Whether you lose weight on hormone replacement therapy (HRT) depends on several factors. When your hormone levels change significantly, your body composition, appetite, and metabolism can shift as well.
Key factors that impact weight loss on HRT:
- Type of HRT. Different hormone therapies can have different effects. For example:
- Estrogen therapy may redistribute body fat to more feminine areas like the hips and thighs. Weight gain is possible due to fluid retention.
- Testosterone therapy can increase muscle mass, which may lead to weight loss or gain.
- Progesterone can increase appetite and cause water retention.
- Dosage. The doses of hormones can impact weight changes. Higher doses are more likely to cause fluctuations.
- Age. Younger transgender people seem more likely to lose weight on hormones than older patients.
- Exercise and diet. Staying physically active and eating healthy can help manage weight throughout an HRT transition.
HRT impacts that may contribute to weight loss
- Body fat redistribution - Fat cells may shift to different areas, changing body shape and appearance. This can create subtle weight changes.
- Muscle mass changes - Testosterone builds more muscle. Estrogen reduces muscle mass. This impacts metabolism.
- Testosterone increases metabolism - A faster metabolism makes weight loss more likely on testosterone therapy.
- Appetite changes - Estrogen can suppress appetite for some. But others report increased hunger from progesterone.
HRT impacts that may contribute to weight gain:
- Fluid retention - Estrogens and progesterone often cause bloating and water retention early in treatment. This may add pounds which could mask fat loss.
- Slowed metabolism - In some cases, estrogen may slow metabolism, making weight loss more difficult.
- Increased body fat - Estrogen therapy can gradually boost body fat percentage. The scale may go up as muscle turns to fat.
- Increased appetite - As mentioned, progesterone especially can stimulate hunger and cravings.
In the first 6-12 months of HRT, patients often experience body changes that affect weight:
- Fluctuating water retention and bloating
- Muscle loss then regain
- Redistribution of fat cells to hips/thighs
- Breast tissue and fat deposit development
These changes impact weight but
do not always affect body fat percentage. New fat cells and breast tissue can increase pounds without making someone “fatter”. The number on the scale alone does not tell the whole story.
To manage weight on HRT:
- Focus on nutrition and getting enough protein
- Participate in strength training and cardio
- Give it time - weight often stabilizes after the first year
- Discuss options with your doctor if weight or appetite changes concern you
The impacts vary significantly person to person.
With lifestyle supports and finding an optimal hormone regimen, many transgender individuals can achieve a healthy weight and body composition over time.
