Transgender London

M2F Hormone Therapy

It is critical to understand that this site does not advocate self medication for any reason. The drugs listed here are specifically devoid of any dosage recommendations for that reason. Links to get further information are provided. This information includes drug action, contraindications, precautions and interactions etc. Anyone undertaking any kind of drug therapy should embark on a path of education to know and understand as much about the drugs being taken as well as interactions with others. Often your pharmacist can assist in this last area.

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Dr. Harry Benjamin found that by administering estrogen; PremarinÒ to be precise, to one of his transgendered patients, the patient responded favourably, reporting that she felt calmer and less stressed. This began the work into HRT and similar reports were gathered as more people were treated.

This approach did not sit well with the psychiatric community of the day who still believed that transgender was a pathology of sexual disorders. Their “treatment” included psychotropic drug intervention, behaviour modification and even electro shock therapy. Of course, none of it was successful. This rift in approaches took many, many years to reconcile. It was accepted by the psych community after an overwhelming body of evidence was able to convince them of the merits of HRT in the treatment of transsexuals. Today, this is the indicated approach advocated by WPATH and the APA.

There are still some dinosaurs in the field of transgender research who continue to hold to the antiquated views of transsexualism as a pathology, but this is largely viewed as academic/political posturing despite the damage it causes. This is despite the growing evidence pointing toward physiological causality of transgender.

HRT usually begins with an intensive set of blood tests and a physical. Administration of HRT is not without risk no matter how small and minimizing these risks is critical to the healthcare administrators.

Blood Tests.

CBC (Complete Blood Count)

This test provides an overview of blood cellular counts for red blood cells, white blood cells, platelets etc. In all there are approximately 11 different counts made. It is used to check for anemia, infections, and disease. This test is normally conducted to establish a baseline then repeated as necessary for conditional change to the body. The results can vary by sex, age, diet among other things.

Comprehensive Metabolic Panel

This series is used to establish blood sugar levels, liver and kidney function, sodium and potassium levels.

Lipid Profile

This series of tests are used as an indicator of potential heart problems by measuring Cholesterol (LDL and HDL) as well as triglycerides.

Testosterone – Total + Free

Testosterone as a steroid in both men and women is medically necessary however the levels between the sexes is greatly different as is the function. For the M2F transsexual, reducing testosterone to the levels of a natal female is essential for administration of estrogen. While estrogen has been administered without anti androgen drugs to limit testosterone, generally the male body responded by increasing testosterone levels. Any changes then were delayed and estrogen application had to be increased. Testosterone is generally bound to receptors in the male body. Free testosterone is very low and its purpose is questioned.

PT/PTT

These tests are used to determine blood coagulation (clotting) times both long and short term. Thrombosis (clots in the blood) can be fatal and so monitoring this is critical.

Urinalysis

This is used to evaluate multiple body functions that could lead to further more in-depth testing for specific conditions or infections.

Hormone Replacement Drugs

Estradiol (EstraceÒ; ClimaraÒ; EstradermÒ; MenostarÒ) http://www.wcrx.com/pdfs/pi/pi_estrace_wc_imprint.pdf

This hormone is essentially the “female” hormone for feminization however to be effective, other drugs such as antiandrogens must also be used. It can be administered by tablet, gel, patch or injectable.

Finasteride (PropeciaÒ, ProscarÒ) http://www.merck.com/mmpe/lexicomp/finasteride.html

This is used primarily as an antiandrogen preventing the conversion of testosterone to DHT that binds to testosterone receptors. Primarily designed to treat prostate condition, it also has the side effect of treating male pattern baldness.

SPIRONOLACTONE (AldactoneÒ, Novo-SpirotonÒ, SpiractinÒ, SpirotoneÒ, VerospironÒ or BerlactoneÒ) http://dailymed.nlm.nih.gov/dailymed/fdaDrugXsl.cfm?id=2479&type=display

This antiandrogen is used similar to Finasteride preventing binding of androgens to androgen receptors, reducing the production of testosterone in the testes. It is also a diuretic meaning that increased awareness of vitamins and minerals is needed for safety; particularly potassium.

Progestin http://en.wikipedia.org/wiki/Progestin

This drug is used in conjunction with estrogens and primarily promotes breast development.

Route of Administration

Why not just swallow a pill and be done with it?

Often swallowing a pill is the best answer for taking medication. But with pre-SRS hormone therapy, it may be a better choice to follow non-oral methods (preferably, under the tongue or applied to the skin).

Medication taken orally (swallowed as compared to under the tongue) first enters into the digestive tract and then is processed by the liver. When taken under the tongue or through the skin, medication directly enters the blood stream. In the case of estradiol, the conversion into its less estrogenic metabolites is curtained, allowing the more potent estradiol to remain present to a greater degree. And this method produces less strain on the liver.

This site was last updated 08/11/10