MALE to FEMALE – CROSS GENDER HORMONES

1. The Legal age of majority for Gender Hormones. (age 18 in the United States and the UK) 
2. Demonstrable knowledge of what hormones can and cannot medically do plus hormone benefits and risks. 
3. Real-life experience of both cross-gender hormones and at least 1 year living in the desired role or a period of psychotherapy  specified by a mental health professional. 

Hormones
male to Female

HOW IS HORMONE THERAPY OBTAINED AND ACHIEVED

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 doctors who choose not to adhere to these guidelines, in respect of hormone regimes through informed consent. 

If the MTF/TS is only seeking hormones. This is viewed as if you are considering going through to the stage of SRS (Sex reassignment surgery) or similar. Where it is advisable to obtain a letter of recommendation to save time and problems later as most reputable gender surgeons require the letter and will normally refuse to carry out the surgery if you do not produce one.

Hormones are manufactured and controlled by the endocrine system, therefore, an endocrinologist is the best person to consult, if one is not available in your area a good gynaecologist would suffice, as they are often more understanding and are used to prescribing testosterone, oestrogen’s, and progesterone.

In male to female sex change candidates, the principal feminizing hormones are oestrogens. Estrogen alone can induce most female characteristics that are required. The second sex steroid produced by the ovaries progesterone.

Gender Reassignment programs for M to F transsexuals normally consist of reducing androgen effects, and stimulating feminization of secondary sex characteristics with Estrogen.

Tests for HRT include the following:
• Comprehensive metabolic panel
• Lipid profile
• Testosterone total + free
• PT/PTT
• Urinalysis
• Electrolytes
• BUN
• And baseline
• Baseline: liver panel, renal panel, lipid profile, prolactin level, glucose
• Mammography or breast exam
• Prostate exam
• Extremity exam for varicose vein, oedema, and signs of DVT
• Cardiac and respiratory exams
• Neurological exam
• Level

RISKS

There are high risks associated with hormone therapy in both men and women it is, therefore, inadvisable to take any form of hormone product unless it is medically prescribed. The use of progesterone to augment breast development is controversial in physicians treating MTF transsexuals. When deciding on a hormone regimen, it should be borne in mind that it is the Estrogen that causes serious side effects, so the lowest effective dose should be used. 
NOTE: The manufacturers of progesterone state for medical use in females and do not acknowledge their use for transsexuals, as there is little clinical data available. 

Estrogen 

Any natural or artificial substance that induces oestrus and the development of female sex characteristics; more specifically hormones produced by the ovary; the female sex hormones. Estrogen is responsible for cyclic changes in the vaginal epithelium and of the uterus. Natural oestrogens include oestradiol, estrone, and their metabolic product, estriol. When used therapeutically, oestrogens are usually given in the form of a conjugate such as Ethinyl oestradiol, conjugated oestrogens, or the synthetic estrogenic substance. These preparations are effective when given by mouth. Estrogen provides a satisfactory replacement hormone for treating menopausal symptoms and for reducing the risk of osteoporosis and cardiovascular disease in postmenopausal women. It is important to observe patients closely for any malignant changes in the breast or, Estrogen should be administered intermittently and in the lowest effective dose. 
“Taber’s Cyclopaedic Medical Dictionary,” Copyright © 2005 by F. A. Davis Co., Phil., PA 

It has been suggested that ‘unopposed action of oestrogens’ by progestogens could constitute a risk of carcinoma of the breast (cancer). 

In terms of its effect, there are no superior oestrogens. The choice relies heavily on availability, cost, and preference. Initial side effects are reported to be non-existent. All oral oestrogens initially pass the liver after intestinal absorption and exert an effect on liver metabolism. 

Ethinyl oestradiol (Lyn oral) 50 orally twice daily or more is the most impotent Estrogen. It is very cheap and available worldwide. It is often used by the male to female transsexual as it can be obtained easily in the form of the contraceptive pill (always combined with progestogens) Metabolised  Estrogen from other sources (pregnant mare urine) are known as conjugated Estrogen (Premarin) active in postmenopausal women is 0625 – 1.25 mg but for cross-gender purposes, the active dose is 5 – 10 mg. These are said to have fewer side effects than other Estrogen. In trials Estrogen in the dose of 2.5 and 5 mg orally per day is associated with an increased risk of thrombosis. 

Estradiol the most potent of the three forms of active oestrogens in the human body. It is produced synthetically and can be administered orally (Progynovak, Estrofem, Zumenon 2 – 4 mg per day) Intramuscularly (Progynon Depot 20 – 200 mg per month) or trans dermally Oeastraden TI’S 100 patches are replaced twice weekly. To date this latter form is very promising with a low number of induced side effects. 

Ethinyl Oestradiol 100 mg orally per day used to be the standard treatment for the most male to female transsexual but due to the relatively high risk of thrombosis in persons (over 40. Most persons over 40 are best treated with Estraderm TTS 100 two patches a week. 

After SRS the dose is usually reduced to a minimum this produces no clinical symptoms of sex hormone deficiency and forms a protection against Osteoporosis.

 EFFECTS FROM CROSS GENDER HORMONES IN MALE TO FEMALE TRANSSEXUALS 

Annihilation of male pattern baldness is possible but only to a limited extent. It will not replace hair that is already lost but will stop further hair loss. The body hair does not disappear but becomes less course and visible. If hairlessness is required then electrolysis is effective.  Even a beard can also become less obtrusive after several years of Estrogen treatment. 

Penis length is not reduced by hormones though due to its continuous flaccid state and an increase in lower abdominal fat it may appear to be reduced. Although spontaneous erections are suppressed usually within three months during erotic arousal erections may still occur in most persons. Testicular size can be reduced by as much as 25 % in the first year. 

Female characteristic induction in the initial phases of hormone therapy can be quite painful and is common. The breast size evolves gradually with periods of little or no growth the maximum growth is attained over two years. In many persons the Estrogen induced breast size is deemed as unsatisfactory, the majority who are not satisfied request breast surgery 

Estrogen does not affect the pitch of the voice. Speech therapy is necessary, therefore, to achieve a more feminine vocal range. 

The bone structure does not change with Estrogen. However, Estrogen treatment does at times result in more fat around the hips this can vary a great deal from individual to individual. 

Dry skin and fragile nails can occur, avoidance of detergents and application of creams are advised. 

Effects of antiandrogens alone or in combination with oestrogens on the mood and the emotional functioning are also prevalent in several persons 

Male to Female Changes

Males transitioning to females (MTF) experience the following effects of estrogen: 
•Breast development (full development takes several years) 
•Loss of ejaculation 
•Loss of erection 
•Shrinkage of testicles 
•Sterility Temporary changes, which are reversible after HT is stopped, include the following:
•Decrease in acne 
•Decrease in facial and body hair 
•Decrease in muscle mass and strength 
•Skin becomes softer and smoother 
•Slowing of balding pattern 
•Redistribution of fat from the abdominal area to hips and buttocks

Risks associated with HT
include the following:
•Benign pituitary tumour’s 

•Gallbladder disease 
•Hypertension (high blood pressure) 
•Hypothyroidism 
•Liver disease 
•Migraine headache 
•Tendency for blood to clot, causing related conditions:
◦Aneurysm 
◦Deep vein thrombosis (DVT) 
◦Pulmonary embolism (can be fatal) 
•Weight gain 
•Worsening of depression (if present); increased sensitivity to stress New Paragraph