A Note About Sex And Gender
Sex and gender exist on spectrums. This article will use the terms, male, female, or both to refer to sex assigned at birth. .
Estrogen hormone therapy involves an individual assigned male at birth taking the hormone estrogen to develop certain feminine characteristics.
Estrogen stops the pituitary gland from forming gonadotropin, which reduces androgen production. Androgens are a group of hormones that help with reproductive development, among other things. Reducing the number of androgens in the body helps a person transition by encouraging changes in fat distribution, breast development, and male pattern hair growth.
Doctors may also prescribe other anti-androgen drugs to help the transitioning process.
A person may not notice significant changes when starting estrogen hormone therapy. The timeline varies, and some people may see more significant changes than others.
People may notice more changes if they use anti-androgen therapy alongside estrogen therapy.
Estrogen hormone therapy can cause physical changes.
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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Side Effects Of Feminizing Hormone Replacement Therapy For Mtf Transgenders
As any other therapy, HRT carries risks and side effects.
There is a , with bones becoming similar to those of cisgender women, but therapy should not induce osteopenia nor osteoporosis. There might be also an increase in body weight due to the increase in body fat mass. There is also a 15% chance of experiencing hyperprolactinemia due to the development of lactotroph cell hyperplasia or prolactinomas.
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Reasons For Taking Less Hormones
As shown in Table , the most commonly endorsed reasons for taking less hormones than prescribed were forgetting to take the medication , forgetting to pick up the prescription , cost of hormones , experiencing transportation barriers when attempting to pick up their prescription , having syringe concerns , health insurance issues , and believing that the prescribed dose was incorrect .
Among those who indicated taking less hormones than prescribed, emergent themes included experiencing other physical concerns , pharmacy issues , and reliance on other people to administer their hormones.
Some participants who endorsed taking less hormones than prescribed reported experiencing psychological and physical concerns about using syringes, particularly pain at the injection site, as well as anxiety and phobia related to the injection. These negative experiences and concerns with syringes could deter some participants from successfully taking their medication, as described by the following respondents:
Intense anxiety about injecting prevents me from completing a shot.
Injection method is uncomfortable.
Injection site pain/fatigue.
The injections are painful, so I often procrastinate on it.
I use IM injections for hormones it is painful to use needles, so rather than every 7 days as prescribed, I do once every 12 days.
It causes lots of hair loss so I just dab it on to feel good, but the regular application makes my hair fall out more.
To reduce acne issues.
Personal Accounts Of Non
Below are some stories that highlight the process of medically transitioning as a non-binary person. People discuss taking low doses of estrogen, talking with doctors about non-binary identity, and what others can expect when starting their own transitioning journey.
- In this NBC news story, non-binary folks discuss their reasons for choosing to microdose. While most of these stories are about people taking low doses of testosterone, there are a couple of accounts about estrogen.
- In this piece, Them.us asks non-binary people to discuss their medical transition, cost barriers to hormone therapy, doctors appointments, and non-binary visibility in the trans community.
- Teen Vogue gives a platform to non-binary folks who have chosen to medically transition in this piece. Folks talk about transitioning, intermittent use of hormones, and the difference between gender identity and gender expression.
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Practical Guidelines For Transgender Hormone Treatment
Adapted from: Gardner, Ivy and Safer, Joshua D. 2013 Progress on the road to better medical care for transgender patients. Current Opinion in Endocrinology, Diabetes and Obesity 20: 553-558.
KEY POINTS
- In order to improve transgender individuals access to health care, the approach to transgender medicine needs to be generalized and accessible to physicians in multiple specialties.
- A practical target for hormone therapy for transgender men is to increase testosterone levels to the normal male physiological range by administering testosterone.
- A practical target for hormone therapy for transgender women is to decrease testosterone levels to the normal female range without supra- physiological levels of estradiol by administering an antiandrogen and estrogen.
- Transgender adolescents usually have stable gender identities and can be given GnRH analogs to suppress puberty until they can proceed with hormone therapy as early as age 16.
Hormone regimes for transgender men
1. Oral
2. Parenterally
- Testosterone enanthate or cypionate 50200mg/week or 100200mg/2 weeks
- Testosterone undecanoate 1000 mg/12 weeks
3. Transdermal
- Testosterone 1% gel 2.5 10 g/day
- Testosterone patch 2.5 7.5 mg/day
i.m., intramuscular.*Not available in the USA.
Monitoring for transgender men on hormone therapy:
At What Point In My Gender Transition Can I Start Feminizing Hormone Therapy
The timing is up to you and your healthcare provider. Some people affirm their new gender identity first by changing their names and dressing differently. But this isnt a requirement.
Adolescents may wish to consider starting feminizing hormone therapy at age 16. Starting at a young age makes it possible to:
- Block the effects of puberty for their assigned gender.
- Proceed with puberty in a manner consistent with their authentic gender identity.
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Male To Female Hormone Replacement Therapy
Male to female hormones help men develop female characteristics like breasts and a more feminine body. The following article will discuss on this hormone therapy and its effects.
Male to female hormones help men develop female characteristics like breasts and a more feminine body. The following article will discuss on this hormone therapy and its effects.
There are many men around the world who feel trapped in their bodies. They think like a woman, feel like a woman, and want to develop physical characteristics like a woman. Cross dressers, transgenders and transvestites are looking for ways that will make them more feminine than masculine. There are many things that will help a man develop a female body, like sex change operations. Before one tries out something so drastic, male-to female-hormone therapies are used as the first step towards womanhood.
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Regression Outcome: Taking Less Hormones Than Prescribed
Table also shows the adjusted multivariable logistic regression models examining factors associated with taking less hormones than prescribed. In the final model, the odds of taking less hormones than prescribed were higher among nonbinary respondents compared to transfeminine respondents , those with a low income , those with no insurance coverage for hormones , and those who had received mental health treatment in the past year .
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Study Sample And Procedures
This is a secondary cross-sectional analysis of survey data from Project VOICE , a needs assessment led by the Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition . Between March and August 2019, trans residents of Massachusetts and Rhode Island were surveyed about their sociodemographics, healthcare experiences, and health. Respondents were purposively sampled and recruited via venues where trans people congregate, including online sites such as listservs and community-based social networking webpages, as well as in-person sites such as trans-specific community events and trans-friendly clinics. Participants were eligible for the study if they were 18 years or older, self-identified as transgender or nonbinary, resided in MA or RI, were willing to provide electronic written informed consent, and spoke either English or Spanish. Eligible respondents who completed the survey were invited to opt into a community raffle for one of 54 gift cards, with values ranging from $10 to $250. Additional details on the study procedures can be found elsewhere .
Hormone Therapy For Transgender Patients
Cécile A. Unger
Center for Urogynecology & Pelvic Reconstructive Surgery, Center for LGBT Care, Department of Obstetrics & Gynecology, Womens Health Institute, Cleveland Clinic, Cleveland, OH, USA
Correspondence to:
Abstract: Many transgender men and women seek hormone therapy as part of the transition process. Exogenous testosterone is used in transgender men to induce virilization and suppress feminizing characteristics. In transgender women, exogenous estrogen is used to help feminize patients, and anti-androgens are used as adjuncts to help suppress masculinizing features. Guidelines exist to help providers choose appropriate candidates for hormone therapy, and act as a framework for choosing treatment regimens and managing surveillance in these patients. Cross-sex hormone therapy has been shown to have positive physical and psychological effects on the transitioning individual and is considered a mainstay treatment for many patients. Bone and cardiovascular health are important considerations in transgender patients on long-term hormones, and care should be taken to monitor certain metabolic indices while patients are on cross-sex hormone therapy.
Keywords: Hormone therapy transgender gender dysphoria cross-sex hormones
Submitted Jul 23, 2016. Accepted for publication Jul 26, 2016.
doi: 10.21037/tau.2016.09.04
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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.
Preparation Before Taking Hormones
Before starting estrogen hormone therapy, it is important to gain as much information as possible. So always discuss the risks and side effects that hormone therapy may cause with a healthcare professional.
It is also essential that a person manages their expectations of when they will begin to see changes. Some people can take hormones for over a year before seeing any noticeable changes.
A persons healthcare provider may ask people to
The cost of estrogen hormone therapy can vary according to a range of factors. These include the type of hormones a person takes and how they use them.
A person wanting to transition must check that their health insurance covers the costs.
People must also check that the healthcare professional or medical center that their doctor has referred them to are in their insurance network.
There are several other gender-affirming procedures that people can opt for.
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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
- alleviation of gender dysphoria
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.
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.
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Where Can I Buy Male To Female Hormones
Transfemme® male to female hormones in pill and cream forms are available online on this website. Transfemme is a completely natural system to feminize the male body to varying degrees depending on which products you use and the dosages. We recommend calling one of our advisors on our Customer Success Team at or email us at
Indications For Estrogen Hrt For The Mtf Transgender
There are some criteria to be met before having access to HRT as established by the international guidelines published in the Standards of Care 7th edition of the WPATH . These are clinical guidelines and may be modified by individual healthcare professionals based on the unique features of each patient.
If mental health conditions are present, they do not preclude access to HRT. Guidelines recommend managing those conditions before beginning therapy and for them to be reasonably well controlled.
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When Hrt Is Not Recommended
Hormone replacement therapy is notrecommended for people who:
- May be pregnant
- Have issues with abnormal vaginal bleeding
- Have a family or personal history of breast cancer
- Have a personal history of heart disease, stroke, blood clots, or liver disease
- Have a family history of gallbladder disease
- Are allergic to estrogen or progesterone
Working With Young Trans People & Families
A Family Court of Australia ruling , the medical practitioner and the young person themselves with regard to:
-
The Gillick competence of an adolescent or
-
A diagnosis of gender dysphoria or
-
Proposed treatment for gender dysphoria
Any dispute requires a mandatory application to the Family Court of Australia as per the judgement of Re. Imogen 20206.
Medical practitioners seeing patients under the age of 18 are unable to initiate puberty blockers or gender affirming hormonal treatment without first ascertaining whether or not a childs parents or legal guardians consent to the proposed treatment. If there is a dispute about consent or treatment, a doctor should not administer puberty blockers , hormones or surgical intervention without court authorisation.
Increasing evidence demonstrates that with supportive, gender affirming care during childhood and adolescence, harms can be ameliorated and mental health and wellbeing outcomes can be significantly improved.
Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents 7
For trans people under 18 whose parents, carers or guardians will not consent to starting hormones, the Family Court must be involved. Unfortunately, in many cases where parents, carers or guardians do not consent, this may result in a trans person simply waiting until they are 18 to access puberty blockers and hormones, or seeking to access them outside of medical care and oversight.
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Types Of Hormone Replacement Therapy
Hormone replacement therapy is made with either one or two types of hormones:
- Estrogen only, which helps reduce night sweats, hot flashes, vaginal dryness, and urinary discomfort, in addition to bone loss that’s associated with aging, and is recommended for people who have had their uterus removed
- Estrogen with added progesterone, which helps protect against the risk of endometrial cancer in people who still have a uterus
Each is available in different formulas and dosages.
Risk Evaluation: Absolute Contraindication To Feminizing Hormone Replacement Therapy
As seen previously, the HRT for MtF transgender carries risks. In some cases, comorbidities can preclude HRT due to its absolute contraindication. This is because the risks for the patient are too high. Among these cases there are:
- previous venous thrombotic events related to an underlying hypercoagulable condition
- history of estrogen-sensitive neoplasm
- Transgender Medicine: A Multidisciplinary Approach.Leonid Poretsky, Wylie C. Hembree. Springer, 2019
- Principles of Transgender Medicine and Surgery, second edition.Randi Ettner, Stan Monstrey, Eli Coleman. Routledge, 2016.
- Management of Gender DysphoriaCarlo Trombetta, Giovanni Liguori, Michele Bertolotto. Springer, 2015
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Reasons For Taking More Hormones
As shown in Table , the most endorsed reasons for taking more hormones than prescribed were believing that it is not the right prescribed dose , taking it to feel good , to speed up transition or the gender-affirmation process , and making up for missed doses .
Table 3 Reasons for taking more or less hormones than prescribed.
Emergent themes from the write-in responses included the following reasons for taking more hormones: making up for missed doses, having concerns about reproductive health, and having an imprecise practice of dose administration.
Many respondents reported making up for missed hormone doses as a reason for taking more hormones than prescribed, with some respondents indicating doubling or taking a little extra dose if missed. These respondents noted:
If I miss a week because my pharmacy took forever to get my T in, Ill sometimes go to 0.45 on the 1mL syringe instead of 0.4.
Accidentally doubling my dose because I forgot that I took the first.
I miss my shot day I accidentally pull a little extra when getting the shot ready.
Reproductive health concerns regarding menstruation also emerged as one of the reasons transmasculine people reported taking more hormones than prescribed. Specifically, many transmasculine respondents reported taking higher doses of their hormones to mitigate ones gender dysphoria and physical discomfort related to menstruation. Participants noted:
Experience menstrual cramping.
If I start bleeding.