When Does Hormone Therapy Start Working? (AKA: Why Two Weeks Feels Like Forever)

If you started hormone therapy and, two weeks later, you’re staring at the mirror like, “Hello? Is this thing on?” you’re not broken, and your meds aren’t necessarily failing. Your body just has the audacity to run on two different clocks.

And yes, that’s incredibly rude.

I’m going to walk you through realistic “what you might notice when” timelines for:

• Menopausal HRT (estrogen ± progestogen)
• Testosterone replacement therapy (TRT)
• Feminizing hormone therapy (estrogen based regimens)

Not as a crystal ball (because bodies are chaotic), but as a sanity saving set of benchmarks so you can stop doom Googling at 1 a.m.

First: Your Body Has Two Timelines (And It Didn’t Tell You)

Here’s the thing most people don’t get warned about:

Timeline #1: “Fast-ish” symptoms

Stuff like hot flashes/night sweats can improve within weeks. That’s because estrogen can affect the brain’s temperature control system relatively quickly.

Timeline #2: “Slow burn” symptoms

Stuff like mood, focus, motivation, brain fog can take months. Your brain has to adapt over time (think: neurotransmitter systems recalibrating, not a light switch flipping).

So if you’re at Day 14 and you’re still foggy, moody, or feeling like your brain is running on dial up internet… that can be normal.

The 8 week checkpoint matters

Clinically, around 6-8 weeks is when many regimens are steady enough to evaluate properly. Judging at week 2 is like poking a lasagna after ten minutes and declaring it a failure. (Let it cook.)

The Delivery Method Matters More Than You’d Think

How you take hormones can change how quickly you feel changes:

• Injections often feel fastest (they skip digestion/first pass liver metabolism).
• Patches/gels are often “middle speed” and steady (also bypass the liver for many hormones).
• Pills can be slower for some people (because of first pass liver processing).

This doesn’t mean pills “don’t work.” It just means your expectations need to match the route. If you hit that 6-8 week window with basically zero improvement, that’s often the moment to talk to your clinician about whether the form (not just the dose) makes sense for you.

My favorite low effort move: write down your start date, your delivery method, and your top 2-3 symptoms. That’s it. Future you will feel so smug at follow up appointments.

Menopausal HRT Timeline (What It Usually Feels Like)

If you’re doing menopausal HRT, here’s the loose, real life rhythm I see most often:

Weeks 1-2: “Is anything happening?”

Sometimes you notice tiny things in hindsight:

• you didn’t wake up drenched one night
• you slept an extra hour
• you didn’t spontaneously combust during a meeting

And sometimes you notice nothing. Annoying, but common.

Weeks 2-4: The first real relief

This is where hot flashes/night sweats often start backing off. Sleep can improve simply because you’re not being woken up by internal lava.

Weeks 4-6: More obvious progress

Often:

• fewer/less intense hot flashes
• energy starts creeping back
• mood may begin to smooth out (not always first!)
• early side effects (bloating, headaches, breast tenderness) may ease

Week 8: The “okay, let’s judge this fairly” moment

Around here is when many people describe that “oh… I feel more like myself” shift especially with focus, motivation, and overall stability.

If you’re going to compare anything, compare week 1 vs. week 8, not “Tuesday vs. Thursday.” Daily symptom swings are liars.

Months 3-6: Your new baseline

This is when the slower stuff tends to settle:

• mood/anxiety may feel more consistently improved
• sexual comfort changes (like lubrication) may show up over time
• brain fog can be the last to budge (rude again)

Quick and dirty expectations (not a promise, just a vibe check)

• Hot flashes/night sweats: often improve first (weeks)
• Sleep: improves as hot flashes calm down (weeks to ~2 months)
• Mood/energy: often follow (1-3 months)
• Cognitive clarity/brain fog: can take the longest (up to 3-6 months)

Testosterone Replacement Therapy (TRT) Timeline

TRT has its own schedule. It’s not “instant superhero serum,” but it can be noticeable in stages.

Weeks 1-4

Common early changes can include:

• improved energy
• mood lift or more mental drive
• libido often increases around weeks 3-4 for many people

Months 1-3

This is where more “body” changes may start to show up:

• strength improvements
• muscle gains (especially if you’re training)
• possible fat distribution changes
• focus/mental clarity improvements for some

Months 3-6+

A lot of the initial ramp up levels out into your new normal:

• gains may slow
• cognitive/energy shifts often stabilize
• some health markers may improve over time (this is very individual and depends on your overall health plan)

Feminizing Hormone Therapy: What Changes When (Broad Strokes)

Big note: feminizing HRT timelines vary a lot. Genetics, age, dose, delivery method, and baseline hormone levels all matter. These are common clinical ranges, not guarantees.

Months 1-3: Early shifts

Often in this window:

• fewer erections / reduced ejaculation may begin (full effects often closer to ~6 months)
• libido often decreases
• scalp hair loss may slow (slowing is not the same as regrowth)

Many of these early effects are generally considered more reversible if treatment stops early.

Months 3-6: Visible changes begin

Common developments:

• breast development often begins (tender “buds” are common)
• skin may become softer / less oily
• muscle mass may decrease
• fat distribution may start shifting (often toward hips/thighs/chest)

Months 6-12 (and beyond): The long game

• body/fat distribution changes become more established
• facial/body hair may slow starting around ~6 months, but full effects can take years
• breast development typically continues over 2-3 years for many people

The permanence question (the one everyone asks)

Breast tissue is the main change that tends to be lasting, and after a couple of years it’s less likely to fully reverse.

What HRT generally can’t change

• voice pitch
• skeletal structure
• existing pattern baldness (slowing loss is different from reversing it)

How to Track Progress Without Losing Your Mind

If you track hormones and morning vs evening DHEA timing like you’re watching stock prices minute by minute, you’ll convince yourself you’re failing by lunchtime. I prefer the “calm scientist” method.

Track 2-3 things, tops

Pick what actually bothers you. Examples:

• hot flashes per day + severity (1-10)
• hours slept + sleep quality
• weekly mood/energy averages (not daily drama)

Look at weekly averages

Your goal isn’t “zero symptoms forever.” Your goal is meaningful improvement:

• 10 hot flashes a day → 2 is a win
• 3 p.m. wall of doom → less doom is a win
• finishing sentences without losing nouns → honestly, iconic

Common mistakes (that I wish I could gently bonk people for)

• Quitting at week 3 because of side effects. A lot of “settling in” effects improve by weeks 4-6. If you’re miserable, talk about switching form before you quit.
• Pushing for dose changes too early. Give it the 6-8 week window unless your clinician says otherwise.
• Expecting perfection by week 6. Look for percent improvement, not a magical symptom wipeout.

When to Call Your Clinician (Don’t Tough It Out Through These)

Hormone therapy is medical treatment. If something feels off, you’re not “being dramatic” you’re being responsible.

Seek urgent care immediately if you have:

• chest pain
• shortness of breath
• leg swelling/redness
• severe headache with vision changes

Other checkpoints that deserve a conversation:

• By ~6-8 weeks: no improvement in key symptoms (like hot flashes) can signal the plan needs adjusting
• Around 3 months: symptoms didn’t improve, improved then returned, or side effects are preventing consistency
• By 6 months: heavy/irregular vaginal bleeding continues (for menopausal HRT regimens where that’s unexpected)
• For feminizing HRT: if expected early signs (like breast tenderness/skin changes) are completely absent by later checkpoints, it may be worth reviewing dose/adherence with your clinician

This post can’t replace medical advice for your specific situation it’s here to help you know what’s typical and when it’s time to ask better questions.

How Long Will You Need Hormone Therapy?

There isn’t one universal finish line. Some people use menopausal HRT for 2-5 years, some longer. Symptoms can return after stopping for a lot of folks.

If you and your clinician decide to stop, tapering over 3-6 months is often recommended rather than quitting abruptly (it can reduce rebound symptoms).

The bottom line

If you’re only a couple weeks in, you’re not “behind.” You’re just early. Give your body time to catch up, track a few meaningful symptoms and nighttime DHEA dosing benefits, and use that 6-8 week mark to evaluate like a sane person (not an anxious detective with a spreadsheet at midnight).

And if you want permission to stop comparing your timeline to your friend’s? Permission granted. Your body didn’t read her instruction manual.