One of the most common questions that Plume patients ask isn’t about the physical changes created by gender-affirming hormone therapy (GAHT): it’s about the psychological aspect of medically supported transition. Hormonal transition is experienced in different ways. Estrogen can have a powerful effect on both the mind and body. One of those aspects is emotional changes and how you may feel during and after the initial stages of starting estrogen. Many people wonder, “How will estrogen, progesterone, blockers, estradiol, or other E+ medications affect my emotions?”

While the physical changes that estrogen and progesterone can create take up to three years to fully express themselves in most people’s bodies, the emotional shifts can be more immediate. Often, it’s the first thing that people notice—long before anything has changed on the outside, our inner selves are transforming as well as our relationships to our identities.

How do estrogen and E+ change my emotions?

Estrogen plays a significant role in mediating moods. This means that the more estrogen you have in your body, the more “moody” you might be. The first signs of hormonal changes often include feeling more “sensitive” to yourself and others, or moods that seem “bigger” than usual. If you’re used to always feeling in control of your feelings, you might be surprised by a sense of deregulation or loss of control. For example, it’s very common to find yourself crying over commercials that never affected you before or feeling moved by others’ kindness.

Some of the most common emotional changes that people share about estrogen are crying more, feeling more tender, and even experiencing greater empathy. These changes can be subtle or intense, depending on your body and sensitivity to GAHT. A 2016 study even showed that people whose estrogen levels were increased through hormone therapy experienced an increase in “vicarious emotions,” where they were better able to read other peoples’ intentions and emotions, and to learn from their experiences.

Will estrogen give me mood swings?

One of the most common fears or questions people have about estrogen is related to mood swings. Although there are some anecdotes that support this, everyone’s experiences are a little different. The link between mood swings and femininity is largely based in cultural stereotypes and misogyny. This includes stories about mood swings and oversensitivity. While some people do have a more exaggerated or marked response to estrogen, intense mood changes are not the case in most patients.

Mood changes during estrogen therapy for patients on GAHT have to do with the parts of the brain that are sensitive to estrogen. The brain has three regions that are super-receptive to estrogen: the amygdala, hippocampus, and hypothalamus. These structures are super-sensitive to estrogen and actually have abundant estrogen receptors, the most of any area of your brain. The amygdala regulates mood and memory, so when your estrogen levels change, so do your moods.

If this sounds familiar, it’s because mood changes are part of a well-known natural cycle. People who menstruate experience mood changes regularly due to shifting estrogen levels. Dr. Louann Brizendine (she/her) explained that fluctuating hormone levels increase crying; this is common when someone’s fluctuating hormones of your menstrual cycle go up and down more aggressively, which can cause more crying. GAHT can cause the same fluctuations, especially as your body adjusts to your medication. Don’t be surprised if you’re more sensitive than usual. Dr. Brizendine said, “Anything can trigger you into crying. You can cry at the drop of a hat.”

The link between estrogen and femininity

Estrogen is associated with feelings of tenderness, which includes tears, empathy, and sensuality. Estrogen is linked with femininity and considered a feminizing hormone. The word “feminizing” refers to physical changes, such as growing breast tissue and softening hair texture. It does not refer to cultural standards of femininity or beauty. For example, taking estrogen does not necessarily mean that someone will become hyper-sensitive, shy, or unassertive. If that’s not who you were prior to starting estrogen, then GAHT is not going to transform you into a shrinking violet. These are stereotypes—not the side effects of hormonal treatment.

Most people who are prescribed gender-affirming hormone therapy describe increased confidence and a sense of self-alignment that is empowering. It’s possible that using GAHT may make you feel more comfortable about embracing your femininity, but that will be a choice you can make consciously. Hormones do not change your essential personality. They help you feel like yourself, while affirming your gender identity.

While some mood changes are inevitable, they aren’t unmanageable. As your body adjusts to suppressed testosterone levels and higher estradiol, mood changes will feel less dramatic. To help ease the transition onto estrogen and help you stay comfortable, Plume’s trans-led care team can support you with medications that balance hormone levels. Some people benefit from blockers, while others find that a different form of estrogen (like a pill or patch) feels more manageable than injections.

If your mood changes feel unmanageable and uncomfortable, it’s important to find mental health help. Don’t wait until things are dire or you’re in crisis! Some of the ways people nurture their mental health during gender transition are support groups, medications to manage anxiety and depression, time with a therapist, and other resources. Estrogen can ease depression and anxiety for some people. For others, it creates emotional changes that are unexpected. Wherever you land, you deserve to feel affirmed and safe during your transition. If you are looking for resources in your area, you can check out the WPATH directory to find a trans-affirming provider or call Trans Lifeline.

Also, bear in mind that beginning to transition and embarking on any gender journey can be exciting, scary and generally overwhelming. These changes and emotions can be amplified when taking hormones—biological and physiological changes can be surprising and intense! Be patient with yourself as you learn to move through your new emotions and moods. Give yourself the grace and inward-facing kindness you deserve as you nurture the wonderful person you’re becoming.