Hormone Therapy and Mood Swings: What to Expect and How to Cope

Yes mood swings can occur as a side effect of hormone therapy, and they’re relatively common. Mood changes are reported with several types of hormone therapy, including menopausal hormone therapy (estrogen with or without progestogen), gender‑affirming hormone therapy, and prostate cancer hormone therapy. ^[1] Moodiness and irritability can also improve in some people when hormone therapy is used to treat menopausal symptoms, showing that effects vary by the individual and the specific regimen. ^[2] Prostate cancer hormone therapy can cause mood changes such as anxiety and depression for some, which may include apathy. ^[3]

Why Mood Swings Happen

• Hormone level shifts: Changes in estrogen, progesterone, testosterone, or their blockers affect brain chemicals tied to mood (like serotonin and dopamine), which can trigger irritability, anxiety, or low mood. This relationship is reflected in clinical observations where different estrogen levels correlate with mood symptoms. [PM7]
• Individual sensitivity: People metabolize and respond to hormones differently, so the same dose can feel very different from one person to another. This variability often requires dose adjustments for best tolerance. [PM7]
• Type and purpose of therapy:
  • Menopause therapy can reduce moodiness for some but also list mood swings as a potential side effect. ^{[1] [2]}
  • Gender‑affirming therapy is generally associated with positive psychological impact, yet many report side effects, with mood swings common in those on masculinizing regimens. [PM10]
  • Prostate cancer therapy lowers or blocks testosterone and may increase risk of anxiety and depressive symptoms. ^[3]

When to Talk to Your Clinician

• New or worsening mood swings that interfere with daily life or relationships. ^[1]
• Depressive symptoms (persistent sadness, loss of interest, changes in sleep or appetite) or anxiety that do not improve. ^[3]
• Any unusual symptoms such as unexpected bleeding on menopausal therapy. ^[1]

Your clinician can review your regimen, check hormone levels, and consider dose changes or different formulations to improve tolerance. Do not stop or change your dose on your own; adjustments should be guided by your clinician. ^[1] Ongoing monitoring of hormone levels and general health markers (like cholesterol, blood sugar, liver enzymes, and blood counts) is part of safe care. ^[4]

Practical Coping Strategies

• Optimize the regimen with your clinician

  • Consider adjusting the dose or switching product type (pill, patch, gel, injection) to achieve the lowest effective dose with fewer side effects. ^{[1] [4]}
  • If you have a uterus and take estrogen for menopause, adding an appropriate progestogen is typically needed; your clinician will tailor this to reduce risks and improve tolerance. ^[5]

• Lifestyle supports

  • Sleep and routine: Keep consistent sleep schedules and limit screens before bed; good sleep stabilizes mood.
  • Physical activity: Regular aerobic and strength exercise can reduce anxiety and improve mood; even brisk walking helps.
  • Nutrition and alcohol: Balanced diet, limited alcohol, and staying hydrated support energy and mood stability. Guidance to maintain healthy weight and manage stress is recommended alongside hormone therapy. ^[5]
  • Stress management: Mindfulness, breathing exercises, yoga, or short daily relaxation practices can ease reactivity and irritability.

• Behavioral health monitoring

  • Plan periodic mood check‑ins and consider brief mood scales to track changes over time; routine behavioral health monitoring is recommended during hormone therapy. ^[4]
  • If mood swings persist, short‑term counseling (CBT), support groups, or psychotherapy can help build coping skills and resilience. Supportive environments and connection with peers can lessen distress. ^[6]

• Targeted treatments when needed

  • For significant anxiety or depression related to hormone therapy, discuss options such as adjusting hormones or adding evidence‑based medications (e.g., antidepressants) as part of a comprehensive plan. Clinicians can also advise on non‑hormonal strategies for menopausal symptoms if mood side effects are prominent. ^[5]

Special Considerations by Therapy Type

• Menopausal hormone therapy (MHT):

  • Side effects may include mood swings; dose or product adjustments can reduce them. ^[1]
  • Some people find MHT helps moodiness and irritability linked to menopause itself. ^[2]
  • Work with your clinician to select the best route and dose and to reassess regularly. ^[5]

• Gender‑affirming hormone therapy (GAHT):

  • Most report positive psychological impacts overall; side effects are common, and mood swings are frequently noted in masculinizing regimens. [PM10]
  • Routine lab and behavioral health monitoring helps fine‑tune therapy and support well‑being. ^[4]

• Prostate cancer hormone therapy:

  • Mood changes, including anxiety and depression, can occur; proactive discussion of side effects and management strategies is advised. ^[3]
  • Ask how your team will monitor and treat side effects during treatment. ^[7]

Red Flags That Need Urgent Attention

• Thoughts of self‑harm or suicide seek immediate help (emergency services or crisis line).
• Severe or rapidly worsening mood symptoms contact your clinician promptly.
• Unexpected vaginal bleeding while on menopausal hormone therapy report right away. ^[1]

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Summary Table: Mood Swings and Management Across Therapies

Therapy type	Can cause mood swings?	Potential benefits on mood	Key management steps
Menopausal hormone therapy	Yes, listed as a side effect. [1]	May reduce moodiness/irritability for some. [2]	Clinician‑guided dose/product changes; add progestogen if uterus present; lifestyle and stress management. [1] [5]
Gender‑affirming hormone therapy	Mood swings common in masculinizing regimens; overall side effects common. [PM10]	Overall positive psychological impact. [PM10]	Routine lab and behavioral health monitoring; adjust doses; counseling/support groups. [4] [6]
Prostate cancer hormone therapy	Mood changes including anxiety/depression may occur. [3]	Not typically mood‑improving; aimed at cancer control.	Discuss risks, monitoring, and side‑effect management with oncology team; consider mental health support. [3] [7]

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Bottom Line

Mood swings can happen with hormone therapy, but they are usually manageable with the right plan. Partner with your clinician to adjust dosing, choose the best product type, monitor labs and mood, and use lifestyle and behavioral supports to stabilize symptoms. ^{[1] [4]} Many people find that with careful monitoring and tailored therapy, mood side effects lessen and overall well‑being improves. ^[2] [PM10]