Hormone Guide for Transsexuals: Male to Female and Female to Male Hormone Replacement Therapy

There are many different hormones used for hormone replacement therapy. This guide will hopefully break down some of the dizzying complexity. While there is much that your physician can help you with if you ask, educating yourself so that you are prepared will ensure that you ask the right questions.

Some doctors may require a certain amount of time living as your identified gender before prescribing hormones. Be prepared for this and ask around to find a caregiver who will meet your needs and desires.

Androgens

The androgen group of hormones work to masculinize the body and are also the precursors of the estrogens. The most important androgens to hormone replacement therapy are testosterone and dihydrotestosterone, also known as DHT.

Individuals on the female to male spectrum are most frequently prescribed testosterone. It's primarily available as an injection or a topical cream. The injection form of testosterone has the fastest and most dramatic effects, with the cream form taking longer to make noticeable changes in the body.

A topic DHT cream is occasionally suggested by some surgeons prior to a metoidioplasty, in addition to clitoral pumping. It's believed that this helps enlarge the tissues further so that there is more to work with during surgery.

Individuals on the male to female spectrum who have not had their testes removed are frequently prescribed an androgen blocker, such as spironolactone. Androgen blockers will both prevent androgens from being used by the body as well as promote the conversion of testosterone into estradiol, a form of estrogen.

Estrogens

The estrogen group of hormones work to feminize the body, as well as aiding in the regulation of female reproduction. Estradiol is the most frequent form of estrogen used in hormone replacement therapy.

When taken in pill form, estradiol must first pass through the liver. This can lead to both a strain on the liver as well as the hormone being unpredictably absorbed, as much of it is removed during this processing. This is still the most common form of estradiol available, though it is not ideal.

Estradiol can also be administered in transdermal patches and topical creams, as well as injections. After sex reassignment surgery, some women may be prescribed vaginal suppositories which include estradiol. These more direct methods result in a reliable amount of estradiol being absorbed by the body and are less taxing on the liver.

Individuals on the female to male spectrum are not typically prescribed anything to block estrogens. In most cases, taking testosterone is sufficient for slowing the body's natural production of estrogens.

Progestogens

The progestogen group of hormones are primarily involved in regulating pregnancy and the female reproductive cycle, but they also play a part in regulating the body in both sexes. Progesterone and synthetically created progestins are the most common forms of progestogens used in hormone replacement therapy.

Breast tissue requires progesterone and estradiol in order to develop fully, and because of this trans women are sometimes prescribed progesterone or a synthetic progestins during breast growth. Synthetic progestins can be absorbed orally, but has many side-effects and may not be very effective. Bioidentical progesterone is frequently produced from plant derivatives and is available as a topical cream. Side-effects are few and effectiveness is generally reported as greater than that of the progestins.

Side-Effects

Sex hormones are potent steroid compounds in the body and while they are very effective at altering secondary sex characteristics, they will change other aspects of the body as well.

Transsexual hormone replacement therapy will often result in sterility. Those who wish to have their own genetic children may want to look into preserving sperm or eggs before they begin. However, sterility does not happen in a perfectly predictable manner and therefore HRT cannot be treated as a form of birth control.

Blood clots, bleeding, and changes in blood pressure are all frequent side-effects. If you have a history of problems with any of these or are going to undergo surgery while on hormones, you will need to inform your physician. Most surgeons will require you to cease taking your hormones for several weeks before any major surgery.

Mood swings and changes in temperament and libido are commonly reported. Trans women often find their libidos dropping or arousal patterns changing, while many trans men typically report a dramatic upswing in sex drive.

Your unique health situation as well as family history will have an impact on what side-effects you may experience. The history of family members of the gender you are transitioning to will be very important in determining what conditions you may find yourself prone to.

These are all things that you should discuss with your doctor before beginning hormones.

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