Severe Side Effects From Ftm Testosterone Hrt
Suicidal tendencies, violence, panic attacks, rage, jaundice , severe allergic reaction , nausea, vomiting, liver failure, cancer, kidney or urinary problems, infection of the injection site, stroke, or heart attack. This list is not exclusive and other severe reactions to testosterone HRT may occur. If you experience any severe side effects or suspected severe side effects from testosterone hormone replacement therapy, call your doctor or seek emergency medical treatment immediately.
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:
Hormonal Treatment In Transgender Women
Initial evaluation of transgender women
Transgender women seek hormone therapy to change their physical appearance to better match their gender identity and expression . Furthermore, transgender women experience improved quality of life and a decrease in gender dysphoria upon initiation of hormone therapy . In the United States, Canada, and most of Europe, transgender women must seek medical professionals for hormone therapy because these medications are available only by prescription, but there is a black market also particularly for oral contraceptives. For non-Western countries, hormone therapy is often self-prescribed without supervision by a medical professional. Available evidence from the United States and Europe suggests that hormone therapy initiated and monitored under the supervision of a medical professional is associated with very low rates of adverse events .
Screening for conditions prior to initiation of hormone therapy
Modalities of hormonal therapy in transgender women
There are two main classes of medications used in transgender women: estrogen therapies and androgen-lowering hormone therapies.
Estrogen therapies.
In a German cohort, transgender women were treated with a regimen of estradiol valerate at 10 mg IM every 10 days. The authors also reported short-term gains in bone density after 24 months of therapy along with higher body mass index with an increase of fat mass and decrease of lean body mass .
Androgen-lowering therapies.
Body composition.
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Hormonal Treatment In Adolescents
GAHT introduction is generally recommended around the age of 16, although it can be considered around the ages of 14-16, even though there are very few published studies of being administered between the ages of 13.5 and 14 . There are two treatment regimens. In the case that GnRHa was introduced early in pubertal development, the puberty of the desired gender is induced by slow increasing doses of testosterone or estradiol, that are modified every six months. In the case that GnRHa began late in puberty, the suppression lasts about 3-6 months and GAHT begins at higher doses, with a faster increase to achieve maintenance dose .
Since the long-term effects of both suppressive and GAHT treatment are uncertain, adolescents must be encouraged to adopt a healthy lifestyle, increase exercise, avoid tobacco, and keep regular check-ups with the endocrinologist for the monitorization of liver and renal function, lipids, and glucose.
Feminizing Hormone Therapy And Fertility
Gender-affirming hormone replacement therapy may affect your fertility, as it impacts sperm production. While some transgender women can produce sperm again after stopping hormone treatment, research indicates that this may not be the case universally, and there is a risk of permanent infertility with long-term use of hormones. If you would like to have biological children, ask your doctor about your options with freezing your sperm before starting hormones.
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Types Of Hormonal Therapy In Transgender Men
The main GAHT used to induce virilization is testosterone. Different testosterone formulations may be available depending on geographical location . Most prescribed are injectable testosterone esters. Both parenteral and transdermal administration of testosterone are equally effective to achieve masculinization and serum testosterone values in the range of 300 – 1000ng/dl in transgender men. Serum testosterone levels in injectable formulations are measured between administrations, although clinicians may choose to measure serum testosterone 24hs after injection and prior to the next dose .
More recently, the subcutaneous administration of testosterone was shown to be effective and preferred by transgender men at a median dosage of 75mg weekly . In Pelusi et al. study, the effects of three different testosterone formulations were evaluated at baseline. After 12 months of treatment, no differences were found regarding short-term safety, compliance, body composition, or metabolic parameters .
If menstrual bleeding does not stop after initiation of testosterone, a progestational agent, such as oral lynestrenol at 5 to 10mg daily or medroxyprogesterone at 5 to 10mg, might be considered .
Differences In Prevalence According To Gender
There are some discrepancies as to whether mental health diagnoses are more common among transgender men or among transgender women. Some studies have found that mental health diagnoses were not related to assigned or identified gender , whereas other studies have demonstrated higher rates of mood disorders , anxiety disorders , adjustment disorders , and substance abuse among transgender women than among transgender men. Most of those studies are biased by not controlling for factors known to influence mental health diagnoses, particularly hormone treatment. This means that people have been recruited for studies independently as to whether they are on hormone treatment or not, although research has confirmed that such treatment reduces mental health problems. Interestingly, more recent large controlled studies involving only transgender people not on treatment have found that anxiety disorders were more prevalent among transgender men than among transgender women . A similar study also found levels of self-harm were also higher among the same group .
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Estrogen Hormone Therapy Treatment
The hormone, estrogen, influences most feminine characteristics. It can be given by pill, injection, or skin preparations like patches, sprays, gels, and creams. Pills are effective, cheap, and convenient, but if youre older than 35 or smoke, their safety can be compromised. Patches are also safe and effective, but you will need to wear them all the time. They can also irritate the skin. We generally start Estrogen at dose of 2 mg/day and titrate the dose to achieve the desired results while limiting negative side effects.
Most transwomen take in estrogen via injection. Injections can cause fluctuating or high estrogen levels, resulting in weight gain, mood swings, anxiety, migraines, or hot flashes. There isnt much information with regards to taking high levels of estrogen over a long time.
Contrary to popular belief, relatively small doses of estrogen can actually have the most effect on the transition. Taking higher doses dont necessarily make the changes happen quickly and may even harm your health. After going through orchiectomy or genital surgery, the estrogen dosage should be lowered by the doctor. Without testicles, you will need less estrogen for good health and feminine characteristics.
You will periodically need to get liver function, cholesterol, and diabetes screenings to check on your health while on estrogen.
Where To Get Hormones
This information is for adults. For younger people, see how to get hormones as a minor.
From your doctor
- Most people get hormones from their healthcare provider. Tell them you want to start hormones. They will probably give you a physical exam that includes blood tests. In some cases, they may ask you to take other steps before prescribing them, like speak with a therapist. You will have to sign something that says you give informed consent.
From a clinic
- Many larger cities have clinics that serve our community. See the resources section for options near you.
- Planned Parenthood offers hormones for our community at many locations and is throughout the US:
Online
- Some people order hormones online from foreign pharmacies.
- This can be an option for those who do not want others to know about their hormone use.
- Buying and importing prescription drugs without a prescription is probably against the law where you live.
- Because it is against the law, you might lose the money you paid:
- No delivery sent
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Metabolic Changes In Transgender Women
The metabolic effects of estrogen therapy are focused on liver function alterations and lipid parameters. Hepatic lipase activity decreases by 64% and lipoprotein lipase by 23%. Hepatic lipase decreases HDL-cholesterol levels and increases the formation of small, dense LDL highly atherogenic. Reduction of hepatic lipase levels with estrogen may reduce the formation of LDL-c . However, the use of estrogen therapy in transgender women showed no statistically significant difference in total cholesterol, serum LDL-c or HDL-c, but an increase in plasma triglyceride levels after 24 months was found . Conflicting data seem to show unmodified or reduced insulin sensitivity, with unaltered fasting glucose and stable or increased blood pressure . Estrogen therapy in transgender women has been associated with reduced plasma homocysteine levels, independently of the route of administration . The impact of estrogens on prothrombotic status remains unclear. While some studies with EE in combination with CPA, but not with transdermal estradiol, show an increase in C-reactive protein and decreased tissue plasminogen activator other studies have shown no effect on CRP .
Motif Enrichment And Gene Ontology Analysis
DMPs were mapped to the closest gene using GREAT and gene promoters were scanned for enriched transcription factor binding motifs using the HOMER findMotifs tool . DNA sequences spanning DMPs were also scanned for enriched motifs using the HOMER findMotifsGenome tool. HOMER scans for 440 validated motifs and the output include the frequency of the motif in the test regions and a p value . Motifs were considered enriched if they had a p value< 0.05,an increase in motif frequency of> 5% compared to a background set of regions and a fold change in frequency of> 1.5 , as previously described . To gain insight into biological function of genes associated with DMPs, enriched biological processes and KEGG pathways, were also identified using HOMER ). The nearest gene to the DMP was the input for the hypergeometric analysis. DMPs were selected only by an unadjusted p< 0.05. Using a more restrictive DMP set with a lower selected p value cut-off could potentially change the gene ontology results. In addition to the HOMER unadjusted p value for pathway enrichment, we added a BenjaminiHochberg corrected p value in the supplementary tables .
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How Hormones Work For Male To Female Transitioning
Hormones are chemical messengers produced by one part of the body totell cells in another part of the body how to function, when to grow, whento divide, and when to die.
They regulate many functions, including growth, sex drive, hunger, thirst, digestion, metabolism, fat burning, and storage, blood sugar and cholesterol levels, and reproduction.
Sex hormones regulate the development of sex characteristics includingthe sex organs that develop before we are born and also the secondary sex characteristics that typically develop atpuberty .
The three categories of sex hormones that naturally occur in the body are:
Androgens: testosterone, dehydroepiandrosterone ,
Generally, males 2 tend to have higher androgen levels, and females 2tend to have higher levels of estrogens and progestagens.
There are various types of medication that can be taken to change thelevels of sex steroids in the body. Changing these levels will affect fatdistribution, muscle mass, hair growth, and other features that areassociated with sex and gender.
For MTFs this can help make the body.
2. The binary terms male, female, masculine, feminine, masculinizing, and feminizing dont accurately reflect the diversity of trans peoples bodies or identities.
But in understanding how hormones work for trans people, it is helpful to understand how testosterone works in typical mens bodies, and how estrogen and progesterone work in typicalwomens bodies.
pill skin patch or gel injection
Study Selection Quality Assessment And Data Extraction
Each study was initially categorised based on its design and examined for quality in line with the Effective Public Health Practise Project tool. This is a generic tool used to evaluate a variety of intervention study designs and is suitable for use in systematic reviews, having content and construct validity. Based on the EPHPP, six domains are evaluated: selection bias study design confounders blinding data collection method and withdrawals/dropouts. Each domain is rated as strong , moderate or weak , and domain scores are averaged to provide the overall mean rating. Based on the overall mean rating, studies are rated as weak , moderate or strong .
For longitudinal studies, data were extracted to examine changes in LBM, CSA, strength and Hgb/HCT in transwomen taking GAHT. In cross-sectional studies, data in transwomen were compared with data from both cisgender men and cisgender women. The study authors were contacted if there were any questions regarding the presented data. In this regard, authors of the nine studies carried out by the European Network for the Investigation of Gender Incongruence were contacted regarding potential overlapping participants and another author was contacted to clarify graphical data content.
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Possible Risks For Trans Men
Hormonal treatments for transgender men can include various formulations of testosterone delivery via injection, skin patches, or topical gel. While these interventions require long-term use just as estrogen therapies do, their potential cardiovascular effects are understood to be much less severeâor at least less likely to result in a cardiovascular eventâthan those for trans women.3
Some of those effects include hypertension and dyslipidemia. For example, elevations in diastolic blood pressure have been found to be significant at 3 mmHg in one study observing 188 transgender men.3,8 Another systematic review and meta-analysis identified marked increases in LDL and triglycerides and decreases in HDL among trans men after two years.3,9 However, these findings do not appear to drive risk of cardiovascular disease.3
Effects Of Testosterone And Estrogen
Many trans men seek maximum virilization, while others desire suppression of their natal secondary sex characteristics only. As a result, hormone therapy can be tailored to a patients transition goals, but must also take into account their medical comorbidities and the risks associated with hormone use.
The following changes are expected after estrogen is initiated: breast growth, increased body fat, slowed growth of body and facial hair, decreased testicular size and erectile function. The extent of these changes and the time interval for maximum change varies across patients and may take up to 18 to 24 months to occur. Use of anti-androgenic therapy as an adjunct helps to achieve maximum change.
Hormone therapy improves transgender patients quality of life . Longitudinal studies also show positive effects on sexual function and mood . There is biologic evidence that may explain this. Kranz et al. have looked at the acute and chronic effects of estrogen and testosterone on serotonin reuptake transporter binding in trans men and women. SERT expression has been shown to be reduced in individuals with major depression . Kranz et al. found that androgen treatment in transmen increased SERT binding in several places in the brain and anti-androgen and estrogen therapy led to decreases in regional SERT binding in trans women. These types of data are preliminary, but do point to the important role of hormone therapy in patients who suffer from gender dysphoria.
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Creating A More Inclusive Care Environment
While the cardiovascular effects of gender-affirming hormonal therapy have only been observed in a formal research context since the late 1980s,3 much has been learned over the past three decades. However, much more study is needed in this area, as longstanding biases have often precluded or investigations or limited their usefulness.
While evidence is mounting that long-term hormone therapy comes with cardiovascular risks, stopping needed treatments is not a solution.5 Managing cardiovascular risk factors in transgender medicine is less an analysis of the risk-benefit ratio and more a question of how to surveil and protect patients against those concerns throughout their lifetimes.
Certain strategiesâsuch as adjusting hormone formulation, dose, or modeâmay help balance the risks. These decisions should be individualized and made in tandem with the patient and the broader care team. However, this may be more difficult with existing research, as many studies do not provide sub-analyses of formulation- or dose-specific treatments.
All cardiologists should be prepared to care for trans patient populations and should be aware of the unique concerns, risk profiles, and barriers they face when receiving vital care. Diagnostic tools such ECG will support clinicians in these workups, as will sensitivity and a commitment to creating a more inclusive, equitable care environment.
References:
Estrogen Supplements For Males Transitioning To Female
Estrogen is the hormone that is primarily responsible to bring about physical feminine changes in ones body during the male to female transition process.
Though estrogen can effective on its own it is best paired with a testosterone blocker which is preferably given weeks prior to starting estrogen hormone therapy.
Estrogen comes in a few different forms which include:
- Gels
- Sprays
Estrogen pill are the most used method of administering thehormone. Though pills are cheap and effective, doctors believe they can causeyou harm if you are older than 35 and smoke.
Estrogen patches such as climara forte can be very effective and safe but require you to always wear one. However, these patches do have some downside- not only are they prescription only they can also cause skin irritations and rashes.
The majority of transwomen first choice in estrogen hormones to help them transition tend to be interested in getting their estrogen through injections.
Estrogen injections can only be administered by doctors andcan cause a huge fluctuation range in your estrogen levels.
Having unstable estrogen levels is what causes:
- Mood swings
- Migraines
Taking a higher doseof estrogen does not mean you will see physical changes faster.
Long term use of prescription estrogen boostingmedication can cause a sever build up of fat inside your heart and or arterieswhich could be fatal.
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Hormones To Transition From Male To Female
Lets take a deeper more in depth look at some of the majorhormones necessary to make your transition from male to female smooth andsimple.
Before we get started, its important to note that male tofemale transition using hormone therapy is not an overnight, one and donething.
Instead, it is a long-termprocess that allows your body to produce hormones and re-enter a state similarto that of puberty to facilitates the changes you desire.
During puberty, your body takes several years to define your dominant features. Using MTF hormones is a method that tries to replicate the phases of puberty but to your liking.
The majority of people who seek to transition using medication are on the more eager side of things, but hormonal changes do not present themselves at a rapid pace.
Everyone is built differently, meaning that we all havedifferent genetic setups, therefore our bodies respond to hormones andtreatment at completely different rates. And because everyone is different,your medicines or dosages may vary widely from those of your friends, or whatyou may have read in books or online.