Archive of Our Own

1. Purpose as a Writing Resource

Since not everyone is familiar with the cultural context or the science behind hormone replacement therapy, this document will serve as a quick introduction for writers interested in portraying things accurately. This document is by necessity reductive and is meant to quickly and simply summarize events. Some details may be oversimplified, and the reader is encouraged to do their own research. The comments section here is explicitly not a forum for debate; if readers feel the burning need to factually correct matters, helpful articles citing scientific studies and marked as Inspired By this work will have links approved.

This article does not constitute medical, financial, or legal advice. It is a writing resource, prepared for a community of fiction writers. As part of the terms of accessing this document, you agree not to hold the author, the host of this document (Archive of Our Own), or any connected entities, agents, heirs, or assigns, liable for any consequences of being exposed to the information shared in it, and you further agree to consult qualified professionals before undertaking medical, investment, or legal action. If you do not agree to these terms, do not read further in this document.

2. Background

The online transgender community has long joked about “MTM” (male-to-male) as a sort of ironic, self-denying transgenderism, in the sense that some men who wish to have higher athletic performance or develop bodybuilder physiques resort to anabolic steroids and/or testosterone replacement therapy, a form of hormone replacement therapy (HRT.) The joke is that they are men taking hormones to better portray themselves as men, just as transgender men take hormones to better portray themselves as men. What, then, is the difference? Indeed, there is an entire online community selling “research peptides,” precursors to testosterone production, as a supposedly more elegant way to counteract the general decline in men’s testosterone.

Male testosterone levels in developed countries are approximately 50% of what they were 100 years ago, and average grip strength, sperm count, and birth rates are down accordingly. With approximately 25% of that 50% drop happening in the last 20 years, that rules out a one-time change that happened in the past, such as the shift from agricultural to industrial society, as the main culprit. In cases of more specific targeted marketing, it is not this general decline in men’s testosterone that is called out, but the anxiety of men who age that they are less virile and less masculine. Since men do produce less testosterone as they age, and get slower and weaker as a result, the thinking is that one can simply take testosterone or testosterone precursors to make up the difference. Either way, men who go on HRT improve their blood levels of testosterone, but reduce their body’s natural production of testosterone, and consequently will usually be on HRT for life, another way in which they parallel the needs and behaviors of transgender men.

3. New Development

Now, the practice of lifelong HRT not to change genders, but to remain the same gender, appears to be coming to women in a big way.

The November 10, 2025 FDA press release of the United States Health and Human Services indicates that the current administration is interested in green lighting female hormone replacement therapy with synthetic estrogen, for many of the same reasons that men might be interested in testosterone replacement therapy: to improve physical performance, to look better, and to feel younger.

“Someday, science will help us slow or reverse all the damage of aging. A good safe way to address estrogen depletion already exists.”
— Health and Human Services Deputy Secretary Jim O’Neill

In case it isn’t clear enough, the article goes on to say:

Women who initiate HRT within 10 years of the onset of menopause (generally before age 60) have a reduction in all-cause mortality and fractures.

They are selling HRT to women, en masse. In a smaller sense, they were before, but with this press release the FDA are explicitly normalizing it as being standard for all women above a certain age, in the way that birth control (which is essentially replacement pregnancy hormones) was normalized in the past.

Now, the press release is packaged as “removing” old guidance that was “misleading” about the cancer risks of hormone replacement. So the angle that they’re presenting is that this isn’t a new thing. And, incidentally, weightlifting, yoga and tai chi all have similar effects in terms of reducing fractures and all-cause mortality. Regular physical activity — which is unfashionable, in an increasingly device-bound society — can fix many of these issues. So, what we’re seeing here is that the chemical intervention paradigm — better living through chemistry — is what Americans prefer and are comfortable with, to the degree that the administration that is least comfortable with transgenderism is still pushing 40 million American women over the age of 60 to undergo hormone replacement treatment. And where American Big Pharma goes, the world follows: American drug companies supply much of the world with its medicines, having outcompeted and destroyed nascent pharmaceutical industries in most of the developing world.

4. Implications

The good news is that people are going to be free to make more choices with their own bodies. The bad news is that the way those choices are going to be sold to you may be confusing, or may require discipline when considering long-term vs. short-term benefits. Now, the average person who had no desire before to take 200mg of trenbolone and knock years off their life in exchange for mood swings and slightly bigger muscles will probably not suddenly jump up and demand HRT for equally meager reasons now. But every new product rollout gains millions of customers. Modern marketing is a fusion of Nazi propaganda methods and panopticon-styled personal data gathering, and it gets results. When medical cannabis was legalized, millions of people who had no real experience with weed got into it for pain management and stress relief; when Ozempic (semaglutide) was introduced for weight loss, rappers started accusing each other of taking it, and millions of people began asking their doctor for prescriptions, believing that they could simply take a pill and lose weight. Simply put, with controversy comes increased public awareness, and with more awareness comes millions of customers. The FDA’s goal is transparently to increase the number of women on HRT.

Taking hormones comes with personality changes. Anabolic steroids are the most notorious for this, with viral video channels serving up “roid rage” incidents, but this fact is no less true for people taking pills which are a concoction of estrogen, progesterone, and in some cases, testosterone as well. There are numerous studies, both scientific and ethnographic, which indicate that human behavior changes while on birth control pills. This is subtle, and not as well understood because its effects are not as blatantly obvious as the steroid-fueled propensity to immediate violence. All sorts of cultural phenomena, from TikTok hashtags to hot yoga to the popularity of Beto O’Rourke, have been attributed to female hormones.

Is it harming people? The case for harm in female post-menopausal HRT is less clear than that for male HRT, precisely because women already produce greatly reduced levels of estrogen following menopause, dropping to a tenth of pre-menopausal levels. There is therefore little to suppress, and the thinking goes, little to lose. The main thing that gave pause to the industrial scale use of HRT before was the possibility of causing cancers. However, the US FDA now argues this increased risk of cancer is “statistically non-significant.”

5. Writing Hooks

Several themes suggest themselves from this press release and the political and economic undercurrents it reveals.

A. Transhumanism

Perhaps taking hormone supplements is just about trying to become a higher performing version of yourself. Is that true, playing this trope straight, or is it the beginning of a dystopian nightmare? Can you have your man-card revoked (or woman-card) by denying you your HRT? Combine with social credit fears for an extra-spicy combo. Also, putting aside the cancer concerns, estradiol by itself is known to cause increased risk of blood clots and heart attack, making this an angst-filled, tearful decision for people trying to be their authentic selves but also take care of their health. What if a doctor tells you your heart can’t take it? Will we see a surge in heart replacement surgeries in an attempt to sidestep the issue?

B. Corruption

To what degree do the politicians involved actually believe what they are saying? RFK Jr. is the last person people would peg for a secret transgender revolutionary, but there’s plenty of room to argue good old-fashioned corruption, with money and political favors changing hands. The Pennsylvania “cash for kids” private prison scandal is (unfortunately) an excellent real-life incident to model your writing upon. What will happen when big corporations get paid for every person shoved through the system? Will it disproportionately affect the poor and minorities? Will the future be feminized — by force?

C. Biopunk

Conceptually, Estrogen For All is only a half-step away from Power to the People. What xenogenders will be concocted on a veritable tidal wave of estrogen? American policy and increased production will make waves throughout the world, making this affect stories in other settings as well. Street vendors in Port-au-Prince, Kingston, or Johannesburg could be awash in American-made pills, which they then try to cheaply offload before they get too far past their expiration dates.

D. Trans Empire

Picture the Roman Imperium, but with cyan-and-pink flags. America 25-50 years after the normalization of HRT could be a completely reshaped social landscape, just as it was reshaped by the Pill after its introduction circa 1950. In this line of thinking, the free love of the 60s and 70s was downstream of the existence of cheap, reliable birth control. What will cheap, reliable HRT do? Something similar? Or something totally different?

E. Purity Rings

For every action, there is a reaction. Just as the prevalence of cheap and easy premarital sex in the 60s and 70s gave way to the greed-fueled 80s and party rockin’ 90s and 00s, ending in the late 2010s meme “She Belongs to the Streets,” what will happen with the people who react negatively to these changes? Will they be considered social conservatives, reactionaries, absurd traditionalists in the vein of the Amish, or something else entirely? The Purity Ring culture in the American Deep South was a reaction to rampant premarital sex that made a few jewelers a lot of money, but doesn’t appear to have had that much impact on actual premarital sex, if STI rates are anything to go by. (Teen pregnancy declined, but it's more complicated to discuss, since it also declined outside of areas where purity ring culture was prevalent.) Were the circumstances that created that subculture unique, or will we see a similar phenomenon again in reaction to widespread HRT? Will the Straight Edge culture of 2050 mostly be about not injecting hormones instead of not injecting drugs?

F. Choose Your Own Adventure

There are a thousand other, more farfetched possibilities. Perhaps a new Constitutional Amendment will explicitly spell out the right to HRT, just as a proposed one would spell out the right to birth control. Perhaps a new Mason-Dixon line will be formed between states that use legal penalties to enforce misgendering as a hate crime, and states that think free speech trumps that. If so, where would the line be? Will there be a new Civil War, fought with estradiol and trenbolone?

6. Works Cited

https://www.fertstert.org/article/S0015-0282(21)01503-X/fulltext

https://doi.org/10.1016/j.euf.2020.02.006

https://pmc.ncbi.nlm.nih.gov/articles/PMC2701485/

https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy

https://www.rollingstone.co.uk/music/news/viral-conspiracy-theories-about-drake-and-kendricks-beef-are-spreading-fast-39582/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10823308/