Breast Tenderness and Nipple Piercings While on Hormone Replacement Therapy (HRT)

One of the most noticeable changes when going on estrogen HRT is breast growth and tenderness, and if you have a piercing or are looking to get one, it’s important to know what to expect.

October 12, 2022
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Breast tenderness is a common experience during puberty and during the early stages of gender affirming hormone therapy because of estradiol effects on early breast tissue tissue. These start as somewhat hard knobs of new breast tissue called breast buds, and they can hurt or feel sensitive. As breasts increase tissue and grow in size, much of this tenderness goes away. But even cis persons with breasts for a long time who start hormones for birth control or menopause might experience some new temporary breast tenderness. 

Transgender women, femmes, and nonbinary people on estrogen HRT will notice breast growth as a major development in their body. In addition to an increase in size of the breast, areola, and nipple, many report breast tenderness as a secondary effect accompanying the growth. People see maximum breast growth 24 - 36 months into taking estrogen at which point tenderness can also start to decrease. 

A FOLX Health illustration of pierced breasts of different body types with cleaning ointments

Similarly to breast growth, tenderness and sensitivity is different for everyone. There are no conclusive studies that connect the difference between methods of taking estrogen - injectable, oral, or transdermal - and their impact on the intensity of breast tenderness. Some transgender women, femmes, and nonbinary people report more tenderness when on injectable estrogen compared to the other two methods, but this is purely anecdotal amongst the community. For those using estrogen patches or other transdermal methods, it’s important to place them on the appropriate areas of the body, which does not include the breasts. 

As the breasts start to develop for transgender, nonbinary, and queer women feminizing their gender, those with nipple piercings should pay close attention. Because the size of the breast will change over time, the piercing itself could become irritated or too small for the nipple. If this is the case, replace your jewelry with a larger version to accommodate the growth. If you don’t have your nipples pierced and are planning to, you might wait until the breasts are fully developed to do so. In addition to the actual tissue of the breast and nipple changing, binding and wearing breast forms can also irritate an existing piercing and cause a “hammerhead” scarring. If this starts to happen, taking out the piercing will be more beneficial in the long run for someone who’s also taking HRT. 

For those ready to get started at FOLX for HRT, the process begins here. For existing FOLX members with questions about physical developments, don't hesitate to message or schedule time with a clinician. And for those who’ve just got some more questions related to LGBTQ health and beyond, read more in the Library, and feel free to reach out to us at


FOLX Health is the first digital healthcare company designed by and for the LGBTQIA+ community. Our services include virtual primary care, gender-affirming hormone therapy including estrogen and testosterone (HRT), mental health care, sexual and reproductive health care, preventive care, and fertility consultations. FOLX memberships give you access to LGBTQIA+ expert clinicians, peer support, thousands of LGBTQIA+ resources, and more. Whether you’re lesbian, gay, bisexual, transgender, queer, gender non-conforming, or nonbinary, you can find LGBTQIA+-specialized health care that helps you meet your wellness goals. FOLX Health is health care that's queer all year. Get all the benefits of becoming a FOLX member and sign up today!