Transgender Hormone Therapy Female-to Male

Masculinizing Hormone Therapy And Fertility

While some transgender men have sucessfully undergone egg freezing or IVF after starting hormone therapy, long-term use of hormones may lead to permanent infertility. If you want to leave open the possibility of starting a family by having children biologically, consult your doctor about your options for egg freezing before starting treatment.

Given that individual responses to testosterone treatment vary, you have a chance of becoming pregnant even while taking hormones. Your doctor can advise you about your options for birth control.

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:

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:

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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How Does Masculinizing Hormone Therapy Work

You can take testosterone as injectables, pills, pellets, patches and gels. Your healthcare provider can recommend the type, dose and frequency thats right for you.

To lower the risk of complications and side effects, you may start with a low dose. As your body gets used to the therapy, your healthcare provider may increase your dosage. After achieving the desired results, youll take a lower dose for the rest of your life.

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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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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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How Do Transmen Rate Their Satisfaction With Self

When asked to rate perceived amount of change following T therapy, voice masculinity was rated as the most changed among the surveyed traits with 72% of participants indicating that voice masculinity was 6 or a 7 on the 1-to-7 scale . When asked to rate satisfaction with perceived changes, voice masculinity was rated the highest among all survey traits with 77% indicating a 1 or a 2 . See Fig. .

Figure 5

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 .

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Evaluation Of Youth And Adults

Gender-affirming treatment is a multidisciplinary effort. After evaluation, education, and diagnosis, treatment may include mental health care, hormone therapy, and/or surgical therapy. Together with an MHP, hormone-prescribing clinicians should examine the psychosocial impact of the potential changes on peoples lives, including mental health, friends, family, jobs, and their role in society. Transgender individuals should be encouraged to experience living in the new gender role and assess whether this improves their quality of life. Although the focus of this guideline is gender-affirming hormone therapy, collaboration with appropriate professionals responsible for each aspect of treatment maximizes a successful outcome.

Diagnostic assessment and mental health care

Because of the psychological vulnerability of many individuals with GD/gender incongruence, it is important that mental health care is available before, during, and sometimes also after transitioning. For children and adolescents, an MHP who has training/experience in child and adolescent gender development should make the diagnosis, because assessing GD/gender incongruence in children and adolescents is often extremely complex.

Social transitioning

Criteria

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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We Are Partners In Your Care

Long-Term Follow-UpTaking hormone therapy is a lifelong commitment to maintain the changes you seek. While your follow-up visits will be less frequent after the first year, you will need to maintain a regular schedule of appointments.

Insurance CoverageGender-affirming hormone therapy is typically covered by insurance. Check with your health plan to confirm how and if it is a covered treatment. If needed, your provider can provide written authorization before starting treatment.

Participate in Research to Help Future GenerationsBecause gender-affirming hormone therapy is a relatively new treatment, research is needed to study its long-term effects. As a Duke patient, you can choose to participate anonymously in research that is studying the long-term risks of hormone-affirming therapy. The information, which is collected anonymously, will help doctors better understand how to treat future generations safely and effectively with hormone therapy.

Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital are recognized as LGBTQ+ Healthcare Equality Leaders by the Human Rights Campaign Foundation and received perfect scores for providing patient-centered care, support services, and inclusive health insurance policies to LGBTQ+ people.

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:

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Feminizing Hormone Replacement Therapy Medication And Timing

While your healthcare provider will help you develop an individualized treatment plan, feminizing hormone therapy often begins by taking 100 to 200 milligrams daily of a diuretic called spironolactone to begin blocking male hormone receptors and suppress testosterone production. Some individuals begin taking estrogen immediately, in tandem with spironolactone, to further reduce testosterone production and develop more feminine characteristics. In other cases, estrogen is introduced after several weeks of spironolactone use. Your doctor will recommend the best plan for your needs.

There are various methods for administering estrogen, including orally, by injection, or as a cream, gel, spray, or patch. Commonly used forms of estrogen during a male-to-female transition include:

• Patches: 17B-Estradiol patch

Feminizing Hormone Replacement Therapy Side Effects

You may experience one or more of the following hormone replacement therapy side effects. Your doctor can advise you about the potential risks and benefits prior to starting hormones.

• A blood clot in a deep vein %20is,other%20areas%20of%20your%20body.” rel=”nofollow”> deep vein thrombosis) or in your lungs
• High levels of triglycerides, a type of fat found in the blood
• High blood pressure

Feminizing hormone replacement therapy may also increase your risk for some chronic health conditions. Since estrogen affects how your body responds to insulin, it can lead to changes in your blood sugar levels and a greater risk for type 2 diabetes. Research into the impact of estrogen on your cardiovascular system is ongoing, and some studies have found a connection between estrogen therapy and a greater risk for heart disease and stroke. You may also face a greater risk of breast cancer after starting hormone replacement therapy.

Certain underlying health conditions may increase your risk of health complications related to the use of estrogen and testosterone-blocking hormones. Its important to share your full medical history with your doctor, especially if youve had a hormone-related cancer, like prostate cancer, or a history of blood clots.

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Research On Hormone Therapy & Transgender Womens Voices

In 2016 a study was designed to investigate the effect of subcutaneous Testosterone therapy on the vocal cords of patients who were assigned female at birth. Ten participants who were about to undergo T hormone therapy were recruited for voice analysis. .

The subjects voices were recorded prior to testosterone treatment and at 3 months, 6 months, and 12 months later. The conclusion of the study supported what many physicians and transgender hormone experts already knew: Therapeutic levels of testosterone, delivered by subcutaneous implant, have no effect on the female voice including lowering or deepening of the voice.

Citation: R. Glaser, A. York & C. Dimitrakakis Effect of testosterone therapy on the female voice Climacteric. 2016 Apr 19:198-203. doi: 10.3109/13697137.2015.1136925. Epub 2016 Feb 9.

What Changes Can I Expect From Masculinizing Hormone Therapy

You may notice changes as early as one month after youve started taking testosterone, but it may take a little longer to achieve the maximum effects. How quickly your body responds to the therapy depends on individual factors, like your age and genetics.

Many of these changes persist even if you stop taking hormones. Others require that you continue taking testosterone regularly. For example, changes related to muscle mass, body fat distribution and menstruation all require that you dont stop taking testosterone.

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Research On Hormone Therapy & Transgender Mens Voices

In a first-of-its-kind study, conducted at Brigham Young University 30 trans men from the Boston area who had been on Testosterone for nine months or more were recruited. The trans men in the study who were undergoing T therapy reported that having a masculine voice was of utmost importance to their identity.

We found that testosterone does a very successful job at bringing the voice into the average cis male range, said the authors of the study. But they also found that Testosterone did not fully masculinize the more subtle sounds and intonations in the participants vocal formants.

This led the researchers to conclude that adding voice therapy to a transition treatment plan for trans men should be a priority since testosterone alone is not going to do the job all by itself.

Citation: Carolyn R. Hodges-Simeon, Graham P. O. Grail, Graham Albert, Matti D. Groll, Cara E. Stepp, Justin M. Carré & Steven A. Arnocky Testosterone therapy masculinizes speech and gender presentation in transgender men Scientific Reports volume 11, Article number: 3494 .

Surgery For Sex Reassignment And Gender Confirmation

• 5.1. We recommend that a patient pursue genital gender-affirming surgery only after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patients overall health and/or well-being.

• 5.2. We advise that clinicians approve genital gender-affirming surgery only after completion of at least 1 year of consistent and compliant hormone treatment, unless hormone therapy is not desired or medically contraindicated.

• 5.3. We advise that the clinician responsible for endocrine treatment and the primary care provider ensure appropriate medical clearance of transgender individuals for genital gender-affirming surgery and collaborate with the surgeon regarding hormone use during and after surgery.

• 5.4. We recommend that clinicians refer hormone-treated transgender individuals for genital surgery when: the individual has had a satisfactory social role change, the individual is satisfied about the hormonal effects, and the individual desires definitive surgical changes.

• 5.5. We suggest that clinicians delay gender-affirming genital surgery involving gonadectomy and/or hysterectomy until the patient is at least 18 years old or legal age of majority in his or her country. .

• 5.6. We suggest that clinicians determine the timing of breast surgery for transgender males based upon the physical and mental health status of the individual. There is insufficient evidence to recommend a specific age requirement.

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Transgender Womens Voices & Hormone Therapy

Unfortunately, for transgender women who begin hormone therapy as adults, female hormones will not raise the pitch of their voice. This is because estrogen does not make vocal cords shorter or thinner once they have already developed and thickened during puberty. Both anti-androgens and estrogens have no effect on the voice.

However, there is evidence that when feminizing hormone therapy is started before puberty, a trans girl will be able to keep her youthful, higher traditionally female-sounding voice. In other words, pre-puberty female hormones can prevent someone assigned male at birth from developing thicker vocal cords before their voice drops.

Fortunately, there are other gender affirming voice treatments that can help raise a trans womans voice so that it matches her gender identity and feels authentic. This can include vocal coaching as well as vocal cord surgery.

But, while voice therapy can be an integral part of combating dysphoria and presenting en femme, it does not mean that it is the right choice for every trans woman. Nobody should feel pressured to present in any way that they arent comfortable presenting or that doesnt align with their authentic identity!

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

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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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