Can I take hormones to feminize my face while minimizing top growth?
March 6, 2020 7:42 AM   Subscribe

I'm an assigned male at birth (AMAB) non-binary person. I have some mild gender dysphoria with my face, which I want to look a bit more feminine. I'm happy with my chest as is and would be unhappy and dysphoric with full-blown breasts. I'm a chunky person so I kind of have titties already and I don't mind them at all. I think I'd be okay with a slight amount of titty growth. Is it possible to get the facially feminizing effects of low-dose hormone replacement therapy without experiencing significant top growth?
posted by fruitdroid to Health & Fitness (10 answers total)
I am transmasculine so not speaking from direct experience. I have run into people online who have explored or tried adding another medication (the name of which escapes me) to inhibit breast growth. I do not know what sort of outcome they had (and be aware that you may quite possibly encounter access problems in terms of getting a doctor on board). However, the received wisdom about hormones, mainly that you can't pick and choose the effects, still applies. If you dig around trans forums online you can sometimes find accounts of people who stopped hormones (either by choice or because they lost access) and what effects were permanent and which weren't (I know where to look for testosterone, but that doesn't help you).
posted by hoyland at 7:57 AM on March 6, 2020 [1 favorite]

The thing I suspect hoyland is thinking of is a Selective Estrogen Receptor Modulator (SERM). I don't know anyone who has succeeded in getting a prescription, but I do know people who have looked into it.
posted by nebulawindphone at 8:02 AM on March 6, 2020

What specifically do you perceive as a more "feminine" face? That could have an impact on what people may suggest. For example if it is less facial hair, then maybe electrolysis would be a path you could take.

(I have no specific suggestions since I'm cisgeneder, but it could help people narrow the options for you)
posted by Julnyes at 8:33 AM on March 6, 2020 [1 favorite]

Yeah, that too. You asked specifically about estrogen, but Julnyes's comment gets at something real, which is that for a lot of people, how they present their face (hair removal, makeup, framing with hairstyle and necklines) has a way bigger effect than estrogen. There's an asymmetry where testosterone does a lot to masculinize a face, because it can cause bone to grow, but estrogen can't undo that by causing bone to shrink. For some people, it causes enough fat redistribution to make a difference. For others, even at high dosages, it doesn't.

Apologies if you know this already. It's hard to tell here who has what background.

Unfortunately, some trans and genderqueer communities are unrealistic about what hormones can do. Others are incredibly cruel about their realism, in a "don't waste your time lol"/"screw you for getting your hopes up" kind of way, which definitely isn't where I'm coming from. I think between hormones, presentation, and surgery if necessary, most people can reduce their dysphoria enough to make a difference in their life. But especially if you don't want all the effects of HRT, it's good to recognize going in that hormones might do less than you want, and that presentation might well do more than you expect.
posted by nebulawindphone at 9:11 AM on March 6, 2020 [8 favorites]

If selective hormone use doesnt end up being a fit right now, there are non hormone routes you could take to alter some facial features.

Permanent hair removal (agree with electrolysis- and also laser) can make a big difference in the texture of chin and cheek skin, which sounds subtle but has a big payoff.

Brow shaping (waxing threading or tweezing) and lash tinting can make a huge difference and are inexpensive and non permanent

Injectable filler can make your lips more feminine, either soften or sculpt your cheeks, or even make your nose look straighter and more upturned (check out “injectable rhinoplasty”).

Botox is known for lessening forehead and eye wrinkles but it can also slim your jaw (masseter muscles), make your lips look more pouty (“lip flip”), soften your temples, or lift your nose tip slightly.

All of those are non-permanent (6-24 months) and relatively affordable, and won’t change any other part of your body. Then there’s much more complex, and permanent, FFS (facial feminization surgery) which you probably know about. I think a lot of trans people share their FFS journeys on social media but the temporary stuff isn’t as widely known in that realm from what I’ve seen.

Instagram is a great resource- a lot of plastic surgeons show procedures and before and afters. BeautyByDrKay is very comprehensive - she mostly works on cis women but the procedures work on anyone.
posted by nouvelle-personne at 9:14 AM on March 6, 2020 [4 favorites]

I mean, you could take anti-androgens and just let your natural estrogen become predominate without taking extra estrogen but I am not sure how that would work with biological males (Obviously not a doctor or biologist here). I have to take them as a biological woman and I notice a HUGE difference in the shape/feminine profile of my face. If I let my excess testosterone take over I definitely have a more boyish face shape.
posted by Young Kullervo at 9:58 AM on March 6, 2020 [1 favorite]

Surgery and even injectables can work miracles. Why go the hormone route if you dont have to? I'd explore your options with a cosmetic surgeon if you haven't already.
posted by shaademaan at 10:15 AM on March 6, 2020

Many trans women end up getting facial feminizing surgery because, as I understand it, even larger doses of estrogen don't do much to change the shape of their face or facial features. Breast tissue is pretty much a sponge for female hormones. I'm a cis woman, and my breasts can change size and texture pretty dramatically due to the hormonal changes during my menstrual cycle, so I think you'd see enlargement there long before you noticed facial changes.

In your shoes, I'd probably take an action plan like this:
1. Eyebrow grooming. There are feminine and masculine eyebrow shapes, and the effect can be dramatic. Do some research and find a professional.
2. Skincare. Female skin tends to be softer, clearer, and brighter. Cleansing, using an AHA liquid exfoliant, and moisturizing could be a game changer.
3. Cosmetics. A little concealer, a little blush, and some mascara (combined with your new eyebrows) would looks natural but distinctly femme. Get thee to Sephora!
3. Electrolysis, if facial hair is an issue for you, which it might not be! I have a trans guy friend who loves a colorful, femme presentation. His full fluffy beard that looks fantastic with his full eye makeup.
4. Injectiables. A dermatologist or medspa can provide fuller lips, lifted brows, and plumper facial contours.
5. Facial feminization surgery. If all of the above doesn't give you the look you want, surgery very likely can. Shaving down the jawline or brow bone (which lots of trans women do), eye lifts, a nose job, or cheekbone implants can radically reshape your face.
posted by mostlymartha at 10:58 AM on March 6, 2020 [2 favorites]

Mod note: Just a note here that "biological male" and "biological female" have fallen out of favored use in a lot of discussion within trans communities; intent above seems well-meaning but be aware that it's language often used in some not-great circles to be critical of the validity of trans identities and is worth being careful in the use of for this sort of context.
posted by cortex (staff) at 11:29 AM on March 6, 2020 [11 favorites]

Paradoxically, you may be better off with higher doses of oestrogens, because a side effect is often decreased breast growth because the glands fuse too early. This would also make anti-androgens unnecessary because high enough doses of an oestrogen will suppress androgen production. However, this does come with a higher risk of blood clots, so you'd need to be careful.

Another option is Selective Oestrogen Receptor Modulators, as noted above - see this post: Ideally, you want a sympathetic endocrinologist to help you navigate this - look for a good informed-consent clinic near you with good reviews from NB people. Also, with love, try to find somewhere that's not Metafilter where you can talk through this with others - you need a trans community. I have had a Bad Time here too many times asking gender related questions.
posted by Acheman at 12:27 PM on March 6, 2020 [3 favorites]

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