How it Works

Progestins are a synthetic hormone made to resemble a naturally occurring hormone, progesterone. Progesterone has a role in pregnancy and having periods for people with uteruses. The potential of progestins causing feminizing effects in people assigned male at birth (AMAB) is a matter of debate. There is limited research on the clinical utility, efficacy, and long-term implications of their use in AMAB people. Much of the research used in clinical decision-making is based on studies with cisgender females. Caution and care should be taken into consideration when choosing whether progestins are right for you.

Readiness

It is important to note that assessing if gender medical treatments, like hormones, are right for someone and if that person is ready to start is complicated. Please see information on the preceding pages regarding The Hasbro Gender & Sexuality Program’s model for making decisions about when it is appropriate to start gender medical treatments based on one’s cognitive, emotional, and physical development using a family-centered approach for shared decision-making.

What to Expect

If Estrogen is part of your gender affirming care goals, it is recommended you be on a stable dose of Estrogen for up to 1 year prior to starting progestin to be able to accurately assess changes.

There are some potential benefits when used for gender affirming care, and few known risks:

Potential benefits include:	*Potential risks include:**
– Improvements in mood and/or sex drive (libido) – Improved sleep – Increased breast development and improved shape – Decreased testosterone production/effect – Decreased facial hair, oily skin	– Negative impact on mood and/or energy; increased sleepiness – Weight gain – Decrease in HDL (“good”) cholesterol and other cardiovascular markers – Increased risk of blood clots when combined with Estrogen

*The effect of progestins on the risks for cancers is multifactorial and still being researched. Family history, tobacco use, obesity, and lifestyle all increase the risk of adult cancers. There is currently no evidence that people taking progestin have an increased risk of cancer compared to cisgender women.

Follow-up and Labs

Monitoring is based on clinical effects. No lab monitoring is recommended.

How its Given

Progestin is available in the following forms. Insurance may or may not cover these medications.

Pills: Micronized progesterone (“Prometrium*”) taken by mouth once daily. Prometrium capsule contains peanut seed oil; do not use if you have a known peanut allergy.
Pills: Medroxyprogesterone acetate (“Provera”) taken by mouth once daily.
Injection: Depo-medroxyprogesterone acetate (“Depo-Provera”) every 3 months
Implant: Etonogestrel (“Nexplanon”) inserted under the skin in the arm every 3-5 years