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Hormones and Gender Transition

Alto is here to support your journey with hormone replacement therapy. Our team of patient care pharmacists has experience working with the LGBTQ+ community and is available to answer any questions you have about the process.

We also make it as simple as possible to stay on top of your medications, with same-day delivery and mediation management tools like reminders and auto refills in our app. Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging with our care team.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Risk Of Heart Problems

Hormone therapy for prostate cancer might increase the risk of heart problems if you have certain medical conditions.

This may be because some of the side effects of hormone therapy, such as weight gain, can make heart disease worse.

  • Gynecomastia in Patients with Prostate Cancer: A Systematic Review

    A Fagerlund and others

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Male And Female Hormones

As I mentioned earlier, men do produce estrogen and progesterone, which are commonly known as female hormones. And women produce testosterone, often seen as the male hormone. This may be shocking to some of you yet its true! Men and women share these three sex hormones, along with insulin and cortisol.

Too little or too much of these male or female hormones can have a cascading effect on the others. Male and female hormones are generally created by the endocrine system which includes the pineal gland, pituitary gland, pancreas, ovaries, testes, thyroid gland, parathyroid gland, hypothalamus, and adrenal glands.

When these organs function optimally, they produce just the right amount of the male and female hormones needed to carry out various processes throughout your body. However, it only takes a slight change in the level of hormones to cause an issue,1 so it is best to spot the signs and symptoms of imbalances early so you can take preventative measures quickly to get these back in check. Ill discuss the signs of a hormonal imbalance later. First, lets look closer at these five hormones and explore what they do.

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Diagnosing High Or Low Estrogen

A doctor will have you take a laboratory blood test if they believe you may have either high or low levels of estrogen.

For this, youll go to a laboratory that collects samples, and someone whos trained to take samples will use a needle and vial to collect the blood for testing.

You should receive your results in about a week. Youll see your blood estrogen levels shown in measurements of picograms per milliliter . Once you get your results, your doctor will let you know what youll need to do next.

If theyre normal, you wont necessarily need to do anything. But if your levels or high or low, your doctor will recommend the next steps to help get your estrogen levels balanced.

Here are some of the possible treatments a doctor may recommend to help control your estrogen levels.

Who Is Feminizing Hormone Therapy For

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Feminizing hormone therapy is an option for transwomen people who were assigned male at birth but identify as women. This therapy is a common treatment for gender dysphoria .

Nonbinary or intersex people may also choose to undergo feminizing hormone therapy. Nonbinary people have gender identities that dont fit inside traditional male or female categories. Intersex people are born with reproductive or sexual characteristics that dont fit traditional perceptions of male and female bodies. They may have conditions affecting their gonads, external genitals or chromosome patterns.

Stated simply, feminizing hormone therapy is for anyone who feels that theres a mismatch between their external appearance and their authentic sense of gender and self.

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Hormone Replacement Therapy For Transgender Men

Hormone replacement therapy for transgender men during a female-to-male transition also combats gender dysphoria, leading to reduced emotional discomfort and better overall mental health.

During the process, you will take testosterone, which decreases estrogen production and suppresses menstruation. Testosterone is typically administered by injection or as a gel applied to the skin . In some cases, it may be applied as a patch or pellets positioned under the skin. If you have a persistent menstrual flow, your doctor might recommend taking progesterone to control it.

You may observe some of the following physical changes within several months of starting hormones, though individual responses to treatment varies:

  • Deepening of the voice
  • Abnormal cholesterol levels
  • High blood pressure

Masculinizing hormone replacement therapy may also increase your risk for type 2 diabetes and cardiovascular disease.

You are more likely to experience one or more of these health complications if you have had breast cancer or have a history of blood clots. It may be unsafe to continue with hormone treatment if you are pregnant or breastfeeding. Be sure to discuss the potential risks and benefits of hormone replacement therapy with your doctor, and make sure they are aware of your full medical history.

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Hormone Therapy For Prostate Cancer

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Hormone therapy is also called androgen suppression therapy. The goal of this treatment is to reduce levels of male hormones, called androgens, in the body, or to stop them from fueling prostate cancer cell growth.

Androgens stimulate prostate cancer cells to grow. The main androgens in the body are testosterone and dihydrotestosterone . Most androgens are made by the testicles, but the adrenal glands as well as the prostate cancer cells themselves, can also make androgens.

Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer.

Drugs That Stop Androgens From Working

Breast tenderness and hormone replacement therapy (HRT) – from Tonic TV


For most prostate cancer cells to grow, androgens have to attach to a protein in the prostate cancer cell called an androgen receptor. Anti-androgens are drugs that also connect to these receptors, keeping the androgens from causing tumor growth. Anti-androgens are also sometimes called androgen receptor antagonists.

Drugs of this type include:

They are taken daily as pills.

In the United States, anti-androgens are not often used by themselves:

  • An anti-androgen may be added to treatment if orchiectomy or an LHRH agonist or antagonist is no longer working by itself.
  • An anti-androgen is also sometimes given for a few weeks when an LHRH agonist is first started. This can help prevent a tumor flare.
  • An anti-androgen can also be combined with orchiectomy or an LHRH agonist as first-line hormone therapy. This is called combined androgen blockade . There is still some debate as to whether CAB is more effective in this setting than using orchiectomy or an LHRH agonist alone. If there is a benefit, it appears to be small.
  • In some men, if an anti-androgen is no longer working, simply stopping the anti-androgen can cause the cancer to stop growing for a short time. This is called the anti-androgen withdrawal effect, although it is not clear why it happens.

Newer anti-androgens

Enzalutamide , apalutamide and darolutamide are newer types of anti-androgens. They can sometimes be helpful even when older anti-androgens are not.

These drugs are taken as pills each day.

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What Are The Emotional And Intellectual Effects Of Estrogen

People are very different so their emotional and intellectual changes vary widely. People taking estrogen have reported:

  • Feeling more emotional and more in touch with their feelings
  • Crying more easily
  • Depression or sadness
  • Thinking differently, having different ways of looking at things
  • Feeling more like myself when taking a hormone that aligns with gender identity feeling more comfortable in ones body

Problematic Aspects In Relation To Sex Reassignment Treatment

It appears obvious that maintenance of steroid hormone levels in the physiological range of the desired sex should be achieved in individuals with GD prior and post-SRS . The Endocrine Society recommends monitoring patients every 3 months during the first year of therapy and once or twice yearly thereafter . For CHT to be well tolerated, it is necessary to perform the hormonal administration in a highly individualized scheme in terms of timing, doses and modes of administration . Treatment can be considered successful if it relieves distress or facilitates substantial improvement in function and well-being of the patient .

The hormonal therapy in MtF subjects lasts 6.0 years on average . Based on expert opinion, however, patients tend to follow their self-controlled individual regimes as estrogen- and androgen-formulations are easily available via the Internet, over the counter, without prescription in certain settings, and through veterinary supply . However, subjects should be strongly discouraged from inducing supra-physiological hormone levels due to serious side effects . According to Leinung et al. , 9.8% of male-to-female transsexuals started hormonal therapy without prescriptions from a physician and nearly all admitted of initiating hormonal therapy without medical supervision . This is surprising as one of the three inclusion criteria of the WPATH for GD therapy is the ability to take hormones in a responsible manner .

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Testosterone Blockers For Males Transitioning Tofemale

Testosterone blockers come in many forms and strengths butfall in either one of two categories.

  • There are testosterone blockersthat block the actions of the testosterone hormones in your body.
  • Testosterone blockers that preventthe production of testosterone all together.
  • Most testosterone blockers used in the male to femaletransition process is very safe, but some can have side effects.

    The most used test blocker is spironolactone which is a prescription only medication. Though it is very effective, spironolactone can be very harsh on the body and comes with its fair share of adverse effects.

    This prescription-based testosterone blocker can cause excessiveurination, dizzy or lightheadedness when taking it. Its very important thatyou consume at least twice your normal daily intake of water in order to keep aconstant flow of fluids through your body.

    Spironolactone is dangerous for people with a prior history of kidney stones because it affects how your body reacts to blood pressure medications.

    Spironolactone can also lead to a higher production ofpotassium in the body, which could cause heart failure.

    While there is many risks associated with taking spironolactone,there is a healthy more effective and cheaper alternative testosterone blocker.

    Naturally testosterone blockers, commonly referred to as Over the counter testosterone blocker have been proven to work time and time again over the years.

    What Are Estrogens

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    Estrogens are hormones that occur naturally in women and men and are also made synthetically. Estrone , estradiol , estriol are the three most common naturally occurring estrogens.

    In women, estrogens are the main hormone responsible for sexual and reproductive development. Estrogen is produced by the ovaries, adrenal glands, and in fat tissue. During pregnancy, the placenta produces estrogen which helps prepare the breasts for milk production and maintain the pregnancy. Estrogens also have critical roles in male sexual function, including modulation of libido, erectile function, and spermatogenesis. In males, estrogens are produced by the adrenal cortex, in fat tissue, and in small amounts by the testes. Testosterone is also converted into estrogen by the enzyme, aromatase. Excessive production of estrogen in men causes feminization.

    Estrogens may be used to treat symptoms of conditions associated with estrogen deficiency such as amenorrhea and menopause. They may be used to suppress lactation and in men to treat androgen-dependent cancers such as prostate cancer. Estrogens are also used as contraceptives, in combination with progestins .

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    How To Take It

    The standard first-choice gender-affirming hormone treatment for those receiving estrogen hormone therapy involves estrogen in combination with anti-androgens.

    A doctor may also monitor health to ensure the body is absorbing medication and to help identify potential health problems.

    Estrogen hormone therapy may involve:

    Symptoms Of High Estrogen Levels In Men

    Here are some of the main symptoms of high estrogen levels in men:

    • Infertility. Estrogen is one of the hormones your body uses to produce sperm. High estrogen levels can slow down sperm production and make it harder to create healthy sperm.
    • Gynecomastia. Increased estrogen can cause more breast tissue to develop than normal. High levels can lead to the development of a condition called gynecomastia. This happens when the amount of breast fat tissue is abnormally high.
    • Erectile dysfunction . Increased estrogen levels can affect the balance of hormones that are needed to help get an erection and stay erect. This is especially true if you also experience low testosterone.
    • Slowed growth. Too much estrogen can result in short stature or delayed puberty in boys.
    • Epiphyseal closure. This can happen in adolescents with high estrogen, causing boys to have short stature.

    Other possible symptoms of high estrogen that may happen along with other hormone imbalances include:

    • reduced sex drive

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    Creating Your Hormone Therapy Plan

    How Hormone Changes Affect Women’s Choice of Mate

    Well need to look at several factors, including:

    • Your goals how much you hope to change
    • Your age and medical history

    A blood test happens first. This will give us a baseline to compare against after you start hormones.

    Analyzing your blood also helps us see if taking hormones could cause side effects. And well continue to monitor your blood levels during therapy to make sure youre OK.

    We usually get lab results back in a couple of days. If we dont see any issues, usually then your transgender hormone therapy can start.

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    What To Know About Transgender Hormone Therapy Side Effects

    Alto Pharmacy

    For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you.

    Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.

    Antiandrogens Gnrh Agonists And Orchidectomy

    Hormone treatment in pre-operative male-to-female subjects is normally supplemented by some form of antiandrogen treatment. While oestrogens and progestogens are to some extent antiandrogenic in themselves, a number of other methods exists to suppress the effects of androgens and make the feminising hormones more effective without having to administer the latter in unreasonably high doses. These treatments also, of course, cause a significant reduction in male sex drive , which is generally considered highly desirable by transsexual subjects. There are three approaches to antiandrogen treatment:

    1. Antiandrogen drugs. 2. GnRN agonists. 3. Bilateral orchidectomy .

    These treatments are not applicable to patients who are post-operative, as their bodies will, by definition, be incapable of producing gonadal androgens. Adrenal androgens are produced in small amounts by both sexes, and no attempt should be made to suppress them unless a serum androgen test has indicated significant overproduction, as in cases of adrenal hyperplasia. In general it is considered unwise to administer antiandrogens to post-operative subjects , as the small amount of adrenal androgens remaining in such subjects are necessary for normal functioning.

    Antiandrogen Drugs

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    What Happens When A Man Takes Female Hormones

    The risks include high blood pressure, high blood sugar, inflammation, higher C-Reactive Protein, high cholesterol, type 2 diabetes, and weight gain, all of which can cause heart disease. Excessive prolactin or the formation of noncancerous tumors in your pituitary gland that causes prolactinoma. Blood clots called deep vein thrombosis or a pulmonary embolism, blood clots can also cause strokes.

    Infertility, decreased libido, erectile dysfunction, gallstones, elevated liver enzymes. Once your testosterone levels decrease your sperm count will decrease and you will not be able to have children. Many men using hormones for a male to female transition are happy to have decreased erectile function, shrinking genitals they can tuck, and smaller testicles. Drugs have side effects, think carefully before you decide to do this. There are safer ways to still have great results without resorting to more extreme measures. We have helped thousands of pre- and post-op transwomen and men seeking partial feminization since 1996.

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