Hormones – news.lgbti.org

Getting Hold of Transsexual Hormone Replacement Therapy

Transsexual hormone replacement therapy helps those who feel they were born in the wrong body transition to what they feel is their proper sex. Many transgender feel discrimination for not having an easily distinguished gender. Hormone therapy helps them easily blend in and not become a target for discrimination.

Those who live near a metropolitan area should be able to gain access to hormone replacement therapy rather easily. First, make sure you are mentally prepared to take the theerapy. If you are severely dysphoric, you may need to seek the help of a certified mental health professional; preferably one that you trust and has experience assisting with someone in your situation. If you are on a constrained budget, try looking into LGBTI advocacy groups in your area that may be able to offer help. Also consider universities in your vicinity, as many offer psychological services on a sliding scale.

Doubting one’s transsexuality may cause psychological issues when hormone therapy begins to change your body. Always consult a physician about hormone therapy before you begin but throughout the process. You need to be carefully monitored to make sure no abnormalities occur. Think of all the questions you have, do thorough research and be sure to ask your doctor. Remember to advocate for your health when you don’t think you are being heard or your questions are not being answered.

Avoid healthcare providers that go by the Harry Benjamin Standards of Care guidelines drafted by the World Professional Association for Transgender Health (WPATH), or what was originally known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA). Therapist intervention levels are high with these guidelines and without meeting these standards, they may block your access to hormone therapy. There are many doctors out there who require these Standards of Care before even approaching your case.

There is another set of guidelines that will give you easier access to hormone therapy with little to no therapist’s intervention. Instead look for doctors and clinics who stick to the Tom Waddell Standards; like a physician in the free clinics in San Francisco. Dr. Tom Waddel personally penned these standards from his own experiences with the transgendered. While you may have to attend group meetings, the standards he implements are very straight forward.

It can be difficult finding a particular clinic’s standards. The best advice is to ask others in the transgender community. Find out which doctor or doctors they used and who they recommend. You can also check the internet for clinics in your area that provide hormone therapy. Just remember to get official help, as too little or too many hormones in the body can cause many serious health problems.

Estrogen Alone Doesn’t Curb Testosterone

Male-to-female transgender patients receiving estrogen alone won’t curb their testosterone production, a new study has found. New York State’s medical college conducted the study on one healthcare center where they found that about half of the patients receiving estradiol as part of hormone therapy experienced adequate testosterone suppression, even if accompanied by progestin says Matthew Leinung, MD, who was one of the researchers involved. These are two female hormones that act like estrogen and progesterone. Adding anti-antigens finasteride or spironolactone didn’t change anything.

Leinung made a presentation on their findings presented at the joint congress of the Endocrine Society and the International Congress on Endocrinology in Chicago. Leinung conceded, “I don’t know why I found what I found,” during his presentation. He went on to say, “I don’t have a good explanation because that’s not what the conventional wisdom is.”

There are lots of options when treating transgender patients, however, medical experts don’t know exactly which treatment is the ideal one. One thing all transgender medical experts agree on is that the hormone level has to be brought up to a normal level in the gender desired and that suppressing some hormone production in the patient is also crucial.

All the patients at his transgender clinic were evaluated by Leinung. Data from 82 patients out of more than 160 person sample was chosen for the study taking place between 2008 and 2013. 2008 was selected as this was when ethyl-estradiol was switched to oral estradiol. Leinung extracted out those who had reassignment surgery, were on Premarin, or hadn’t been taking estradiol long enough. He began giving them the hormones 4 mg doses of estradiol. 46% of the patients had significant testosterone suppression. Those that didn’t, the doses were upped to 6 mg. For those whom 6 mgs worked, the rate was still only 52%. Those who were still resistant and given finasteride to suppress their testosterone production actually saw the opposite come true, the body ramped up testosterone production.

Leuning, in his presentation, also mentioned research out of Maine Medical Center in Portland. That team, led by Lindsey Spratt, MD, and his colleagues, did find sufficient suppression in estrogen hormone therapy alone, which suggested against any added therapies until the physician got to see if the hormone therapy alone was sufficient.

Dr. M. Mirza, LGBT Health Wellness – August, 2014

Do Hormones change your mind?

There are many who say that any mind changes for those on MTF (male to female) hormones are mostly psy-chological.They also say that any sexual orientation changes are psychological as well. Does this mean that if this does happen that there was some secret desire there all along? Some say yes. I say No. I believe that at least Female hormones can change the way we think, who we’re attracted to and what our intrests are. I suspect that that is true of male hormones as well.

Let me start by saying that I’ve been in therapy off and on since I was 21 years old. I’m 55 now. The longest stint in therapy is the most recent, 20 years. You would think that in all that time if there were any secret desires or intrests that I would’ve noticed them before i recently restarted hormones again after a long absense. Certainly my shrink of 20 years would’ve found that out.

I’ve got to say that from my own experience that estrogen no matter what the source can have a powerful effect on the mind. Actually most changes were subtle while one a few years ago was quite a shock.

Editor’s note 1: Originally I took herbal phytoestrogen’s because the ad’s said they were safe. What they didn’t say is that for feminization they were recommending mega dose of 8 pills a day when the actual suggestion on the bottle was 1 a day for menopausal syptoms in born women. In March 1996 I had a stroke from bleeding on the brain. My Doctor said it was caused by excessive blood thinning from the high doses. Since I was already on blood thinners this was a disaster. He also said that the pills significantly raise chloresterol which leads to clogged arteries and heart attacks. In three 1/2 years we have had several reports of users here who have had strokes and heart attacks while on Phytoestrogens. All took the megadoses recommended for trans people. To me this is proof that phytoestrogens are not safe at least for trans people. The slight miniscule growth I got was not worth a stroke. All of us reported this to the manufacturers who did not return our calls. This indicates they know full well of the risks though they still insist they are safe.

Editor’s note: In August of 2004 I went to an Endocrinologist who prescribed .4mg Estradol and 2 mg of Premarin. In November of 2004 I had to stop hormones because of a bloodclot in my leg. I am Presently hoping to restart hormones soon after blood levels are satisfactory. When I do restart it will be without the Premarin.

I used to kid my girlfriend about her cleaning habits. No matter where she was she always felt obligated to clean up. I’ve always at least cleaned up after myself but not to the point she does. Even if we’re in a bar she’ll take everything in front of us bring it up to the bar, ask for a rag and wipe up the place we were sitting in front of. She’d even do this kind of thing in other peoples homes. I’d explain that’s what waitresses are paid for. Now after restarting hormones for a couple of months I find myself doing the same thing everywhere I go. Even others have noticed. My bartender recently pointed that out to me. I don’t even think about it.

Another change is I’ve always been into video games. I’d spend hours at it. I even had a web site devoted too it. Suddenly I stopped and lost all intrest and closed the site and stopped playing. While I’ve never been a sports nut I always at least watched the major games especially when the local teams were playing. Now I’m not intrested at all. Out of the blue I developed an intrest in sewing. I used to throw out shirts with missing buttons and now I’m making myself an apron. Wow! Does this mean at the family holiday gatherings I’ll automatically start washing dishes with the girls instead of watching football with the guys? I tend to think so. The wierd thing is my behavior is changing and I’m not even offically out of the closet yet, though that will be soon. Even the words I’ve used have changed all without even thinking about it. It makes me wonder who creates stereo-types. Is it really society or hormones? Fortunatley I don’t mind these changes. In fact I embrace them.

About three years ago I tried the hormones for the second time. I stayed on them for almost six months. Then something happened that scared me and I suddenly stopped them. I’ll tell you why. I always have always been attracted to women. if you check my bio you’ll see that I can’t stand men. I can’t even imagine a friendship with one let alone a relationship even if I become the woman I desire. One day I noticed something. This woman whose derrierre I have admired and lusted after for years suddenly didn’t intrest me. Instead I noticed this one guys ass and it shocked the hell out of me enough to quit the hormones. Why? Was it psychological? I don’t think so.

This time on hormones (2 months) I’ve noticed none of that. if anything, no one intrests me any more. The one thing I did notice was that all three times on hormones I did notice one thing though. I suddenly got intrested in shopping… shopping… Shopping.

Hmmmm.. so my changing estrogen soaked brain is coming to a conclusion here, but is it logical? If you want to stop a woman from shopping give her testosterone and if my girlfriend wants her sons to clean there rooms she should give them estrogen. I wonder if all the worlds problems could be solved this easily?

Sounds logical to me.

Laura, 2006 @ Laura’s Playground

Female to Male Transgender: Hormones

Any person on hormones is a chemistry experiment. It is very important to listen to the FTM (or MTF) as they tell you what is occurring for them physically and emotionally. FTMs have learned to watch and monitor the changes they experience over time. On this note, it is very important that if you have a pre-op transsexual come to you for help, you educate that person to listen to their body and know how to monitor changes. It will be up to them to guide you through their changes so that you can help them navigate their future health as safely as possible. This is also true for the individuals who choose not to do hormones or surgery. Transsexuals are often dissociated from their bodies due to the schisms they experience between the way they feel and the way their bodies are (sometimes) perceived by others, or the way they know their bodies are. Many transsexuals have extremely high thresholds for pain, or cannot differentiate pain from other experiences.

It is important for every FTM to get a complete blood work-up before even beginning hormone therapy. Those who decide to go through the black market to obtain hormones are at risk for a variety of health problems. Even if someone comes to you who is not receiving injections through a program or doctor following the Harry Benjamin Standards of Care, it is important to listen closely to what they tell you. They will often times be able to tell you what it is that they need from you. (We do not wish to imply that we are telling you to throw out your knowledge or ideas. We simply ask that you not throw out the information and knowledge being given to you by the FTM in your office.)

Once hormone therapy has begun, it is a good idea to do blood work-ups every three months for the first year. If there are no indicators of complications, this can be changed to every six months in the second year. After the third year, unless complications arise, once a year is not unusual practice for blood work-ups. The blood work-ups should not only monitor bilirubin levels for the liver, but should also monitor the cholesterol level. An occasional check of the serum testosterone level is a good idea, to be certain that the level is within the normal range for a male of the patient’s age.

In the United States, the most common approach to hormone therapy for the FTM is intramuscular injection. This is usually prescribed at 200 ml/cc, lcc every two weeks. This can vary between individuals, and it will take time to determine the proper dosage and frequency of injections. Testosterone Cypionate, a cottonseed oil suspension, and Testosterone Enanthate, a sesame seed oil suspension, are the two most common forms prescribed. There are doctors who insist on administering the shots. However, most doctors will do so only for the first few injections, and will then teach the FTM how to inject himself so the FTM can take care of this at home. Most doctors who insist on injecting the hormones themselves are also charging higher rates for the injections as well as the office visits. This usually occurs in rural areas or isolated areas where the FTM has little choice but to comply. Oral Testosterone is still sometimes prescribed, but is strongly discouraged. The high doses of testosterone administered through this method are harmful to the liver. This method has also caused high blood pressure in many FTMs.

A growing number of FTMs who have been on hormones for 4 to 5 years who have not had hysterectomies, have developed intrauterine complications. These range from endometriosis to fibroid cysts, to fibrous scar tissue forming around the reproductive organs, to absorption of the organs into the abdominal muscles or even, in a couple of cases, into the intestines. The rising number of FTMs who have been experiencing these complications has pushed many of us to ask for an hysterectomy earlier in our transition. Many FTMs, however, do not experience these problems, and for them hysterectomy may be an unnecessary surgery. Some FTMs require hysterectomy/oophorectomy for psychological reasons.

Some FTMs may experience migraines in the first few months of hormone therapy. This can sometimes be alleviated by adjusting the dosage or the frequency of injections. Whether the dosage should be raised or lowered varies from person to person. This is a totally experimental stage, and also a very important time for the doctor to be listening to the instincts of the patient. Many FTMs choose to weather the headaches. They usually dissipate after 3 – 6 months. Others may experience cold-like symptoms in the first few months; others may be at a higher risk for yeast infections for the first few months.

Diet is very important. Lowering fat intake will reduce the risks of high blood pressure and heart disease. Taking supplements of milk thistle can assist the liver in processing any toxicity. Smoking and drinking should be discouraged. If the FTM intends to pursue any kind of surgery, he should be educated on the damage smoking does to the vascular system. Most surgeons performing any of the alterations sought by transsexuals insist that the patient quit smoking 6 to 9 months before surgery.

Hormone therapy begins at different times in life for different people. Those who start at a very early age will probably notice a variety of changes at several stages of their lives. Even people who do not walk this path experience hormonal fluctuations throughout their lives. Those who begin hormone therapy later on in life will probably have fewer fluctuations, but will need to pay closer attention to the changes that do occur. Anybody is at risk of arthritis and heart disease, but with the added factor of hormone therapy, the usual course of events may not apply. It is also important to note that all of this information will vary from person-to-person depending on age, ethnicity, diet, and current health.

Listed below are some of the differences between the cypionate and enanthate suspensions.

Testosterone cypionate&emdash;This form brings on the secondary male characteristics sooner than enanthate. However, since this is a cottonseed oil suspension, more guys have a variety of allergy reactions to it. These reactions can manifest in the form of mild rashes or itching at the site of injection. Acne is usually more prevalent and harder to control. Muscle and bone density increase is fairly rapid. However, ligaments and tendons are at risk of damage or injury because they take longer to “beef up” in correspondence with the muscle/bone increase. Any sport activity for the first two years of hormone therapy should be approached with this in mind. The voice usually begins to change at two months and settles at about nine months. Body hair appears within the first two months and can continue to grow in new places up to seven years. Balding is a very real possibility. It can begin as soon as three months into hormone therapy. Fat distribution shifts: thighs and hips may flatten out. However, fat frequently does not disappear, it merely shifts to the sides and the gut. Depending on the FTM’s body type and diet, the person will gain or lose weight.

Testosterone enanthate&emdash;Since this is a sesame seed oil suspension, it is usually easier for the body to absorb. The secondary male sex characteristics usually take longer to manifest than with the cypionate – usually the process is 3 – 6 months behind, though this can vary, too. This slower body adjustment can make it easier on the tendons and ligaments, however, the risk for injury still exists. Acne is less of a problem, and for some has been non-existent.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor