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All medication comes with effects, hormone replacement therapy for transition is complex because the hormones involved also effect the general risks. However, it can be hard to work out exact risks because often it's extrapolations from research on cis men or cis women. For example a lot of feminising hormone therapy is based on research on cis women with menopause and changes in risk profile for them, these changes won't always be the same for transfems as they are starting with a different risk baseline.
Bones are not inert structures in the human body, they are constantly in the process of bone remodeling. A balanced process for resorption of old or damaged bone and deposition of new bone material. Estrogen deficiency leads to a state where the resorption is happening more than the formation leading to loss of bone over time.
For feminising therapy this happens when the estradiol dose is too low and blockers like
Bone health is maintained by estrogen. , having too little estrogen can cause
The following is from the latest guild lines put out from AusPATH.
| Feminising Hormone Therapy | Masculinising Hormone Therapy |
|---|---|
| Blood clots, deep vein thrombosis, stroke or potentially fatal pulmonary embolism | Polycythaemia - increased number of red blood cells, resulting in “thickened” blood |
| Increased risk of heart disease or heart attack | Increased risk of cardiovascular disease |
| Difficultly controlling blood sugars in people with diabetes | Difficulty controlling blood sugars in people with diabetes |
| Raised blood pressure | New or worsened obstructive sleep apnoea |
| Liver damage | Liver damage |
| Osteoporosis | Osteoporosis |
| Potentially increased risk of breast cancer | Increased salt and water retention |
| Development of prolactinoma | |
| Development of Meningioma |