Hormone replacement therapy (HRT) for transgender and transsexual people replaces the hormones naturally occurring in their bodies with those of the other sex. Its purpose is to cause the development of the secondary sex characteristics of the desired gender. It can not undo the changes produced by the first natural occurring puberty of transgender people, this is done by sexual reassignment surgery and for transwomen by epilation. Some intersex people also receive HRT, either starting in childhood to confirm the gender they were assigned, or later, if this assignment has proven to be incorrect. Transgender (IPA: , from trans (Latin) and gender (English) ) is a general term applied to a variety of individuals, behaviors, and groups involving tendencies that diverge from the normative gender role (woman or man) commonly, but not always, assigned at birth, as well as the role traditionally held by society. ... A transsexual (sometimes transexual) person establishes a permanent identity with the opposite gender to their assigned (usually at birth) sex. ... Norepinephrine A hormone (from Greek όρμή - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ... This article or section does not cite its references or sources. ... A peacock displays his long, colored feathers, an example of his secondary sexual characteristics. ... Gender in common usage refers to the sexual distinction between male and female. ... Puberty refers to the process of physical changes by which a childs body becomes an adult body capable of reproduction. ... Sex reassignment surgery (SRS) includes the surgical procedures by which a persons physical appearance and function of their existing sexual characteristics are changed to that of the other sex. ... Transwomen or trans women are transsexual or transgendered people who were assigned male sex at birth (or, in some cases of intersexuality, later) and feel that this is not an accurate or complete description of themselves. ... Depilation is a generic term for hair removal which affects the part of the hair above the surface of the skin. ... An intersexual is a person (or individual of any unisexual species) who is born with genitalia and/or secondary sexual characteristics of indeterminate sex, or which combine features of both sexes. ...

While some argue that hormonal therapy does not truly masculinize or feminize, the question is one of definitions. If by masculinize and feminize one means to completely reproduce the male or female biological state, that cannot be done with current medical or surgical therapy. However, the goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their true psychological gender identity. It should be noted that the effects of hormonal therapy are often much more satisfying to transgender men than transgender women. It is easier to produce secondary male sexual characteristics with androgens than it is to rid transgender women of those established characteristics.

Transgender (IPA: , from trans (Latin) and gender (English) ) is a general term applied to a variety of individuals, behaviors, and groups involving tendencies that diverge from the normative gender role (woman or man) commonly, but not always, assigned at birth, as well as the role traditionally held by society. ... Image File history File links Transgender_Pride_flag. ... This article or section does not cite any references or sources. ... Bigender (bi+gender) is a tendency to move between masculine and feminine gender-typed behaviour depending on context, expressing a distinctly male persona and a distinctly female persona. ... This articles is about cross-dressing in general, that is the act of wearing the clothing of another gender for any reason. ... A drag king performance troupe Drag kings are female bodied or identified performance artists who dress in masculine drag as part of their routine. ... Drag queens Luc DArcy and Jerry Cyr and friend at Montreals 2003 Divers/Cité pride parade. ... This article or section does not adequately cite its references or sources. ... Third gender was used from the late 19th century to describe people who did not fit into the then existing gender categories: female genitalia = female identity = female behavior = desire male partner male genitalia = male identity = male behavior = desires female partner Today this scheme is also known as binary gender system... Look up Transsexualism in Wiktionary, the free dictionary. ... This article deals with the history of the word transvestite. For information about cross-dressing, see there. ... LGBT history refers to the history of lesbian, gay, bisexual, and transgender cultures around the world, dating back to the first recorded instances of same-sex love and sexuality within ancient civilizations. ... Manifestations Slavery · Racial profiling · Lynching Hate speech · Hate crime · Hate groups Genocide · Holocaust · Pogrom Ethnocide · Ethnic cleansing · Race war Religious persecution · Gay bashing Pedophobia · Ephebiphobia Movements Discriminatory Aryanism · Neo-Nazism · Supremacism Kahanism Anti-discriminatory Abolitionism · Civil rights LGBT rights Womens/Universal suffrage · Feminism Mens/Fathers rights · Masculinism Children... Homosexuality and transgender are two separate concepts. ... Gynephilia (or gynophilia) (From Greek gunē, women, + -philia, love) is the romantic and/or sexual attraction to adult females, and its counterpart androphilia (from Greek andro-, male, + -philia, love) is attraction to adult males. ... Transsexual people are those who establish a permanent identity with the opposite gender to their birth Gender. ... Transgender and Transexual people may face difficulty when trying to access amenities, such as toilets and change rooms, when presenting as their chosen gender // From Main Article: Toilet Sex-separated public toilets are often difficult to negotiate for transgendered or androgynous people, who are often subject to embarrassment, harassment, or... Transgender is a very complex topic, where consensual and precise definitions have not yet been reached. ... This is a list of lesbian, gay, bisexual or transgender-related films. ...

Formal requirements for HRT

The requirements for hormone replacement therapy vary immensely, often at least a certain time of psychological counselling is required, and so is a time of living in the desired gender role, if that is at all possible, in order to assure that they can psychologically function in that gender role. This period is sometimes called the Real Life Experience (RLE). See also Standards of care for gender identity disorders. In many countries or areas, an individuals pursuit of sexual reassignment surgery (SRS) is often governed, or at least guided, by documents called standards of care (SOC), or standards of care for gender identity disorders. ...

Some individuals choose to self-administer their medication ("do-it-yourself"), often because available doctors have too little experience in this matter, or no doctor is available in the first place. Sometimes, trans persons choose to self-administer because their doctor will not prescribe hormones without a letter from the patient's therapist stating that the patient meets the diagnostic criteria for GID and is making an informed decision to transition. Many therapists require at least 3 months of continuous psychotherapy and/or a real life test in order to write such a letter as is suggested in the HBIGDA Standards of Care. In these circumstances, the individual may self-administer until they can get these authorizations, feeling that they shouldn't have to wait for a medical professional to be convinced of their situation. In addition, as many individuals must pay for evaluation and care out-of-pocket, expense can also be prohibitive to pursuing such therapy. Out-of-pocket expenses are direct outlays of cash which are not reimbursed. ...

However, self-administration of hormones is potentially dangerous. Individuals seeking physicians who are knowledgeable and willing to treat transgender patients may wish to consult transgender support groups or a directory of LGBT-friendly doctors, in the USA for example the Gay and Lesbian Medical Association's referral service at GLMA.org.

Changes established at puberty

A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times. Sometime in the late teen years epiphyseal clusure (in other words, the ends of bones are fused closed) takes place and the length of bones is fixed for life. Consequently total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching. Cartilage is type of dense connective tissue. ... Desmond Morris (born January 24th, 1928) is most famous for his work as a zoologist and ethologist. ...

• Pelvis: The pelvis in females tends to be wider than in males and tilted forward; the pelvis is males tends to be more circular and tilted upwards.
• Hands: Male hands and feet tend to be larger than female hands and feet in persons of equal height.
• Upper Arm: The upper arm in females tends to be significantly longer (about 1") than in males of the same height.
• Head: Females tend to have larger heads than males of the same height.
• Chest: Female ribcages tend to be narrower than those of males. (Need to know if this is true for individuals of the same body size.)

Facial changes develop gradually over time, and sexual dimorphism (physical difference between the sexes) tends to increase with age. Within a population of similar body size and ethnicity:

• Brow: Males tend to develop heavier bony brows than females.
• Cheeks: Female cheeks tend to be fuller and more rounded. Under the influence of estrogen, fat is deposited beneath the skin and overall facial and body contours become softer.
• Nose: The tips of the nasal bones tend to grow more in males than females, creating a larger (longer or wider) nose.
• Jaw: The jaw in males tends to grow wider and more deeply sculptured than in females.
• Larynx: At puberty, the bones and cartilage of the voicebox tend to enlarge less in females than males. In some males, the larynx becomes visible as a bony "adam's apple."

HRT female-to-male

For transmen, taking androgens (i.e. testosterone) causes reversible and irreversible changes. Transmen or trans men are transgender or transsexual people who were assigned female at birth based on genital appearance (or, in cases of intersexuality, were later assigned to the female gender) and who feel that this is not an accurate or complete description of themselves. ... Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of masculine characteristics in vertebrates by binding to androgen receptors. ... Testosterone is a steroid hormone from the androgen group. ...

Changes

Irreversible changes

• deepening of the voice,
• growth of facial and body hair,
• male pattern baldness (in some individuals),
• an enlargement of the clitoris,
• growth spurt and closure of growth plates if given before the end of puberty, and
• possible shrinking and/or softening of breasts, although this is due to changes in fat tissue.

This article or section does not cite any references or sources. ... The clitori (Greek ) is a sexual organ. ...

Reversible changes

• increased libido,
• redistribution of body fat,
• cessation of ovulation and menstruation,
• further muscle development (especially upper body),
• increased sweat and changes in body odor,
• prominence of veins and coarser skin,
• acne (especially in the first few years of therapy),
• alterations in blood lipids (cholesterol and triglycerides), and
• increased red blood cell count.

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most transmen report an increase of energy and an increased sex drive. Many also report feeling more confident. Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... Triglyceride (blue: fatty acid; red: glycerol backbone) Triglycerides are glycerides in which the glycerol is esterified with three fatty acids. ... Psychology (ancient Greek: psyche = soul and logos = word) is the study of mind, thought, and behaviour. ...

While a high level of testosterone is often associated with an increase in aggression, this is not a noticeable effect in most transmen. HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most non-trans men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen. It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that the overall level of aggression actually decreases. Aggression is sometimes used to intimidate and coerce during extremely rigorous physical training. ...

Some transmen are unable to pass as men without hormones. The most commonly cited reason for this is that their voice may reveal them. The examples and perspective in this article or section may not represent a worldwide view. ... The human voice consists of sound made by a human using the vocal folds for talking, singing, laughing, screaming. ...

Contraindications

Several contraindications to androgen therapy exist. An absolute medical contraindication is pregnancy In medicine, a contraindication is a condition or factor that increases the risk involved in using a particular drug, carrying out a medical procedure or engaging in a particular activity. ... A pregnant woman near the end of her term Pregnancy is the carrying of one or more embryos or fetuses by female mammals, including humans, inside their bodies. ...

Relative medical contraindications are:

• androgen sensitive epilepsy,
• migraines,
• sleep apnea,
• polycythemia (elevated red blood cell count,)
• cardiac failure, renal failure, or severe hypertension susceptible to salt retention and fluid overload
• significant liver disease
• coronary artery disease or risk factors for CAD
• history of uterine cancer
• bleeding disorders (for injected testosterone)
• significant history of violent behavior
• history of breast cancer (testosterone has anti-proliferative effects on most but not all breast cancers)

Sleep apnea or sleep apnoea is a sleep disorder characterized by pauses in breathing during sleep. ... Polycythemia is a condition in which there is a net increase in the total number of red blood cells in the body. ... Congestive heart failure (CHF) (also called heart failure) is the inability of the heart to pump blood effectively to the body, or requiring elevated filling pressures in order to pump effectively. ... Renal failure is the condition in which the kidneys fail to function properly. ... This article or section does not cite any references or sources. ... The liver is an organ present in vertebrates and some other animals. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ... It has been suggested that this article or section be merged with Endometrial cancer. ...

Types of androgen therapy

The half-life of testosterone in blood is about 70 minutes, so it is necessary to have a continuous supply of the hormone for masculinization. Half-Life For a quantity subject to exponential decay, the half-life is the time required for the quantity to fall to half of its initial value. ...

Injected

'Depot' drug formulations are created by mixing a substance with the drug that slows its release and prolongs the action of the drug. The two primarily used forms in the US are the testosterone esters testosterone cypionate (Depo-Testosterone) and testosterone enanthate (Delatestryl) which are almost interchangeable. Enanthate is purported to be slightly better with respect to even testosterone release, but this is probably more of a concern for bodybuilders who use the drugs at higher doses (250-1000 mg/week) than the replacement doses used by transgender men (50-100mg/week.) They are mixed with different oils, so some individuals may tolerate one better than the other. Enanthate costs more than cypionate and is more typically the one prescribed for hypogonadal males in the US. Cypionate is more popular in the US than elsewhere (especially amongst bodybuilders.) Other formulations exist but are more difficult to come by in the US. Sustanon is a formulation that mixes shorter acting and longer acting testosterone preparations that gives more even levels of testosterone with injections given every three weeks. A newly marketed formulation of injected testosterone available in Europe, Nebido (testosterone undecanoate in oil) provides significantly improved testosterone delivery with far less variation outside the eugonadal range than other formulations with injections required only four times yearly. However, each quarterly dose requires injection of 4ml which may require multiple simultaneous injections. Nebido is also much more expensive and currently unavailable in the United States. Natural olive oil Synthetic motor oil An oil is any substance that is in a viscous liquid state (oily) at ambient temperatures or slightly warmer, and is both hydrophobic (immiscible with water, literally water fearing) and lipophilic (miscible with other oils, literally fat loving). This general definition includes compound classes... Bodybuilder Anders Graneheim (Sweden) Bodybuilding is the sport of developing muscle fibers through the combination of weight training, increased caloric intake, and rest. ... Sustanon 250 is a trade name for an oil-based injectable blend of four testosterone compounds: 30mg testosterone propionate 60mg testosterone phenylpropionate 60mg testosterone isocaproate 100mg testosterone decanoate The different testosterone esters have unique half lives. ...

The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection. Some side effects may be ameliorated by using a shorter dosing interval (weekly or every ten days instead of twice monthly with enanthate or cypionate.) 100 mg weekly gives a much lower peak level of testosterone than does 200 mg every two weeks, while still maintaining the same total dose of androgen. This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections.

Injected testosterone esters should be started at a low dose and titrated upwards based on trough levels (blood levels drawn just before your next shot.) A trough level of 500 ng/dl is sought. (Normal range for a biological male is 290 to 900 ng/dl.) In medicine, a trough level is the lowest level that a medicine is present in the body. ...

Transdermal

Both testosterone patches and gels are available. Both approximate normal physiological levels of testosterone better than the higher peaks associated with injection. Both can cause local skin irritation (more so with the patches.) A Patch can refer to several different things: A piece of fabric. ... In optical filters and theatrical lighting a color gel is a transparent or translucent colored panel used to change the color of transmitted light. ...

Patches slowly diffuse testosterone through the skin and are replaced daily. The cost varies, as with all medication, from country to country, it is about $150/month in the US, and about 60 Euros in Germany.

Transdermal testosterone is available in the United States under the brand names Androgel and Testim. Both are absorbed quickly when applied and produce a temporary drug depot in the skin which diffuses into the circulation, peaking at 4 hours and decreasing slowly over the rest of the day. The cost varies, as with all medication, from country to country, it is about $150/month in the US for either brand name drug. However, certain pharmacies are able to compound the drug more cheaply.

Transdermal testosterone poses a risk of inadvertent exposure to others who come in contact with the patient's skin. This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens. Case reports of significant virilization of young children after exposure to topical androgen preparations (both prescription and 'supplement' products) used by their caregivers demonstrates this very real risk.

Testosterone pellets

6-12 pellets are inserted under the skin every three months. This must be done in a physicians office, but is a relatively minor procedure done under local anesthetic. Pellets cost about $20 each, so the cost is greater than injected testosterone when the cost of the physician visit and procedure are included. The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly.

Oral

Not frequently used in the US, sometimes used in Europe. Once absorbed from the GI tract testosterone is shunted (at very high blood levels) to the liver where it can cause liver damage and worsens some of the adverse effects of testosterone - lower SHBG levels, lower HDL (good) cholesterol. In addition, the ‘first pass’ metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses. The safest of the oral formulations is Andriol (testosterone undecanoate) which is not available in the US.

Sublingual/Buccal

In 2003 the FDA approved a buccal form of testosterone (Striant®.) Sublingual testosterone can also be made by some compounding pharmacies. Cost for Striant® is greater than other formulations ($180-210/month.) Testosterone is absorbed through the oral mucosa and avoids the 'first pass metabolism' in the liver which is cause of many of the adverse effect with oral testosterone. The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks. The lozenge is 'mucoadhesive' and but be applied twice daily.

Non-testosterone hormonal therapy

GnRH agonists

In both sexes, the hypothalamus releases GnRH (gonadotropin-releasing hormone) to stimulate the pituitary to produce LH (luteinizing hormone) and FSH (follicle stimulating hormone) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH agonists, such as nafarelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH agonists work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced. There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this. The Harry Benjamin International Gender Dysphoria Association Standards of Care permit from Tanner Stage 2, but do not allow the addition of gender-appropriate hormones until 16, which could be five or more years. The sex steroids do have important other functions. The high cost of GnRH agonists is often a significant factor. Gonadotropin-releasing hormone 1 (GNRH1 also called LHRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... Follicle stimulating hormone (FSH) is a hormone produced by gonadotropes in the anterior pituitary gland. ... Steroid skeleton of lanosterol. ... A GnRH agonist is a synthetic peptide that acts like the gonadotropin-releasing hormone (GnRH) but has a much longer biological half life. ... Nafarelin is a gonadotropin releasing hormone agonist (GnRH agonist). ...

Progestin injections

Depo-Provera (depot medroxyprogesterone acetate, or DMPA) may be injected every three months just as it is used for contraception. Generally after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy. This article is about the contraceptive injection. ... The menstrual cycle is the periodic change in a womans body that occurs every month between puberty and menopause and that relates to reproduction. ...

Supplements

Andro ‘Pro-hormones’: Androstenedione, 4-androstenediol, 5-androstenediol, 19-androstenediol, and 19-norandrostenediol are sold as supplements that are purported to increase serum testosterone, increase muscle mass, decrease fat, elevate mood, and increase sexual performance (i.e. many of the effects transgender men seek with androgen therapy.) However, there is no good medical evidence that the pro-hormones do any of these things. However, there is evidence that ingestion of these substances can cause elevated estrogen levels, and decreases in HDL (good) cholesterol.

Testosterone effects

Cardiovascular

• In biological men, testosterone levels that are either significantly above or below normal are associated with increase cardiovascular risk. This may be causative or simply a correlation.
• A single retrospective study in the medical literature of 293 transmen treated with testosterone (range of 2 months to 41 years) by the Amsterdam Gender Dysphoria Clinic from 1975 to 1994 showed no increase in cardiovascular mortality or morbidity when compared with the general female Dutch population. (As with all scientific studies, this does not conclusively prove that no causal link exists. A small to moderate detrimental effect remains a possibility, though a very large effect is more unlikely.)
• Androgen therapy does adversely affect the blood lipid profile by causing decreases in HDL (good) cholesterol, increases in LDL (bad) cholesterol, and increases in triglycerides.
• Androgen therapy redistributes the fat toward abdominal obesity, which is associated with increased cardiovascular risk than fat carried on the buttocks and hips.
• Androgen therapy can cause weight gain and decreased insulin sensitivity (perhaps worsening a predisposition to develop Type II diabetes.)
• Androgen therapy effects are not all negative, however. Acutely it causes dilation of the coronary arteries, and in men with testosterone levels within the normal physiological range, higher levels are actually associated with a slight decrease in cardiovascular disease.
• Supra-physiological levels of androgens (generally due to abuse) are associated with significantly increased risks of strokes and heart attacks (even in the young.) More is not better!
• Cardiovascular risk factors are more than additive. (If high blood pressure is worth 10 and smoking is worth 10, together they are worth more than 20.) So for transgender men, the addition of risk with androgen therapy makes improving modifiable risk factors more important.
• The most important modifiable risk factor for many men is smoking.

Nickname: Motto: Heldhaftig, Vastberaden, Barmhartig (Valiant, Determined, Compassionate) Location of Amsterdam Coordinates: Country Netherlands Province North Holland Government  - Mayor Job Cohen (PvdA)  - Aldermen Lodewijk Asscher Hennah Buyne Carolien Gehrels Tjeerd Herrema Maarten van Poelgeest Marijke Vos  - Secretary Erik Gerritsen Area [1][2]  - City 219 km²  (84. ... 1975 (MCMLXXV) was a common year starting on Wednesday. ... 1994 (MCMXCIV) was a common year starting on Saturday of the Gregorian calendar, and was designated as the International Year of the Family and the International Year of the Sport and the Olympic Ideal by United Nations. ... In medicine, epidemiology and actuarial science, the term morbidity can refer to the state of being diseased (from Latin morbidus: sick, unhealthy), the degree or severity of a disease, the prevalence of a disease: the total number of cases in a particular population at a particular point in time, the... Cholesterol is a sterol (a combination steroid and alcohol) and a lipid found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... Triglyceride (blue: fatty acid; red: glycerol backbone) Triglycerides are glycerides in which the glycerol is esterified with three fatty acids. ... Insulin (from Latin insula, island, as it is produced in the Islets of Langerhans in the pancreas) is a polypeptide hormone that regulates carbohydrate metabolism. ... See diabetes mellitus for further general information on diabetes. ... The cigarette is the most common method of smoking tobacco. ...

Hair

• The action of testosterone on hair follicles is mainly due to the more potent androgen, dihydrotestosterone, DHT.
• With androgen therapy, genetics primarily determines how much hair will develop (and where) as well as whether male pattern baldness will develop.
• Testosterone is converted (within the cells of the hair follicle's dermal papilla) by 5-alpha reductase to DHT. There are two forms of this enzyme: type 1 and 2. However, type 2 is the form that is important to the development of male pattern baldness. Male pseudohermaphrodites with congenital deficiency of type 2 5-alpha reductase (but functional Type 1) never develop male pattern baldness.
• Propecia (Finasteride) and Avodart (Dutasteride) are Type-2, 5-a-Reductase inhibitors that work by blocking the conversion of testosterone to DHT. While they will not make facial hair growth that has occurred regress, they may slow or prevent further development of new facial hair. Finasteride is sold as 5mg tablets as ‘Proscar’ which is used to treat prostate enlargement and ‘Propecia’ as 1 mg tablet to treat baldness. The cost of 'Propecia' per mg is significantly higher than 'Proscar' so some patients split tablets into quarters. At the 1-1.25mg/day dose it may also decrease libido.
• Saw palmetto is a naturally occurring 5-alpha reductase inhibitor which is used by some to treat male pattern baldness and prostate enlargement.
• Rogaine (Minoxidil – available without a prescription in the US) is a topical preparation of a potent blood pressure medicine. It is sold as 2% and 5% solutions. The 5% solution is not recommended for use by women because it may cause the adverse effect of unwanted facial hair growth in a small percentage of women. It may also cause skin irritation and itching. One ml is applied twice daily to the scalp (predominantly in the areas where hair loss is greatest.) It may take several months to show effects and may cause a slight paradoxical worsening of hair loss initially (that does eventually recover.)

With either minoxidil or finasteride the beneficial effect will be lost within months upon ceasing use of product. With either, best results occur when they are started before significant hair loss has occurred. A strand of human hair under magnification Hair is also the name of a musical, see respective articles for the stage production and the movie. ... For other uses, see DHT (disambiguation). ... Baldness (formally alopecia) is the state of lacking hair where it usually would grow, especially on the head. ... 5-alpha reductase is an enzyme (EC 1. ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Dutasteride inhibits the conversion of testosterone into dihydrotestosterone. ... Binomial name Serenoa repens Hooker Saw Palmetto, Serenoa repens, is the sole species currently classified in the genus Serenoa. ... Minoxidil is a vasodilator and originally was exclusively used as an oral drug (Loniten®) to treat high blood pressure. ... A sphygmomanometer, a device used for measuring blood pressure. ...

Gynecological effects

• Menses should cease within 5 months of testosterone therapy (often sooner.) If bleeding continues past 5 months, transmen must see a gynecologist.
• Clitoromegaly occurs, and frequently reaches its apex within 2-3 years of therapy. Sizes generally range from 3-8 cm with 4-5 cm being about average. This is genetically determined, but some physicians advocate topical clitoral testosterone as an adjunct to growth before metaidioplasty. However, this testosterone is absorbed and should be calculated into your total regimen.
• After long-term androgen therapy, ovaries may develop polycystic ovary syndrome (PCOS) morphology. (In both PCOS and transgender men there is an up-regulation of testosterone receptors in the ovaries.)
• Untreated PCOS is associated with a possibly increased risk of endometrial cancer as well as decreased fertility.
• It is unknown whether the risk of ovarian cancer is increased, decreased or unchanged in transgender men compared to women. It is unlikely to be determined in the near future because ovarian cancer is a relatively rare disease and the population of transgender men is too small to do the appropriate study. However, it has been recommended by some physicians that transgender men have an oophorectomy within 2-5 years of starting androgen therapy due to the possible increased risk. (Note: Testosterone dose can frequently be decreased after oophorectomy.)
• The risk of endometrial cancer is similarly unknown. However, A high prevalence of endometrial hyperplasia has been noted in a small study of transgender men undergoing hysterectomy. (Futterweit W, and Deligdisch L. “Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals.” J Clin Endo & Metab. 62(1):16-21. 1986.)

Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should have an endometrial biopsy (and possibly an ultrasound) done to rule-out endometrial cancer. Polycystic ovary syndrome (PCOS, also known clinically as Stein-Leventhal syndrome), is an endocrine disorder that affects 5–10% of women. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Oophorectomy is the surgical removal of the ovaries of a female animal. ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ...

• Some sources recommend endometrial ultrasounds every two years. Testosterone usually causes atrophy of the endometrium. Any transgender man with an endometrium that is not thinned on ultrasound should have a biopsy to evaluate for endometrial cancer and possibly use progesterone to cause sloughing of the endometrium. Vaginal bleeding from progesterone may be emotionally uncomfortable for a transman, but it is preferable to developing endometrial cancer.
• Until recently, any adult with a uterus/cervix was advised to have a Pap smear yearly. This interval might be increased to every 2-3 years for certain people on the advice of a gynecologist. However, recent research has linked cervical cancer to a sexually transmitted virus; transmen who have never had vaginal sex may not be at risk. However, since the long-term effects of testosterone on cervical tissues are not well understood, Pap smears may be considered a general precaution.
• Some transgender men report a decrease in breast size with androgen therapy. However, no morphological changes were found when this was studied and likely it is due to loss of fat in the breasts.
• Androgen therapy (and suppression of estrogen production) may cause vaginal atrophy and dryness, which may result in dyspareunia (painful vaginal intercourse.) This can be alleviated with topical estrogen cream.
• Most transgender men report a significantly increased libido. Some report that this decreases somewhat after several years on testosterone. (Natural testosterone levels peak in women just before ovulation which may account for the mid-cycle increase in libido many women experience.)

The endometrium is the inner membrane of the mammalian uterus. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... Schematic frontal view of female anatomy The cervix (from Latin neck) is the lower, narrow portion of the uterus where it joins with the top end of the vagina. ... The pap smear as we know it is an invention of Dr. Georgios Papanikolaou (1883-1962), an American of Greek birth, the father of cytopathology. ...

Childbearing

• As the age at which transgender people begin therapy decreases, retention of reproductive potential becomes more important.
• If a transgender man has not undergone hysterectomy and oophorectomy, he may regain fertility on cessation of testosterone. With the ovarian changes of long-term androgen therapy, however it may require months of cessation of testosterone and possibly assistive reproductive technology to become pregnant. Testosterone must be withheld for the duration of pregnancy.
• If a transgender man is planning on having a hysterectomy/oophorectomy, future reproduction may still be preserved by:
  • Oocyte banking – hormonal stimulation to ‘hyper-ovulate’ with transvaginal oocyte harvest for freezing. Very poor survival of banked oocytes.
  • Embryo banking – oocyte harvest as above with immediate fertilization and banking of the embryo. Much better survival, but the sperm donor must be chosen before oophorectomy.
  • Ovarian tissue banking – probably the best option. Ovarian tissue is frozen after oophorectomy. Even after long term androgen therapy, ovaries usually retain usable follicles. Eventual use of frozen ovaries will require replantation into the transgender man for stimulation and harvest, but may eventually be possible in a lab as techniques for tissue culture improve.

This article or section is in need of attention from an expert on the subject. ... Oophorectomy is the surgical removal of the ovaries of a female animal. ... Reproductive technology is a term for all current and anticipated uses of technology in human and animal reproduction, including: artificial insemination artificial wombs cloning (see human cloning for the special case of human beings) cryopreservation of sperm, oocytes, embryos embryo transfer germinal choice technology hormone treatment to increase fertility in...

Bone

• Both estrogens and androgens are necessary in both biological males and females for healthy bone. (Young healthy women produce about 10 mg of testosterone monthly. Higher bone mineral density in males is associated with higher serum estrogen.)
• Bone is not static. It is constantly being reabsorbed and created. Osteoporosis results when bone formation occurs at a rate less than bone reabsorption.
• Estrogen is the predominant sex hormone that slows bone loss (even in men.)
• Both estrogen and testosterone help stimulate bone formation (T, especially at puberty.)
• Testosterone may cause an increase in cortical bone thickness in transgender men (however this does not necessarily translate to a greater mechanical stability.)
• Transgender men who have been oophorectomized must continue androgen therapy to avoid premature osteoporosis. Estrogen supplementation is theoretically not usually necessary, as some of the injected testosterone will be aromatized into estrogen sufficient to maintain bone (as it does in biological men.) However, a single small study of transmen after oophorectomy demonstrated that androgens alone may be insufficient to retard bone loss. (van Kesteren P, et al. “Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones.” Clin Endocrin. 48(3):347-54. 1998.) It is likely the case that pre-oophorectomy, residual estrogen production is protective. However, after oophorectomy, some transmen may have insufficient estrogen to retard bone loss.
• Some physicians advocate a Dexa (bone density) scan at the time of oophorectomy and every year or two thereafter to diagnose osteoporosis before it becomes severe enough to be symptomatic. This is important because treatment of osteoporosis is most effective if done early.
• Daily calcium supplementation and possibly Vitamin D is probably a good idea for most transgender men, but it is even more important after removal of the ovaries.

Estriol. ... Grays Anatomy illustration of a human femur. ... Osteoporosis is a disease of bone in which the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. ...

Drug interactions

Testosterone (and all the sex steroids) are metabolized by the Cytochrome P-450 enzyme system in the liver. (Specifically CYP3A.) There are certain drugs that increase or decrease the activity of this enzyme and may cause increased or decreased levels of testosterone and other sex steroids.

• Cyt P-450 Inducers – May cause decreased levels of testosterone (and other sex steroid) levels: Phenobarbital and Dilantin (seizure medicines,) Rifampin (antibiotic,) and Alcohol!
• Cyt P-450 Inhibitors – May cause increased levels of testosterone: Serzone, Prozac, Paxil (antidepressants,) Sporanox, Diflucan, and other ‘azole’ antifungals, Tagamet (anti-ulcer agent that can cause gynecomastia in men because of this effect.) Biaxin and other ‘erythromycin type’ antibiotics, Protease Inhibitors (HIV treatment.)

Testosterone can also alter the effects of other drugs:

• Increases the blood thinning effect of Coumadin (warfarin.)
• Decreases the effectiveness of Inderal (propranolol) a blood-pressure medicine.
• Increases the effect of some oral medicines for diabetes and can cause dangerously low blood sugar levels.

Because of these interactions, it is imperative that transmen tell any health care provider that he sees for any reason that he is on androgen therapy (and any other medication or supplement that he takes.)

Obstructive sleep apnea

• OSA may be worsened or unmasked by androgen therapy.
• Risk is greater in transgender men who are obese, smoke, or have COPD (Chronic Obstructive Pulmonary Disease.)
• Untreated OSA may have significant adverse effects on the heart, blood pressure, mood, and may cause headaches and worsen seizure disorders.
• Symptoms of OSA are noisy sleeping (snoring,) excessive daytime sleepiness, morning headache, personality changes, and problems with judgment, memory, and attention.

Sleep apnea or sleep apnoea is a sleep disorder characterized by pauses in breathing during sleep. ...

Polycythemia

• Increased red blood cell mass usually from overproduction by the bone marrow.
• Testosterone (frequently in large doses) was previously used to treat anemia from bone marrow failure.
• A transgender man’s hematocrit (the percentage of whole blood made up of red blood cells) should be judged against normal age adjusted values for men.
• Therapy is via phlebotomy (periodic therapeutic blood draws similar to blood donation.)
• Tendency to become polycythemic worsens with age.
• Worse with injected testosterone (especially with longer intervals between doses) than with oral, transdermal, or Testopel. (Increase in RBCs occurs with the very high peaks from injection. So decreasing dose and interval to 7-10 days instead of 14 may help.)
• Severe polycythemia predisposes to both venous and arterial thrombosis (blood clots) such as: deep venous thrombosis, pulmonary embolism, heart attack, and stroke.
• Aspirin may decrease the risk

Polycythemia is a condition in which there is a net increase in the total number of red blood cells in the body. ... It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... Acute myocardial infarction (AMI or MI), commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Stroke is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ...

Skin

• Increased activity of oil and sweat glands.
• Change in body odor – less sweet and musky, more metallic and acrid.
• If severe odor is a problem, an antibacterial soap like chlorhexidine may be used in the armpits when showering. After 1-2 weeks of daily use, a noticeable decrease in odor should occur.
• Acne: generally worse the first few years of testosterone therapy (mimicking a second puberty.) Can be treated with standard acne therapy. Initial treatment is with increased cleansing (at least twice daily) with an anti-acne or oil reducing scrub. If this doesn’t work, additional therapy may be prescribed by a physician.
• Some physicians see acne as a contraindication to increasing testosterone dose.

Gastrointestinal

• There is a risk of liver damage and liver cancer with all testosterone formulations, but this is minimal with all forms except oral or unless very high levels are administered. However, as with any drug that carries even a small risk of liver damage, liver function tests (or at least ALT) should be periodically monitored.

Liver function tests (LFTs or LFs), which include liver enzymes, are groups of clinical biochemistry laboratory blood assays designed to give information about the state of a patients liver. ...

Neurological/Psychiatric

• Headaches: Pre-existing migraine headaches can be significantly worsened with androgen therapy. Headaches can also become problematic in men without prior headache disorders.
• Epilepsy: some seizure disorders are androgen-dependent. These may be worsened or (very rarely) unmasked with androgen therapy.
• Sleep deprivation worsens almost all seizure disorders, so concurrent obstructive sleep apnea caused or worsened by androgen therapy may also be responsible.
• Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy (similarly to the effects reported with body builders who abuse androgens.) This is much less severe however than the ‘roid rage’ experienced by bodybuilders because with transgender men significantly supraphysiologic levels are not present.
• Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression. Likely this is not a physiologic effect but rather the alleviation of emotional distress from long-standing gender dysphoria.
• Recent studies have indicated that cross-hormone therapy in transmen may result in an increase in brain volume towards male proportions.^[1]

This article is about migraine disease[1]. For the Finnish melodic death metal group, see myGRAIN. Migraine (pronouced Mee-grain but also, and especially in American English, My-grain) is a neurological disease[2], of which the most common symptom is an intense and disabling episodic headache. ...

Metabolic

• Testosterone increases body weight (and increases appetite.) The form that this weight gain will take depends on diet and exercise as well as genetic factors. Since testosterone has anabolic effects, gain of lean muscle mass will be easier than it previously was for transgender men. Moderate amounts of exercise will cause greater gains and will ameliorate some of the adverse effects of testosterone.
• Many transgender men report an increased energy level, decreased need for sleep, and increased alertness after testosterone therapy.
• In biological men, abnormally high or low levels of testosterone are both associated with insulin resistance (which eventually can result in Type II diabetes.) So mid-normal levels of testosterone are the target for androgen therapy.
• In women, increased levels of either estrogen or androgens are associated with decreased insulin sensitivity (which may predispose to diabetes.) In a study of transgender males and females, decreased insulin sensitivity was found in both populations after four months or hormonal treatment. (Polderman K, et al. “Induction of insulin resistance by androgens and estrogens.” J Clin Endo Metab. 79(1):265-71. 1994.)

HRT male-to-female

For transwomen, taking estrogens causes among other changes: A transwoman (also spelled trans-woman) is a transsexual or transgender person who was physically identified as male at birth, but believes that this is not an accurate or complete description of herself and identifies as a woman. ... Estriol. ...

• the growth of breasts, with concomitant enlargement of the nipples, and
• redistribution of body fat.
• thinning of skin.

For male-to-female transgendered people, HRT often includes antiandrogens in addition to the estrogens and progestagens mentioned above. A pregnant womans breasts. ... Fats consist of a wide group of compounds that are generally soluble in organic solvents and largely insoluble in water. ... In zootomy and dermatology, skin is the largest organ of the integumentary system made up of multiple layers of epithelial tissues that guard underlying muscles and organs. ... Transgender (IPA: , from trans (Latin) and gender (English) ) is a general term applied to a variety of individuals, behaviors, and groups involving tendencies that diverge from the normative gender role (woman or man) commonly, but not always, assigned at birth, as well as the role traditionally held by society. ... An antiandrogen, or androgen antagonist, is any of a group of hormone antagonist compounds that are capable of preventing or inhibiting the biologic effects of androgens, male sex hormones, on normally responsive tissues in the body (see androgen insensitivity syndrome). ... Estriol. ... Progestagens (also spelled progestogens or gestagens) are hormones which produce effects similar to progesterone, the only natural progestagen. ...

HRT does not usually cause facial hair growth to be impeded; or the voice to change. Modern bearded adult. ... The human voice consists of sound made by a human using the vocal folds for talking, singing, laughing, screaming. ...

Changes

Irreversible changes

• breast development,
• enlarged nipples and areolae
• stretch marks (for some)

Reversible changes

• decreased libido,
• redistribution of body fat,
• reduced muscle development,
• various skin changes,
• significantly reduced body hair,
• change in body odor and sweat production,
• less prominence of veins,
• ocular changes,
• genital size

The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Many also report feeling more confident. Libido in its common usage means sexual desire; however, more technical definitions, such as those found in the work of Carl Jung, are more general, referring to libido as the free creative—or psychic—energy an individual has to put toward personal development, or individuation. ... Psychology (ancient Greek: psyche = soul and logos = word) is the study of mind, thought, and behaviour. ...

Contraindications

• Absolute: history of estrogen sensitive cancer (for example breast cancer), history of thromboembolic disease (unless provided with concurrent anti-coagulation therapy), or history of macroprolactinoma.
• Relative: Liver, kidney, or heart disease and stroke (or any of the risk factors for heart disease: high cholesterol, diabetes, obesity, smoking); Strong family history of breast cancer or thromboembolic disease; Gallbladder disease; circulation or clotting conditions such as peripheral vascular disease, polycythemia vera, sickle cell anaemia, paroxysmal nocturnal hemoglobinuria, hyperlipidemia/hypercholesterolemia, hyperlipoproteinaemia, hypertension, factor V leiden, prothrombin mutation, antiphospholipid antibodies, anticardiolipin antibodies, lupus anticoagulants, plasminogen or fibrinolysis disorders, protein C deficiency, protein S deficiency, or antithrombin III deficiency.

Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Peripheral vascular disease (PVD) is a disease in the large blood vessels of the arms, legs, and feet. ... Polycythemia is a condition in which there is a net increase in the total circulating erythrocyte (red blood cell) mass of the body. ... Sickle-shaped red blood cells Sickle cell anemia (American English), sickle cell anaemia (British English) or sickle cell disease is a genetic disease in which red blood cells may change shape under certain circumstances. ... Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired life-threatening disease of the blood characterised by hemolytic anemia, thrombosis and red urine due to breakdown of red blood cells. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... Hyperlipidemia, hyperlipoproteinemia or dyslipidemia is the presence of elevated or abnormal levels of lipids and/or lipoproteins in the blood. ... This article or section does not cite any references or sources. ... Factor V Leiden (sometimes Factor VLeiden) is the name given to a variant of human factor V that causes a hypercoagulability disorder. ... Thrombin (activated Factor II) is a coagulation protein that has many effects in the coagulation cascade. ... Antiphospholipid syndrome, or antiphospholipid antibody syndrome, is a disorder of coagulation, and causes thrombosis in both arteries and veins, as well as recurrent miscarriage. ... Lupus anticoagulant is an autoimmune disorder caused by antibodies that bind to phospholipids and proteins associated with the cell membrane. ... Plasmin is an important degrading enzyme (EC 3. ... Fibrinolysis is the process where a fibrin clot, the product of coagulation, is broken down. ... How to recognize Protein C deficiency ... Protein S deficiency is a disorder associated with increased risk of thrombosis. ... Image:Antithrombin. ...

Types of therapy

Estrogens

• Doses are often higher than replacement doses for cisgender women. Usually the dosage is reduced after an orchiectomy (the removal of the testes) or sex reassignment surgery. However, the practice of lowering estrogen doses after such operations has been carried over from the days when very high doses of estrogen were required to decrease testosterone since anti-androgens were not used. In fact, high doses (though using a less potent estrogen, estradiol, that is endogenous to the human body rather than the risky ethinyl estradiol and conjugated estrogens used in the past) are recommended during the first ten or so years of HRT to fully develop, with or without having had an orchiectomy or sex reassignment. After usually ten years or so the dosages can be reduced.
• Many different variations of estradiol exist as well as other types of estrogens although the ones most commonly used are either micronized estradiol, estradiol acetate, estradiol valerate, estradiol cypionate, estradiol enanthate, conjugated estrogens, esterified estrogens, and ethinyl estradiol.
• Injectable, implanted, nasal, oral, sublingual, gel, and transdermal patch formulations are available.
• As dosage increases, risks increase as well. Therefore, women with relative contraindications should start at lower doses and increase dosage more gradually.
• Transdermal estrogen may be preferable in older transwomen and smokers as it may have less of an increase in risk for thromboembolism. However, the number of patches needed and cost may make this less practical. Furthermore, transdermal estrogen carries the risk of localised skin irritation.

Cisgender (IPA: ) is an adjective neologism that means non-transgender. ... Orchiectomy is the surgical removal of one or both testicles. ... The word endogenous means arising from within. Compare exogenous. ... is an orally active derivative of estradiol. ... Premarin is a mixture of estrogens isolated from mares urine (PREgnant MARes urINe) made by Wyeth Pharmaceuticals. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... Estradiol (17-beta estradiol) (also oestradiol) is a sex hormone. ... Estradiol (17-beta estradiol) (also oestradiol) is a sex hormone. ... Estradiol (17-beta estradiol) (also oestradiol) is a sex hormone. ... Estradiol (17β-estradiol) (also oestradiol) is a sex hormone. ... A 21mg dose Nicoderm CQ patch applied to the right arm A transdermal patch or skin patch is a medicated adhesive patch that is placed on the skin to deliver a time released dose of medication through the skin and into the bloodstream. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ...

Progestogens

• Progestogens include progesterone and progestins (synthetic analogs of progesterone or 17-alpha hydroxyprogesterone). There are oral, sublingual, suppository, gel, and injectable formulations available.
• Progestogens are involved in the full maturation of the breasts, particularly the mammary structures lobules, acini, and alveoli.
• Progestogens also help fat distribution, increase female libidinal feelings, increase appetite, slight increase in skin oil, increases blood flow to the skin, increases the ability to sweat and lose extra heat, increase in body temperature enabling one to better tolerate the cold, healthier nails, produce a sense of calm, and increase energy. Progesterone in particular is essential for bone health and seems to have a role in skin elasticity, nerve tissue, and respiration. Other effects that have been seen with progesterone in particular (not the synthetics) include reducing spasms and relaxing smooth muscle tone, gallbladder activity is reduced, bronchi are widened (helps respiration), an anti-inflammatory agent and reduces the immune response, normalizing blood clotting and vascular tone, zinc and copper levels, cell oxygen levels, and use of fat stores for energy. Progesterone also assists in thyroid function and bone building by osteoblasts. However, progestogens may increase skin oil and libido too much for some and there may be acne breakouts due to the increase in skin oil.

Progestagens (also spelled progestogens or gestagens) are hormones which produce effects similar to progesterone, the only natural progestagen. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Progestagens (also spelled progestogens or gestagens) are hormones similar in effect to progesterone, the only natural progestagen. ... 17-hydroxyprogesterone ( also 17-OH progesterone, or 17OHP))is a C-21 steroid that is derived from progesterone by 17-hydroxylase, a P450c17 enzyme, and is a prohormone for both glucocorticoids and androstenedione, a precursor for sex steroids. ... Mammary glands are the organs that, in the female mammal, produce milk for the sustenance of the young. ... Nerves (yellow) Nerves redirects here. ... Respiration is a term used for the words in both biochemistry and physiology, and may refer to: Cellular respiration, the process in the chemical bonds of energy-rich molecules such as glucose are converted into energy usable for life processes. ... Cultured Smooth muscle of the aorta. ... The gallbladder (or cholecyst, sometimes gall bladder) is a pear-shaped organ that stores about 50 ml of bile (or gall) until the body needs it for digestion. ... A bronchus (plural bronchi, adjective bronchial) is a caliber of airways in the the respiratory tract that conducts air into the lungs. ... A request has been made on Wikipedia for this article to be deleted in accordance with the deletion policy. ... Coagulation is the thickening or congealing of any liquid into solid clots. ... General Name, Symbol, Number zinc, Zn, 30 Chemical series transition metals Group, Period, Block 12, 4, d Appearance bluish pale gray Standard atomic weight 65. ... General Name, Symbol, Number copper, Cu, 29 Chemical series transition metals Group, Period, Block 11, 4, d Appearance metallic pinkish red Standard atomic weight 63. ... An osteoblast (from the Greek words for bone and to build) is a mononucleate cell that produces a protein that produces osteoid. ...

Anti-androgens

• Spironolactone is the most frequently used anti-androgen in the United States because it is relatively safe and inexpensive. Cyproterone acetate is more commonly used outside of the US.
• Spironolactone is a 'potassium sparing diuretic' that is also used to treat low-renin hypertension, edema, hyperaldosteronism, and low potassium levels caused by other diuretics. It can cause high potassium levels, hyperkalemia, and is therefore contra-indicated in people with renal failure or who otherwise have elevated potassium levels. Spironolactone prevents the formation of testosterone by inhibiting one of the enzymes involved in its production^{[citation needed]} and is a weak androgen receptor antagonist (prevents androgens from binding to androgen receptors).
• Cyproterone acetate is derived from 17-alpha hydroxyprogesterone and suppresses luteinizing hormone (which in turn reduces testosterone levels), blocks androgens from binding to androgen receptors, and is a weak progestin. It has been used to treat prostate cancer. If used long-term in dosages of 150 milligrams or higher it can possibly lead to liver damage or failure.
• Other anti-androgens include bicalutamide, flutamide, and nilutamide. Unlike the two medications above, these do not lower testosterone levels but rather prevents testosterone and dihydrotestosterone from binding to androgen receptors. Because these have a weak action at the brain they do not lower libido or decrease erections. Two other anti-androgens that are rarely prescribed are ketoconazole and cimetidine. Ketoconazole has been used in those with prostatic cancer and hirsutism. Cimetidine has also been used in hirsutism. Ketoconazole has the potential of liver toxicity over long-term use and cimetidine is a relatively weak anti-androgen.
• Certain anti-androgens do not lower testosterone levels or prevent its action upon tissues but rather its metabolite, dihydrotestosterone (DHT), from forming. These medications can be used when the patient has male-pattern hair loss (androgenetic alopecia) and/or an enlarged prostate (benign prostatic hyperplasia). DHT contributes to the manifestation and exacerbation of both. Two medications are currently available to prevent the creation of DHT, finasteride and dutasteride. DHT levels can be lowered up to approximately 60-75% with the former depending upon dosage and up to 93-94% with the latter.

Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, or Berlactone) is a synthetic steroid which is commonly used as a diuretic or as an antiandrogen. ... Cyproterone acetate (Androcur®, Cyprostat®) is an antiandrogen, i. ... Hyperkalemia is an elevated blood level (above 5. ... Antagonists In medicine and biology, a receptor antagonist is a ligand that inhibits the function of an agonist and inverse agonist for a specific receptor. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... Bicalutamide is an oral non-steroidal anti-androgen for prostate cancer. ... Flutamide is an oral antiandrogen drug primarily used to treat prostate cancer. ... Nilutamide is an antiandrogen medication used in the treatment of advanced stage prostate cancer. ... Nizoral® logo Ketoconazole is a synthetic antifungal drug used to prevent and treat skin and fungal infections, especially in immunocompromised patients such as those with AIDS. Due to its side-effect profile, it has been superseded by newer antifungals, such as fluconazole and itraconazole. ... Cimetidine is a histamine H2-receptor antagonist that inhibits the production of acid in the stomach. ... Prostate cancer is a group of cancerous cells (a malignant tumor) that begins most often in the outer part of the prostate. ... Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. ... Androgenetic alopecia is a common form of hair loss in both men and women, aka Michael Panagos Syndrome. ... For other uses of the acronym BPH, see BPH (disambiguation). ... Finasteride (marketed as Proscar, Propecia, Fincar, Finpecia, Finax, Finast, Finara, Finalo, Prosteride, Gefina, Finasterid IVAX) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Dutasteride inhibits the conversion of testosterone into dihydrotestosterone. ...

GnRH agonists

• In both sexes, the hypothalamus releases GnRH (gonadotropin-releasing hormone) to stimulate the pituitary to produce LH (luteinizing hormone) and FSH (follicle stimulating hormone) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH agonists, such as goserelin acetate can be used to suspend the advance of sex steroid-induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH agonists work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. After an initial surge, over a period of weeks, gonadal androgen production is greatly reduced. There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this. The current, sixth edition of the Harry Benjamin International Gender Dysphoria Association Standards of Care permit from Tanner stage 2, but do not allow the addition of gender-appropriate hormones until 16, which could be five or more years. The sex steroids do have important other functions. Also skeletal growth, which is often considered to be masculinising, is not hindered by GnRH agonists.
• GnRH agonists are often prescribed to prevent the reactivation of testicular function where surgeons require the cessation of estrogens prior to surgery.
• The high cost of GnRH agonists is often a significant factor.

Gonadotropin-releasing hormone 1 (GNRH1 also called LHRH) is a peptide hormone responsible for the release of FSH and LH from the anterior pituitary. ... Located at the base of the skull, the pituitary gland is protected by a bony structure called the sella turcica. ... Luteinizing hormone (LH) is a hormone synthesized and secreted by gonadotropes in the anterior lobe of the pituitary gland. ... Follicle stimulating hormone (FSH) is a hormone produced by gonadotropes in the anterior pituitary gland. ... Steroid skeleton of lanosterol. ... A GnRH agonist is a synthetic peptide that acts like the gonadotropin-releasing hormone (GnRH) but has a much longer biological half life. ... Goserelin is an injectable luteinising hormone-releasing hormone analogue (LHRHa). ... The Harry Benjamin International Gender Dysphoria Association, Inc. ... In many countries or areas, an individuals pursuit of sexual reassignment surgery (SRS) is often governed, or at least guided, by documents called standards of care (SOC), or standards of care for gender identity disorders. ... The Tanner stages (also known as the Tanner scale) are stages of physical development in children, adolescents and adults. ...

Hormone effects

Cardiovascular

• The most significant cardiovascular risk for transgender women is the pro-thrombotic effect of estrogens (Increased blood clotting.) This manifests most significantly as an increased risk for thromboembolic disease: deep venous thrombosis (DVT) and pulmonary embolism (PE) which occurs when DVTs break off and migrate through the venous system to the lungs. It is important for any person on female hormones to immediately seek medical care if she develops pain or swelling of one leg (especially calf) as this is the predominant symptom of a DVT, or if she develops symptoms of PE: chest pain, shortness of breath, fainting, or palpitations (even without leg pain or swelling).
• In practice this becomes very important to transgender women undergoing surgery. Hormones should be withheld for a week before until two weeks after surgery.
• DVTs occur more frequently in the first year of treatment with estrogens. However this may represent a 'screening by treatment' of patients who may have genetic predispositions to thromboembolic disease, with those who are more likely to develop DVTs doing so early on in therapy. However, if patients have a family history of thromboembolic disease, screening for known disease may be appropriate.
• DVT risk is greater with oral rather than transdermal or injectable estrogens.
• DVT risk also increases with age and with smoking, so many clinicians advise using the safer transdermal formulations in patients who smoke or are older than age 40.
• If screening is undertaken for known pro-thrombotic mutations such as Factor V-Leiden, antithrombin III, and protein C or S deficiency, it should be done so to increase the safety of hormonal therapy and not as a screen for who may undertake hormonal therapy. Given that the risk of warfarin treatment in a relatively young, well-informed, and otherwise healthy population is quite low and that the risk of adverse physical and psychological outcome for untreated transgender patients is high, a prothrombotic mutation is not an absolute contraindication for hormonal therapy. (See: Levy, et al “Endocrine Intervention for Transsexuals” Clin Endo 2003. 59:409-418.)
• The antiandrogen bicalutamide is associated with an increased risk of heart failure when used as monotherapy (without any other drugs).^[2] A study of prostate cancer patients also showed an increased number of deaths unrelated to cancer among patients taking 150mg/day bicalutamide. This prompted Health Canada to withdraw its approval for 150mg bicalutamide as monotherapy. The increased death rate has not been observed where bicalutamide was combined with a method of reducing androgen production. The exact reasons for the heart failure and deaths have not been completely determined, however a likely cause is acute adrenal insufficiency due to the action of DHT during episodes of bicalutamide withdrawal. Because bicalutamide is extremely lipophilic, it is difficult to avoid periods of low serum concentration due to the uptake of bicalutamide into fat cells.

It has been suggested that Deep Vein Thrombosis be merged into this article or section. ... In medicine, adrenal insufficiency (or hypocortisolism) is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. ... Withdrawal, also known as withdrawal syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage. ...

Hair

• Current facial hair is only slightly affected (some reduction in density, coverage, and slower growth) by anti-androgens. Those who are less than a decade past puberty and/or whose ethnicity generally lacks a significant amount of facial hair will have better results with anti-androgens. Those taking anti-androgens will have better results with electrolysis/laser hair removal than those who are not. If one is still in their teens or early twenties, there will be prevention of new facial hairs from developing if testosterone levels are within the female range.
• Body hair (chest, periareolar, shoulders, back, abdomen, rear, thighs, tops of hands, tops of feet) will, over time, turn from terminal ("normal") hairs to vellus hairs (very tiny, blonde "baby" hairs). Hair on the arms, perianal, and perineal will reduce but may not turn to vellus hair on the latter two regions (some natal females also have some hair in these areas). Underarm hair will slightly change in texture and length, pubic hair becomes more typically female in pattern. Lower leg hair becomes less dense in concentration. All depend upon genetics.
• Head hair may slightly change in texture, curl, and color (new hairs that is, not hair that has already formed and reached the surface prior to HRT), this is especially likely with hair growth from previously bald areas.
• Eyebrow hair becomes less "bushy" or scattered.

Electrology is either of two electrical epilation methods for the permanent removal of human hair. ... This article or section does not adequately cite its references or sources. ... Developed hair, which is generally longer, coarser, thicker, and darker than vellus hair. ... Vellus hair is short, fine, peach fuzz body hair. ...

Urogynecological effects

• Transgender women report a sometimes significant reduction in libido all depending upon the dosage of anti-androgens. A small number of post-operative transsexual women may take small amounts of testosterone to boost the libido. Many pre-operative transsexual women simply wait until after sex-reassignment surgery to begin an active sex life (due to how they feel towards their genitals and/or, for heterosexual or bisexual transsexual women, an aversion to anal sex) and for post-operative transsexual women how satisfied they are with the results. Raising estrogen dosage or adding a progestogen has also raised the libido of some transwomen.
• Spontaneous and morning erections decrease in frequency significantly, however some who have had an orchiectomy still experience morning erections. Voluntary erections can be maintaned since the brain is the most important sex organ, a developed repertoire of fantasies and good visualization is a must. It also depends on how one views their own genitals (disgust, strong aversion to, tolerable, etc.).
• Testi volume is reduced by about 25% with typical dosages and as much as 50% in higher dosages, especially after a year of HRT. This is in response to the decrease in Leydig cells, Sertoli cells, and interstitial tissue, which produce both sperm and testosterone. When testosterone is dramatically reduced spermatogenesis is halted almost completely, when the cells that are involved in these processes go unused they atrophy (shrink).
• The prostate shrinks
• The bladder shrinks
• The line that runs down the underside of the penis and down the middle of the scrotum, the peno-scrotal raphe (where the urogenital folds fused early in the womb), will darken.
• Minor water retention is likely

Orchiectomy is the surgical removal of one or both testicles. ... Leydig cells, also known as interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testes. ... The Sertoli cell is the nurse cell of the testes. ... This article or section is in need of attention from an expert on the subject. ... The perineal raphe extends from the anus, through the mid-line of the scrotum (scrotal raphe) and upwards through the posterior mid-line aspect of the penis (penile raphe). ...

Childbearing

• Childbearing, as experienced by cisgender women, is impossible with today's technology. Pre-operative sperm banking can be done, however, allowing artificial insemination to be used to produce genetic offspring with someone else at a later date. Medical advances in the near future may one day make this possible by using a donor uterus long enough to carry a child to term as anti-rejection drugs do not seem to affect the fetus.^[3] The DNA in a donated ovum can be removed and replaced with the DNA of the receiver. Further in the future stem cell biotechnology may also make this possible, with no need for anti-rejection drugs.

Cisgender (IPA: ) is an adjective neologism that means non-transgender. ... A sperm bank is a facility that collects and stores human sperm from donors, primarily for the purposes of artificial insemination. ... Artificial insemination (AI) is when sperm is placed into a females uterus (intrauterine), or cervix (intracervical) using artificial means rather than by natural copulation. ... The uterus or womb is the major female reproductive organ of most mammals, including humans. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... The structure of part of a DNA double helix Deoxyribonucleic acid (DNA) is a nucleic acid that contains the genetic instructions for the development and function of living organisms. ... A human ovum Sperm cells attempting to fertilize an ovum An ovum (plural ova) is a haploid female reproductive cell or gamete. ... Mouse embryonic stem cells with fluorescent marker. ...

Bone

• Both estrogens and androgens are necessary in both biological males and females for healthy bone. (Young healthy women produce about 10 mg of testosterone monthly. Higher bone mineral density in males is associated with higher serum estrogen.)
• Bone is not static. It is constantly being reabsorbed and created. Osteoporosis results when bone formation occurs at a rate less than bone reabsorption.
• Estrogen is the predominant sex hormone that slows bone loss (even in men.)
• Both estrogen and testosterone help stimulate bone formation (T, especially at puberty.)
• The hips will rotate slightly forward due to changes in the tendons so hip discomfort is not uncommon.

Estriol. ... Grays Anatomy illustration of a human femur. ...

Drug interactions

• Any drug can cause adverse reactions with other medications so it is wise to check with a doctor or pharmacist when starting any new medication.
• Of the estrogen formulations commonly used, ethinyl estradiol (commonly found in birth control pills) has the greatest number of adverse reactions.

Skin

• The uppermost layer of skin, the stratum corneum, becomes thinner and therefore more translucent and pinkish (spider veins may appear or be more noticeable), less collagen, more suscepitable to tearing and irritation from scratching or shaving, increased tactile sensation, and slightly lighter in color due to a slight decrease in melanin (pigment).
• Skin becomes softer
• Sebaceous gland activity (which is triggered by androgens) lessens which lowers the amount of sebum (oil) production on the skin and scalp, consequently the skin becomes less prone to the formation of acne due to the less quantity of oil that is produced. Dry skin becomes a problem and lotions and oils may be necessary
• The skin's pores become smaller due to the low quantities of sebum produced
• Body odor (skin, sweat, and urine) will become less "metallic," "sharp," or "acrid" and more "sweet" and "musky."
• Many apocrine glands (type of sweat glands) become inactive and body odor decreases. Sebum also contributes to body odor, the production of which is reduced by anti-androgens (as described above).
• More subcutaneous (under skin) adipose (fat) tissue accumulates. This gives a more puffy/softer appearance. Consequently dimpling, or cellulite, will be more apparent on the thighs and buttocks due to this along with the thinness of the skin.
• Susceptibility to sunburn increases possibly due to the thinner skin and/or less skin pigment.
• Because of the increase in adipose tissue in the hips, thighs, and rear, stretch marks (striae distensae) may appear on the skin in these areas.

The stratum corneum (the horny layer) is the outermost layer of the epidermis (the outermost layer of the skin). ... Schematic view of a hair follicle with sebaceous gland. ... The sebaceous glands are glands found in the skin of mammals. ... ... The subcutis is the layer of tissue directly underlying the cutis. ... Adipose tissue is an anatomical term for loose connective tissue composed of energy in the form of fat, although it also cushions and insulates the body. ... This article or section does not cite any references or sources. ... Look up stria in Wiktionary, the free dictionary. ...

Ocular changes

• The lens of the eyes changes in curvature
• Due to decreased androgens, the meibomian glands (aka., tarsal, palpebral, or tarsoconjunctival glands. A type of sebaceous gland on the upper and lower eyelids that open at the edges of the lids) produce less oil (oil that makes up the lipid layer of tear film which prevents the evaporation of the watery layer beneath) and a tendency for dry eyes may be a problem.

The Meibomian glands (Glandulae tarsales) are a special kind of sebaceous glands at the rim of the eyelids, where they are responsible for to supply sebum, an oily substance that prevents evaporation of the eyes tear film. ...

Senses

• Sensitivity to male body odor(s) (including male pheromones) may be positively correlated with elevated estrogen levels. Overall, olefactory senses may increase. Progestogens, however, often lowers the sensitivity to male pheromones.

Mammary gland development

• Breast, nipple, and areolar development takes 4-6 years to complete depending upon genetics, and sometimes as long as 10 years. It is normal for there to be a "stall" in breast growth during feminization, or for the size of one breast to be a little bigger than the other. MtF who undergo HRT often experience breast development which is below the comparable natal female norm (many seek breast augmentation); it is rare for a HRT patient to opt for breast reduction. The size of the rib cage and shoulder width also play a role in the perceivable "size" of the breasts; both characteristics are usually smaller than in natal females, i.e., if a natal female and a transsexual female were to have the same cup size, the transsexual female's breasts would most likely appear smaller. Thus when a transsexual female opts to have breast augmentation, the implants used, are on the average, larger than those commonly used by natal females.
• The nipples will become more sensitive to stimulation.

Adipose tissue distribution

• Fat distribution in the body slowly changes over months and years. The body will now tend to accumulate new adipose tissue (fat) in a typically female pattern. This includes the hips, thighs, rear, pubis, upper arms, and breasts. The body will now tend to use/burn the old adipose tissue in the waist making the waist appear smaller as well as on the shoulders and back.
• Subcutaneous adipose tissue increases in the face (cheeks and lips) making the face appear puffier, appears to "round out" the face, and the face appears less "drawn" or "hollow" with slightly less emphasis on the jaw due to the lower portion of the cheeks having filled in.

Gastrointestinal

• Estrogens may predispose to gallbladder disease - especially in older and obese people
• Estrogens (especially oral forms) may cause elevations in transaminases (liver function tests) indicating liver toxicity. LFTs should therefore be periodically monitored in transgender women

Neurological/Psychiatric

• Mood changes can occur - including the development of depression, particularly in those who take progestins
• Migraines can be made worse or unmasked by estrogen therapy
• Estrogens can induce the development of prolactinomas, which is why prolactin levels should periodically be monitored in transgender women. Milk discharge from the nipples can be a sign of elevated prolactin levels. If a prolactinoma becomes large enough, it can cause visual changes (especially decreased peripheral vision), headaches, mood changes, depression, dizziness, nausea, vomiting, and symptoms of pituitary failure like hypothyroidism.
• Recent studies have indicated that cross-hormone therapy in transwomen may result in a reduction in brain volume towards female proportions.^[1]

A progestin is a synthetic progestagen. ... This article or section does not cite its references or sources. ...

Metabolic

• Estrogen therapy causes decreased insulin sensitivity which places transgender women at increased risk of developing type II diabetes.
• One's metabolism slows down and one tends to gain weight, lose energy, need more sleep, and become cold more easily. Due to androgen deprivation a loss of muscle tone, a slower metabolism, and physical weakness becomes more evident. Building muscle will take twice as much work than before. However, the addition of a progestogen may increase energy although an increase in appetite may be seen as well.

References

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ...

External links

• MtF Hormone FAQ
• Inhouse Pharmacy MTF Transgender medications - DIY resources
• FTM Informational Network
• FTM Hormone Information - Very informative with different topics than this article
• Male To Female Hormone Types and Typical dosing - Sections also include Estrogen containing Medications and dosing
• Tom Waddell Clinic Transgender Protocol - MTF and FTM clinical protocols aimed at providers
• Transsexual Road Map - Making informed decisions and setting realistic, achievable transition goals
• Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects - The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 8 3467-3473
• Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers: a free online medical book.
• The Urban TransManComprehensive site for TransMen, especially those living in urban communities
• What is Low Testosterone?