Hormone Treatment For Male To Female Transsexuals

A gender reassignment program for male to female transsexuals normally includes the prescription of feminising hormones, estrogen and progesterone which develop female secondary sexual characteristics. In addition this may be accompanied before surgery by anti-androgen treatment to reduce the effect of the patient's own male sex hormones. There can be risks attached to hormone therapy in both men and women and therefore it is definitely inadvisable to take any form of hormone product unless it is medically prescribed. The manufacturers of estrogen and progesterone products specify them for medical use in females and do not acknowledge their use for transsexuals, so there is little clinical data available regarding this usage. The effect of feminising hormones varies between patients, but many experience changes within two to three months such as change in skin tone, development of breasts, expansion of the nipples, redistribution of body fat causing fuller cheeks, a more pronounced waist and fleshier hips and buttocks. Body and scalp hair may change in texture but hormone treatment will not inhibit beard growth or improve male pattern baldness. Emotions may be heightened with a greater tendency to mood swings, but in general the transsexual will feel more comfortable with the new self that is emerging. For this reason hormone therapy can be a useful diagnostic tool, as a male who is not transsexual is unlikely to feel this heightened ease with themselves and may become anxious at the drop in their male sex drive. The transsexual on hormone treatment should receive regular check-ups from their doctor. There are various forms of hormone products available and the following is a review of those commonly in use.
Estrogens
Estrogens are responsible for the development of female secondary sexual characteristics, so the main component of any hormone regime for a TS patient will be some form of estrogen. Typically this is obtained either from combined oral contraceptives or estrogen tablets intended for HRT in postmenopausal women. The principle natural estrogen produced from the ovaries in a natural-born premenopausal female is 17 beta-oestradiol. Numerous derivatives and metabolites exist and play specific roles in the female body. While some of the metabolites (e.g. estrogen, oestriol) may be used successfully in treating menopause symptoms in post menopausal women, they are not suitable for transsexual patients; it is necessary to supply 17 beta-oestradiol or a synthetic replacement for it. Estrogen therapy must be continued for life in a post-operative subject, otherwise numerous problems can occur. In particular, several very severe case of osteoporosis have been reported in post-ops who have discontinued their estrogen treatment. Menopause-like symptoms also occur if oestrogen is discontinued.
Oestradiol Valerate
This drug is equivalent to natural 17 beta-oestradiol. It is generally well-tolerated, and clinical data from postmenopausal women suggest it is safer than ethinyloestradiol for long-term use, with less risk of breast cancer, thromboembolic events, or liver problems. It is not certain whether this improved safety applies in the high doses necessary for pre-op transsexuals. This is widely regarded as the estrogen of choice for long-term maintenance in post-op TS patients due to its good safety record; typical post-op dose would be 1-2mg daily, ideally divided into two doses. Oestradiol Valerate appears to be less effective at inducing feminisation in pre-op subjects than ethinyloestradiol, probably due to it's short serum half life-particularly, as it appears to fare poorly when "in competition" with endogenous male hormones; adequate results have been obtained with oestradiol valerate combined with an effective anti androgen. Typical pre-op dose would be 4-6mg daily in divided doses (1 or 2mg per dose); if menopause-type symptoms appear (hot flushes, night sweats, etc) this can often be a sign that the dose is not sufficient to overcome the endogenous male hormones and a switch to ethinyloestradiol would probably be advisable.
Ethinyloestradiol
This drug is a synthetically-produced modification of natural 17 beta-oestradiol. The modified molecule is eliminated only slowly by the liver, giving it a far greater potency and much longer half life that other estrogens. It is generally well-tolerated, but appears to be less safe in very long-term use that oestradiol valerate. Ethinyloestradiol is widely regarded as the estrogen of choice in pre-operative subjects. A dose of 100ug daily in two doses) is typical; this can be increased to 150ug if necessary. It's long half life and potency give it excellent feminising effects. In post-op patients, this drug may still be used, especially for patients whose feminisation has not completed by the time they have GRS. For short-term post-op use, the full pre-op dose of 100ug may be used, this is normally reduced to 50ug after 6-12 months. For long-term post-op use, the full pre-op dose, oestradiol valerate is probably preferable. It should be noted here that estrogen over dosage may paradoxically cause vasomotor symptoms similar to those produced by insufficient estrogen dosage.
This is sometimes seen in post-op patients who are still on pre-op dosage, and if this effect is suspected then the estrogen dosage should immediately be reduced to a typical post-op level. This effect is more likely with ethinyloestradiol than with other estrogens due to its high potency, and consideration may be given to an early switch to oestradiol valerate if the problem persists.

Conjugated Natural Estrogens (Premarin)
This drug is a mixture of various estrogenic substances extracted from the urine of pregnant mares. It lacks the potency of ethinyloestradiol, and there is no evidence that it has any advantages over oestradiol valerate. Many patients dislike this drug because of ethical concerns over the manner in which it is produced. It is increasingly regarded as an outmoded treatment for TS patients. It is also more expensive than the synthetically-manufactured drugs. A typical pre-op dose would be 5-7.5mg daily in divided doses, reducing to 1-2.5mg daily post up.

Other Estrogens
A number of other estrogenic drugs exist, many of which have been tried in the past in TS patients. It has already been mentioned that metabolites such as oestrone and oestriol are not suitable for use in TS patients; other estrogen derivatives exist but have no advantages over the three estrogens listed above. Diethylstilboestrol has been used in the past, and while it certainty produces worthwhile feminising effects, its safety record contraindicates its use in TS subjects : many serious problems, including fatalities, have been reported.

Progestogens
 Progestogens administered alone do not produce feminisation in a phenotypic male. However, progestogens are generally quite anti-androgenic and will often promote a useful degree of testosterone suppression in a pre-op patient, and more importantly when administered in conjunction with estrogen, improve the feminisation attained compared to estrogen-only therapy, particularly in terms of breast weight and texture. One UK endocrinologist has claimed that progestogens have no effect in transsexual patients, however numerous studies both in the UK and elsewhere have demonstrated that this claim is false. Progestogens are now very widely used in conjunction with estrogens in the treatment of male-to-female Transsexualism. Progestogens may also lessen the risk of cancer associated with long-term estrogen treatment, according to some studies in natural-born females. In addition, some patients report that progestogens affect them psychologically, particularly in terms of maintaining the libido. For all these reasons, it may well be desirable to continue with a low dose of Progestogens post operatively, even though there is no absolute need for it. No reliable data exists regarding the incidence of breast cancer in transsexuals. Many are lost to follow-up and conceal their transsexual past after completing their treatment, and any instances of breast cancer in this group are likely to be recorded as occurring in normal women rather than transsexuals. One researcher has claimed to find a significant excess of breast cancers among certain chromosomally-intersexed patients who have been reassigned to female. A few patients experience androgenic effects from some progestogens, possibly including an increase in body hair. If this occurs, a different Progestogen should be tried. Similarly, if fluid retention occurs, a switch to an alternative drug will probably resolve it.

Medroxyprogesterone Acetate
This progestogen (trade name Provera) is normally used for treating irregular menstrual bleeding or endometriosis, and its safety record is good. It is widely regarded as the preferred progestogen, at least when the patient is not using combined contraceptive pills as a low-cost source of estrogen and progestogens. Some patients, however, report slight virilising effects including, occasionally, a return of some degree of male sexual function even in post-orchidectomy subjects, which can be found disturbing; it appears that a proportion of the drug may be metabolised into testosterone in some patients. Medroxyprogesterone acetate is generally less virilising than the testosterone-derived synthetic progestogens (e.g. norethisterone and levonorgestrel), but more virilising than dydrogesterone. If a patient experiences virilising effects with medroxyprogesterone acetate then a switch to dydrogesterone should be considered. A typical pre-op (or early post-op) dose (to maximize feminisation) would be 10mg in two doses; post-op 5mg or even 2.5mg may be sufficient to maintain the patient's libido.

Dydrogesterone
This progestogen (trade name Duphaston) may be used as an alternative to medroxyprogesterone acetate. It is not metabolised into testosterone within the body, and is therefore ftee of the virilising effects which some patients experience ftom other progesterones. Conversely it may be less effective in maintaining libido than medroxyprogesterone acetate. Dydrogesterone is regarded as the progestogen of choice when patients have experienced virilising effects from other progestogens. A typical pre-op (or early post-op) dose would be 20mg in two doses, reducing to a single dose of 10mg daily post-op.

Natural Progesterone 
USP This drug. which is probably unavailable in the UK, has a small but vocal group of transsexual adherents in the USA, who claim that it is superior to other progestogens. The present authors have been unable to find any clinical data to support this claim; while it appears to be free of virilising effects, first-pass effects are liable to make it relatively ineffective relative to dydrogesterone, which is also non-virilising. The main problem with 'Natural Progesterone' is that it is largely destroyed by the digestive tract and liver upon ingestion, so very large doses (hundreds of milligrams) are used. Since the precise percentage of the drug metabolised in this way is variable and unknown, the actual serum levels obtained are unpredictable.

Synthetic Progestogens This heading covers substances such as levonorgestrel and norethisterone, which are usually found in combined contraceptive tablets, usually with ethinyloestradiol. Contraceptive pills provide a useful low-cost source of feminising hormones for patients who have to pay for their own medications, but of course the patient is limited to the combinations of substances available, and cannot 'mix and match' as one can with separate estrogen and progestogen drugs. Care should be taken with some preparations (for example, Brevinor) as they contain too high a ratio of progestogen to estrogen, so that taking enough tablets to obtain a suitable dose of estrogen would result in a dangerously high intake of progestogen.
One combined tablet that has been used widely in the treatment of transsexual patients is Ovran; a typical pre-op dose of two tablets daily gives 100ug of ethinyloestradiol and 500ug of levonorgestrel. Most patients tolerate this well, and it generally produces satisfactory feminisation, but levonorgestrel appears (anecdotally) to give more frequent problems with water retention, hypertension and weight gain than medroxyprogesterone acetate. Safety fears have also been raised in the past about levonorgestrel-based contraceptive implants. Some patients experience virilising effects with norethisterone or levonorgestrel, which may impair the feminising effects of estrogen. If this is suspected then an alternative progestogen should be tried.

ANTIANDROGENS, GnRH AGONISTS AND ORCHIDECTOMY 
Hormone treatment in pre-operative male-to-female subjects is normally supplemented by some form of antiandrogen treatment. While oestrogens and progestogens are to some extent antiandrogenic in themselves, a number of other methods exists to suppress the effects of androgens and make the feminising hormones more effective without having to administer the latter in unreasonably high doses. These treatments also, of course, cause a significant reduction in male sex drive (and indeed sexual function), which is generally considered highly desirable by transsexual subjects. There are three approaches to antiandrogen treatment:
1 . Antiandrogen drugs. 2. GnRN (Gonadotropin-releasing-hormone) agonists. 3. Bilateral orchidectomy (castration).
These treatments are not applicable to patients who are post-operative, as their bodies will, by definition, be incapable of producing gonadal androgens. Adrenal androgens are produced in small amounts by both sexes, and no attempt should be made to suppress them unless a serum androgen test has indicated significant overproduction, as in cases of adrenal hyperplasia. In general it is considered unwise to administer antiandrogens to post-operative subjects (and indeed to severely hypogonadal subjects such as certain intersexed patients), as the small amount of adrenal androgens remaining in such subjects are necessary for normal functioning.

Antiandrogen Drugs These drugs either inhibit gonadal androgen production, interfere with androgen receptor sites, or both. Most are likely to produce some side effects in effective doses; some patients cannot tolerate some or all antiandrogen drugs, in which case bilateral orchidectomy is likely to be a preferable treatment. The effect of these drugs on fertility and male sexual function is reversible to an extent, however (like feminising hormones) irreversible infertility may ensue after some months of treatment. All antiandrogen drugs, like feminising hormones, must be withdrawn prior to major surgery This may lead to a degree of reversion towards masculinity, which may be pronounced and disturbing in some patients.

Cyproterone Acetate 
This drug (brand names Androcur, Cyprostat) is widely regarded as the antiandrogen of choice by practitioners in Europe (it is not approved in the USA). It is an androgen receptor antagonist and weak gonadal androgen production inhibitor;
normal dose is 50mg daily, which may be increased to 100 or in exceptional cases 150mg daily if required. In these doses there are some risks associated with the drug, particularly a heightened risk of thromboembolic disease or liver damage.
Carbohydrate metabolism changes are also reported; patients should receive regular blood tests (LFT and fasting glucose) and BP checks. Possible side effects include severe lassitude, loss of concentration and depression, also weight gain and nausea. Anecdotal reports suggest that the side effects can be lessened by taking the drug after meals; opinions differ as to the best time of day to take a single dose to minimise the tiredness effect: patients are best advised to experiment for themselves, though after lunch or after the evening meal seem to be the usual choices.

Flutamide 
This is a relatively new drug which has been used with success in some transsexual patients, particularly those who have experienced unacceptable side effects with cyproterone. There is relatively little clinical data available for this drug in transsexual patients. It is a strong androgen receptor antagonist. Like cyproterone it can be hepatotoxic, it can also have significant adverse haematological effects (reduced platelet, leukocyte or erythrocyte count) or cause hypertension, and it can also produce less serious side effects such as fluid retention. Regular LFTs and blood checks are advisable when using this drug. This drug also produces psychological side effects which can be severe in some patients. Depression, anxiety or nervousness can be extreme, and patients should be made aware of this possibility Lassitude, insomnia and gastrointestinal disturbances have also been reported. Typical dose is 250mg to 750mg daily (one to three 250mg tablets).

Spironolactone 
This drug was originally developed as an antihypertensive/diuretic; it is also a weak androgen receptor antagonist. It is much less effective as an antiandrogen than cyproterone or flutamide, but can find use in patients who have hypertension or severe fluid retention, either pre-existing or as a result of hormone treatment. Side effects may include lassitude, loss of concentration, and various gastrointestinal problems. There is a risk of potassium retention. Doses range typically from 100 to 400mg daily.

Finasteride 
This drug is not suitable as a general antiandrogen, but is mentioned here as it can be useful in countering male-pattern baldness in transsexuals. Classed as an androgen conversion inhibitor, it blocks the conversion of testosterone to DHT. It is generally ftee ftom significant side effects, but does not appear to affect male sex drive. Typical dosage is 5mg daily.

GnRH Agonists 
These drugs take a different approach to antiandrogens: they act on the pituitary, initially overstimulating it and then rapidly desensitising it to GnRH. The effect of this is that over a period of weeks, gonadal androgen production is greatly reduced. Their principal advantages are that they are generally fullly reversible in their effects, which makes them a useful treatment in adolescent subjects where it is desired to stall the changes of puberty but not desired to induce permanent feminisation until the subject is older; and that they do not carry the risks of thromboembolic disease associated with antiandrogens. This can be particularly useful when hormones/antiandrogens are withdrawn prior to surgery - GnRH agonist treatment can be used to minimise the reversion to male biochemistry that many transsexual subjects find deeply disturbing. GnRH agonists do carry risks of significant side effects and should be used with great caution. There is as yet relatively little clinical data on the use of these substances in transsexual subjects, particularly in long-term use.

Nafarelin 
Acetate Normally administered as a nasal spray (typical dosage 1600l.tg daily). May cause depression, insomnia. skin problems and other side effects. Being administered daily, the drug can easily be withdrawn should side effects occur.

Goserelin Acetate 
Administered as a depot (i.e. time-release) injection (typically 3.6mg monthly). Reported adverse effects include heart failure, obstructive pulmonary disease and severe allergic reactions as well as more minor side effects such as lethargy and nausea. In view of the fact that it is a depot injection, this drug should be treated with caution as it cannot be rapidly withdrawn should problems occur.

Leunrorelin Acetate 
Similar to Goserelin Acetate, with a typical dose of 3.75mg every 4 weeks. This drug has been used to good effect in adolescent subjects. Allergic reactions and other side effects have been reported.

Bilateral Orchidectomy 
Orchidectomy offers several advantages over antiandrogen or GnRH-agonist therapy: After orchidectomy, the patient is endocrinologically equivalent to a post-operative subject. This has clear safety advantages especially in patients thought to be at elevated risk of thromboembolic events. Some patients report transient lethargy as their body adapts to the loss of androgens, but all the side effects associated with antiandrogens or GnRH agonists are eliminated. There are some disadvantages to orchidectomy such as irreversibility and shrinkage of scrotal tissue. Bilateral orchidectomy normally requires a referral from a psychiatrist; some surgeons may require a second opinion from an independent psychiatrist.

This information sheet is based on the paper Transsexualism: A Medical Overview published by The Looking Glass Society in March 1998.

source : http://www.g7ucl.fsnet.co.uk/hormones.htm

Hormones in Context: Estrogens and Androgens

The negative feedback system.

Androgens and estrogens are collectively known as gonadotrophins by virtue of the fact that the testes and ovaries are the main sites of production. In both males and females the hypothalamus and the pituitary gland are closely linked in nervous and endocrine communication, in this case by peptide hormones called Gonadotrophin Releasing Hormones.
The pituitary gland produces LH (luteinising hormone) and FSH (follicle stimulating hormone) which stimulate the gonads in two ways:
FSH stimulates growth of the sex cells, the ovarian follicles in a woman, the seminiferous tubules and early stages of sperm production in a man. LH in a woman, in high concentration, induces ovulation in a Graafian follicle which has been primed with FSH.

In addition, LH and FSH stimulate the production of testosterone (primarily) by the testes in a man, estrogens by the ovaries in a woman. It should be noted that they are also produced in small quantities by the adrenal cortex.
Negative feedback operates on the hypothalamus and pituitary, to reduce the output of the pituitary, in response to the overall levels of all gonadal steroids, which are controlled at different levels in men and women.
In adult males the concentration is about 240mg/100ml, about eight times higher than in adult females. However, only about 2% is free and biologically active. The rest is bound to blood protein, some to albumin which are relatively free and the rest to SHBG which provides a store. It is important, then, when reading accounts of hormone concentration, to be sure which testosterone is being considered. In women, the quantity is about 30mg/100ml, of which about 1% is free. Androgens in women are mainly present as androstenedione, which has a number of functions, but testosterone and dihydrotestosterone can be synthesised from it as needed.

Female positive feedback.

The feedback system described in the last section is a homeostatic mechanism for both sexes. In women it is interrupted by a period each month when LH goes into positive feedback, as part of the menstrual cycle.
Day one is typically taken as the last day of menses.
Effectively, initially, the set point is increased and the concentration of FSH and LH gradually rises, when growth starts of a new Graafian follicle in the ovary. The latter begins to secrete estradiol 17ß, androstenedione and a precursor of progesterone.
This increase in steroid levels causes FSH to fall. However, LH begins to stimulate the pituitary, instead of inhibiting it. Note that the feedback system previously described, compensates for loss of steroids. It cannot deal with increases from other sources and, at about day 16, LH and estradiol go into positive feedback, causing a rapid rise, causing the ripe follicle, now a mature ovum, to be released into the Fallopian tube.
The follicle, at this point becomes a corpus luteum, which generates progesterone as well as estradiol. This terminates the positive feedback and initiates another negative feedback system by which LH production by the pituitary is inhibited., Within a day, LH drops rapidly to its normal level.
Estradiol having fallen away, it begins to rise again, along with progesterone, in preparation for pregnancy. In the last few days before menstruation, if the egg has not been fertilised, the corpus luteum regresses, and both fall away to their base levels. There is also a gradual rise and fall in testosterone, peaking at about 17 days.
If the egg is fertilised, the corpus luteum is preserved.

Conversion to estrogen.

It is this process and the production of male sperm, of course, that causes these hormones to be referred to as the sex hormones. However, testosterone is one of a number of androgens. Both androgens and estrogens are involved in a great many other processes. 
Estrogens and androgens are not uniquely male or female. What differs is the ratio between the two sexes. Both seem to be required in both sexes to achieve sexual maturity. Both are produced by the ovaries or testes, and by the adrenal cortex.

A base level of testosterone in men is needed for spermatogenesis and for prostate and seminal vesicle action. However recent work suggests that a high level of estrogen is also required within the testes to regulate the concentration of sperm in the semen.⁽¹⁾

In men the main circulating androgen is testosterone. Estrogen is present in small amounts, and can be synthesised from testosterone at the point where it is needed. Progesterone is present only as a trace. In women, androgens are present, principally as androstenedione, which can be converted to testosterone and dihydrotestosterone as needed.
	To summarise, then, negative feedback senses the total complement of the gonadotrophins of whatever kind, causing the hypothalamus and pituitary to reduce the output of FSH and LH and, in women, periodically, a positive feedback system is superimposed.
	Role in general metabolism. Looking once more at the feedback diagram at the beginning of this piece, it would seem that sperm production in men is controlled by LH concentration rather than testosterone. If fertility is the criterion of maleness, one might expect that testosterone is not absolutely essential. Similarly, in the presence of exogenous (from without) hormones, which would cause FSH production to fall, one might expect sterility to be an early result. This was an initial worry when men were prescribed estrogens for various conditions. In fact, it seems remarkably difficult to prevent sperm production, hence the difficulties in developing a male contraceptive pill, without using the dangerously high doses used illegally by certain athletes. What role does testosterone have for men? It turns out that it isn't an easy question to answer. The consensus opinion seems to be that testosterone is largely concerned with sexual appetite, the reduction of which, for some gender dysphoric people, is a welcome relief. Bancroft(2) points out that one must distinguish this from sexual interest, as mainly cognitive. As regards sexual performance, erection and climax is organised by the peripheral nervous system. On the other hand, lack of testosterone does seem to be associated with reduced seminal emission. Clearly, though, without an appetite for sex, one's level of interest is not likely to be high, and performance will be unenthusiastic. Androgens and estrogens are concerned in the development and maintenance of secondary sexual characteristics, such as breasts, external genitalia, body hair distribution and so on. Male pattern baldness is to some extent determined genetically, and may be countered in women by the presence of estrogens. However preoccupied the TG community is with androgens and estrogens, they seem to have little interest for endocrinologists. There is very little about them in the textbooks, and Rose(3) in his book The Chemistry of Life barely mentions them at all. Complicating the issue is the fact that there is actually a family of different estrogens and androgens, which may be converted from one to another at the point of action. They play a part in organisation, as for instance modifying development in a male or female direction. Some such developments may remain dormant during childhood. They are to be the source of activation in puberty, though this may be an oversimplification. Hormones may simply moderate other metabolic processes, perhaps stimulating certain modes of behaviour. Clues to their activity may be gained from the presence of receptors on various organs. But, in addition, cells develop particular biochemical environments and develop within those environments. In relation to accounts of effects on mood, and on gender identity, the cells of the brain are not excepted.

Recent work has also indicated that estrogens may counter some of the degenerative conditions of the brain which occur with old age. Since the cells concerned do not have receptors for estrogen, it would seem to be a function of the biochemical environment.

The role in bone metabolism of estrogens is fairly well- known, in that one of the benefits of hormone replacement therapy for women is the prevention of osteoporosis. There is a feeling among some workers that an excess above the normal physiological quantity, as when male-to-female transsexuals are prescribed estrogen therapy, may result in bone metabolism being retarded, though they warn that more work needs to be done.(4) One of the more alarming tests (for mothers) that are performed on new born babies is to manipulate their legs to look for signs of congenital hip dysplasia, a weakness of the thigh bone's joint with the hip.

There is an interesting interaction of genes, sex and environment here, which puzzled researchers for many years. It became clear that the predisposing factor is an inherited geometry of the joint but why was there such cultural variation and why were girls affected more often than boys? It turned out that, near the moment of birth, the mother's estrogen rises greatly, assisting the articulation, or spreading, of her pelvis to facilitate the process. Some of this estrogen enters the bloodstream of the baby. For a while after birth, the baby's cartilage is also elastic, so that, with this geometry, the hip is more likely to pop out of joint. The problem was more prevalent in cultures that swaddle their babies tightly. If the baby is allowed to keep its legs in a natural position and exercise them, the joint soon strengthens. Although testosterone levels are higher in boys at birth, it seems that boys' cartilage is less plastic under the influence of estrogens, which accounts for the difference. The role that testosterone plays during prenatal development has already been described. In childhood, the concentration of hormones is much the same both sexes. Therefore social theorists assert that any differences in behaviour must be due to upbringing. The biological school insist that the organisational effects extend to the brain. Some go further and suggest that, when born, children are 'pre-wired' as boys or girls. They suggest that cognitive changes in puberty arise from such organising effects being activated by hormone changes, rather than changes in the educational curriculum and changing social expectations. In the extreme, there is no point in trying to rectify social factors behind closing-time pub brawls and joy-riding, even rape and child abuse, because it is written indelibly in human biology. Similarly, women are only fit for rearing children and having the supper ready for when hubby comes home from work. Although there is plenty of literature about the effects of this supposed wiring, no one has really shown how it works, still less that it somehow 'tells' a child it is a boy or a girl.   Bibliography Hess, R.A., et al, (1997) A role for estrogens in the male reproductive system, Letter to Nature, 390, 509. Bancroft J. (1989) Human Sexuality and its Problems, Edinburgh: Churchill Livingstone. (bookshelf) Rose, S., (1991) The Chemistry of Life, London: Penguin Books. (bookshelf) Thomas, M., Barrett, J.S., Montgomery, D.H., (1994) Serum markers of bone metabolism in a group of transsexual patients receiving estrogen therapy, in GENDYS' 94, The Third International Gender Dysphoria Conference, Report, Belper: GENDYS Conferences.

^{SOURCE : http://www.gender.org.uk/about/06encrn/62_hormn.htm}

Food nutrients that effect hormone levels

There are many plants and vegetables which contain natural estrogens and estradiol. There are also plants and foods which contain phyto-androgens and also plants which lower testosterone levels. Beer contains massive amounts of estradiol which is excellent for feminizing effects.

increase androgens & less estrogens

Nutrients for less testosterone and more estrogen

fava beans anti-estrogens : brussels, broccoli, oats. chrysin tribulus epimedium damania wild yam yarrow sage angelica chickweed saw palmetto l-arginine amino acid citrulline phyto-androgenic plants include: parsnips, corn, pine nuts, oats, garlic,onions, celery. zinc nettle root celery juice ginseng radish turnip cabbage contains indoles (anti-estrogen) cauliflower sprouts Goji berries watermelon contains citrulline tomatoes contain lycopene oysters have zinc and dopamine saturated fat monounsaturated fat beef mucuna maca tuna red kidney beans ginger choline olives avocado choline carrots honey asparagus vanilla strawberries curcumin (cox-2 inhibiter) berries citrus figs grapes melons pineapple buckwheat millet tapioca white rice white flour corn green beans

all types of soya all plant phyto-estrogens beer and hops black cohosh licorice grapefruit flax seed evening primrose black currant polyunsaturated fat aspartate glutamate coca cola light nutrasweet MSG :chinese food green tea don quai motherwort yucca red clover jumiper thyme mistletoe dried apricots alfalfa sprouts damiana, verbana, thyme oregano dried dates chestnuts tumeric bloodroot selenium peanuts, almonds isoflavonoids flavonoids stilbenes lignans tofu sesame seed multigrain bread hummus mung bean sprouts corn, lentils black-eyed peas, chickpeas lima beans,navy beans red beans, soybeans soybean sprouts split peas, apples, cherries, dates papaya,plums, bananas pomegranates, pears barley, brown rice wheat clover parsley, sage, alfalfa anise, fennel pumpkin seed, sesame seed sunflower seed beets carrots, celery, cucumbers eggplant, peppers potatoes, rhubarb

 

HORMONE THERAPY

It’s a fact that some transsexuals choose—usually because it’s the only option available to them—to self-prescribe hormones and/or androgen-blocking drugs. This article compares recommendations from medical and non-medical sources, and explains conditions that could result from HRT, whether therapy is medically monitored or not. This information is not provided or intended as a substitute for professional medical advice or care.

I am not a medical professional. Please also note that the glossary at the end of this article is just that: a glossary, and not a dictionary. The descriptions of the terms in the glossary are meant to help you interpret their use in this article only, and are not comprehensive definitions.

Because the populations are so different, this article is arranged in two sections, one reporting on MTFs and one on FTMs.

MTFs

Dosage

There are no generally agreed upon recommended dosages, or recommended drugs within categories. The following recommendations are based upon three sources, but the categorization of drugs into "recommended" and "less recommended" come from "Hormone Treatment in Transsexual People" (Asscheman and Gooren 1992). Dosage recommendations and notes, unless otherwise noted, are also from Asscheman and Gooren.

It is recommended that MTFs take both an anti-androgen and a source of estrogen before having an orchiectomy, and discontinue using anti-androgens after an orchiectomy (Asscheman & Gooren). Taking only an anti-androgen incurs risk of serious bone density loss, and taking only estrogen does not significantly lower testosterone levels. You should only be using one drug at the recommended dosage from each category.

Note that mg is an abbreviation for milligrams, not to be confused with μg, the abbreviation for micrograms. A microgram is 1/1,000 of a milligram. To avoid some confusion, the abbreviation for micrograms is not used in these tables. Other abbreviations that have been replaced for clarity are t.i.d., which is the Latin abbreviation for "three times a day," p.o., which indicates an oral dose, and i.m., for intramuscular injections.

For common names and descriptions of commercially available preparations of the drugs, click the generic name.

Recommended anti-androgens and their dosage:

Generic name	Dosage	Notes
cyproterone acetate (injectable Androcur Depot)	100-150 mg/day orally	Antigonadotropic.
spironolactone	100-200 mg/day orally	Works by interfering with testosterone or DHT production. Also has receptor-blocking properties. Originally developed as a diuretic, it has antihypertensive properties.

Less recommended anti-androgens and their dosage:

Generic name	Dosage	Notes
medroxyprogesterone	5-10 mg/day orally [1],[3]	Antigonadotropic. Less effective than cyproterone and spironolactone
	150 mg/month intramuscular injection
nilutamide	300 mg/day orally	Androgen receptor blocker. Not as effective for MTF hormone therapy, because it can potentially stimulate androgen production.
flutamide	250 mg three times a day, orally	Works by interfering with testosterone or DHT production. Not as effective for MTF hormone therapy, because it can potentially stimulate androgen production.

Recommended estrogens and their dosages:

Generic name	Dosage	Notes
ethinyl estradiol	100 micrograms/day orally [1], [3]	Most potent estrogenic drug. Slowly metabolized by the liver, but has a large effect on other metabolic pathways in the liver. Very cheap and easily available. Can be obtained as the oral contraceptive pill, which is always combined with progestogen.
conjugated estrogens	5-10 mg/day orally [1] 1.25-2.5 mg/day orally [3]	Active dose in postmenopausal women is 0.625-1.25 mg, but for cross-gender hormone therapy the active dose is 5-10 mg (Meyer et al., 1986). Largely metabolized at first liver passage. Conjugated estrogens in a dose of 2.5 and 5 mg orally per day are clearly associated with an increased risk of thrombosis.
17β estradiol	2-4 mg/day orally [1] 6-8 mg/day orally [2] 10 mg/2 weeks to 200 mg/month intramuscular injection [1]	Most potent of the three forms of native estrogens in the human body. Produced synthetically. Largely metabolized at first liver passage.
	50-100 micrograms/day transdermally [1] two 0.1 mg patches, applied simultaneously[2]	Patches are replaced twice weekly. Low number of estrogen-induced side effects. Can cause skin irritation. Most expensive form. Very strongly recommended for patients over the age of 40, because of the risk of thromboembolism.
estriol	4-6 mg/day orally [1]	In cross-gender hormone treatment, high doses are necessary.

[1] Asscheman and Gooren 1992

[2] Lawrence

[3] Futterweit 1998

Non-Medical Sources of Information on Hormone Dosage

How reliable are websites and mailing lists created by other trans women for providing safe, accurate information about hormone therapy? One way to gauge their reliability is to compare the concrete dosage recommendations against those provided by medical sources.

I subscribed to an electronic mailing list on which transsexuals who are self-medicating (primarily MTFs) exchange advice on hormone therapy, and selected twenty-one individual posters who identified their own regimens, including drug names and dosage, and did not report dissatisfaction or ask for help in modifying their hormone regimens. (See Appendix A: Self-Reported Dosage Recommendations from Electronic Mailing List) Of those, four (19%) reported hormone regimens that were within the guidelines given by Asscheman and Gooren or Lawrence.

Of those who were not within the guidelines, the differences ranged from the possibly ineffective to the potentially dangerous. Five (25%) used an anti-androgen considered less effective by Asscheman and Gooren. Two (10%) reported cycling doses, which has no known therapeutic value. Five (25%) used a higher dose of anti-androgen than recommended, and four (19%) used a lower dose of anti-androgen than recommended. A high number (7, one third) reported using a lower dose of estrogen than recommended by Asscheman and Gooren, while one used a higher than recommended dose. Included in the numbers already reported, four (19%) used lower than recommended doses of both the anti-androgen and estrogen. Three (14%) who did not report having had orchiectomies said they used no anti-androgen. Of those reported above, one trans woman was taking three times the normal dose of anti-androgen, and another twice the normal dose of estrogen.

Phytoestrogens

Phytoestrogens work by weakly binding with estrogen receptors, giving in some cases very mild feminizing effects. However, the doses required to achieve any effects at all are prohibitively large and toxic. (FAQ: Hormone Therapy for M2F Transsexuals) Most sources do not recommend that trans women use black cohosh, dong quai, milk thistle, or any other phytoestrogenic herb as a replacement for hormone therapy, even as a low-dose measure, because of their inefficacy. Because of the way that phytoestrogens compete with estrogen for receptors, using them in addition to hormone therapy may also be counterproductive.

Side Effects

Thromboembolism

Combined treatment with estrogen and cyproterone acetate is associated with increases in thromboembolic events (Asscheman, Gooren, & Eklund). The more serious risk of thromboembolism, according to a later study by two of the same researchers, is greatly reduced by the use of transdermal estrogen therapy in patients over the age of 40, in whom “a high incidence of venous thromboembolism was observed with oral oestrogens.” (van Kesteren et al 1997) A 1998 study in which estrogen was administered by injection or orally reported incidence of thromboembolic events as “negligible” (Schlatterer et al).

Hyperprolactinemia

In a 1989 retrospective study, combined treatment with estrogen and cyproterone acetate was associated with increases in hyperprolactinemia (Asscheman, Gooren, & Eklund). An article dealing specifically with the risks of self-treatment by transsexual women also noted increased rates of hyperprolactinemia (Becerra Fernandez et al 1999). The complications of hyperprolactinemia are limited, but can include blindness and hemorraging (Schenenberger & Knee 2001). In one case study, prolactin-producing pituitary adenoma was linked with long-term estrogen use (Kovacs et al 1994). In study of elevated prolactin levels in transsexual women, of fifteen patients with persistently high prolactin levels, the patients were also reported to have developed enlarged pituitary glands. The study linked elevated prolactin levels with higher estrogen dosage as well as with increased age, and suggested using the lowest effective dosages of estrogen (Asscheman et al 1988). Another study of transsexual women with elevated prolactin levels “suggest that the risk of inducing prolactinomas through cross-gender hormone treatment is likely to be small.” (Gooren et al 1985)

Liver Function

Combined treatment with estrogen and cyproterone acetate [an androgen-blocker] is associated with transient elevation of liver enzymes (Asscheman, Gooren, & Eklund). An article dealing specifically with the risks of self-treatment by transsexual women also noted elevation of liver enzymes (Becerra Fernandez et al 1999). The liver function issues in the 1989 study were attributed to other causes, such as alcohol abuse and hepatitis B, and were mainly successfully treated, either with other medications or temporarily halting hormone treatment.

Osteoporosis

In a German case study, bone loss was reversed in an MTF woman by adding 2 mg of oral estradiol valerate daily to the 100 mg of cyproterone daily she was already taking. She was losing bone mass at the rate of 5% per year while taking androgen-blockers without also taking estrogen (Hierl et al 1999). A case study comparing trans women who had been on estrogen for less than two years with those who’d been on it for longer found increased bone density in the women who’d been on estrogen longer (Reutrakul et al 1998).

Depressive Mood Changes

In a 1989 retrospective study, combined treatment with estrogen and cyproterone acetate [an androgen-blocker] was associated with increases in depressive mood changes (Asscheman, Gooren, & Eklund). Depression has been tied to both high and low testosterone levels in women (Rohr 2002) and to the isolation of transsexuals (Rauchfleisch 1998).

Cholesterol Levels

An article dealing specifically with the risks of self-treatment by transsexual women noted higher levels of total cholesterol, LDL cholesterol, and triglycerides. (Becerra Fernandez et al 1999) However, the higher levels of cholesterol and triglycerides were still within normal levels (Citkowitz 2001, Isley 2002) and the lower incidence of other factors associated with heart disease, such as elevated plasma tHcy levels (Giltay et al 1998), suggest this is an acceptable risk.

Hyperkalemia

Spironolactone use can cause hyperkalemia, an excessive amount of potassium in the blood. Hyperkalemia, an often symptomless condition, can cause serious kidney problems, including renal failure, and heart problems, including difficult to cure cardiac rhythm disturbances. (RxList). People using spironolactone are advised to avoid excessive potassium in their diets, including salt substitutes containing potassium chloride.

SOURCE : http://www.trans-health.com/displayarticle.php?aid=62

HORMON

Selama hampir 10 tahun aku berusaha mencari info mengenai hormon, namun aku tidak pernah berhasil. Pertama kali aku menemukan sesuatu yang disebut estrogen adalah di tahun 2010.  ( namun beberapa tahun lalu aku sempat memcoba microgynon karena saat itu ini merupakan obat yang termurah yang aku tahu dan satu satunya yang fani tahu tapi efeknya bulu malah makin bertambah makanya lyn hentikan ).Oleh sebab itu lyn akan membagikan apa yang lyn tahu sebab lyn selalu ingin tahu mengenai pil ini tapi tidak berhasil.  Usaha yang tak kenal putus asa membawa aku menemukan forum indocrossdresser lefora. Dari Forum Lefora aku belajar banyak mengenai hormon termasuk jenis jenis pil kb. Oleh sebab itu lyn akan membagikan apa yang lyn tahu karena lyn sempat tersiksa ketika gagal selama bertahun tahun dan lyn tidak mau itu terjadi pada orang lain. namun hasil pencarian selalu mengatakan bahwa pil estrogen itu berbahaya menggunakan pil estrogen sama saja dengan bunuh diri. ketakutan akan hal ini membuat aku tidak berani menggunakan pil sampai akhirnya di akhir tahun 2011 aku mengambil keputusan terpenting dalam hidup ak, aku ingat pepatah mengatakan : pada umumnya orang yang akan mati sering kali menyesal akan sesuatu yang ingin dilakukan tapi tidak dilakukan. Dari sinilah aku mengambil keputusan : JIka aku mati karena menggunakan pil estrogen aku tidak akan menyesal karena setidaknya aku telah melakukan sesuatu yang ingin aku lakukan.Mati pun aku tidak menyesal. Pil yang pertama kali aku gunakan adalah DIANE 35.
 

Beberapa adalah obat yang telah lyn coba sendiri dan beberapa telah digunakan oleh teman lyn. Hasil berbeda pada setiap orang.

Jenis obat yang digunakan untuk membentuk tubuh cewe umumnya adalah pil kb dan anti androgen.

Jenis jenis pil kb :

  1. Andalan ( harga berkisar 3 ribuan )

  2. Microgynon ( harga berkisar 3 ribuan )

  3. Marvelon ( harga berkisar 60 ribuan 3 papan )

  4. Diane 35 ( harga berkisar 80 ribuan )

  5. Cyclo Progynova ( harga berkisar 110 ribuan )

  6. Yasmin ( harga berkisar 150 ribuan )

   7. Cyclofem ( harga berkisar 9 ribuan )

   8. Premarin

   9. Provera

 10. Esthero

 11. Lynoral ( harga per biji 2 ribuan ) 
 12. Andalan ( VIal )

 buat kamu yang tidak mau mandul tidak disarankan menggunakan diane 35 dan buat kamu yang tidak mau ukuran P nya bertambah kecil jangan gunakan CYCLOFEM dan lynoral boleh kamu gunakan kalo sudah terbiasa dengan hormon karena lynoral menpunyai kandungan yang lebih tinggi

adapun obat tambahan lainnya adalah androcur/spironolactone dan finasteride. Spironolactone ada banyak jenisnya : ada letonal produksi otto, spirolacton produksi phaphros bahkan sampai yang generik. Sprironolactone ada beberapa macam kandungannya 25, 50, 75, 100. Untuk yang 25 mg kalo yang generiknya cuma 4rb sepapan dan yang 100 mg harganya 45-50rb sepapan sementara Finasteride fani belum dapat informasinya
Menurut informasi yang fani dengar spironolactone digunakan untuk mengeluarkan hormon cowo tapi menurut informasi yang fani baca itu digunakan untuk meningkatkan tekanan darah dan Finastride adalah anti androgen. Dan Harga Finastride adalah 10.000 perbiji. untuk Finastride belum pernah fani gunakan. 

sumber informasi ini dirangkum dari beberapa teman fani ditambah pengalaman fani sendiri, jadi ini semua sudah pernah dicoba dan memberikan hasil minimal ada perubahan 30% setelah memakai obat ini, Ada yang ototnya hilang, P nya mengecil, dsb dan yang terpenting harus disiplin dan teratur serta menjaga pola makan. Karena estrogen bersifat menggemukkan badan jadi ya hati hati dech hehehe dan ada pantangan selama terapi hormon :
1. tidak boleh minum Es
2. tidak boleh minum minuman soda 
3. tidak boleh minum susu dan kopi
4. tidak boleh minum teh
5. perbanyak konsumsi buah buahan
6. tidak boleh minum air kelapa muda
  
( untuk beberapa item di izinkan kalo g sering hehe )



JADI, UDAH SIAPKAH UNTUK MENINGGALKAN KESENANGAN ANDA DEMI IMPIAN ANDA MENJADI CEWE ?