Warning:
Never take hormones unless you have consulted a medical specialist
or gender reassignment clinic and are fully aware of the possible
risks and side effects. Do not smoke whilst taking hormones. Serious
risks can include venous thromboembolism (VTE), i.e. deep venous
thrombosis (DVT deep vein thrombosis), pulmonary embolism and cardiac
problems.
For
the full range of hormone related products that we have available
(including birth control pills and HRT drugs) and also including
those drugs which are mentioned on this page please visit our hormone
section. You should note that these medications listed
are the real thing and are NOT phyto or herbally based estrogens
as supplied on some transgender related websites under the banner
of sex change drugs.
For
more detailed information on each drug please click on any of the
medication names below to go to the specific medication page.
If a drug is not listed use our site search on our medications
index page. For complete comprehensive information
on transsexualism, transgender resources, links and gender re-assignment
see www.crissywild.com
the leading transgender library online.
The
following information should be used as a general guide
Estrogen
is the most important part of any feminizing regime ..
A gender reassignment program for male to female transsexuals normally
includes the prescription of feminising hormones, oestrogen and
progesterone which develop female secondary sexual characteristics.
In addition this may be accompanied before surgery by anti-androgen
treatment to reduce the effect of the patients own male sex hormones.
There can be risks attached to hormone therapy in both men and women
and therefore it is definitely inadvisable to take any form of hormone
product unless it is medically prescribed.
Estrogens
are powerful steroid hormones, chemicals which affect the form and
function of the body and its organs. In M2F transsexuals the
effects of these hormones will become obvious after three months
and usually irreversable after six to nine months.
There
are three basic human estrogens: estradiol, estrone, and estrial.
Estradiol is the most active form and estrial is the least active.
In women, large amounts of estrogen are produced by the ovaries,
and in men a small amount is present due to chemical conversion
of testosterone.
Some
typically-used initial estrogen dosages for pre-operative transsexual
women who have not had an orchiectomy (castration) are as follows:
Oral
estrogens:
|
estradiol
(Estrace®,
Estrofem,
Zumenon Progynova),
6 mg daily; |
| |
OR
|
|
conjugated
equine estrogen (Premarin®),
5 mg daily; |
| |
OR
|
|
ethinyl
estradiol (Estinyl®),
Lynoral),
100 mcg (0.1 mg) daily; (ethinyl
estradiol is pure synthetic estradiol and favoured
by many gender reassignment clinics) |
| OTHER
OPTIONS .. |
|
| (Diane-35®
is also used as it contains a small amount of the anti-androgen,
cyproterone and inhibits facial hair growth) |
| (Ovral/
Ovran is also used as it contains a small
amount of progesterone) |
|
OR
Transdermal
estrogen:
estradiol (e.g., Climara®,
Estraderm or equiv),
two 0.1 mg patches, applied simultaneously;
OR
Injectable (intramuscular) estrogen:
estradiol valerate (Delestrogen®), 20 mg IM every two weeks.
estreva gel and hormodose gel (used in addition to other regimes)
Occasionally half the suggested dosage may be sufficient; sometimes
the dosage will need to be increased, rarely even doubled. Beyond
a certain point, larger dosages will not increase tissue response,
but will only cause more side effects.
Oral estrogens are most commonly used, and are typically very satisfactory.
Among the oral preparations, estradiol is preferred. It has low
hepatic toxicity. Most clinical laboratories can perform estradiol
blood levels; it is more difficult to obtain meaningful measurements
of blood levels with conjugated equine estrogen or with ethinyl
estradiol. Estradiol is also produced synthetically, without cruelty
to animals; this is not the case with conjugated equine estrogen
(Premarin®),
which is prepared from the urine of pregnant mares.
Estradiol tablets can be taken sublingually (placed under the tongue
to dissolve) instead of being swallowed. This may reduce possible
liver toxicity, since with sublingual administration, much of the
medication is absorbed directly into the blood stream, rather than
being metabolized by the liver after first passing through the digestive
tract. Less metabolism is also likely to result in higher levels
of estradiol itself, and lower levels of its less-active metabolites,
estrone and estriol. Micronized estradiol tablets are specifically
designed for either oral or sublingual use, and dissolve quickly
under the tongue without an unpleasant taste.
Premarin®
is the more expensive oral preparation. One of its advantages is
its relative potency, which is notably higher than estradiol on
a milligram-per-milligram basis. This is because some of the equine
estrogens in Premarin, especially equilin, have higher biologic
potency than the estrogens normally found in humans. Ethinyl estradiol
is a chemically-modified form of natural estradiol; the ethinyl
substitution results in a longer duration of action, and greatly
increased potency.
Transdermal estrogen causes less clotting tendency than oral estrogen,
possibly important to some patients; but transdermal preparations
are more expensive, and skin reactions to the adhesives employed
are not uncommon. Injectable estrogen also causes less clotting
tendency, and is less expensive. Its major drawbacks are the need
to employ syringes and perform injections, and the somewhat greater
tendency of injectable estrogen to increase serum prolactin levels.
If the former is not a problem, and if the latter can be checked
regularly, injectable estrogen can be a very good way to go; a good
suggestion is Gestadinone injectable estradiol valerate.
If you have access to laboratory testing, a serum estradiol level
of about 150 - 200 pg/ml -- about one-third to one-half the normal
female mid-cycle peak -- is often considered ideal, at least for
the first two years or so of feminizing therapy. Taking 81
mg of aspirin daily is a good precaution for persons taking oral
estrogens, assuming no contraindication to aspirin exists. It is
not necessary or desirable to "cycle" estrogen, or any other medication,
in an attempt to mimic the normal female menstrual cycle.
Besides providing estrogen, a hormone regimen should also reduce
testosterone to normal female levels. This requires adding an anti-androgen
(a male hormone inhibitor).
In persons who have not had an orchiectomy, testosterone levels
are also a concern. Although the desired reduction in testosterone
can theoretically be accomplished with estrogens alone, the dosage
required is usually in excess of what is needed for feminization.
Adding an anti-androgen allows lower dosages of estrogen to be used;
this is usually highly desirable. Typical dosages of anti-androgens
are as follows:
Note:
For pre-operative transsexuals taking estrogen alone will not be
properly effective without anti androgens as the natural male body
hormones will counter the effects of the estrogen..
Oral
anti-androgens (Male Hormone Inhibitors):
(Without using an anti-androgen, hormones are compromised as
to their effectiveness)
spironolactone
(Aldactone®),
100 - 300 mg daily in divided doses; OR
cyproterone acetate (Androcur®),
100 - 150 mg daily.
Sometimes
100 mg of spironolactone may be sufficient, but 200 mg is a more
typical dose. The Vancouver group uses up to 600 mg daily, apparently
without problems. Spironolactone is fairly inexpensive and is usually
quite well tolerated. Cyproterone is not available in the US, but
is very popular elsewhere. If you have access to laboratory testing,
a serum testosterone level of about 5 - 85 ng/dl -- the normal female
range -- is usually considered ideal. Within this range, lower numbers
are not necessarily better.
Progestogens (progesterone and synthetics) are sometimes added to
a hormone regimen. These are optional.
Progestogens are usually given in an attempt to improve breast development.
Based on limited anecdotal evidence improved breast development
sometimes does occur, but it is usually not very significant. Progestogens
can also inhibit testosterone, and are sometimes used for this purpose.
Medroxyprogesterone, the most commonly used product, has the disadvantage
of counteracting some of the beneficial effects of estrogen on blood
lipids; some people also find that it causes mental irritability.
Micronized ("natural") progesterone is an alternative, but it is
more expensive, and sometimes hard to find without prescription.
Progestogens are optional, and usually unnecessary. If you decide
to take them, here are some typical dosages:
Oral
progestogens:
medroxyprogesterone (Provera®),
5 -10 mg daily; OR
micronized progesterone (Prometrium®,
Microgest),
100 mg twice daily; OR
Injectable (intramuscular) progestogen:
medroxyprogesterone (Depo-Provera®),
50 mg every two weeks; OR
progesterone in oil, 50 mg every two weeks.
Combination
Medications:
Diane-35®
(cyproterone
acetate/ ethinyl estradiol)
After
orchiectomy (castration) or SRS, dosages can be reduced:
Following orchiectomy or SRS, anti-androgens can be discontinued,
and the estrogen dosage can usually be decreased to one-half or
one-quarter of the pre-op dosage, i.e.:
Oral estrogens:
estradiol (Estrace®),
1 - 2 mg daily; OR
conjugated equine estrogen (Premarin®),
1.25 - 2.5 mg daily; OR
ethinyl estradiol
(Estinyl®),
20 - 50 mcg (0.02 - 0.05 mg) daily.
Cautions with Hormones / HRT
Smoking cigarettes or high alcohol input while
using these medicines may increase your risk of stroke, heart attack,
blood clots (venous thromboembolism (VTE), i.e. deep venous thrombosis
or pulmonary embolism), high blood pressure, or other diseases of
the heart and blood vessels. If you have vomiting or diarrhea for
any reason, your medicine may not work as well. Taking certain antibiotics
or anticonvulsants while you are using this medicine may decrease
the effectiveness of this medicine. For gender changes MtF recommended
regimes are listed above.
Possible
Side Effects of HRT
Side effects can include nausea, vomiting,
bleeding between menstrual periods, breast tenderness, changes of
skin and hair texture, increased breast size or weight change.
If they continue or are bothersome, check with your doctor. Check
with your doctor as soon as possible if you experience persistent
or recurrent abnormal vaginal bleeding, a missed menstrual period,
dizziness or fainting, swelling of fingers or ankles, headache,
or difficulty wearing contact lenses. Contact your doctor immediately
if you experience sharp or crushing chest pain, sudden shortness
of breath, sudden severe headache or leg pain, yellow skin or eyes,
changes in vision, numbness of an arm or leg, or severe stomach
pain. If you notice other effects not listed above, contact your
doctor, nurse, or pharmacist.
Estrogens
are powerful steroid hormones, chemicals which affect the form and
function of the body and its organs. In M2F transsexuals the effects
of these hormones will become obvious after three months and usually
irreversable after six to nine months.
Use
of this medicine will not prevent the spread of sexually transmitted
diseases (STDs). |
