Thursday, June 20, 2024

How To Start Hormone Therapy

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How to Start HRT

You have options with how to take your hormones. Typically, gender hormones include:

  • Testosterone comes as a gel, patch, or injection.
  • Estrogen, and sometimes progesterone, come as a pill, patch, or injection.
  • Spironolactone, which blocks testosterone, is taken as a pill.

Your insurer may cover certain types of hormones and not others.

Hormones at home? Yes, we can teach you how to give yourself a hormone injection at home.

Less Common Types Of Hormone Therapy

Some other types of hormone therapy that were used more often in the past, but are rarely given now include:

  • Megestrol acetate , a progesterone-like drug
  • Androgens
  • High doses of estrogen

These might be options if other forms of hormone therapy are no longer working, but they can often cause side effects.

Other Treatments For Menopausal Symptoms

Studies have shown that some prescription medications can reduce hot flushes and sweats. These treatments may be an option if HRT cannot be used for health or other reasons, and should be discussed with a doctor.

The herbal medicine, black cohosh, may take the edge off hot flushes and sweats, but there is no data to support long-term use. There is also a rare liver condition that may be associated with the use of black cohosh.

Other complementary and alternative medicines have not been shown to be effective for menopausal symptoms when compared with dummy or placebo treatment in research studies.

Commercially available vaginal moisturisers may reduce vaginal dryness if used regularly. Consult your doctor about what will work best for you.

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What Is The Follow

In general, most patients have a clinic visit every 3 months during the first year of treatment. At this clinic visit, we check their vital signs, talk with them about the changes they are experiencing and any concerns, and draw some blood to check their hormone levels. Based on the patients response to their treatment and their lab results, we make adjustments in their medications.

After the first year, most patients are seen every 6 months for the same evaluation. In the third year and beyond, most patients are seen on an annual basis. These are general guidelines. An individual patients follow-up would be tailored to their needs.

What Happens During Follow


These appointments enable healthcare providers to track your response to treatment. Care includes tests to check for signs of complications. These often include blood tests. Occasionally, you may need a bone density test .

You can expect to see your healthcare provider:

  • Every three months during the first year of hormone therapy.
  • Every six to 12 months after that.

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Creating Your Hormone Therapy Plan

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.

When Will These Physical Changes Occur

According to a , a person can expect a decrease in sexual desire and function within 13 months. However, these changes can take 36 years to reach their maximum effect.

After 36 months, a person can expect:

  • a decrease in muscle mass
  • softer skin

The UCSF state that a person may notice that they experience a wider range of emotions. They may also develop different tastes and interests. These emotional changes should settle.

During this time, some people might find it helpful to talk to a mental health professional to help explore and understand these new emotions and thoughts.

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What Are Male Sex Hormones

Hormones are substances that are made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs.

Androgens are a class of hormones that control the development and maintenance of male characteristics. The most abundant androgens in men are testosterone and dihydrotestosterone .

Androgens are required for normal growth and function of the prostate, a gland in the male reproductive system that helps make semen. Androgens are also necessary for prostate cancers to grow. Androgens promote the growth of both normal and cancerous prostate cells by binding to and activating the androgen receptor, a protein that is expressed in prostate cells . Once activated, the androgen receptor stimulates the expression of specific genes that cause prostate cells to grow .

Almost all testosterone is produced in the testicles a small amount is produced by the adrenal glands. Although prostate cells do not normally make testosterone, some prostate cancer cells acquire the ability to do so .

What Is Known About Hormone Therapy And The Risk Of Heart Disease


Scientists continue to learn about the effects of HT on the heart and blood vessels. Many large clinical trials have attempted to answer questions about HT and heart disease. Some have shown positive effects in women who started HT within 10 years of menopause some have shown negative effects when started greater than 10 years of menopause. Some studies have raised more questions about the potential benefits of HT.

Based on the data, the American Heart Association issued a statement for use of HT. They say:

  • Hormone therapy for the sole purpose of preventing heart disease is not recommended.

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For Use In Certain Men

Some men with unnaturally low levels of testosterone can benefit from hormone therapy. For example, the condition hypogonadism can cause unnaturally low levels of testosterone. Its a dysfunction of the testicles that prevents the body from producing the right amount of testosterone.

Whats less certain is whether testosterone therapy can benefit healthy men whose testosterone decline is simply caused by aging. This has been a difficult question for researchers to answer. Not many studies have observed the effects of testosterone therapy in men with healthy levels of the hormone. The studies that have were smaller and had unclear results.

Menopause Symptoms And Hrt

Menopause symptoms that may be relieved by HRT include:

  • hot flushes and night sweats
  • vaginal dryness
  • hair loss or abnormal hair growth
  • dry and itchy eyes.

Other therapies, including vaginal oestrogen products, antidepressants or other medications, may be used depending on the symptoms and risk factors. Seek advice from your doctor.

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What If Im Nonbinary Or Otherwise Dont Identify With Mtf/ftm Does That Affect My Access To Hormones

The short answer is no. We have a ton of nonbinary trans patients, said Pellegrino. With HRT, you often cannot pick and choose your effects, but we can do our best to help maximize HRT for you and your goals.

Microdosing is the colloquial term for taking a lower dosage of hormones than a typical regimen, and one way that people undertake nonbinary medical transition. You can have half-dose testosterone, or half the usual regimen used for feminizing, said Safer. Thats perfectly safe and perfectly reasonable. Its really just a matter of customizing the regimen for the individual circumstance, whatever it is. Safer warned, however, that many providers are still not educated about nonbinary identity, and many electronic medical systems still use binary language. Nonbinary stories are rarer, and that may not be as automatic with certain providers who are less knowledgable, said Safer. Theres going to be a lag on that being as generalized.

Is Hormone Therapy The Right Choice

Starting HRT

Every person is different, so we work closely with each patient to determine whether hormone therapy is the right choice. People who benefit most from hormone therapy usually have:

  • Persistent, well-documented gender dysphoria or gender incongruence
  • The capacity to make a fully informed decision and consent to treatment
  • Good, or well-controlled, emotional health

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Added Benefits Of Hrt

HRT reduces the risk of various chronic conditions that can affect postmenopausal women, including:

  • diabetes taking HRT around the time of menopause reduces a womans risk of developing diabetes
  • osteoporosis HRT prevents further bone density loss, preserving bone integrity and reducing the risk of fractures, but it is not usually recommended as the first choice of treatment for osteoporosis, except in younger postmenopausal women
  • bowel cancer HRT slightly reduces the risk of colorectal cancer
  • cardiovascular disease HRT has been shown to reduce cardiovascular disease markers when used around the time of menopause.

Contraception Pregnancy And Hrt

Oestrogen used in HRT is different from oestrogen used in the contraceptive pill, and is not as powerful.

This means it’s possible to become pregnant if you are taking HRT to control menopausal symptoms. In some cases, a woman can be fertile for up to 2 years after her last period if she is under 50, or for a year if she is over 50.

If you don’t want to get pregnant, you can use a non-hormonal method of contraception, such as a condom or diaphragm.

An alternative is the IUS , which is also licensed for heavy periods and as the progestogen part of HRT. You will need to add oestrogen as either a tablet, gel or patch.

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How To Get Access To Estrogen Hormone Therapy

If a person decides to transition, it is essential to receive estrogen hormone therapy from healthcare professionals.

Buying and taking hormones from other sources carries many risks, such as poor quality of drugs, improper doses, and possible harm.

In order to start the process, a person must discuss their options with a healthcare professional.

Transcaresite has a directory of trans-friendly medical professionals. If an individuals healthcare insurance covers the cost of transitioning, it is important to check that the healthcare professional a person chooses is in their insurance network.

The World Professional Association for Transgender Health recommends healthcare professionals and individuals undergo several steps before starting estrogen hormone therapy.

These include:

  • assessing a person for and diagnosing gender dysphoria
  • educating an individual on the different treatment options available
  • assessing, diagnosing, and treating any mental health conditions
  • assessing eligibility and referring a person for hormone therapy
  • The GLMA is the national LGBTQI+ medical association that also has provider listings for trans-affirming care.

    • psychiatric, including any mental health conditions
    • social, such as social support and legal history
    • family, such as a history of psychiatric illnesses, suicides, and substance use
    • developmental, such as education level and any history of trauma
    • any instances of substance use

    Trans Health: Hormone Therapy Starts And Surgery Referral Support


    The Trans Health Program offers hormone therapy starts and surgery referral support to trans and non-binary people, ages 17 and up from Ottawa and surrounding areas. We tailor our services to the needs and transition goals of our clients. For example, some of our clients seek maximum feminization/ masculinization, while others seek a more androgynous appearance.

    Our service model follows the Sherbourne Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients. Our services are continuously evolving, as we learn from our clients and other experts.

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    How Will I Know That My Hormone Therapy Is Working

    Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.

    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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    What Types Of Hormone Therapy Are There

    There are three main ways to have hormone therapy for prostate cancer. These are:

    • injections or implants
    • tablets
    • surgery to remove the testicles .

    The type of hormone therapy you have will depend on whether your cancer has spread, any other treatments youre having, and your own personal choice. You may have more than one type of hormone therapy at the same time.

    Injections or implants

    These stop your body from making testosterone. They work by blocking the message from the brain that tells your testicles to make testosterone.

    Injections or implants are as good at controlling prostate cancer as surgery to remove the testicles.

    Ask your doctor or nurse whether you will have injections or implants. They are both given using a needle.

    Injections use a needle to inject a small amount of liquid under the skin or into muscle. They may be given in your arm, abdomen , thigh or bottom , depending on the type youre having.

    Implants may be given as a small pellet that is placed under the skin in the abdomen and slowly releases the drug.

    You will have the injections or implants at your GP surgery or local hospital. How often you have them will vary, depending on the type you are having.

    Some men have an injection or implant once a month, while others have an injection every three or six months.

    LHRH agonists

    LHRH agonists are the most common type of injection or implant. There are several available that all work in the same way, including:

    GnRH antagonists


    Abiraterone acetate

    Emotional Effects Of Gender Confirming Estrogen Hormone Therapy

    At What Age Should You Start Hormone Replacement Therapy ...

    The impact of hormone therapy on a transgender womans emotional state also varies from person to person. Just like the emotional roller coaster of puberty, the influx of hormones during feminizing therapy can affect your mental state. Many women find that you they experience a wider range of emotions or feelings and some even take an interest in new tastes or pastimes!

    A great benefit of estrogen is that it increases serotonin, the feel-good chemical in the brain. So female gender affirming hormone therapy typically results in an improvement in overall mood.

    Whatever new thoughts and feeling result from your hormone therapy, working with a therapist while in transition can help you get to know and understand your new body and your true self.

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    A Very Serious Warning Before You Begin

    Please, please, please understand that this advice is intended only for the seriously gender dysphoric and those who understand that they are transsexual. If you have any doubt at all about your transsexuality do not seek out hormone replacement therapy and contact a therapist to discuss your situation. Many universities offer therapy to the general population on a sliding scale. There is a high cost for those who transition but are not transsexuals and Lynn Conway explains this better than I can.

    Also understand that it is highly recommended that you consult a doctor at all stages of your transition to ensure that you are doing the right thing, being monitored for any abnormalities that hormone replacement therapy may cause and that you are physically fit and able to have any therapy that you seek.

    In summary: Remember that in the end, you are the only one responsible for your own health and you are the one to suffer the consequences if you do not listen to good advice. In other words, don’t blame me if you fuck up!

    What Should I Know Before Starting Feminizing Or Masculinizing Hrt

    Before starting hormone therapy, itâs important to learn about the short-term and long-term effects of gender-affirming hormone replacement therapy, as well as the risks associated with this kind of treatment.

    Someone may choose to start HRT to ease gender dysphoria or emotional distress associated with societal transphobia. They may also select HRT to improve their social functioning or sexual satisfaction in relation to their gender identity. There are many reasons why people may choose to be on HRTs.

    There are several benefits of HRT, including improved psychological and social functioning, sexual satisfaction and overall quality of life. However, there are risks and changes that you should consider before starting HRT. Be sure to think through impacts on fertility, sexual functioning and other health problems with your doctor.

    Thus, HRT allows for these hormonal and physical changes to occur and, as a result, decrease gender dysphoria and psychological distress that stems from a transphobic society.

    Feminizing HRT can impede the effects of testosterone via hormone blockers and the replacement of testosterone with estrogen. Feminizing treatment can also impact your fertility and sexual functioning.

    Masculinizing HRT impedes the effects of estrogen on your system by replacing estrogen with testosterone and encouraging the development of masculine features. This replacement process can also impact your fertility.

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