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Transgender male to female counselling leading to  gender change 

HORMONE Eligibility  Legal age of majority (age 18 in the United States) Demonstrable knowledge of what hormones can and cannot medically do and hormone benefits and risks Either  real-life experience of at least 3 months living in the desired role or  a period of gender discussion leading to a letter of recommendation (6 weekly sessions) 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 hormone and SRS referral letters. At times you can find a doctor who chooses not to adhere to these guidelines, in respect of hormone regimes. If the MTF/TS is only seeking hormones. This is viewed as acceptable but if you are considering going through to the stage of SRS (Sex reassignment surgery) or similar related surgeries 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 then a good gynecologist would suffice, as they are often more understanding and are used to prescribing testosterone, estrogens, and progesterone.  

In male to female sex change candidates, the principal feminizing hormones are estrogens. Estrogen alone can induce most of the female characteristics that are required. The second sex steroid produced by the ovaries is progesterone. Its feminizing effect is likely limited but the formation of breast tissue has been noted Gender Reassignment programs for M to F transsexuals normally consist of reducing androgen effects with spironolactone/cyproterone and stimulating feminization of secondary sex characteristics with estrogen.


Comprehensive metabolic panel
• Lipid profile
• Testosterone: total + free
• Urinalysis
• Electrolytes
• Creatinine and baseline
• Baseline: liver panel, renal panel, lipid  profile, prolactin level, glucose
• Mammography or breast exam
• Prostate exam
• Extremity exam for varicose vein, enema, and signs of DVT
• Cardiac and respiratory exams
• Neurological exam
• Oestradiol level RISKS

There are high 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. 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 Estrogen that causes e serious side effects, so the lowest effective dose should be used.

NOTE: The manufacturers of Estrogen and progesterone products specify them for medical use in females and do not acknowledge their use for transsexuals, there is little clinical data available. Estrogen Any natural or artificial substance that induces oestrus and the development of female sex characteristics; more specifically, the estrogenic hormones produced by the ovary; the female sex hormones. Estrogen is responsible for cyclic changes in the vaginal epithelium and endometrium of the uterus. Natural oestrogens include estradiol, estrone, and their metabolic product, estriol. When used therapeutically, estrogens are usually given in the form of a conjugate such as ethinyloestradiol, conjugated estrogens, or the synthetic estrogenic substance diethylstilboestrol. 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 endometrium. 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 the ‘unopposed action of estrogens’ by progestogens could constitute a risk of carcinoma of the breast (cancer). In terms of its effect, there are no superior estrogens. The choice relies heavily on availability, cost and preference. Initial side effects are reported to be non-existent. All oral estrogens initially pass the liver after intestinal absorption and exert an effect on liver metabolism.  Ethinyloestradiol  (Lyn oral) 50 orally twice daily or more is the most impotent estrogenic drug. It is very cheap and available worldwide. It is often used by the male to female transsexuals as it can be obtained easily in the form of the contraceptive pill (always combined with progestogins) Metabolized estrogens from other sources (pregnant mare urine) are known as conjugated estrogens (Premarin) an active does 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 is the most potent of the three forms of active estrogens in the human body. It is produced synthetically and can be administered orally (Progynova, Estrofem, Zumenon 2 – 4 mg per day) Intramuscularly (Progynon Depot 20 – 200 mg per month) or transdermally, Estraderm TI’S 100 patches are replaced twice weekly. To date, this latter form is very promising with a low number of induced side effects.  . Ethinyloestradiol 100 mg orally per day used to be the standard treatment for most male to female transsexuals, 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.



Annihilation of male pattern baldness is possible but only to a limited extent. It will not replace hair that is already lost but may stop further hair loss. 

The body hair does not disappear but becomes less course and visible. If hairlessness is desired then electrolysis is effective. the beard can also become less obtrusive after several years of Estrogen treatment. 

Penis length is not reduced by hormones but 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 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 a period 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 estrogens  on the mood and the emotional functioning are also prevalent in many persons

  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.


which are reversible after HRT is stopped, including

A decrease in acne

A decrease in facial and body hair

A 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.



Benign pituitary tumors

Gallbladder disease

Hypertension (high blood pressure) 


Liver disease Migraine  headache 

A tendency for blood to clot, causing related conditions: 


Deep vein thrombosis (DVT) 

Pulmonary embolism (can be fatal)

 Weight gain

 Worsening of depression (if present); increased sensitivity to stress