TransLife.net Transgender 101 - Medical

Hormones are the most important part of the transitional process as far as physical changes go. They are responsible for most of the physical changes in a transsexual body. There are a lot of benefits that a transsexual gets out of hormone replacement, but it is not without risks as well. First we'll hit the benefits.

Male-to-Female

Male-to-female transsexuals are given estrogen, sometimes progesterone, and lots of anti-androgens. There are three different methods of taking these. The most common and cheapest is the pill form. However, the downside to pills is that the system must process them in one huge lump, which can cause damage to the liver and kidneys. The second most common is the patch form. This is a relatively recent development, and is the most safe of all the methods. It's time released, so the body gets the same amount all the time. It does much less damage that way. The third method is somewhat rare. It's the injectible format. This is prescribed only to those who aren't seeing much response to the other two formats. Typically, the injectible format yeilds slightly faster results than the other two since it is direct to the blood. However, this format can make the person very moody. Injections are done once every two weeks. In the first few days, there is way too much estrogen in the system, and then in the last few days, there isn't enough. It's quite the large cycle. None of the methods of treatment will yeild more superior results than the other.

Usually the levels of estrogen involved are quite high. They can be up to ten times that of the average female. This is to counteract the androgen (testosterone) in the system. Anti-androgens are a key part of the hormone replacement as well for this reason. Testosterone is doing a lot of unwanted things to the body, and to stop that, the hormone has to be blocked. This aids the physical changes, and is often a relief to the individual as well. The most commonly used anti-androgen is spironolactone.

Progesterone is sometimes, but not always given. This hormone is also known as the "PMS" hormone. Most often it just makes things more complicated and can do more harm than good. The only reason it may be given is due to lack of breast development. Typically, adding progesterone will speed that up. However, there are some long term risks involved, and then there's the potential for mood swings. If this is prescribed, it's done later in the treatment after assessments of development have been made.

The effects of these hormones are pretty drastic. They include breast growth, redistribution of body fat into the female body norm, decreased upper body strength, softening of skin, decrease in body hair, slowing or stopping of male pattern baldness, decreased fertility and testicular size, and diminished erections. Most of these are reversible, however, not all of them are. The breast development is permanent and will only be reversible through surgical means. Infertility is also a permanent change. For this reason, the decision to take hormones is not to be made lightly.

The negative effects can include an increased risk of blood clotting, benign pituitary prolactinomas (a tumor which can cause false symptoms of pregnancy), weight gain, emotional instability, liver disease, gallstone formation, sleepiness, hypertension, and diabetes mellitus. Most of these are uncommon or only occur after long term usage. Combination HRT (estrogen and progesterone together) can produce other side effects over long term. They include a risk of dementia, risk of alzheimers, heart attack and stroke.

To get the full effects of these hormones, it takes about two years of continuous treatment. They do not change the voice, bone structure, or facial hair. Also, the younger the person starts taking hormones, the better results they will have. As a person gets older, testosterone's effects on the body are more and more pronounced and less reversible. No amount of estrogen will de-masculinize them.

Female-to-Male

The female-to-male is given testosterone to induce changes. The changes are as drastic as they are in the male-to-female. The first change is the deepening of the voice. This is a permanent change and happens just like a teenage boy going through puberty. The voice box enlarges, which also forms the adam's apple. Some of the other effects include clitoral enlargement, mild breast atrophy, increased body and facial hair, as well as the potential for male pattern baldness. The clitoral enlargement and voice change are permanent changes. Reversible effects include increased upper body strength, weight gain, increased sex drive, and decreased hip fat.

Testosterone is only taken in the injectible format. So, those afraid of needles will have a bit of trouble with it, as it is usually self-injected. Some of the negative effects can include acne, emotional instability (typically aggression), the potential development of benign and malignant liver tumors, hepatic dysfunction, risk of diabetes, cardiovascular disease, as well as infertility. As with the male-to-female hormone replacement, it is a big decision to make.

Testosterone will not decrease breast size, change bone structure, or grow a penis. Results with testosterone can be visible in a few months, however it may take up to five years for the full effects.