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Self-medication And HRT

It is inconceivable to this writer that anyone would want to self administer HRT bypassing the medical community, yet they do and from my position, it seems to be a growing trend.  It is a dangerous one to be sure; one where I believe the doctor has a fool for a patient.

The necessary medications for Hormone Replacement Therapy are widely available over the internet.  I am ignoring herbal/bioidentical medications because they are NOT proven to work but can be equally dangerous if used improperly.

My Position (and that of Transgender London)

I want to be absolutely crystalline in this.  I absolutely support the Harry Benjamin Standards of Care (HBSOC) as maintained by The World Professional Association for Transgender Health (WPATH).  These are guidelines used by the medical community and others, for establishing acceptable protocols for the treatment of transgendered people.  They are not rules for us to follow but guidelines for the professional community.

As transgendered people, we are obliged to read and understand them so that we understand the positions those working with us toward transition are taking and why.  They are not for us to dictate to the medical community.

The Process

Those standards require that the client (us) undergoes psychological assessment prior to being referred to an Endocrinologist or OB/GYN  for Hormone Replacement Therapy to treat Gender Identity Disorder.  The psych assessment is to ensure that the patient is mentally healthy and capable of fully understanding the decisions they are about to take to permanently alter their body.  The pdoc is morally and ethically bound to ensure this is the truth.

The psych professional will provide a letter to a specialist that a) establishes his or her credentials in the treatment of transgender, b) recommends a consultation with the medical professional to undertake a regimen of Hormone Therapy. c) establishes the reasons for this recommendation.

Once the referral is made a consultation to discuss the patient's needs is made with the specialist.  The doctor wants to reassure him/herself that the pdoc has made a correct diagnosis.  S/he wants to ensure the patient understands the risks associated with the medical interventions being sought are fully understood by the patient.  Once satisfied that the client is a candidate for HRT, the doctor will order blood tests to ensure the patient's physical condition is such that HRT is indicated as a treatment.  (These tests etc. can be read here)  The doctor is primarily concerned about kidney and liver function, blood pressure, cholesterol levels, and testosterone levels.  Once the results of these tests are known and the doctor is satisfied that any risks are minimized, then HRT can begin.  The medications and dosages prescribed are based on a number of factors and are not a consideration of who the last drug salesperson through the door was.  They are patient centered in consideration of the individual's health.

The Dangers of Self Medicating

Hormone Replacement Therapy is indicated where transsexualism has reached a diagnosis of Gender Identity Disorder.  It is not for the purpose of feminization because as a CD, you would like boobs or softer skin or whatever other desires you might have.  As was outlined above, there are dangers attached to this process; dangers that could potentially cause organ impairment or failure or even death.  It is not something to be taken lightly.  Most of the changes are irreversible.

The beginning of the process is with an anti androgen to lower testosterone levels.  Depending upon the method of administration, it can wreak havoc with your liver and/or kidneys.  Again the method of administration is up to your doctor and is based on your general health and age.  It can alter the effects of blood pressure medication as well as initiate some other negative side effects such as headaches, bowel problems, skin irritations, and calcium deficiencies leading toward osteoporosis, and depression, to name a few.  Oh, and let's not forget thrombosis (blood clots), that can sneak up on you and kill you.  These are not aspirins you are taking they are serious drugs often used in the treatment of prostatic cancer.  The health of the body must be monitored closely.

The desired effects from anti androgen treatment include: loss of libido (sex drive), loss of upper body muscle mass (less strength), slower growth of beard and body hair.  Let's not forget that this IS chemical castration.

It is often of little use to introduce estrogen until testosterone levels are lowered to that of a prepubescent natal female.  The male body will naturally increase testosterone levels to match the estrogen levels.  This can have serious side effects as well, both mental and physical.

Once the testosterone levels are lowered, then administration of estrogen can begin.  Again, it is not without risks, many of which are the same as those already given.  Of course you will begin to acquire a more feminine physique with breasts, rounder hips, softer skin etc., but you also have to live with these changes.  Stopping HRT wont change developed breast tissue.  You got it for life.

The Social Realities

Okay so now you have begun feminizing and you look pretty good; that is until you hit the locker room...  Then of course there comes the problem of buying clothing that you must wear for work.  Thought about button down dress shirts with darts for breasts?  How about new jeans that aren't feminine so you can go away with the boys fishing... oops.  Forgot about that one huh?

Okay so you dont do that, dont need to worry.  How about summer social events with your family?  Care to explain it to them?  Cant go swimming because it isn't a wet tee shirt contest at your crossdresser meeting?

Feminization is a serious process, one that often cannot be undone; some changes being permanent.  The transsexual realizes the changes, the risks on all levels and is fully prepared to face them.  It could mean the loss of career, family and friends.  It often results in a much lower standard of living and frequently, poverty.  There is discrimination everywhere.  The CD while wanting desperately to emulate the female is not prepared for the changes in social structures that come with physical change.

The Bottom Line

If you aren't a transsexual then forget about feminization.  The changes are permanent and the risks are high.  You are a CD so spend your time and money on breast forms, wigs, clothing, makeup and enjoy having it both ways.  If you cant honestly look the surgeon in the eye and say "Bring it on", then you shouldn't even be thinking about feminization.  If you cant get your head around it then go see a psych doctor.

Physical change for the transsexual is a necessity.  If they are M2F then they ARE female and not emulating one.  If they are F2M they ARE male and not trying to play a role.  The changes to body image are to relieve the Gender Identity Disorder that leads toward transition; living full time in their true gender role.  For the TS it isn't a game or passing desire, it is necessary.

Self medication has serious risks attached.  Improper or nonexistent medical monitoring is inviting an increase in those risks.  Yes, many get away with it, but there is always a price to pay in consequences for every action.  Some are intended, others not.  Will you be the one who is placed in the morgue or on a transplant list?  I hope not.