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Hormones:  What Is It All About?

The Disclaimer/Warning

I have intentionally avoided this subject for the simple and oft repeated warning here about self medicating.  I am totally opposed to this potentially very dangerous practice.  However, the other side of the coin is that many girls, particularly in remote areas, don't have access to properly informed medical care and so, the following is designed to help them educate their doctors.  While this information is general in nature, this writer strongly urges any physician involved in the administration of HRT for the treatment of transsexualism to contact either WPATH or CPATH for current treatment protocols.  HRT is not complicated, but does require a few basics.

There are 2 sides to this coin; the administration of hormone replacement, and monitoring.  One cannot be done without the other.  It requires a practical approach that has been proven successful time and again.  If properly followed, the risks are low.

The Risks

As with any medical intervention, there are risks and they can be so minimal as to be nearly nonexistent at one end of the spectrum, or they could cause death at the other extreme.  With proper medical monitoring, the former is the general rule.

 

First of all, the patient should be mentally healthy and be able to appreciate the changes and the risks of embarking on a regimen of HRT.  This usually is assured by a qualified and experienced mental health practitioner in the form of a letter that will recommend the patient for hormone replacement therapy.  Of course, in remote regions, this could pose a barrier in which case the medical practitioner will have to make such judgements after a period of careful evaluation through counselling.

 

On the physical side, kidney function needs to be continuously monitored, particularly if antiandrogens such as Spirolactonone is used.  The other danger is thrombosis which again, necessitates continued monitoring for early detection of any abnormalities.

 

General Health

Before beginning any HRT, baselines are needed.  This begins with a complete physical and extensive blood workups prior to the administration of hormones.  This will provide a detailed description of the patient's general health and allow for comprehensive monitoring of any changes that could be a concern.

 

The initial blood work should include the following:

  • CBC with Differential

  • Comprehensive Metabolic Panel

  • Lipid Profile

  • Testosterone:  Total and Free

  • PT/PTT

  • Urinalysis

Follow up tests are at the discretion of the physician but should be performed at least annually.  Some physicians will order these tests every 3 months for the first year, then semi annually after that.  It is perhaps over zealous, but none the less prudent to ensure continued good health.

 

Other factors that can complicate things include cholesterol, sodium and potassium levels.  These can often be controlled with proper diet and this should be emphasized.  While a Lipid Profile is desired, it is not necessary to monitor extensively unless there are specific concerns by the physician.

 

Smoking is also a serious health risk and could create even greater risks for the patient undergoing HRT.  Proper exercise should also be a part of the regimen to maintain good health.

 

Sexual health is another area that needs to be emphasized with the patient.  Many girls are forced to turn to the sex trade for survival, so education about protection from STD's is essential.

 

Hormonal Levels for the M2F Transsexual

The following are guidelines and in no way should be construed as hard and fast rules.  The physician should determine HRT dosages that are safe for his/her patient in conjunction with the patient's general health, lifestyle and needs, then make the appropriate adjustments.

 

There are 2 basic methods considered for the administration of HRT.  One is to control Testosterone and the other Estrogen.

 

In the control of Estrogen, the period of transition is slow but sure as Testosterone is generally ignored in the equation.

 

Using the other more commonly approved and practiced approach of control of Testosterone, the transitional changes are faster.  This method is generally considered the safer of the two.

 

So, the question is: What should the hormonal levels be?  For a client seeking a fast transition the Estrogen levels should be in the higher range and the testosterone toward the lower end of the range.  Again, each patient is different and medication dosages can be adjusted accordingly.

 

Oestradiol (Estradiol) or 17 Beta estradiol is considered as the primary female hormone.  It is worthy of note that the level of the M2F is extremely high.  This is due to peaking for those taking IM injection.  It is recommended that the range desired should be held within the normal range for a female.

17-beta OESTRADIOL (E2)
REF. RANGE 15-60M / 12.5-166F pg/ml
Follicular Phase 20-130 pg/ml
Ovulatory Phase 130-370 pg/ml
Luteal Phase 70-250 pg/ml
Post Menopausal 15-60 pg/ml
M2F Transgender 63-1150 pg/ml
Males 15-60 pg/ml

 

Progesterone (P4) effectively blocks 5-alpha-reductase conversion of testosterone into DHT.

PROGESTERONE (P4)
REF. RANGE 0.1-1.0M / 0.2-25F ng/dl
Follicular Phase 0.2-1.4 ng/dl
Luteal Phase 4-25 ng/dl
M2F Transgender 0.4-2.5 ng/dl
Males 0.1-1.0 ng/dl

 

Testosterone (T)

TOTAL Testosterone (T)
REF. RANGE 270-1100M / 6-86F ng/dl
Female 6-86 ng/dl
M2F Transgender 5-85 ng/dl
Males 270-1100 ng/dl
 

Dihydrotestosterone (DHT) is a more potent form of testosterone that is metabolized by the body from other androgens. In men most is made from testosterone, while in women the main source is androstenedione. Current research indicates that DHT is responsible for male-pattern balding and excessive, unwanted hair in both sexes. In males it is also responsible for non-cancerous prostate swelling (BPH). DHT is a more potent form of testosterone while oestradiol has completely different activities (feminisation) compared to testosterone (masculinisation).

Dihydrotestosterone (DHT)

REF. RANGE

250-990M / 24-368F

ng/dl

Pre Menopausal

24-368

ng/dl

Post Menopausal

 10-181

ng/dl

M2F Transgender

 20-200

ng/dl

Males

250-990

ng/dl

 

Prolactin (PRL)

PROLACTIN (PRL)

REF. RANGE

2.1-17.7M / 4.1-18.4F

ng/dl

Female

 4.1-18.4

ng/dl

M2F Transgender

 2.8-25.7

ng/dl

Males

2.1-17.7

ng/dl

 

Lipid Profile

LIPID PROFILE

Test

Reference Range

Units

Cholesterol

0 - 250

mg/dl

Triglyceride

0 - 150

mg/dl

HDL - Cholesterol

35 - 60

mg/dl

Total Protein

6.6 - 8.7

g/dl

Albumin

3.8 - 5,1

g/dl

Globulin

2.8 - 3.6

g/dl

Total Bilirubin-Auto

0 - 1.1

mg/dl

Direct Bilirubin Auto

0 - 0.3

mg/dl

AST (SGOT)

0 - 37

U/L

ALT (SGPT)

0 - 42

U/L

LDC-C

0 - 200

mg/dl

Alkaline Phos DGKC

64 - 306

U/L

 

Electrolyte

ELECTROLYTE
Test Reference Range Unit
Sodium 135 - 150 mEq/L
Potassium 3.8 - 5.5 mEq/L
Chloride 98 - 106 mEq/L
CO2 22.0 - 32.0 mEq/L

 

The Hormones et al.

My bet is that most people (except the physicians) will just jump to this section.  Okay, but there is no magic number here either because again, everyone is different and based upon your health, existing levels etc. your dosages will change.  Once again,

SELF MEDICATION IS DANGEROUS AND YOU HAVE A FOOL FOR A PATIENT!!

See a doctor

 

HRT generally consists of reducing the unwanted male hormone (Testosterone) then replacing it with the wanted female hormone (Estrogen).  While that is a very simplistic view, it is none the less accurate. 

 

The following table is a guide for physicians.

Antiandrogens
LHRH Analogues
  leuprorelin Lucrin depotR 3.75 mg/months s.c.
  triptorelin Decapepty1-CRR 3.75 mg/months i.m
Interference with Testosterone or DHT production
  spironolactone AidactoneR 100-200 mg/day p.o.
  finasteride not registered  
  flutamide EulexinR 250 mg t.i.d., p.o.
Antigonadotropic
  cyproterone acetate AndrocurR 100-150 mg/day p.o.
  medroxyprogesterone ProveraR 5-10 mg/day p.o.
    Depo-ProveraR 150 mg/month i.m.
    FarlutaiR 5-10 mg/day p.o.
    Farlutal depotR 100 mg/month i.m.
Androgen Receptor Blockers
  cyproterone acetate AndrocurR 100-150 mg/day p.o.
  nilutamide AnandronR 300 mg/day p.o.
  spironolactone AldactoneR 100-200 mg/day p.o.
 
Estrogens
  ethinyl estradiol LynoraiR 100 µg/day p.o.
  conjugated estrogens PremarinR 5-10 mg/day p.o.
  17ß estradiol ProgynovaR 2-4 mg/day p.o.
    Progynon depotR 10 mg/2 weeks to 100 mg/month i.m.
    Estraderm TTSR 50-100 µg/day transdermal
  estradiol SynapauseR 4-6 mg/day p.o.
Androgens
  testosterone esters TestoylronR 250 mg/2 weeks 1.m.
    SustanonR 250 mg/2 weeks i.m.
  testosterone undecanoate AndrinlR 160-240 mg/day p.o.

A more recent addition is SuprefactR (buserelin acetate), a drug also designed to reduce Testosterone.  It fits into the LHRH Analogues category.  It is available as a nasal spray.  More information can be found at http://www.sanofi-aventis.ca/products/en/suprefact.pdf

Also missing from the above is Progesterone (PrometriumR).  More information is available at http://www.prometrium.com/

This site was last updated 08/11/10