Transgender Breast Implants, not on hormones

Dr. Reed,

I am a 23 year old transgendered woman seeking breast implants.  I am very passable and for that reason have never been in hormones. What are your thoughts?


Dear Marilyn,

We have done breast implants on patients in the late 50’s who have never been on estrogens.  As you know the FDA advises caution giving estrogens to patients over 55 because of potential coagulopathy.

One goal in breast augmentation surgery is to conceal the implant as such which results in a more natural look. When the implant is placed under the skin as opposed to a sub-pectoral approach there could be a “double bubble” effect.  Let’s also talk about estrogens and testosterone blockers.  That way you can still say “no” but be more informed.

(taken from WPATH Standards of Care, Version 7)…

Medical Necessity of Hormone Therapy Feminizing/masculinizing hormone therapy – the administration of exogenous endocrine agents to induce feminizing or masculinizing changes – is a medically necessary intervention for many transsexual, transgender, and gender nonconforming individuals with gender dysphoria (Newfield, Hart, Dibble, & Kohler, 2006; Pfäfflin & Junge, 1998). Some people seek maximum feminization/ masculinization, while others experience relief with an androgynous presentation resulting from hormonal minimization of existing secondary sex characteristics (Factor & Rothblum, 2008). Evidence for the psychosocial outcomes of hormone therapy is summarized in Appendix D. Hormone therapy must be individualized based on a patient’s goals, the risk/benefit ratio of medications, the presence of other medical conditions, and consideration of social and economic issues. Hormone therapy can provide significant comfort to patients who do not wish to make a social gender role transition or undergo surgery, or who are unable to do so (Meyer III, 2009).

Table 1b: Effects and Expected Time Course of Feminizing Hormones a Effect Expected Onset  b Expected Maximum Effect   b Body fat redistribution 3-6 months 2-5 years Decreased muscle mass/ strength 3-6 months 1-2 years   c Softening of skin/decreased oiliness 3-6 months unknown Decreased libido 1-3 months 1-2 years Decreased spontaneous erections 1-3 months 3-6 months Male sexual dysfunction variable variable  Breast growth 3-6 months 2-3 years Decreased testicular volume 3-6 months 2-3 years  Decreased sperm production variable variable Thinning and slowed growth of body and facial hair 6-12 months > 3 years  d Male pattern baldness No regrowth, loss stops 1-3 months 1-2 years a Adapted with permission from Hembree et al. (2009). Copyright 2009, The Endocrine Society. b Estimates represent published and unpublished clinical observations. c Significantly dependent on amount of exercise. d Complete removal of male facial and body hair requires electrolysis, laser.

1/1 - Before

Breast implant patient before


Breast implant patient after

Breast implant patient after, stunning outfit



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