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    • Diyhrt.com

      Typical Results

      By Diyhrt.com, in Articles,

      While the individual's response to feminizing therapy will vary, we have observed several key changes that appear for the majority of transgendered women in addition to the general estrogenic effects related in Section 5.
      Breasts
      For the transgendered woman, breast development will vary greatly, as it does with the genetic female population.  However, breast development will typically be less than what is experienced in the genetic female population.
      With the transgendered woman, breast tissue growth is basically promoted by estrogens and anti-androgens.  Under most circumstances, breast development exceeding a B cup is rare. Development will take at least 2 years to reach maximum size.
      Changes in the nipple will likely be somewhat less than in the genetic female. The areola (the small ring of color around the nipple in the center portion of the breast) will change in appearance and size in relationship to the breast.
      Soon after beginning hormone therapy (about 2 to 3 months), there will be a nodule-like formation behind the nipple and a feeling of tenderness or sensitivity in the area. This early stage of development is caused by an increase in the ductal system behind the nipple is part of the transition process and will usually normalize in a matter of months.
      Body Hair
      Depending on how hirsute (possessing hair) an individual's body may be, body hair will generally lessen noticeably to almost entirely over a period of several years.  Individuals will generally notice a diminishment of bodily hair occurring on the extremities, and most of the torso.  As example, arm and leg hair as well as hair on the abdomen, chest, and shoulders will greatly lessen and in some instances disappear completely.  Hair growth in specific regions including that around the areola, armpits and pubic area will not lessen to the same extent.
      Skin
      The general appearance of the skin, overall, will change greatly by becoming softer and less coarse.  With proper skin care, which includes protection against the damaging effects of the sun, the skin's general appearance will be noticeably enhanced by the influence of estrogen and anti-androgens.
      Fat Distribution
      Over a period of time (1 to 2 years time), a change in the subcutaneous fat (located just beneath the skin) will occur.  The hips, thighs and buttocks will collect the majority of this distribution, and the tendency to collect fat in the stomach will diminish somewhat. The resulting redistribution will result in a smaller waistline and larger hips.
      Muscle Mass
      A good deal of the size that is normally attributed to large or broad shoulders, arms and chest is actually contained in upper body muscle mass—not bones.  Through the process of feminization much of the upper body bulk will disappear.  Muscle mass will generally take longer to diminish (about 3 years) than the accompanying shift in fat distribution previously mentioned. As upper body mass is lost, a certain degree of looseness may be seen in the skin of the upper arms and shoulders. As is the case with normal weight loss in these areas, a period of one to two years may be necessary for the skin to adjust to the smaller frame.
      Genitals
      Genitals
      With regard to appearance, hormone therapy will produce its most marked change in lessening the size of the testes. Due to the influence of estrogen, the testes' production of testosterone and sperm will be greatly reduced.
      Penile size will likely diminish somewhat.  While penile skin is used for lining the neo-vagina, the amount of donor skin available is more a matter of inherent size than that of the diminishing effects of testosterone. Sexual function will decrease, but the degree of which is unpredictable. Erections may still continue, but will probably be much less frequent and long lasting, or may not be possible. Ejaculate will lessen, probably to the point of only producing a very small, clear discharge as a result of the prostate and the associated structures responsible for semen production being impeded. (See Section 9, Male Genital Anatomy)
      Prostate Gland
      The prostate will diminish in size due to the effects of estrogen and finasteride (Proscar), the latter being administered as an anti-androgen. Beside from the feminizing effect of these medications, both drugs are helpful in the treatment of benign prostatic enlargement.  This condition is often responsible for the difficulty with urination experienced by many older individuals. Through the course of hormone therapy, this urinary complaint will likely be relieved.
      Cardiovascular
      Coronary heart disease is the leading cause of death in the United States. Due to various lifestyle and hereditary factors, cardiovascular conditions may pose additional risks to those undertaking elective medical therapies, such as the variety of drug treatments engaged in the feminization process.  However, the effects of hormonal therapy may be similarly beneficial to the male-to-female transgender patient with respect to arteriosclerotic plaque disease and cardiovascular conditions, as it demonstrates itself in the genetic female population.
      Infertility/Impotence
      Infertility/Impotence
      Long term use of estrogens may likely result in infertility, with permanent infertility being a distinct possibility.  Sexual responsiveness will likely diminish over the course of hormonal therapy, potentially resulting in the inability to achieve or maintain an erection.  These effects are the basis for feminizing hormone therapy being termed chemical castration.
      If the transgendered individual has any concern or desire to "father" children in the future, it is imperative that the male-to-female transgendered individual choose the option of sperm banking –  having samples of their sperm frozen and stored for later use – prior to beginning hormone therapy.  
      Results Not to be Expected
      Given a discussion of the physical changes that are typical as a result of feminizing hormone therapy, some misconceptions concerning the process arise. The following topics address those physical changes that one will see very little or no change specific to the hormonal regimen.
      Beard Hair
      Whatever active hair is present in the beard area upon onset of hormone therapy will remain.  Given years of hormone therapy and removal of the testicles, the beard will remain albeit somewhat slower growing and not quite as thick. Naturally, this status is far from acceptable.  A method of permanent hair removal, or combination of methods thereof, must be used to rid oneself of facial hair.
      Permanent hair removal will show its greatest results by concentrating efforts on those areas least affected by hormone therapy, i.e., the beard area, and leaving treatment of chest hair and the like until last, if treatment is even required at all. See Electrology Guide.
      Raised Voice
      The depth in pitch and resonance of the voice are unaffected by hormone therapy.  However, inflection and manner of speech are very well suited to change.  Additionally, pitch can be raised through persistent vocal practice.  Given the importance of a gender congruent voice, surgical options have been explored in an attempt to alter pitch, but this most delicate of instruments is not likely to be properly retuned through surgery.
       
    • Diyhrt.com
      The general process of supplementing a woman's natural hormones is often called hormone replacement therapy or HRT. The oldest form of supplemental hormones is estrogen.  When estrogen is taken alone (that is, not mixed with a progestin), it is called unopposed estrogen (also, estrogen replacement therapy or ERT). When estrogen is taken in combinationwith progestins, the process is called combined hormone therapy.
      For transgender women, the standard HRT regimen is inadequate. The latest and most effective therapies include more potent estrogens and anti-androgens.  This combination of medications not only offers greater feminization, but also provides a greater reduction of the masculinizing effects from past virilization.  Each regimen and form of administration not only has its own specific benefits, but also carries with it a variety of differing risks.
      Over the years, we have used many different feminizing and de-masculinizing drugs with our patients in order to maximize the positive benefits while reducing any negative side effects. The feedback from these ongoing treatment methods coupled with consultations with other professionals, and discussions with patients who have experienced other regimens have allowed us to compile a sizeable amount of data concerning the administration of hormonal therapies. 
      The following is a brief synopsis of medications that are used in feminizing hormone programs.
      Estrogen
      ESTROGENS - ORAL USE
      Estradiol (Estrace)
      17-Beta Estradiol provides the most potent estrogen available, and is most commonly taken by mouth. It may also be administered by way of a skin patch or injected into muscle, whereby the drug travels expeditiously through the bloodstream to the areas it affects or targets.
      Oral estradiol provides a very effective means of feminization. Its dosing and subsequent adjustments, like other medications to follow, is dependant on measured testosterone levels, the degree of feminization achieved, side effects and other impediments to a healthy condition.
      Oral estradiol is usually supplied in 0.5 mg (milligram), 1.0 mg, and 2.0 mg tablets.
       
      Conjugated Estrogens-Naturally Occurring (e.g., Premarin)
      The most common mixture of natural estrogens is called Premarin. Derived from the urine of pregnant mares, Premarin contains a number of different (conjugated) estrogens and is obtained through the extraction process.  Compounds derived from such a process not only subject animals to unduly harsh conditions, but may contain additional substances  that create a potential for unknown or adverse effects.  In our observation, there is a greater likelihood of mood swings and depression seen in patients using naturally derived estrogens as compared to synthesized preparations such as estradiol. 
      Conjugated Estrogens-Synthesized (Cenestin)
      Conjugated estrogens may be synthesized also. One such medication, Cenestin, is a slow-release conjugated estrogens product derived from plant sources.  Cenestin contains the same three primary and six minor estrogens found in Premarin.
      Other Estrogens
      Other plant-derived estrogens, called esterified estrogens, are usually made from modified soy (Estratab, Menest).
      Estropipate (Ogen, Ortho-Est) is a version of estrone, a weaker form of estrogen.
      ESTROGENS - FOR INJECTION
       
      home > Medical/Hormonal > Resources > TransGenderCare Medical Feminizing Program
       TRANSGENDERCARE MEDICAL FEMINIZING PROGRAMCONTENTS  
      •About :About the TransGenderCare Medical Feminizing Program.
      •Introduction :Introduction to our Medical Feminizing Program.
      •Regimens :TransGenderCare's specific regimens and dosing tables.
      •Section 1 :The Biochemistry of Gender.
      •Section 2 :The Hormonal System. 
      •Section 3 :The Biochemistry of Sex Hormones.
      •Section 4 :The Feminization Regimen.
      •Section 5 :A Look at Medications.
      •Section 6 :Typical Results of male-to-female hormonal therapy.
      •Section 7 :Measuring Your Transition — recording body size measurements during transition.
      •Section 8 :Male Genital Anatomy — a summary review of external and internal anatomy.
       CLICK ON AN ITEM, ABOVE, TO GO TO THAT TOPIC   
       SECTION 
      5
      Page:About Intro Regimens 1 2 3 4 5 6 7 8
      A Look at Medications
      Forms of Feminizing Hormone Therapy
      The general process of supplementing a woman's natural hormones is often called hormone replacement therapy or HRT. The oldest form of supplemental hormones is estrogen.  When estrogen is taken alone (that is, not mixed with a progestin), it is called unopposed estrogen (also, estrogen replacement therapy or ERT). When estrogen is taken in combinationwith progestins, the process is called combined hormone therapy.
      For transgender women, the standard HRT regimen is inadequate. The latest and most effective therapies include more potent estrogens and anti-androgens.  This combination of medications not only offers greater feminization, but also provides a greater reduction of the masculinizing effects from past virilization.  Each regimen and form of administration not only has its own specific benefits, but also carries with it a variety of differing risks.
      Over the years, we have used many different feminizing and de-masculinizing drugs with our patients in order to maximize the positive benefits while reducing any negative side effects. The feedback from these ongoing treatment methods coupled with consultations with other professionals, and discussions with patients who have experienced other regimens have allowed us to compile a sizeable amount of data concerning the administration of hormonal therapies. 
      The following is a brief synopsis of medications that are used in feminizing hormone programs.
      Estrogen
      ESTROGENS - ORAL USE
      Estradiol (Estrace)
      17-Beta Estradiol provides the most potent estrogen available, and is most commonly taken by mouth. It may also be administered by way of a skin patch or injected into muscle, whereby the drug travels expeditiously through the bloodstream to the areas it affects or targets.
      Oral estradiol provides a very effective means of feminization. Its dosing and subsequent adjustments, like other medications to follow, is dependant on measured testosterone levels, the degree of feminization achieved, side effects and other impediments to a healthy condition.
      Oral estradiol is usually supplied in 0.5 mg (milligram), 1.0 mg, and 2.0 mg tablets.
      Conjugated Estrogens-Naturally Occurring (e.g., Premarin)
      The most common mixture of natural estrogens is called Premarin. Derived from the urine of pregnant mares, Premarin contains a number of different (conjugated) estrogens and is obtained through the extraction process.  Compounds derived from such a process not only subject animals to unduly harsh conditions, but may contain additional substances  that create a potential for unknown or adverse effects.  In our observation, there is a greater likelihood of mood swings and depression seen in patients using naturally derived estrogens as compared to synthesized preparations such as estradiol. 
      Conjugated Estrogens-Synthesized (Cenestin)
      Conjugated estrogens may be synthesized also. One such medication, Cenestin, is a slow-release conjugated estrogens product derived from plant sources.  Cenestin contains the same three primary and six minor estrogens found in Premarin.
      Other Estrogens
      Other plant-derived estrogens, called esterified estrogens, are usually made from modified soy (Estratab, Menest).
      Estropipate (Ogen, Ortho-Est) is a version of estrone, a weaker form of estrogen.
      ESTROGENS - FOR INJECTION
      Estradiol Valerate
      Estradiol Valerate is formulated as a longer-acting product that is usually contained in an oil preparation. Like oral medications, injectable preparations are manufactured in differing strengths. In the case of Estradiol Valerate, the drug is typically formulated in a concentration between 10mg to 40mg of active ingredient per milliliter (mL).
      While some may be fearful of injection, the amount administered will usually be contained in one mL. To give an idea about that amount of liquid, a small spoon holds about 5 milliliters. Estradiol Valerate may be typically injected weekly to monthly, with the frequency/concentration based on the measured testosterone levels for the patient.
      The more direct route of administration provided by injection may speed the physical change by creating a higher and more constant source of estrogen.  Ideally, injection should require less processing by the liver, but all to often improper administration (poor or no monitoring, self-medicating, etc.) instead creates undue health risks.
      ESTROGENS - TOPICAL USE (Through the skin)
      Interestingly, some of the most ineffective as well as some of the most beneficial preparations are available in topical form.
      Creams
      Estrogen creams (e.g., Premarin cream) are sometimes applied to areas of the skin, such as the breasts. The benefits from such an approach usually range from very minimal to unfelt.
      Skin patches
      Medication skin patches, also called transdermal or percutaneous patches, provide a very effective means of medicating.  In this approach, the estrogen (estradiol is used) is transferred into the body directly through the skin.  The transdermal approach offers ample delivery of medication for full feminization.  And its consistent and prolonged release make for a safe and sensible approach.
      But the transdermal approach is pricey, being probably the most expensive means of administration.  Some individuals suffer skin irritation related to the adhesive. For others, the presence of a patch is awkward or tends to come loose from the skin, especially during sustained activity, such as sports or outdoor activities.  The adherence problem can be addressed with the use of a skin preparation that helps the patch stay in place even in the presence of moist conditions or heavy perspiration. See A Sticky Solution to Transdermal Adhesion Problems.
      Transdermal patches uniformly contain estradiol as the active medication, produced in 0.05mg (50 micrograms, 50 mcg) and 0.1 mg (100 mcg) concentrations, and are branded under a variety of names such as Climara and Alora. The reader will notice that the dose amount contained in the patch is about one-tenth to one-twentieth as the same drug that is taken orally.  These concentrations are considered potent since transdermal entry of the drug is many factors more efficient than oral administration.
      Progesterone
      PROGESTINS (PROGESTERONE) - ORAL USE
      As mentioned in Section 5, progestins have an arguable positive effect for the transgender individual. It is likely that if a progestin is chosen, a minimal dose of oral medroxyprogesterone acetate (Provera) may be given on a cyclic basis.  Such a typical regimen may provide for its use for about ten days of the month.  Less likely would be its use on an uninterrupted basis.
      PROGESTINS (PROGESTERONE) - FOR INJECTION
      A progestin may also be given by injection. The same medication, medroxyprogesterone acetate, is available in an aqueous suspension for injection. It is typically branded as Depo-Provera and its typical use is to provide long-term (about three months) contraception from a single injection. Another injectable medication sometimes chosen for transgender use is hydroprogesterone caproate (Proluton Depot). From our experience, we do not see a benefit from the use of injectable progestins. Patients have regularly expressed complaints and have suffered adverse side effects.
      Anti-Androgens
      The use of an anti-androgen has been used for many years by endocrinologists as a biochemical means of controlling unwanted hair growth in the genetic female. In recent years, this treatment approach had been introduced in treatment of transgendered women and is now being widely practiced.
      It has been our experience that anti-androgens have a role second only to estrogen in the feminizing process.  Further, without the use of anti-androgens, adequate and desirable demasculinization will likely be greatly curtailed. And following genital surgery or castration, continued use of anti-androgens is strongly recommended if continued feminization is expected.
      Spironolactone (Aldactone)
      The drug most commonly used for the task of diminishing one's response to androgens is spironolactone (branded as Aldactone). Like many other drugs in the category of anti-androgen, spironolactone is used other than for its primary or generally intended purpose.  In the case of spironolactone, it is a diuretic and anti-hypertensive medication.
      Spironolactone is a good choice for an anti-androgen.  It is generally well tolerated, even when administered over a period of years. And when by happenstance, a mildly hypertensive patient enters into transgender treatment, often spironolactone can be provided as a substitute; by doing so, the medication now serves a dual purpose.  While spironolactone is a potassium saving diuretic, the normal monitoring of blood chemistry during transgender treatment assures its safe administration.
      Patients often report increased unpleasant side effects (such as a need for frequent urination) when doses over 300mg per day are taken. Typically doses of 200mg daily or less are well tolerated.
      Finasteride (Proscar, Propecia)
      Another good choice for an anti-androgen is finasteride (Proscar, Propecia), and is able to be used in concert with spironolactone. The primary use of Proscar (finasteride 5 mg) was in the treatment of benign prostatic enlargement, but with its reintroduction as Propecia (finasteride 1 mg), the drug is being largely marketed to promote scalp hair growth.  For transgendered women, finasteride when given in the larger dose promotes not only scalp hair growth but acts as an potent anti-androgen as it is highly effective in inhibiting the conversion of testosterone to DHT (dehydrotestosterone) responsible for male sexual characteristics.  Finasteride is usually physically well tolerated over long durations, but is expensive. 
      Anti-Androgens whose potential risk may outweigh their benefit
      Keep in mind that unlike estrogens, the drugs that are used as anti-androgens, when initially released, were typically intended for a variety of medical conditions, including some very serious conditions. In effect, through clinical use, these drugs have been re-purposed for a feminization regimen.
      Typically, drugs that address more serious medical conditions (e.g., cancer) have effects that may be not only potent, but harmful and unexpected, as their potential hazards may far outweigh their benefits. Simply put, these drugs may be more harm than good.  Such drugs include:
      Leuprolide acetate (Lupron)
      Leuprolide acetate (Lupron) is used as an anti-androgen as it has the potential to reduce testosterone to castrate levels. It is an analog of naturally occurring gonadotropin releasing hormone (GnRH or LH-RH). The analog possesses greater potency than the natural hormone. Lupron is normally used in the treatment of advanced prostatic cancer when orchiectomy (removal of the testicles) or estrogen administration are either not indicated or unacceptable to the patient.
      Lupron does carry a variety of risks that have been associated with its use including a variety of cardiovascular difficulties (congestive heart failure, ECG changes/ischemia, blood pressure changes, murmur), musculoskeletal pain and fluid retention.  While the non-transgender male suffering from prostatic cancer may consider these risks acceptable as compared to castration or estrogens, these same risks seem absurd in the parlance of a feminization regimen.
      Flutamide (Eulexin)
      Flutamide (Eulexin) is another drug used ordinarily in the treatment of prostatic cancer and has somehow been adopted as acceptable medication in transgender treatment.  Flutamide carries the risk of liver injury to the patient.
      Ketoconazole (Nizoral)
      Ketoconazole (Nizoral) similarly carries the potential of injury to the liver, however its normal use is as an anti-fungal agent.
      Cyproterone acetate (Androcur)
      Cyproterone acetate (Androcur) is an anti-androgen that has been used to treat hypersexuality and sexual deviation in men; it is also used in the treatment of cancer of the prostate. It is used, in part,  to treat severe acne in women.  Its high-dose treatment sufficient for a feminization regimen may cause liver damage, resulting in jaundice or hepatitis.
      Overview
      When one considers the advancements and availability of sound medical management in the area of transgender treatment, most often the feminization regimen required for the transgendered individual can be handled with little complication.  Today, there are well trained providers available worldwide.
      Sadly, too few individuals have addressed their own internal conflicts and fears concerning their transgenderism. As a result, addressing one's transgender concerns may unsettle the individual wishing to pursue proper and sound medical treatment. The individual who may readily appreciate the risks associated with self-medication and less than acceptable therapies under other circumstances, may opt for such solutions in the transgender milieu.  And accordingly, the likelihood of serious health risks and poor outcomes is unacceptably high as a result. Sensibility and proper medical management are the cornerstones for a successful outcome. 
    • Diyhrt.com
      Feminizing hormone therapy is generally a safe process, and the likelihood of being physically able to undergo hormonal reassignment is very good.  But to assure your well being and that the hormonal process will produce the utmost results, a medical evaluation is very important, and periodic blood monitoring is a necessity. 
      Medical Evaluation
      The physical evaluation should include a health history, diagnostic laboratory (blood and urine) testing, and physical examination. Most individuals are in generally good health and can comfortably begin a hormonal regimen without compromising their health status.  And if one is in good health, additional flexibility may be possible when receiving transgender treatment.
      Often one's primary care physician (or local physician contacted) may likely oversee general health care matters during transition provided that hormonal management is obtained elsewhere.  During the course of managing our extended transgender medical program—treating patients literally coast-to-coast, we have often found that our patients had easy local access to general health care.  However the local/primary care physician was typically not comfortable with directly prescribing as this was not their area of expertise. But the local/primary physician was comfortable in providing indirect transgender care—providing a baseline of the person's health status (e.g., initial physical exam, etc.) and overseeing routine health care matters without directly prescribing.  In such a case, our gender program would medically coordinate by periodically reviewing laboratory data via ordering necessary blood testing and prescribe the appropriate medical feminizing regimen.
      But when other medical conditions are present, such as hypertension, heart disease, obesity, diabetes, and liver disorders, amongst others, transgender medical care must be addressed with additional caution. Other important factors include alcohol, drug and tobacco use. 
      By fully and accurately disclosing all other medications currently being taken, your hormonal management will not interfere with other medical therapies you may be undergoing. Through the use of drug interaction software, your physician will be able to analyze multiple types of differing medication being taken for potential side effects or adverse reactions.  And combined with regular diagnostic review, good health can more effectively be maintained throughout one's entire transition. Keep in mind that completion of your physical transition is not the end, but the beginning of a new lifestyle. Your future physical well-being will play a vital role in fully enjoying the years ahead.
      The Process of Hormonal Reassignment
      Male-to-female hormonal therapy is a crucial therapy in the transition process. The process of hormonal feminization, while essential, is one that nature does not permit to be unduly rushed or accelerated. Given the best of techniques, the genetic male's full response to feminizing therapy appears over a matter of years; this process can be akin to a second puberty.
      The bodily processes that are about to be undermined and redefined have been in place since birth. Because of the altering effects of testosterone, not all of the masculine physical characteristics can be hormonally reversed. Many characteristics such as height, the bones that comprise the hands and feet, as well as facial bones have been well defined before the time of hormonal adjustment. And as well, one's genetic makeup is male, so tissue response to feminizing factors for the male may not be as efficient as the genetic female. 
      However, many more changes will likely be in store than are usually anticipated. The musculature of hands and feet will diminish.  While the bones comprising these appendages remain unchanged, often the reduction in musculature reduces ring and shoe size.  The skin's appearance will also change markedly.  Facial contour will be redefined by hormonal influence, and much of the angularity and fullness in the lower face will disappear due to electrolysis beard removal. See Electrolysis Guide.
      Fat distribution will redefine the general body shape, consistent with the typical hour-glass shape of the genetic female.  Also, medical and hormonal therapies will restore, partially or fully, the fullness and pattern of scalp hair that may have diminished due to the effects of testosterone and DHT.  While hormone therapy has little effect on beard hair, bodily hair will likely diminish to a large extent.
      For hormonal and related medical therapies to be successful for the whole person, body as well as spirit, one should realize that there is only a fine line of demarcation between a successful feminizing/ beautifying process and a life of endless physical preoccupation, continually focusing on physical imperfection.  As daunting as the physical process may appear at the onset of transition, the real obstacle for many is failing to fully realize the emotional growth that this undertaking may require. (See Gender Expressions)
      The Drug Regimen
      While the overall process of hormonal feminization is somewhat straightforward, a variety of factors contribute to the wide range of outcomes; certain medical conditions may require special attention, testosterone levels vary over a wide range in normal healthy males, and one's response to the drug therapy will additionally vary significantly. And as such, tailoring specific medication regimens and dosing schemas requires beginning with a thorough understanding of the individual's health along with monitoring throughout the process. With consideration given to these variances, the overall process can be examined.
      Feminizing hormone therapy consists of administration of a highly estrogenic component and anti-androgens.  Therapy usually begins with oral estradiol (17-Beta Estradiol often branded as Estrace tablets), which is the most potent estrogen available. While the reader will naturally focus on the estrogenic component, the other important factor considered in drug therapy is its administration, or more precisely, the route of administration. The path by which the hormone is introduced into one's system, such as, taken orally, injected into muscle, or transferred through the skin in the form of a medication skin patch affect the process.
      The second category of medication, equally important to the traditional hormonal preparations that produce a direct estrogenic effect, is anti-androgens. These compounds aid in the overall feminizing effect by lessening or reversing the previous masculinizing effects produced by the presence of testosterone and DHT.  With the aid of anti-androgens, the available estrogens are also able to produce more desirable effects while using less medication, allowing the male form to more readily morph into a female form.
      But all anti-androgens are far from a panacea.  One should realize that the bulk of these preparations used in transgender medicine are comprised of drugs that produce an anti-androgenic effect incidental to their designed purpose.  The anti-androgens that some transgender patients are taking, are being taken by many others for a variety of very different medical conditions that include anti-hypertensive treatment (reducing high blood pressure), treating prostactic cancer, prostatic enlargement, and fungal conditions, amongst others.  And as common sense would dictate, these drugs with their wide scope of uses may also produce a wide variety of potentially serious side effects.  For example, a particular drug when used in treating cancer may work within acceptable limits of overall risk, even though it produces a certain stain on the liver.  But when the same drug is used to add a mild anti-androgenic (de-masculinizing) effect to an otherwise healthy individual, are the mild feminizing effects of this mediation worth the potentially serious health risks associated with its use? This is the question the transgender patient should consider, and naturally, the physician entrusted with the care of that individual is also considering.
      But anti-androgens' risk-to-benefit ratio is not bleak for all potential medications. Certain anti-androgens, when used reasonably, will greatly increase the feminization process with minimal risk.  Two such medications, spironolactone and finasteride, are relatively benign and produce desirable effects when given within normally acceptable dosing limits.
      A third category is the progestin.  These drugs are derivative of the normally occuring substance progesterone found in both males and females.  Amongst treating physicians, there is uncertainty as to whether progestin products have any positive effect for the transgender individual. 
      The most common preparation seen in this category is medroxyprogesterone acetate, often branded as Provera. The wisdom of adding a progestin can be linked to mimicking the female hormonal cycle.  Additionally, naturally occurring progesterone aids in breast development in genetic females.  A decreased incidence of cervical cancer is also noted when a progestin is added into the estrogen replacement regimen.  But transgender women do not have a cervix, and the role of progestins in breast development is debated.
      Progestins are also known to produce mildly androgenic (masculinizing) effects and can compete with the actions of estrogens, reducing their effect.  Progestins also may produce negative reactions in the form of weight gain, edema and phlebitis, but without notable feminizing effects. Some may also experience mild depression and mood swings.
      With these counterposing factors considered, progestins may be introduced in the regimen in a minimal way, or possibly altogether excluded.
       
       
       
       
       
    • Diyhrt.com

      What is HRT?

      By Diyhrt.com, in Articles,

      HRT refers to the use of prescription drugs to "replace" the hormones that the ovaries quit making at the time of menopause. These hormones are estrogen and progesterone. Estrogen is made synthetically from plants and other sources or obtained from the urine of pregnant horses.
       
      Two main types of progesterone are available. The most commonly used forms are made synthetically and called "progestins."   A form of progesterone that is nearly identical to the hormone made by the ovaries is also available and called "natural progesterone" or "micronized progesterone."
       
      Women who still have a uterus usually take both estrogen and progestin. If taken without progestin, estrogen makes the lining of the uterus (the endometrium) grow and can cause endometrial, or uterine, cancer. Women who take estrogen without progestin must have a yearly endometrial biopsy, in which tissue from the lining of the uterus is evaluated for cancer.
       
      Women who do not have a uterus can take estrogen alone. This is often referred to simply as estrogen replacement therapy, or ERT. Estrogen is most often taken orally, as pills, or absorbed from skin patches placed on the abdomen.
       
      Why take HRT?
       
      HRT (or ERT) is commonly prescribed to relieve menopausal symptoms. HRT may also be used to treat osteoporosis or to reduce a woman's chances of getting osteoporosis, and there is a possibility that HRT may reduce the risk of coronary heart disease. 
      On the other hand, HRT may increase a woman's chance of getting breast cancer.
       
      What are the effects of HRT on menopausal symptoms?
       
      HRT is extremely successful at relieving menopausal symptoms, such as hot flashes,
      night sweats, and sleep disturbances. When taken only to relieve menopausal symptoms, HRT is used for a relatively short period of time typically from several months to several years.
       
      What are the long-term health effects of HRT? 
       
      In addition to relievingthe symptoms of menopause, HRT reduces bone loss and helps prevent thinning of the walls of the vagina. Remember, though, if you are taking HRT for prevention of osteoporosis, it helps the most if you take it for many years. Once you stop taking HRT, you start losing bone again. However, if you begin (or resume) using HRT later in life, it protects against further bone loss. The effect of HRT on heart disease is uncertain, and HRT may also increase your risk of breast cancer.
       
      What are the side effects of HRT? 
       
      The most common side effects of HRT, and the percentage of women in the United States who experience them, are listed below. If you experience any of these, discuss them with your healthcare provider.
      In addition to relieving the symptoms of menopause, HRT reduces  bone loss and helps prevent thinning of the walls of the vagina.
       
      Common Side Effects of HRT
       
      Percentage of Women Who Develop This Side Effect:
       
      Monthly bleeding (from cyclical estrogen and progestin)
       
      Most women
       

      Irregular spotting (from daily estrogen and progestin) (Women who are having heavy periods and irregular bleeding or bleeding between periods should see a healthcare provider.)
       
      30%-50% (stops permanently for most women within a year)
       

       
      Breast tenderness or enlargement
       
      12% on unopposed estrogen
       
      33% on estrogen & progestin
       

       
      Fluid retention
       
      1%-10%
       

       
      Headaches, including migraine
       
      1%-10%
       

       
      Dizziness
       
      Less than 1%
       

       
      Skin discoloration
       
      Less than 1%
       

       
      Nausea
       
      Unknown
       

       

       
      Changing either the type of HRT you are taking or the dose may reduce side effects and improve HRT's acceptability to you.
       

       
      Women sometimes worry that HRT will make them gain weight. We now know that this is not true. Some women gain weight after menopause. This is most likely because the metabolism gradually slows down with increasing age. Some women find that they retain water or feel bloated while taking HRT. This is different from true weight gain.
       

       
      Is HRT safe? In general, HRT is a safe and effective way of managing menopausal symptoms and preventing osteoporosis. However, some women should not take HRT, or if they decide to take it, they should be monitored closely by their healthcare providers. 
       

       
      HRT is generally not recommended for women who have any of the following conditions:
       
       
      Vaginal bleeding of unknown cause ( this should be evaluated before HRT is initiated) .
       
      Suspected breast cancer or a history of breast cancer.
       
      History of endometrial cancer or cancer of the uterus.
       
      History of-or active-venous thrombosis (blood clots in the veins of the legs or in the lung) . This includes women who have had thrombosis or blood clots during pregnancy or when taking birth control pills.  Although the risk of blood clots in women is very low, HRT increases the risk of blood clots in the legs and lungs.
      Chronic disease of the liver.
       

       
      In some women, HRT can cause gall bladder disease or gallstones that may require surgery. Women with uterine fibroids ( benign or noncancerous tumors of the uterus) should know that HRT may make fibroids grow larger (ordinarily the withdrawal of estrogen after menopause causes them to shrink) . However, most women with fibroids can take HRT safely.
       
      Are there different ways to take HRT? 
       
      There are many different ways to take HRT. Estrogen is typically taken by pill or skin patch, and progestin is almost always taken by pill. The estrogen from either pills or patches is absorbed into the blood stream, and in general the effects are similar. However, most studies have been done on women taking estrogen pills, so scientists are not certain that estrogen from the patch affects disease risks in the same ways as estrogen taken by pill. While the pill is taken just once a day, the patch releases estrogen at a steady rate throughout the day and night.
       
         
       
           I started doing research a year or two ago, reading every book I
       
           could get my hands on, magazine articles, talking to other women 
       
           because I knew I was going to have to make this decision at some
       
           point. And I've learned a lot, and you know, it's still not an
       
           easy subject. I am concerned about taking drugs for the rest of my
       
           life. After all the research, I think the conclusion I've come to
       
           is that I want to try natural methods first.
       

       
      There are also differences in the mix of hormones and in the scheduling of the medication. When discussing HRT with your healthcare provider if you decide to take HRT you can talk about which of these schedules is best for you. These differences are described briefly here.
       

       
      Unopposed estrogen: Women who have had a hysterectomy typically will take estrogen alone with no progestin.
       

       
      Cyclical estrogen and progestin: With cyclic HRT a woman usually takes estrogen every day, adding progestin for 12 to 14 days a month, and then takes no hormone for 5 to 6 days per month. This regimen is often selected for women who are still having periods when they begin HRT. Most women have a light period or "withdrawal bleeding" during the time when they take no hormones each month.
       

       
      Daily estrogen and progestin: With this regimen, often called continuous combined HRT,   a woman takes both estrogen and progestin every day. This regimen is usually selected by women who have had no period for at least 6 to 12 months. The major disadvantage is that 30% to 50% of women will have episodes of irregular bleeding or spotting.  After 6 to 8 months, however, bleeding stops permanently for 75% to 80% of women.
       

       
      Your dose and schedule may need to be adjusted. Let your healthcare provider know if you decide to take HRT and are uncomfortable with the regimen or are having unacceptable side effects. You may be able to try different combinations of drugs and/or schedules in order to minimize side effects.
       

       
      HRT is not a one-time decision. Women may want to consider the pros and cons of HRT in several stages: first, at the time of menopause, as a short-term therapy for relief of menopausal symptoms; later, as the symptoms fade, as a longer-term regimen for prevention of osteoporosis.
       
      As new information about HRT becomes available, we are learning more about the effects of starting HRT some years after menopause. At the same time, new alternatives for preventing osteoporosis are being developed, so it's important to stay informed. Changes in your
       
      personal health may also lead you to re-evaluate your decision. For prevention of osteoporosis, women reap the greatest benefits if they
       
      start HRT around the time of menopause and take it indefinitely. But whenever a woman starts taking HRT, she will reduce her risk for further
       
      bone loss.
       
      Are there other ways - besides taking HRT - to relieve menopausal symptoms?
       

       
      Hot flashes:
       
      Hot flashes are sometimes brought on by specific things, such as a hot environment; eating or drinking hot or spicy foods, alcohol, and caffeine; and stress. Some women find they can decrease hot flashes by avoiding these "triggers."  You may want to dress in layers. If you are having hot flashes at work, you may want to bring a small fan to your workplace and keep ice water at your desk. Some women
       
      find that a program of regular exercise brings relief of hot flashes and other menopausal symptoms.
       

       
      Vaginal dryness:
       
      Some women find that vaginal lubricants relieve vaginal dryness. Estrogen cream may also help relieve vaginal dryness and
       
      painful intercourse. Although estrogen creams are absorbed into the blood in smaller amounts than similar doses of estrogen pills, remember
       
      that you are still taking estrogen. If you use estrogen creams regularly and you still have a uterus, the creams could affect the uterine lining
       
      in the same way that estrogen pills do. Your doctor may recommend that if you use vaginal estrogen, you take progestin pills for at least 10
       
      days per month. If you have spotting or bleeding while using estrogen creams, you should have this evaluated by your healthcare provider.
       

       
           I look forward to a long life. I want to be useful in my sixties
       
           and my seventies and my eighties and nineties. I think that is why
       
           I feel that being healthy is very very important now because I
       
           want to be useful in those ages.
       

       
      Difficulty sleeping: 
       
      There are many "home remedies" to promote a good night's sleep. Regular exercise - such as walking 30 minutes a day can help promote a good night's sleep. However, you should avoid vigorous exercise too close to the time you plan to go to bed. Some women sleep better after drinking something warm, such as herb tea or a glass of warm milk (milk has the added advantage of calcium) . Other tips: Keep your room a comfortable temperature; avoid caffeine, alcohol, or large meals close to bedtime; avoid working right before bedtime; define the amount of sleep you need and then go to bed and get up at the same time every day to get the right amount of sleep; don't nap in the daytime if you are having trouble sleeping at night.
       

       
      An important message about uterine cancer and HRT: It has been proven that in women who still have a uterus, taking estrogen without progestin dramatically increases the risk of endometrial cancer (cancer of the uterus). Women with a uterus should take estrogen with progestin unless they are followed closely (at least once a year) by a healthcare provider and have a yearly endometrial biopsy.
       

       
      Unresolved issues and misconceptions about HRT:
       

       
      How early to start HRT: Some women believe they cannot begin taking HRT until their periods have completely stopped. This is not the case. Women may have menopausal symptoms for several years before they stop menstruating. In this case a healthcare provider may suggest some kind of hormonal regimen to help manage symptoms and regularize menstrualperiods.
       

       
      HRT’s effects on Alzheimer's disease, memory, and colon cancer: 
       
      You may have heard that HRT prevents Alzheimers disease, improves memory, and decreases the risks of colon cancer. Although there have been encouraging results from some studies, very little is known, and at this
       
      point we do not have scientific evidence that HRT is beneficial for these conditions.
       

       
      Herbal remedies and plant estrogens for menopause:
       
      You may wonder if herbal remedies for menopause are safer than HRT. You may also want to know if certain estrogen - like chemicals in plants ( called phytoestrogens) can help with menopausal symptoms. Many over-the-counter herbal remedies are available to help women through menopause (for example, black cohosh or Remifemin(r)*) . Unfortunately, at this time there is little more than anecdotal evidence that these remedies are effective. The observation that women in Japan and China, where traditional diets are higher in soy, are less likely to suffer from menopausal symptoms suggests that phytoestrogens found in soy products might be beneficial. So far, some studies show that soy estrogens decrease hot flashes, but many studies have found no difference with soy. Some over-the-counter herbal remedies contain progestins or estrogens. We know very little about their effects on the body. If you choose to use alternative botanical remedies, we recommend that you see a health professional who is familiar with them and can monitor their effects.
       

       
      Natural versus artificial hormones: 
       
      The estrogens and progestins in currently used pills come from a variety of sources. Some, for example the estrogens in Premarin(r)*, come from the urine of pregnant horses (mares). Others are mostly synthetic. Still others, "natural" estrogens and progestins, are made from plant sources. For example, the estrogen in Cenestin(r) is synthesized from Mexican yam and soybeans. Some women believe that "natural" estrogen and progestin may be safer than artificial (synthetic) hormones. However, natural and synthetic sources of estrogen and progestin are believed to be equally safe and effective. Some women react differently to different sources of estrogens and progestins. If this is an issue for you, discuss it with your healthcare provider.
       

       
      * Use of trade names is for identification only and does not imply
       
        endorsement by the U. S. Department of Health and Human Services.
       

       
           I've found doctors that I can work with. And they know that I'm        
       
           going to do what I think is best. You know, I'll listen to them  
       
           and what they have to say, and then I'll decide what I'm going to
       
           do.
       
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