1. Legal age of majority (age 18 in the United States)
2. Demonstrable knowledge of what hormones can and cannot medically do and hormone benefit and risks
3. Either real-life experience of at least 3 months living in the desired role or a period of psychotherapy (usually at least 3 months) specified by a mental health professional
Most reputable Medical Practitioners, Mental Health professionals and Gender Therapists who work with transsexuals follow as closely as possible the Harry Benjamin Standards of Care. Although only guidelines, they do provide specific instructions related to hormonal, and SRS referral letters. Some doctors can choose not to consult these guidelines, in respect of hormone regimes. Normally that is if the transmission is only seeking hormones. Although this is viewed as acceptable, if you are considering going through to the stage of SRS or chest reconstruction surgery (Sex reassignment surgery) or similar related surgeries, it is advisable to obtain a letter of recommendation to save time and problems later, as most gender surgeons require the letter and will normally refuse to carry out the surgery if you do not produce one.
Hormones are manufactured controlled and produced by the endocrine system. An endocrinologist is, for hormones, therefore, the best person to consult, if one is not available in your area, then a good gynecologist may suffice, as they can be more understanding and are used to prescribing testosterone, estrogens and progesterone’s.
It is important to have a thorough medical check up both before and follow-up during Hormone therapy to lessen the inherent risks (see under)
There are risks associated with hormone therapy in both men and women and it is, therefore, inadvisable to take any form of hormone product unless it is medically prescribed.
A type of steroid that is responsible for the growth and development of masculine characteristics. It directly influences the maturation of male sexual organs, the development of sperm within the testes, sexual drive, an erectile function of the penis, and male secondary sexual characteristics (facial hair, thickened vocal cords, and pronounced musculature). In addition, it is linked to aggressive and predatory behaviours.
Testosterone is produced in the Leydig cells of the testes. It has also been synthesized for replacement therapy in men with sex hormone deficiencies (e.g., men with a hypogonadal , conditions such as Klinefelter’s syndrome).
Testosterone adversely affects diseases of the prostate gland by sponsoring the growth of both benign hyperplasia’s of the gland and carcinomas of the prostate. Both of these conditions may be treated with anti-androgenic therapies. Predatory sexual behaviours also depend on testosterone and can be treated with interventions that block the effects of the hormone.
The most effective and recognized treatment for Female to Male are intramuscular testosterone injections of 200 -250mL. Once every 14 – 21 days. Once the person has commenced testosterone treatment and within a short period (within one year or less) several visible and irreversible characteristics develop.
It contains male hormone testosterone. This gel is prescribed as replacement hormone therapy for men who have abnormally low testosterone levels. Other forms of testosterone replacement include tablets, skin patches, or intramuscular injections. The gel provides more consistent levels of testosterone compared to injections and causes less skin irritation than patches.
Testosterone is needed for normal physical development in males and is also responsible for maintaining secondary sexual characteristics that include a man’s beard, chest hair, muscle mass, and libido. In clinical studies, AndroGel successfully produced normal testosterone levels in men who didn’t make enough testosterone naturally. It also successfully reduced the symptoms of low testosterone, such as low libido and decreased muscle mass.
AndroGel is a clear, colourless gel that comes in a carton containing 30 single-use packets. The usual dose range is 25 to 100 mg daily. Every morning, apply the gel to clean, dry skin on your shoulders, upper arms, or abdomen. Wash your hands with soap and water immediately after applying the gel. Wait until the gel dries before putting on a shirt. The gel won’t affect the skin site it is rubbed into – so it won’t grow hair on your shoulder, for example, or make your biceps bigger. Instead, it works by penetrating the skin and getting absorbed into the bloodstream.
Known permanent changes are the following:
Deepening of the voice (6 – 12 weeks)
Clitoral elongation of varying degrees, for a small amount. the size can
become sufficient enough for penetration with a partner.
Some mild breast atrophy (reduction)
Cessation of the menstrual cycle within three months is said to affect over (90% of recipients.
Increase of facial hair similar to that which occurs in pubertal boys.
Male pattern baldness will usually represent family ‘traits’ and is quite accurately predictable.
Fat redistribution and change to those areas more prevalent of a male
Increased upper body strength
Male pattern fat distribution throughout the body
For the Female to male, this is a life long treatment
F to M SURGERY
The most common and sought after surgery is that of body contouring. Similar, but not the same as routine ‘mastectomy’ surgery.
Body contouring is necessary as removal of the breast tissue does not mean that one receives a masculine shaped chest. A mastectomy would likely result in a concave front with no nipples and bad scarring.
Initially a vast number of F to M persons themselves or wear chest flattening clothes. Many individuals have breast reconstructive surgery or some form of breast reduction surgery before Hormone Therapy. This can ease the physical transition and achieve a more masculine presentation.
After reconstructive chest surgery and at the onset of secondary sex characteristics by the use of testosterone a ‘male’ with transsexual traits can be, at most times, indistinguishable from any other male.
A hysterectomy is the surgical removal of the reproductive organs, the uterus ovaries, and cervix. It is currently felt that the retention of these organs (ovaries) beneficial to the health of the female TS. It is suggested that the presence of theses organs may afford a low level of benefiting bone structure as well as health.
It is, therefore, no longer recommended as a treatment for Female TS until the FTM reaches post-menopausal age. Some FTM TS’s have a hysterectomy as Testosterone can cause erosion of the cervix. For the majority as menstruation and fertility will have ceased within two months of starting hormone therapy, they decide to avoid the serious risks of invasive surgery.
This procedure entails the freeing of the testosterone-enhanced clitoris and the surgical creation of a scrotal sac with testicular implants (). The clitoral head is released to enable the clitoris to be more forward and upright when erect, this resembles a small penis. The procedure is an alternative to the more invasive Phalloplasty. At times this is not an acceptable alternative for some FTM’s as they have not achieved sufficient clitoral enlargement.
For some, the urethra may be re-routed through the erectile tissue to allow urinating standing up. The results are usually that of a realistic scrotum and small penis. Surgeons carrying out this procedure need to be skilled in microsurgical procedures.
The procedure is usually carried out in a series of two surgical sessions requiring the healing of the skin tissue between surgeries. The major complications are mostly related to the ‘urethra’ as with other genitalia surgery.
FM’s seeking this will produce a phallus that looks realistic through which a urinary void is present, which is sexual and functional for an orgasm.
The Transmen who are fortunate enough to have the financial resources and physical health to persist with this demanding procedure can achieve urinary voiding as long as they do not experience complications that are, unfortunately, common in this form of surgery. Due to the amount of time for the procedures can be spread over two years or more, which require many weeks in the hospital do require further research.
Although it is improving and there have been some good results, Current the best medical advice and practice recommend that people do not undergo this form of surgery.
Lower surgical procedures:
Can be debilitating procedures
They usually result in catastrophic failure of the the Phalloplasty donor site, leaving the TS with physical scarring.
They can result in incontinence and continuous pain.
Social cost and isolation.
They can lead to major disability
Require up to 14 to 16 periods of hospitalization lasting up to four weeks and can cost between 30.000 and 150.000 USD.
As stated previously ‘Phalloplasty’ is, at this time’ not an easily recommended surgery