Male To Female Self Medicating Informative Guide
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Information sources and citations:
We thank the Canadian Rainbow Health Coalition and Vancouver Coastal Health for funding this project.
We also thank Jacqueline Allan, Fionna Bayley, Dr.Marshall Dahl, Emily Hodge, and Sam Larkham for their input.
Web: http://www.vch.ca/transhealthThe Transgender Health Program is an anonymous and confidential freeservice for anyone in BC who has a trans health question or concern.
Services for trans people and loved ones include: Information about trans advocacy, medical care, hormones, speech change, and surgery Help to find health/social services, and help to navigate the trans healthsystem Non-judgmental peer counseling and support Information about trans community organizations and peer supportgroups
Typical Changes From Estrogen
|13 months after starting oestrogen||
Table source: Gender Affirming Hormones Prescribers Guide, Version 2, August 2019
Psychological Effects Of Sex Reassignment
No significant psychopathologies have been reported in pre- and post-operative assessments of GD patients under CHT . However, primarily after initiation of CHT, the majority of patients reported to be in better mood, they were happier, and less anxious . Also, they appeared more self-confident and encountered a better body-related experience, indicating a less distorted self-image . The most important effect resulted from the confirmation of the diagnosis and the initiation of hormone therapy .
However, a Swedish study showed that GD patients after SRS have considerably higher risks of mortality, suicidal behavior, and psychiatric morbidity compared to the general population . This study suggests that sex reassignment, although alleviating GD, may not suffice as treatment for transsexualism. Instead, improved psychiatric and somatic care after sex reassignment for this patient group appear to be necessary . In contrast, a German study concluded that the suicide rate was not increased compared to the general population . To the best of our knowledge, no study correlated sex hormone status or spermatogenic level with psychological and physiological outcomes during CHT, neither before nor after SRS.
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What Are The New Findings
Longitudinal and cross-sectional studies identify that hormone therapy in transwomen decreases muscle cross-sectional area, lean body mass, strength and haemogloblin levels, with noted differences in the time course of change.
Haemoglobin levels decrease to those seen in cisgender women after 4 months of hormone therapy. In contrast, despite significant decreases in muscle cross-sectional area, lean body mass and strength after 1236 months of hormone therapy, values remain higher than that in cisgender women.
It is possible that transwomen competing in sports may retain strength advantages over cisgender women, even after 3 years of hormone therapy.
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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
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.
Transgender Hormones: Women And Transfeminine
Many people take hormones as part of a gender transition. They must think about their reproductive options before they start hormones. Hormones may change your body so you can not make children. You need to know the other risks and side effects that can happen before you start taking hormones.
In the case of hormones, talk to your healthcare provider about your goals. You can start and stop hormones if you want to try them for a while. Some people try them for a few weeks or a few months to see how they feel. You can stop and restart anytime, but its a good idea to do it under a doctors care.
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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:
- 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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What Changes Can I Expect From Feminizing Hormone Therapy
People assigned male at birth produce low levels of estrogen. Feminizing hormone therapy brings about physical and emotional changes that are more consistent with feminine anatomy and behavior.
With this treatment, you will receive hormones and other substances. They include anti-androgens medication, estrogen and possibly progesterone.
Anti-androgen therapy blocks male sex hormone production.
Changes from anti-androgen therapy include:
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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.
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
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How Does Feminizing Hormone Therapy Work
You start by taking anti-androgens to block testosterone production. Then, after a few weeks, you take estrogen. This hormone comes in many forms, including:
People who choose feminizing hormone therapy start with a low dose of estrogen. The appropriate amount is different for each person. Your healthcare provider determines the type and dose thats right for you.
Starting with a low dose helps reduce the risk of complications and side effects. Then, as your body gets used to it, your provider will increase the dosage. After achieving the desired results, you take a lower dose for the rest of your life.
Erik Steele Mfa Ma Ccc
Erik Steele, MFA, MA, CCC-SLP, is a Speech Language Pathologist at the UCSF Voice and Swallowing Center and Head and Neck Surgical Oncology in the Department of Otolaryngology Head and Neck Surgery. He specializes in the evaluation and treatment of patients with wide ranging voice, swallowing, and upper airway problems. Clinical and scholarly interests include individualized care of the professional voice, the use of advanced instrumental diagnostics in voice and swallowing, patient-centered rehabilitation of voice, speech and swallowing following head and neck cancer treatment, and community outreach to promote greater awareness of voice, swallowing and upper airway problems and therapies.
Before joining the Department of Otolaryngology and Head and Neck Surgery at UCSF, Mr. Steele completed his graduate work at San Diego State University, a clinical internship at the Scripps Center for Voice and Swallowing in San Diego, and his postgraduate fellowship at the Center for Voice and Swallowing at UC Davis, where he then remained for two years.
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What To Know About Transgender Hormone Therapy Side Effects
For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you.
Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.
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.
- 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
- Testosterone enanthate or cypionate 50200mg/week or 100200mg/2 weeks
- Testosterone undecanoate 1000 mg/12 weeks
- 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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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.
Male To Female 6 Months Hormones Update
This is my six months hormones update for being on hormone replacement therapy . I will be answering some questions that were sent to me from you guys. Stay tuned for more updates on my medical, emotional, and physical journey.
One question I have been getting asked a lot is about pronouns because a lot of you have been going back through my videos and noticing that in the first half of my channel, as in the first 10 videos, my family has referred to me as he.
How did they evolve? Why is your brother calling you he on your video? I just wanted to explain it a little bit more, so in my journal, my first entry I discussed how I didnt feel comfortable asking others to officially call me by she/her pronouns. I preferred him because I didnt feel like I was worthy of changing yet. I really think that it was in my head. I just wasnt female enough or girly enough. I felt it was too early to officially recognize myself as she. Even though I wear a bra, extensions, and a full face of makeup, daily. I was wearing hair extensions for a year before I finally asked someone to recognize me as she, which happened to be after I started seeing a gender therapist.
After starting gender therapy, my journey toward transitioning moved along very quickly. After talking to that therapist 2 times I knew the time was now. I know I dont see myself growing into a man. All I see in my future is me growing up, into womanhood, getting married, and being a mother.
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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.
Problematic Aspects In Relation To Sex Reassignment Treatment
It appears obvious that maintenance of steroid hormone levels in the physiological range of the desired sex should be achieved in individuals with GD prior and post-SRS . The Endocrine Society recommends monitoring patients every 3 months during the first year of therapy and once or twice yearly thereafter . For CHT to be well tolerated, it is necessary to perform the hormonal administration in a highly individualized scheme in terms of timing, doses and modes of administration . Treatment can be considered successful if it relieves distress or facilitates substantial improvement in function and well-being of the patient .
The hormonal therapy in MtF subjects lasts 6.0 years on average . Based on expert opinion, however, patients tend to follow their self-controlled individual regimes as estrogen- and androgen-formulations are easily available via the Internet, over the counter, without prescription in certain settings, and through veterinary supply . However, subjects should be strongly discouraged from inducing supra-physiological hormone levels due to serious side effects . According to Leinung et al. , 9.8% of male-to-female transsexuals started hormonal therapy without prescriptions from a physician and nearly all admitted of initiating hormonal therapy without medical supervision . This is surprising as one of the three inclusion criteria of the WPATH for GD therapy is the ability to take hormones in a responsible manner .
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