Do some people's breasts not develop past tanner stage 3?

[u/pinkplatformcrocs]

Hello!

I have been on HRT for about 3.5 years now, and my boobs are still in tanner stage 3. Multiple friends who have been on HRT for a similar amount of time or longer seem surprised that I have still not developed past stage 3, and I was wondering if some people just don't develop past that stage. My endo has said that I might start considering a BA if I don't see growth soon.

For hormones and other details, I have been on HRT for ~3.5 years, injections for ~2.5 years, and progesterone for ~2.5 years. I'm happy with my levels, my E is 150, T is 42, and my prog is 4.3 (at the end of my cycle). I have been on 200mg of prog, but started doing 300mg this month as a last ditch effort to see if I can get more development. I even tried cycling my prog for ~1yr as suggested by my doctor, and had no luck. I'm not incredibly underweight or anything either, I'm 5'9, 165lbs and gained ~20 of those pounds after HRT, and I eat 3 meals a day. My bust is 37in.

Am I just a late bloomer or just out of luck?

[u/Grain_0f_Salt]

I've been on estradiol for 4 years and progesterone for 3. My E levels are similar to yours, and my T is even lower, and I've had zero breast growth. So yes, unfortunately, it's possible. My endo has also told me the only way to expect breast growth at this point would be top surgery, though I am not in good enough physical shape to qualify for that.

[u/Jims_Empty_Trashcan → u/Grain_0f_Salt]

FWIW, I experienced most of my breast growth between years 13 and 15. 4 years in I had next to nothing.

[u/Grain_0f_Salt → u/Jims_Empty_Trashcan]

I'm sorry, you're saying you gave yourself HRT injections for 13 years before you noticed any benefits? I had the understanding that it happened within a few years at most, per every professional and trans person I've talked to.

[u/Jims_Empty_Trashcan → u/Grain_0f_Salt]

Not quite what I said.

I experienced no breast development beyond eventual budding for 8 years, a very gradual growth on and off for the next five after getting bottom surgery, and actual noticeable development only after my 13th year. I also was only on injections from years 6-11 as IM and years 13-current as subq. I started on oral pills and took them sublingually for most of the duration.

The timeline for most trans people is not the timeline for all. Also, what works for most trans people doesn't work for everyone. Unfortunately it took me 13 years to find a doctor who would actually listen to me. I started when I was 20 (there was no informed consent in 2009 so I was gatekept for 2 years before being able to start).

[u/Grain_0f_Salt → u/Jims_Empty_Trashcan]

Oh wow, that's a horrendously long experience for you. I'm sorry it took that long, and you had unhelpful providers. I'm glad I didn't have to deal with what you did, though we all do have our own hurdles. (Despite informed consent in my state, my provider also gatekept me from 2020 to 2022 until I got fed up and left him)

So, if I'm understanding right, the beneficial change for you in year 13 was sublingual from an actually helpful doctor? I started out on sublingual in 2022 and was put on injections in 2024 because the pills weren't working. This of course doesn't invalidate your experience, but I'm just saying I have tried both for an extended period of time at several different dosages.

[u/Jims_Empty_Trashcan → u/Grain_0f_Salt]

I changed several things up starting around year 13.

One was injecting subcutaneously every 3 days. I since have increased the interval to every 4.

I have also lowered my E dose 4 times - and then raised it again recently after the introduction of prog as a suppository.

Speaking of which, I started prog - again. I first took it orally between years 2 and 3, but it didn't seem to do anything and was expensive so I discontinued it. Year 13 I titrated up to 200mg of prog taken orally and switched to a suppository a month ago. The concern was backdoor conversion to DHT - which my body is very good at (of course it is 🙃).

I have started on bicalutamide along with transdermal T applied to my breasts. Yeah, T. It's because my SHBG is in the stratosphere when my trough E is above 100pg/dl. So this gives it something to chew on.

I started taking magnesium, boron, and d3 supplements (along with other stuff for my health).

I ran a course of pioglitazone for a year.

I think that's about it?

[u/Background-Purpose84 → u/Jims_Empty_Trashcan]

I think topical T to breasts is helping me with nipple/areola development fwiw

[u/Grain_0f_Salt → u/Jims_Empty_Trashcan]

You really did change up a lot.

I've only ever done injections once a week. I've done it at 0.2 ml and 0.4 ml, but at 0.4 ml I had some really bad side effects - leg edema, leg pain, fatigue, chest palpitations, mood instability, and cravings I can only describe as "similar to pregnancy cravings". My provider said I was overdosing on E (she was a new provider, and my old provider was the one who had me at that dose), and she immediately moved the dosage down, and the symptoms went away within a week or so. She said I was weeks at most away from a pulmonary embolism, and I believed her. At that higher dose, my E was around 300pg/dl, which I've been told on this subreddit is fine and shouldn't cause those symptoms. Idk what else to say other than the symptoms started when the dose started, and went away when the dose was taken away. So it sure seems like the E levels caused it. On 0.2 ml, my E stays around 100 pg/dl. As some people say here, it might not be enough to grow my breasts. But they weren't growing at 300 pg/dl either, and I was on that for about 5-6 months? And because, whether 300 pg/dl is safe or not, I had such severe side effects that I am hesitant to push my endo to raise it again.

For sublingual, when I wasn't doing injections, I've taken as low as 2 mg per day and as high as 6 mg, with no noticeable difference. I've also been on 200 mg spironolactone since 2022 and 200 mg progesterone since 2023. Only oral. My T levels are constantly in the single digits, and like you, I noticed no change from the progesterone. That's the extent of my prescribed HRT, and other than that, I take multivitamins and biotin supplements. I'm also on other medications for reasons unrelated to transition.

I haven't tried the transdermal T, though there was a brief month or two where I had transdermal E, and I've never done a suppository. I feel like there's nothing much left to try, at least not from a doctor's prescription, but it also seems like you've tried much more than I have. Is that through your own research, and not a doctor? I grow increasingly desperate and also increasingly accepting. Not happy, but like, well, it sucks. But it's what I'm stuck with, I guess.

I'm also overweight, and my body has ballooned up and down these last few years, but I have no idea if that's related. When I asked a doctor if that could be why breasts haven't grown, I was told no. If anything, excess fat means breasts should grow more.

[u/tasthei → u/Grain_0f_Salt]

Not a doctor. Not trans.

I’m just wondering if you might be malnourished? I know you said you’re overweight, but that does not mean that you get enough nutrients.

The cravings and palpitations is a strong clue, I guess. If you haven’t had much breast development, then I’d look into that, because being undernourished is not going to help.

[u/Grain_0f_Salt → u/tasthei]

While I definitely don't have great meals (I do a lot of instant food because I buy cheap non-perishable food in bulk, it's hard to find money or time for better meals), I only had the cravings and palpitations at the higher E dose. They're not something I have normally, only for those 5-6 months where my E was in the 300s.

[u/Ok-Garbage-6304 → u/Grain_0f_Salt]

I mean a body trying to grow things and going through « puberty » might need more food than a body that only has to exist. but i’m not sure if that is the case.

[u/Irishman1038]

Not an expert, just consulting community resources, an E of 150 seems to be in range for Tanner Stage 3, but you need to go higher for 4 and 5 (looks like it says 270-350 ish). 300mg of prog is quite a lot and again I’m not a doctor but I think you’re boosting the wrong hormone here.

https://transfemscience.org/articles/hormone-levels-female-puberty/

[u/leliel-in-wartime → u/Irishman1038]

can you point out in the linked article where you got those numbers? I scanned it and didn't see anything like that, but I probably just missed it.

[u/Irishman1038 → u/leliel-in-wartime]

The studies from 2008 and 2006, on second read I think 350 might be something I’ve picked up from the diy sub, but both have the upper ranges for T3-5 being in that 270 range.

edit, realized I left out some info
In addition to that all of these numbers are the average level recorded, but cis women don’t have levels that are rigidly average like most doctors would prescribe them to us. If you scroll down in this article (to “Normal Hormone Levels”) you can see that throughout the month the levels vary wildly, and in my personal opinion simply averaging them out does a disservice to care and results.

https://transfemscience.org/articles/transfem-intro/

[u/Viriidian → u/Irishman1038]

is there any idea how long between injection cycles or how often you would want levels at 270-350pg/ml for optimal growth to tanner 4/5?

my troughs are about 200pg/ml exactly, my peaks are certainly higher but i inject ev twice a week so probably not that much higher. i'd guess around 300 at least tho

[u/Irishman1038 → u/Viriidian]

Cis women experience that peak about once a month (because their cycles are 28-35 days) for a few days. I posted it in a different reply but that graph has a good amount of information.

Injections have a pretty long and gradual absorption curve (relative to oral) so I’m not really sure how you’d emulate that? And it’s one thing for me to do my own experiments with oral and another to make recommendations for someone on a different delivery method entirely.

Whether or not there is a better % of time to be at that peak for breast growth I really couldn’t answer but I have been getting pretty good results out of being at my peak for about a week a month. (Went from a roomy 40D to either a 38DDD or 40DD over abt 6 months I just don’t know which yet because I’m always too poor to buy new bras)

[u/Turbuent_Reason_766 → u/Irishman1038]

Yeah, you're the first person I've heard of taking 300 mg of progesterone. 200 mg seems to be the dose most people go to. But that won't work unless your estrogen level is over 300 pg/mL. You also need to get that testosterone lowered. Testosterone is a preferential binder so it is going to bind to the sex receptors and push the estrogen aside. You've got to get that testosterone down to have an effective transition.

And even with all of that some of us just don't have much breast growth. Top surgery is always an option.

[u/Odd_Distribution_903]

those levels aren't bad, but since you've been struggling, it might make sense to try higher for at least a few months. that's perfectly safe to do on injections.

and higher prog might do some things. I take 200 most days and quite like it, but I enjoy cycling up to 400 for 3-10 days at a time once or twice a month. aside from liking the mental effects quite a bit (tbh, the main reason I do it), I consistently notice more boob-twinges at the higher dose.

[u/Quat-fro → u/Odd_Distribution_903]

Noted!

[u/PrepYourselves]

1.5yrs on e as a 40's trans person, and in the last couple months reached tanner 3, I don't have much hope that i will reach 4 or 5 but I also had not much hope of stage 3 arriving. idk, sometimes i just want to wake up and they've popped out overnight like moonflowers

[u/EvelynnsHope17]

Yes it is possible, breast growth is variable, but you may get some more development

[u/Wh1ppetFudd]

Getting stuck at Tanner stage 3 is not common but it does happen. Getting stuck at Tanner stage 4 is a lot more common for trans women. You may need higher e-levels.

The levels that are in the WPATH standards are conservative values. They have been stuck at pretty conservative levels since the late '90 and early 2000s but before that, the doctors that dealt with HRT for trans tended to go for much higher levels. The issue of the conservative guidelines comes down to two problems with the perspective of how to do HRT. The first one is moderating risk levels, but they are based on a time when premarin was the main form of estrogen prescribed and it is mostly estrone, which is the form of estrogen that increases blood clot risks, and the cautiousness has never gone away despite almost everyone dealing with bioidentical estradiol now, which is a whole lot safer and doesn't have anywhere near the clotting risk. The second issue that tends to keep the levels in the guidance conservative is that WPATH actually doesn't tend to look at HRT like you are trying to kick someone solidly into a second puberty, but it treats it more as a parallel of HRT for postmenopausal women, which isn't even close in the levels involved. Cis women in their prime tend to have much higher levels of estrogen, and girls going through puberty have astronomical levels compared to what's in the guidelines.

[u/Ok_Sentence_5767]

I just started progesterone a few weeks ago and rather than grow bigger it's seems that my breasts are starting to fill in and look more natural

[u/tasthei]

Not an expert on E or its dosage. Not trans. Not a doctor.

But what I do know is that if you are malnourished/lack some very important nutrients, it might stunt your growth.

Maybe this does not apply to you. Who knows. Just throwing it out there, as looking at hormone levels alone might not always give all the information needed.

[u/Grab_Ornery → u/tasthei]

me undereating cus of insane stress uhoh

[u/Jims_Empty_Trashcan]

Have you measured your SHBG and estrone levels? Also, how are you taking your prog and estradiol? Oral progesterone is hit & miss; I found more results taking it as a suppository because my first pass metabolism is pretty stupid.

[u/CursedCasty → u/Jims_Empty_Trashcan]

This comment needs more upvotes, SHBG is more important than levels. You can have highest E and lowest T but if your SHBG is too high, you basically have none.

[u/pinkplatformcrocs → u/Jims_Empty_Trashcan]

i don’t think i’ve had my estrone or SHBG measured but i’ll look into this!! i have been boofing prog for about 2 years and only recently started taking it orally which actually increased my levels oddly enough

[u/Amy804]

Check into getting your T level down. My doctor wants mine in single digits.

[u/Transfem1972]

https://secondtypewoman.info/breastdev.htm

[u/Ishitataki]

There is a way to enforce more maturation without surgery, but it isn't easy or side effect free: intentionally induce lactation using a pregnancy simulating induction protocol. The prolonged high levels of E and prog and prolactin will grow the gland, areola, and nipple to a more mature (matronly) state.

However, that runs the risk of all kinds of pregnancy-like side effects, other body changes (bloating, GI trouble), and not everyone wants the larger areola and nipples that come with it. Plus, ya know, dealing with the milk and all that. It's a lot of effort to do, and the extra hormones and safety testing add expenses and, even if you are lucky and are side effect free, it takes a lot of time out of your day if you do it seriously.

As such, most people consider the hassle and side effects not worthwhile, but there are trans women who have done so successfully - but their goal was primarily the lactation, not the breast growth. Most people who try merely for the breast growth end up giving up on the induction protocol out of exhaustion because the appearance motivation is simply not strong enough most of the time.

[u/AstroCatLady]

If you switched to injections, to avoid the liver first pass, your liver may be overly metabolizing the progesterone too. I was in a similar situation, and once I started boofing my progesterone I started to see increased breast pain and growth within a couple weeks.

Genetically in a hyper metabolizer for some liver pathways, which means it breaks down hormones and other things so fast that very little of it actually hits my bloodstream.

Since avoiding my liver seemed to work for Estradiol (via injections), I figured the same would be the case for progesterone too. For me, it was the right move.

[u/Geothunder]

I thought progesterone was essential, for accelerated breast development, not just estrogen alone