HORMONE THERAPY- GENERAL OUTLINE



Introduction
This section gives a general overall view of what to expect when you start along the transition path. It does give a fairly full description of Hormone Therapy as this is possibly the biggest area of concern for people starting out due to the dangers and permanent changes that take place.

Before You Do Anything
Before you even consider starting Hormone Replacement Therapy or changing your name, you should prepare yourself psychologically - Be sure you know what you really want - Be prepared to make lots of sacrifices and face many losses and hard times emotionally to get what you want.
Tell your partner, parents, closest friends and find a good G.P. who has a background in sex counselling at least, and if possible, who has treated others in your situation.
If you are married or have a long term partner consider taking them along too, as it involves you both. Tell your G.P. 'the whole story', let him or her (note women tend to be more compassionate and understanding) try a few things - they need to eliminate any possibility of mental illness or fetishes which can manifest similar symptoms. They may try "Prozac" type drugs in the short term to eliminate these possibilities. This and the associated counselling may take six months or more.
Then when the G.P. is fully satisfyed that your case is genuine, you can start thinking about Hormone Replacement Therapy (H.R.T.). Remember, include your partner in this decision.

Before you actually start H.R.T. be sure your G.P. takes a full blood test including -

Your G.P. may refer you to an Endocrinologist, a blood and hormone specialist, to supervise your H.R.T. as this is their field of expertise.

It is very important to have a record of baseline tests in case of complications. H.R.T. is a very invasive type of treatment and has many side effects.(Get your G.P. to explain anything you don't understand before proceeding).
Some side effects are reversible if you decide to stop H.R.T. for any reason. Some however are not, and after 12 to 18 months most changes are permanent.
Remember these are dangerous chemicals DON'T ABUSE THEM.
Overdosing on testosterone or estrogen wont make things happen any faster or make things bigger, just cause problems!.

Hormones and their effects

Female hormones on Males
Nausea is very common and severity depends on dosage and your individual body chemistry. It relates very closely with morning sickness of which pregnant women often suffer but isn't just restricted to mornings. Some people can tolerate only very small doses of estrogens (Note there are different medications available one may cause less of a problem than another ).
Nipples become very hard and sensitive, nipples and breasts can become itchy and even painful to touch. This usually subsides after 2 or 3 months. You may find you develop darker pigment spots in the skin, this is the same as what happens in pregnant women and are referred to as 'hormone spots' the number, and colour vary greatly between individuals, but are usually not a major problem.
Under the influence of estrogens and anti-androgens libido diminishes and erections eventually stop.
There can be depression of varying degrees, bouts of unexplained crying similar to "baby blues" which many women suffer from shortly after the birth of their baby.
There is usually a reduction in body hair growth and some redistribution of body hair. Body fat is also redistributed - from tummy, back, arms, and shoulders; to the thighs, chest (breasts), hips, and bottom. There is usually some weight gain associated with this, which you will find is much harder to get off than before, and a general rounding of the body into a more female shape is quite noticeable.
Upper body strength diminishes and voice may also change becoming noticeably higher. Some people also report changes in the quality of finger nails which can become brittle and peel, and hair which can become dry and brittle. These effects are particulaly noticed if taking large doses of Androcur.

Male hormones on Females - Androgens The majority of changes here are non-reversible almost as soon as they are apparent and include a significant increase in body and facial hair, deepening of the voice, development of more pronounced muscles in arms and legs, (particularly with exercise). There can also be some minor reduction in body weight, an increase in libido, and increase in stamina and in some cases a tendency to become aggressive and violent easily.
Menstruation will stop, breasts may reduce in size slightly and body fat will redistribute into a more male typical pattern.

Further considerations

These Hormonal effects are noticeable to others, so before they become too noticeable (2-4 months) it is a good idea to have your transition planned out. Let relatives and friends know, talking to them in person is best but also by personal letter or lastly by phone could suffice, then it's up to them to decide how they will adjust. This is where things can become hard: you may well lose friends or relatives who are unable to cope with the situation but your real friends will stick by you and the decision you have made.
Your family, friends and G.P. will become your support network who you can fall back on when times get tough.

Another area of concern for many people going through transition is facial and body hair. For F-M people time and a good H.R.T. regime will 'cure' their problem of lack of hair but for the M-F people hair particulaly facial hair can be a real problem and often either delays their transition or makes transition more difficult.
H.R.T. will help slow, but will not stop facial or body hair growth see the page on Electrolysis and Hair Removal for more information .

We have already covered some medical aspects to do with H.R.T. and its dangers. We stress again don't be stupid with these chemicals - THEY CAN KILL!.
There are a few less common problems that can occur. Statistics show 30 percent of the general population have pituitary adenoma, a non-cancerous, benign tumor of the pituitary gland at the base of the brain. Most of the people who have these are totally unaware of it, and it never causes a problem. This gland controls the sex hormones, body temperature, metabolism, calcium in the blood, and to and from the bones. What symptoms are seen depends on which part of the gland the tumor is located. With H.R.T. these can become quite apparent. The most common is raised blood prolactin levels in response to estrogen intake. Prolactin is the hormone that triggers lactation and production of milk in the breasts of pregnant women. Taking large dosages of an estrogen hormone (Premarin and Estigyn are two) in the hope of increasing breast size or speed of development of the breasts this often has the opposite effect, and can also cause lactation ranging from minor nipple discharges to full on 'need nursing pads' type milk production. This is bothersome and at times embarrassing. If not controlled, excessive estrogen levels can lead to eyesight problems by causing the tumor to grow and put pressure on the optic nerves and could eventually lead to blindness. A doubling of the blood prolactin levels can mean a doubling in tumor size!

Another common problem with over use of estrogen is the possibility of blood thickening and clotting. This can be a significant problem that can cause thrombosis, varicous viens and even strokes it is the main reason some surgeons ask you to stop your H.R.T. prior to any major surgical procedures being performed.

Another problem occurs if you stop or reduce your hormone levels significantly over a short space of time. You can encounter symptoms of menopause, irritability, emotional outbursts, general emotional instability, spontaneous crying, hot and cold flushes. It is important to reduce or stop your hormones under supervision of your G.P. or Endocrinologist.
Both of the above are avoidable or at least controllable under supervision. There are several drugs available to control prolactin levels but prevention is better than cure. Why increase the chemical loading of your body unnecessarily? Weaning off hormones slowly reduces the likelihood of menopausal symptoms.

The most common H.R.T. regime's here in Australia for male to female persons are:-
Estrogens
Premarin Between 2.5 and 3.75 mg (milligrams) per day or
Estygin between 50 and 150 mcg (micrograms) per day
In combination with
Anti-Androgens such as
Androcur between 50 and 150 mg per day or
Aldactone between 100 and 200 mg per day

Some specialists are also perscribing 'Provera' a progesterone hormone at between 5 and 10 mg per day, it is believed this helps with breast development, general shape and maturing of the breast milk ducts.
There are quite a number of other combinations and delivery systems including Dermal patches, time release sub-dermal implants, and injections, each have their advantages and disadvantages. Discussion of these are however beyond the scope of this info-file, ask your GP or specialist if you would like more information on H.R.T.
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