Hormone Replacement Therapy Physical transition of transpeople has many different possibilities. Not everyone chooses to pursue hormone replacement therapy (HRT), and those who do take many different doses and types of hormones for varying lengths of time.There are also several different forms of hormones to choose from. Here we discuss the many types and brands of HRT medications.
Female-to-Male (FTM)
Changes to expect * A lower voice * Distribution of body fat from breasts, hips, and thighs to stomach * Increased strength and muscle development * Enlargement of the clitoris * Increased body hair * Masculinization of facial features * Male-pattern hairline and baldness * Increased aggression, heightened libido * Cessation of menstruation * Facial Hair grows and thickens * Skin texture becomes more coarse
Traits that won’t change *Height (unless starting treatment at a young age) * Size of hands (though feet may grow a few sizes) * Breast growth (though they may shrink a little)
Male-to-Female (MTF) Changes to expect * Redistribution of body fat from stomach to breasts, hips, and thighs * Softer skin and body appearance * Breast growth * Diminished ability to achieve erections and to ejaculate * Increased emotional sensitivity, especially to stress – depression not uncommon * Hair loss stops, but what has been lost won’t grow back * Lessening of body hair * Loss of strength Traits that won’t change * Size of hands and feet * Adam’s apple * Voice * Height * Presence of facial hair (may grow more fine)
Possible Health Risks There are some potentially serious health risks that are involved when beginning hormone therapy, and should be fully researched and considered before beginning. Pre-existing health problems could also disqualify a person for HRT.
One of the most troublesome aspects of HRT is that such little research has been performed to find out what health risks are involved. There could possibly be serious long-term health risks involved that still have not been uncovered.
One serious risk that is definitely correlated with HRT is thromboembolic disease, which is a disease that causes blood clots. The risk for this can be decreased by regular exercise, and not smoking.
MTFs can experience extreme mood swings on estrogen and severe depression and loss of energy can result.
The mortality rate in MTFs is 6 times higher than the general population. This is primarily due to suicide, violence and unknown causes. Estrogen can also cause MTFs to be a higher risk for benign pituitary tumors, gallbladder disease, and hypertension.
FTMs can develop serious acne problems, and weight gain of greater than 10%is fairly common. FTMs face higher risks of breast cancer, diabetes,high cholesterol, hypertension, heart attacks, and liver disease.Smoking tobacco makes these risks even greater, so a person pursuing HRT should be or become a non-smoker.
Themost obvious risk with HRT is that once changes begin to occur, many ofthe changes are irreversible. Sterility results in both MTFs and FTMs after prolonged treatment.
If an MTF thinks she would eventually like to have a child, she should seriously consider storing sperm in a sperm bank prior to starting HRT. If an FTM would like to have a child,it is sometimes possible to become pregnant after being on testosterone for a period of time, though pregnancy would require cessation of hormone treatment. It is possible to freeze eggs, but the technology has not sufficiently developed yet for this to be a long-term feasible solution for most people.
Reduce Your Risk of Complications:
By following a few common sense rules before starting hormone therapy, you can reduce you risk of dangerous complications associated with HRT.
1. If you smoke or use tobacco products, quit before starting HRT. Smoking greatly increases your chance of Heart Attack, Stroke, and Pulmanary Embolism, as well as various types of cancer.
2. Limit your intake of Caffiene. Caffiene raises your blood pressure, and can make you more irritable and hyper, potentially amplifying or inducing mood swings brought on by hormones.
3. If you are overweight, slim down. Obesity by itself is a big health hazard. When you combine it with hormone therapy, and you are asking for trouble.
4. Lighten up on sodium intake.High sodium intake and HRT can make you retain water and bloat, as well as raise your blood pressure.
5. Excercise regularly. Regular moderate excercise will help you to keep your weight under control, and strengthen your heart. It can help to reduce stress and even ease the symptoms of depression, and has been linked to reducing the risk of getting cancer.
6. KeepProtien Intake to around 50 grams per day. Many North Americans consume too much protien on a daily basis. Over half consume more than 250 grams per day! This is hard on the kidneys, and can lead to a whole range of health problems. The adult body needs around 50 grams per day. If you can, vary your sources. Turkey breast is the easiest animal protien source to digest. Limit your intake of fatty meats such as pork, beef, sausage and bacon. Include plant-derived sources such as beans and soy.
Treatment Options:
MTFs have several different options for HRT, but there has been little research as to which treatments are superior to the others or as to which dosage amounts provide the best results. Mostly, the drug used depends on whatis available, cost, and personal preference.
For MTFs, estrogen alone is not enough to block the effects of testosterone; anti-androgens are also a very important part of hormone therapy. After removal of the testes, though, anti-androgens are nolonger necessary. Oral estrogens can cause more problems with theliver, but they are generally cheaper. “Natural” estrogens (metabolized estrogen from other species) have fewer side effects than other estrogens, but they also increase the risk of thrombosis. Estrogen canalso be administered in shots or transdermally (with patches). The patches have very few estrogen-induced side effects, but they can cause skin problems where they stick to the skin. The patches are also the most expensive form of treatment.
FTMs typically do not require any additional treatments to block the effects of estrogen; the testosterone treatment is usually strong enough to make it unnecessary. However, when that is not enough to stop menstruation on its own, progestagens can be used in conjunction with testosterone to stop it.
Testosterone comes in several forms: patches, gels, pills (not available in the US), and intramuscular shots. Shots are the most common and cheapest method.
Itis possible to take hormones for a short period of time to achieve some physical changes, but the health effects have not been adequately researched. However, if a person completes sex reassignment surgery, a person must stay on hormone treatment for the rest of their life in order to prevent osteoporosis, though the dosage can be reduced once all competing hormones are eliminated.
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