How Do I Start Hrt Now That Im Ready
Youll learn how hormone therapy can help you reach your transition goals during an Information Gathering Session with one of our gender specialists.
If hormone therapy is right for you, youll receive your first prescription via post or direct from your choice of pharmacy. Alternatively, we can send a treatment summary to your doctor, who will provide you with your prescription.
Every three months, well review your treatment to ensure its working for you. Every six months, we recommend a wellbeing review to ensure youre in tip-top shape. Whether you want to fully medically transition or achieve minor masculinisation or feminisation with microdosingwe can go at the pace that suits you.
Its important to remember that youll need to take hormones for as long as you want the gender-affirming benefits to last. Certain procedures, on the other hand, will result in a reduction in your dosage. We want you to feel confident that your treatment and progress are exactly right for you.
Starting Hormone Therapy Later In Life
If you are reading this later in life, andparticularly over the age of 65, you may assume that it is too late to startHRT. You may fear that you have missed your window not only to derive thegreatest benefits of HRT, but to receive treatment at all. But being olderdoesnt mean the possibility of HRT is closed.
Many women continue to experience a plethora of disruptive symptoms in their postmenopausal years, compromising overall health, functionality, and quality of life. Meanwhile, you are facing an ever-increasing risk of bone density loss and osteoporosis. Until relatively recently, however, HRT was not recommended to address these concerns after a certain age doctors have long been reluctant to prescribe HRT to women over the age of 65or even 60due to both a lack of appreciation for the impact of womens symptoms and, sometimes, a belief that it carried too many risks for too few benefits. But, now, that is changing.
It is true that many of the protective benefitsof HRT appear to diminish or disappear with age. It is also true that olderwomen may be more likely to have risk factors that make them less than idealcandidates for HRT. However, for many women, HRT can be a truly transformative,positive intervention even after the age of 65.
Growing understanding of the benefits of hormone therapy for older women recently led the North American Menopause Society to update its position on HRT after 65. According to their 2017 position statement:
How Can Hormones Affect The Growth Of Breast Cancer
Hormones like estrogen and progesterone are chemicals produced by glands in the body. Normally, these hormones help regulate body cycles, like menstruation. However, sometimes these same hormones can cause cancer to grow.
The pathologist will perform tests on the breast cancer cells to determine if they have receptors that feed on estrogen or progesterone, stimulating their growth. If the cancer cells have these receptors, your doctor may recommend hormone therapy drugs, such as blockers or inhibitors. Both types of drugs help to destroy cancer cells by cutting off their supply of hormones.
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Who Can Take Hrt
Most women can have HRT if they’re having symptoms associated with the menopause.
But HRT may not be suitable if you:
- are pregnant it’s still possible to get pregnant while taking HRT, so you should use contraception until 2 years after your last period if you’re under 50, or for 1 year after the age of 50
In these circumstances, alternatives to HRT may be recommended instead.
Assessing Readiness And Appropriateness
While historically a “referral letter” from a mental health professional was required prior to initiation of hormone therapy, many large volume and experienced providers of transgender care have for years used an “informed consent” pathway to hormone initiation. WPATH Standards of Care, Seventh Version recognizes both of these pathways to the initiation of gender affirming hormone therapy as valid. Medical providers who feel comfortable making an assessment and diagnosis of gender dysphoria, as well as assessing for capacity to provide informed consent are able to initiate gender affirming hormones without a prior assessment or referral from a mental health provider. A study of the practices of 12 such clinics in a diversity of settings found minimal risk of regret and no known cases of malpractice suits. More detail on assessing readiness and appropriateness for various gender affirming treatments can be found in the topic on mental health.
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What Is Hormone Replacement Therapy
Hormone replacement therapy is an effective treatment for restoring hormone levels to a normal physiologic range and can be useful for patients struggling with the side effects of menopause, andropause, and other forms of hormone imbalance. At CosmeticGyn Center in Dallas, Dr. Huertas offers a number of HRT options, including bioidentical hormone replacement therapy using a uniquely beneficial pellet delivery system. This exciting treatment allows the plant-based hormones to be custom-compounded, and each pellet administers a consistent dose of medicine that lasts up to 4 6 months. Additionally, Dr. Huertas can prescribe HRT in the form of patches, creams, oral medication, and another form that best meets your needs.
When To Start Hrt: Earlier May Be Better But Its Never Too Late
Asking, When should I start hormone replacementtherapy? seems like it risks slipping into tautology, or at the very leastredundancy. After all, isnt the answer, When you need more hormones. But thereal answer is more complicated.
Every woman ages differently. Every woman goes through hormonal changes differently. And every woman approaches menopause differently. However, there are broad guidelines that can help you decide if and when hormone replacement therapy is the best choice. Significantly, knowing when to start HRT can help you maximize its impact while minimizing any risks. By strategically considering the timing of treatment, you may not only prevent unnecessary suffering, but protect your health for years to come.
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Lower Your Chances Of Issues
If you and your doctor decide HRT is right for you, you should use the lowest dose that works for you for the shortest amount of time. Many of the serious problems linked with HRT have been tied to using it for a long time. But using them at a low dose for 3 to 5 years may help protect you from some health issues like bone loss.
What Are The Disadvantages Of Hormone Replacement Therapy
A disadvantage of hormone replacement therapy is an increased risk of forming gall-bladder stones and undergoing cholecystectomy. Unopposed estrogen therapy gives a higher incidence of endometrial cancer in women with an intact uterus, but the contribution of progestins for about 10 days every month excludes this risk.
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Who Shouldn’t Take Hormone Therapy
Hormone therapy is not usually recommended if you:
- Have or had breast cancer or endometrial cancer.
- Have abnormal vaginal bleeding.
Less common side effects of hormone therapy include:
- Fluid retention.
- Skin discoloration .
- Increased breast density making mammogram interpretation more difficult.
- Skin irritation under estrogen patch.
Is It Possible To Bridge The Gap Between How I Feel And What I See
Youve longed to accept the reflection in the mirror. Starting hormones that validate your gender can be extremely encouraging. Some people fully accept this and can live again. Some will take each day as it comes, amazed by the effects. On the other hand, others may have a more complex relationship with their bodies and fall somewhere in the middle.
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Information On Estrogen Hormone Therapy
Overview of Feminizing Hormone TherapyUCSF Transgender CareUniversity of California – San FranciscoJuly, 2020
Hi, I’m Dr. Maddie Deutsch, Associate Professor of Clinical Family & Community Medicine at the University of California San Francisco , and Medical Director for UCSF Transgender Care. In this document I will review various aspects of feminizing hormone theray, including, choices, risks, and unknowns associated with feminizing hormone therapy.
As you prepare to begin treatment, now is a great time to think through what your goals are. Do you want to get started right away on a path to the maximum degree of medically appropriate feminizing effects? Or, do you want to begin at a lower dose and allow things to progress more slowly? Perhaps you are seeking less-than-maximal effects and would like to remain on a low dose for the long term. Thinking about your goals will help you communicate more effectively with your medical provider as you work together to map out your care plan.
Many people are eager for hormonal changes to take place rapidly which is totally understandable. It is important to remember that the extent of, and rate at which your changes take place, depend on many factors. These factors primarily include your genetics and the age at which you start taking hormones.
There are four areas where you can expect changes to occur as your hormone therapy progresses. Physical, emotional, sexual, and reproductive.
The first is physical.
Counseling Patients About Hormone Therapy And Alternatives For Menopausal Symptoms
D. ASHLEY HILL, MD, Florida Hospital Graduate Medical Education Program, Orlando, Florida
SUSAN R. HILL, MD, Orlando, Florida
Am Fam Physician. 2010 Oct 1 82:801-807.
Patient information: See related handout on treating menopausal symptoms, written by the authors this article.
Menopause is a normal, physiologic transition when a woman stops producing eggs and ovarian function diminishes, sometimes causing bothersome symptoms such as hot flashes or vaginal dryness. The media attention to recent clinical trials of treatments for menopausal symptoms has provided women with a large amount of information, some of it contradictory. This makes it challenging for patients to understand which treatment options are available, effective, and safe. In the past, physicians typically prescribed hormone therapy for menopause, whereas now they increasingly prescribe medications to treat specific symptoms. The U.S. Food and Drug Administration issued a boxed warning for hormone preparations and, with the American College of Obstetricians and Gynecologists , advises that hormone therapy be prescribed at the lowest effective dosages and for the shortest possible duration.1,2 Dozens of medications, dominated by hormone formulations, are available to treat menopausal symptoms. When counseling menopausal patients, physicians should understand the benefits and risks of hormone therapy and alternative treatments, and the key differences among the various delivery systems.
Risks And Benefits Of Hormone Therapy: Focus On Cardiac Health
In 2002, the Women’s Health Initiative clinical trial was published, causing patients and physicians to question the safety of menopausal hormone therapy.3 Before this study, many patients took hormones in an attempt to improve overall health, prevent future cardiac disease, and treat menopausal symptoms, in part because results of observational studies showed apparent protection from cardiac disease. The WHI study compared a combined oral regimen consisting of conjugated equine estrogen and medroxyprogesterone acetate with placebo, and found that the combined regimen increased the risk of coronary artery disease, breast cancer, stroke, and venous thromboembolism . This large study of approximately 16,000 women also found a decreased risk of colorectal cancer, hip fractures, and total fractures.3
Critics of the 2002 WHI trial believe it is not appropriate to generalize results to all menopausal women, because the population studied may not represent women who typically use hormone therapy. Specifically, the average age of participants was 63 years, more than a decade older than the average age of the menopausal transition , when women are more likely to start hormone therapy.
How To Get On Transsexual Hormone Replacement Therapy Relatively Easy
Having gone through hormone therapy replacement myself, I want to offer some tips for those who are serious about transitioning.
This article is designed for the transsexual who is looking to get on hormone replacement therapy relatively quickly and easily. I discuss a number of systems that may be available to use in your community. More often than not, if you live in a giant metropolitan area, you will be able to get onto hormone therapy using the first method relatively easily.
The reason why one would want to get on hormone replacement therapy quickly is to alleviate much of the stress of being in the wrongly sexed body. I use this terminology because the term “a woman trapped in a man’s body” seems foolish to me. We all start out as prototypical female in the womb and we develop due to the pattern that the predominant hormone therapy provides for us. Therefore, a transsexual girl who starts her hormone therapy before puberty will look almost indistinguishable from any other girl. The body can feminized to a point with hormones and/or surgery so I would not even call my body a “man’s body” even though I am a male-to-female transsexual.
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What Are The Side Effects Of Hormone Therapy For Prostate Cancer
Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:
- loss of interest in sex
Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.
Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.
Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.
A Note From Cleveland Clinic
The decision to take hormone therapy needs to be a very personalized one. Hormone therapy is not for everyone. Discuss the risks and benefits of hormone therapy with your healthcare provider at an office visit specifically dedicated for this conversation. Youll need the time to address all the issues and answer questions in order to arrive at a decision that is best for you. Factors considered should be your age, family history, personal medical history and the severity of your menopausal symptoms.
Be sure to talk about the pros and cons of the different types and forms of HT as well as non-hormonal options such as dietary changes, exercise and weight management, meditation and alternative options.
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What Are The Risks Of Taking Hormone Therapy
While hormone therapy helps many women get through menopause, the treatment is not risk-free. Known health risks include:
- An increased risk of endometrial cancer .
- Increased risk of blood clots and stroke.
- Increased chance of gallbladder/gallstone problems.
- Increased risk of dementia if hormone therapy is started after midlife. HT started during midlife is associated with a reduced risk of Alzheimers disease and dementia.
- Increased risk of breast cancer with long-term use.
What If Starting Hrt Doesnt Feel Right For Me
Its normal to have doubts when stepping into the unknown. Navigating friends, family, colleagues, and people on the street can be challenging and uncomfortable. If things seem to be happening too fast, it may be alarming to you. This is your journey, and you can take things at your own pace. You can start, stop, increase, or reduce your levels of HRT depending on what feels right to you.
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Surgery To Stop The Ovaries From Working
This is also a type of ovarian ablation. You might choose to have an operation to remove your ovaries instead of having drug treatment to stop them working. You have this operation as keyhole surgery. It is called laparoscopic oophorectomy and you have it under general anaesthetic . You usually stay in hospital overnight.
The surgeon makes a number of small cuts into your tummy . They put a long bendy tube called a laparoscope into one of the cuts. The laparoscope connects to a video screen.
The surgeon puts small instruments through the other cuts to carry out the operation and remove the ovaries. They close the cuts with stitches and cover them with small dressings.
Removing your ovaries causes you to have a sudden menopause. The symptoms include hot flushes, sweating and mood swings.
How The Study Was Performed
During the study, scientists randomized 1,071 men with intermediate- or high-risk localized prostate cancer into four groups. One group received radiation and six months of an anti-testosterone drug called leuporelin, and the second group received radiation plus 18 months of leuporelin therapy. Two other groups were treated with the same regimens of either radiation plus six or 18 months of leuporelin therapy, along with another drug called zoledronic acid, which helps to limit skeletal pain and related complications should cancer spread to the bones. Study enrollment occurred between 2003 and 2007 at 23 treatment centers across New Zealand and Australia.
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Are There Any Side Effects To Hrt That I Should Know About
Professionals recommend quitting smoking tobacco across the board. studies on post-menopausal or perimenopausal cis womenthe ones who smoke tobacco had reported less positive effects of estrogen than their counterparts, said Pellegrino. Definitely quit smoking if youre going to take estrogen because its not going to work as well, beyond just the risks. Its also worth noting that both taking testosterone and smoking tobacco can raise red blood cell count, which can cause fatigue, shortness of breath, lightheadedness and several other potential adverse symptoms.
Certain medications can interact negatively with estrogen. Theres a whole list of medicines that are sensitive to this, said Safer. Men and women have fairly similar estrogen levels, so it may not make that much difference. But its certainly reasonable to maybe check the dosing of some medications and to see if you need just a slightly higher dose with those estrogens on board than you had otherwise, he said.
Fewer drugs are known to interact with testosterone, but as with estrogen, you should talk with your doctor. You can also check for interactions with specific medications at the above links.
Ultimately, in the absence of robust institutional research, your local communities, and also Reddit, will often be your best friends for information on some of these lesser-discussed effects.