRT include:

Potential risks for males using testosterone-based HRT include:

  • breast enlargement
  • decreased testicle size
  • worsening of existing sleep apnea
  • increased cholesterol levels
  • decreased sperm count
  • infertility
  • increased number of red blood cells
  • high blood pressure

There are also a few other effects of HRT that may or may not be desirable, depending on who you are and what you want out of HRT:

Did you know?

Some people may see additional benefits from HRT that are unrelated to transitioning or gender affirming care. For example, HRT for transfeminine people can actually improve bone health!

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The length of your HRT treatments depends on your:

  • age
  • overall health conditions
  • individual risk factors
  • personal health goals

Some trans and intersex people use HRT for the majority of their lives and have lived as long as their cis counterparts. Others may use HRT for fewer than 10 years or less than 2 years.

There aren’t enough long-term studies documenting long-term health factors on HRT. But from what we can gather from the current research, medical professionals deem HRT to be safe for most trans people.

For people experiencing menopause, they may take HRT to lessen symptoms of menopause. Doctors typically recommend taking them for only 2–5 years. After 5 years, risks of heart attacks increase.

For people using TRT, the risks may outweigh the benefits in the long run, so most advantages plateau after 12 months.

Is HRT safe? Overall, yes. As long as you and your healthcare team consistently track your progress with regular checkups and blood work, there typically isn’t cause for concern.

For trans people, HRT can be part of a long-term healthcare plan. However, cisgender people using HRT to treat menopause or other effects of aging will typically only see results in the short term.

If you’re interested in HRT, it’s best to talk with your doctor to find out if it’s right for you. Trans people may wish to see healthcare professionals using the informed consent model for HRT use.