It’s a fact that some transsexuals choose—usually because it’s the only option available to them—to self-prescribe hormones and/or androgen-blocking drugs. This article compares recommendations from medical and non-medical sources, and explains conditions that could result from HRT, whether therapy is medically monitored or not. This information is not provided or intended as a substitute for professional medical advice or care.
I am not a medical professional. Please also note that the glossary at the end of this article is just that: a glossary, and not a dictionary. The descriptions of the terms in the glossary are meant to help you interpret their use in this article only, and are not comprehensive definitions.
Because the populations are so different, this article is arranged in two sections, one reporting on MTFs and one on FTMs.
MTFs
Dosage
There are no generally agreed upon recommended dosages, or recommended drugs within categories. The following recommendations are based upon three sources, but the categorization of drugs into “recommended” and “less recommended” come from “Hormone Treatment in Transsexual People” (Asscheman and Gooren 1992). Dosage recommendations and notes, unless otherwise noted, are also from Asscheman and Gooren.
It is recommended that MTFs take both an anti-androgen and a source of estrogen before having an orchiectomy, and discontinue using anti-androgens after an orchiectomy (Asscheman & Gooren). Taking only an anti-androgen incurs risk of serious bone density loss, and taking only estrogen does not significantly lower testosterone levels. You should only be using one drug at the recommended dosage from each category.
Note that mg is an abbreviation for milligrams, not to be confused with µg, the abbreviation for micrograms. A microgram is 1/1,000 of a milligram. To avoid some confusion, the abbreviation for micrograms is not used in these tables. Other abbreviations that have been replaced for clarity are t.i.d., which is the Latin abbreviation for “three times a day,” p.o., which indicates an oral dose, and i.m., for intramuscular injections.
For common names and descriptions of commercially available preparations of the drugs, click the generic name.
Recommended anti-androgens and their dosage:
| Generic name | Dosage | Notes |
| cyproterone acetate (injectable Androcur Depot) | 100-150 mg/day orally | Antigonadotropic. |
| spironolactone | 100-200 mg/day orally | Works by interfering with testosterone or DHT production. Also has receptor-blocking properties. Originally developed as a diuretic, it has antihypertensive properties. |
Less recommended anti-androgens and their dosage:
| Generic name | Dosage | Notes |
| medroxyprogesterone | 5-10 mg/day orally [1],[3] | Antigonadotropic. Less effective than cyproterone and spironolactone |
| 150 mg/month intramuscular injection | ||
| nilutamide | 300 mg/day orally | Androgen receptor blocker. Not as effective for MTF hormone therapy, because it can potentially stimulate androgen production. |
| flutamide | 250 mg three times a day, orally | Works by interfering with testosterone or DHT production. Not as effective for MTF hormone therapy, because it can potentially stimulate androgen production. |
Recommended estrogens and their dosages:
| Generic name | Dosage | Notes |
| ethinyl estradiol | 100 micrograms/day orally [1], [3] | Most potent estrogenic drug. Slowly metabolized by the liver, but has a large effect on other metabolic pathways in the liver. Very cheap and easily available. Can be obtained as the oral contraceptive pill, which is always combined with progestogen. |
| conjugated estrogens | 5-10 mg/day orally [1]1.25-2.5 mg/day orally [3] | Active dose in postmenopausal women is 0.625-1.25 mg, but for cross-gender hormone therapy the active dose is 5-10 mg (Meyer et al., 1986). Largely metabolized at first liver passage. Conjugated estrogens in a dose of 2.5 and 5 mg orally per day are clearly associated with an increased risk of thrombosis. |
| 17ß estradiol | 2-4 mg/day orally [1]6-8 mg/day orally [2]10 mg/2 weeks to 200 mg/month intramuscular injection [1] | Most potent of the three forms of native estrogens in the human body. Produced synthetically. Largely metabolized at first liver passage. |
| 50-100 micrograms/day transdermally [1]two 0.1 mg patches, applied simultaneously[2] | Patches are replaced twice weekly. Low number of estrogen-induced side effects. Can cause skin irritation. Most expensive form. Very strongly recommended for patients over the age of 40, because of the risk of thromboembolism. | |
| estriol | 4-6 mg/day orally [1] | In cross-gender hormone treatment, high doses are necessary. |
[1] Asscheman and Gooren 1992
[2] Lawrence
[3] Futterweit 1998
Non-Medical Sources of Information on Hormone Dosage
How reliable are websites and mailing lists created by other trans women for providing safe, accurate information about hormone therapy? One way to gauge their reliability is to compare the concrete dosage recommendations against those provided by medical sources.
I subscribed to an electronic mailing list on which transsexuals who are self-medicating (primarily MTFs) exchange advice on hormone therapy, and selected twenty-one individual posters who identified their own regimens, including drug names and dosage, and did not report dissatisfaction or ask for help in modifying their hormone regimens. (See Appendix A: Self-Reported Dosage Recommendations from Electronic Mailing List) Of those, four (19%) reported hormone regimens that were within the guidelines given by Asscheman and Gooren or Lawrence.
Of those who were not within the guidelines, the differences ranged from the possibly ineffective to the potentially dangerous. Five (25%) used an anti-androgen considered less effective by Asscheman and Gooren. Two (10%) reported cycling doses, which has no known therapeutic value. Five (25%) used a higher dose of anti-androgen than recommended, and four (19%) used a lower dose of anti-androgen than recommended. A high number (7, one third) reported using a lower dose of estrogen than recommended by Asscheman and Gooren, while one used a higher than recommended dose. Included in the numbers already reported, four (19%) used lower than recommended doses of both the anti-androgen and estrogen. Three (14%) who did not report having had orchiectomies said they used no anti-androgen. Of those reported above, one trans woman was taking three times the normal dose of anti-androgen, and another twice the normal dose of estrogen.
Phytoestrogens
Phytoestrogens work by weakly binding with estrogen receptors, giving in some cases very mild feminizing effects. However, the doses required to achieve any effects at all are prohibitively large and toxic. (FAQ: Hormone Therapy for M2F Transsexuals) Most sources do not recommend that trans women use black cohosh, dong quai, milk thistle, or any other phytoestrogenic herb as a replacement for hormone therapy, even as a low-dose measure, because of their inefficacy. Because of the way that phytoestrogens compete with estrogen for receptors, using them in addition to hormone therapy may also be counterproductive.
Side Effects
Thromboembolism
Combined treatment with estrogen and cyproterone acetate is associated with increases in thromboembolic events (Asscheman, Gooren, & Eklund). The more serious risk of thromboembolism, according to a later study by two of the same researchers, is greatly reduced by the use of transdermal estrogen therapy in patients over the age of 40, in whom “a high incidence of venous thromboembolism was observed with oral oestrogens.” (van Kesteren et al 1997) A 1998 study in which estrogen was administered by injection or orally reported incidence of thromboembolic events as “negligible” (Schlatterer et al).
Hyperprolactinemia
In a 1989 retrospective study, combined treatment with estrogen and cyproterone acetate was associated with increases in hyperprolactinemia (Asscheman, Gooren, & Eklund). An article dealing specifically with the risks of self-treatment by transsexual women also noted increased rates of hyperprolactinemia (Becerra Fernandez et al 1999). The complications of hyperprolactinemia are limited, but can include blindness and hemorraging (Schenenberger & Knee 2001). In one case study, prolactin-producing pituitary adenoma was linked with long-term estrogen use (Kovacs et al 1994). In study of elevated prolactin levels in transsexual women, of fifteen patients with persistently high prolactin levels, the patients were also reported to have developed enlarged pituitary glands. The study linked elevated prolactin levels with higher estrogen dosage as well as with increased age, and suggested using the lowest effective dosages of estrogen (Asscheman et al 1988). Another study of transsexual women with elevated prolactin levels “suggest that the risk of inducing prolactinomas through cross-gender hormone treatment is likely to be small.” (Gooren et al 1985)
Liver Function
Combined treatment with estrogen and cyproterone acetate [an androgen-blocker] is associated with transient elevation of liver enzymes (Asscheman, Gooren, & Eklund). An article dealing specifically with the risks of self-treatment by transsexual women also noted elevation of liver enzymes (Becerra Fernandez et al 1999). The liver function issues in the 1989 study were attributed to other causes, such as alcohol abuse and hepatitis B, and were mainly successfully treated, either with other medications or temporarily halting hormone treatment.
Osteoporosis
In a German case study, bone loss was reversed in an MTF woman by adding 2 mg of oral estradiol valerate daily to the 100 mg of cyproterone daily she was already taking. She was losing bone mass at the rate of 5% per year while taking androgen-blockers without also taking estrogen (Hierl et al 1999). A case study comparing trans women who had been on estrogen for less than two years with those who’d been on it for longer found increased bone density in the women who’d been on estrogen longer (Reutrakul et al 1998).
Depressive Mood Changes
In a 1989 retrospective study, combined treatment with estrogen and cyproterone acetate [an androgen-blocker] was associated with increases in depressive mood changes (Asscheman, Gooren, & Eklund). Depression has been tied to both high and low testosterone levels in women (Rohr 2002) and to the isolation of transsexuals (Rauchfleisch 1998).
Cholesterol Levels
An article dealing specifically with the risks of self-treatment by transsexual women noted higher levels of total cholesterol, LDL cholesterol, and triglycerides. (Becerra Fernandez et al 1999) However, the higher levels of cholesterol and triglycerides were still within normal levels (Citkowitz 2001, Isley 2002) and the lower incidence of other factors associated with heart disease, such as elevated plasma tHcy levels (Giltay et al 1998), suggest this is an acceptable risk.
Hyperkalemia
Spironolactone use can cause hyperkalemia, an excessive amount of potassium in the blood. Hyperkalemia, an often symptomless condition, can cause serious kidney problems, including renal failure, and heart problems, including difficult to cure cardiac rhythm disturbances. (RxList). People using spironolactone are advised to avoid excessive potassium in their diets, including salt substitutes containing potassium chloride.
FTMs
Dosage
Only a testosterone ester is necessary, unless one is taking testosterone undecanoate, in which case a progestogen may be supplemented. Taking only a testosterone is preferred to avoid the requirement of progestogen, and because they are more widely available.
Recommended testosterones and their dosages:
| testosterone esters (transdermal, enanthate, Sustanon, cypionate) | 200-250 mg/2 weeks intramuscular injection [1]250-400 mg/2-3 weeks intramuscular injection [2] | Androgen treatment has an unfavorable effect on the lipid profile. Oral androgens such as mesterolone and fluoxymesterone are too weak for the induction of virilization. |
| testosterone undecanoate | 160-240 mg/day orally [1] | Not available in the U.S. Does not suppress menstruation in half the patients, and in these cases, can be supplemented with progestogens. |
[1] Asscheman & Gooren 1992
[2] Futterweit 1998
Progestogens and their dosages (Asscheman & Gooren 1992):
| medroxyprogesterone acetate | 5 mg, 1-2 tablets/day or 150 mg intramuscularly/3 months |
| lynestrenol | 5 mg, 1-2 tablets/day |
| norethisterone | 5 mg, 1 or 2 tablets/day |
Non-Medical Sources of Information on Hormone Dosage
Hormone regimens for transmen are less complicated, and there are fewer drugs to choose from, apparently reducing the temptation to play the armchair pharmacist. Unlike MTFs, there do not appear to be any electronic mailing lists dedicated to do-it-yourself hormone use for FTMs. A review of twenty-seven responses to an online survey of FTM hormone use and surgery indicate most are taking low to normal amounts of testosterone, and none of the 27 reviewed were taking anti-estrogens or progestogens. (FTM Survey)
Websites from non-medical sources give information on recommended or typical dosage of testosterone. A survey of these sources is available in Appendix B: Website Hormone Recommendations for FTMs.
Testosterone Enhancers or Precursors
A variety of products marketed to body builders as nutritional supplements are popular among transmen as alternatives to testosterone. If you’re considering using supplements marketed as anabolic steroids or replacements for anabolic steroids, that the characteristics of anabolic steroids are that they help create muscle (anabolic), but have weak masculinizing (androgenic) properties. As a result, in the amounts sufficient to produce masculinizing effects, there is a risk of liver damage, particularly when taking these products orally.Of eleven survey respondents who used DHEA without testosterone, no one reported more than slightly noticeable results. Three respondents using large quantities of norandrostenediol and androstendiol had some noticeable results within two to fifteen months. (FTM Survey)
Side Effects
Cardiovascular Disease
An elevated plasma level of total (free and protein-bound) homocysteine (tHcy) is a risk factor independent of other known risk factors for cardiovascular disease. Increased levels of tHcy were found in FTMs on hormone therapy (Giltay et al 1998). Androgen treatment in 122 female-to-male transsexuals was also associated with weight increase greater than 10% in 17.2% of the subjects (Asscheman et al 1989). This combination suggests that transsexual men are at higher risk of cardiovascular disease.
Cholesterol Levels
An article dealing specifically with the risks of self-treatment by transsexual men noted higher levels of total cholesterol, LDL cholesterol, and triglycerides. (Becerra Fernandez et al 1999) However, the higher levels of cholesterol and triglycerides were still within normal levels (Citkowitz 2001, Isley 2002).
Liver Function
An article dealing specifically with the risks of self-treatment by transsexual men also noted elevation of liver enzymes (Becerra Fernandez et al 1999). The liver enzyme abnormalities in a 1989 study that included both MTFs and FTMs were attributed to other causes, such as alcohol abuse and hepatitis B, and were mainly successfully treated, either with other medications or temporarily halting hormone treatment (Asscheman el al).
Hyperprolactinemia
An article dealing specifically with the risks of self-treatment by transsexual men noted increased rates of hyperprolactinemia (Becerra Fernandez et al 1999). The complications of hyperprolactinemia are limited, but can include blindness and hemorraging (Shenenberger & Knee 2001).
Polycythemia and Bleeding Disorders
Possible side effects of testosterone use include polycythemia, or having too many red blood cells, and suppression of some clotting factors. Polycythemia can kill by thrombosis or hemorrhage. Suppression of clotting factors, particularly when combined with the use of anticoagulants, can also result in hemorrhage.
Glossary
Adenoma – A benign tumor in the epithelial tissue—the tissue covering the insides and outsides of parts of the body– in which the cells of the tumor form glandular structures or in which the cells come from glandular epithelium.
Anabolic steroids – Any of a group of synthetic derivatives of testosterone, having pronounced anabolic properties and relatively weak androgenic properties, which are used mainly to promote growth and repair body tissues.
Androgen – general term for any male sex hormone.
Anti-androgen – A substance which interferes with the function of an androgen, or male sex hormone, by taking over the androgen’s receptors.
Antigonadotropic– Reducing the growth and/or function of the gonads.
Cyproterone acetate – An agent with anti-androgen and progesterone-releasing properties. It competes at the receptor sites with androgens and reduces their effects.
DHEA – An androgenic steroid hormone secreted largely by the adrenal cortex and found in human urine, or synthetic preparation of this hormone used as a nutritional supplement.
DHT – Dihydrotestosterone. An androgen derived from testosterone and having tumor-suppressing capabilities useful in the treatment of certain breast cancers.
Diuretic – An agent that promotes the excretion of urine.
Estradiol – A potent estrogen.
Estrogen – A generic term for any of a number of female sex hormones. Estrogen is formed in ovaries and testes, has various functions in both sexes, and in females causes the development of secondary sex characteristics. It is used in oral contraceptives, to relieve discomfort of menopause, and to treat osteoporosis and breast and prostate cancer.
Estrogenic– – Having an action similar to that of an estrogen.
Hemorrhage – Bleeding.
Homocysteine – An amino acid used normally by the body in cellular metabolism and the manufacture of proteins. Elevated concentrations in the blood are thought to increase the risk for heart disease by damaging the lining of blood vessels and enhancing blood clotting.
Hyperprolactinemia – An increased level of prolactin.
Orchiectomy – The surgical removal of the testicles.
Phytoestrogen – A naturally occurring compound of plants, such as soybeans, or plant products, such as whole grain cereals, that acts like estrogen in the body.
Progestogen – A term applied to any substance capable of stimulating the uterine changes essential for implantation and growth of a fertilized ovum.
Prolactin – A hormone that prepares the pregnant female’s breasts for milk production.
Prolactinoma – A pituitary gland tumor that secretes prolactin.
Spironolactone – A steroid derivative that blocks the action of aldosterone, steroid hormone that regulates the salt and water balance in the body. Used as a diuretic primarily in the treatment of hypertension.
Testosterone – Male sex hormone secreted by the testes and responsible for triggering the development of sperm and of many secondary sexual characteristics.
Thromboembolism – Obstruction of a blood vessel with a clot of fibrin— an elastic, insoluble, whitish protein— carried by the blood stream.
Thrombosis – Formation of a thrombus— platelets, fibrin, and pieces of other cells— that obstruct a blood vessel at the place where the thrombus is formed.
Appendix A: Self-Reported Dosage Recommendations from Electronic Mailing List
| Regimen as described on mailing list | Does the regimen match the guidelines available? | |
| 1. | First two weeks:4mg estradiol valerate per day 10mg Provera per dayThird week:10mg estradiol cypionate per day 50mg Depo-Provera injection |
This regimen includes normal dose of a recommended estrogen source and a dose of a less effective anti-androgen. The source of anti-androgen is cycled between oral and intramuscular injection. |
| 2. | Month 1 – 5 mg Premarin per day 200 mg of Aldactone per dayMonth 2 – Continue Premarin Increase Aldactone to 300 mgMonth 3 – Continue Premarin and Aldactone Add 10 mg Provera per day |
This regimen is using recommended sources of estrogen and anti-androgen, both within normal recommended dosage.This regimen increases the anti-androgen above the recommended dose.This regimen further increases the anti-androgen dose by adding a second, less effective source of anti-androgens. |
| 3. | 50mg Androcur per day Eight 10mcg ethinyl estradiol per day |
This regimen uses lower than normally recommended doses of recommended anti-androgen and estrogen. |
| 4. | Ethinyl estradiol .05mg twice a day Spironalactone 100mg twice a day Proscar 5mg once a day |
This regimen uses a lower than recommended dose of estrogen with a normal dose of anti-androgen. It also includes a hormone-blocker used to prevent hair loss. |
| 5. | Ethinyl estradiol 25 micrograms a day | This regimen does not include anti-androgens, but uses a potent, recommended estrogen at a below normal dose. |
| 6. | 1.25 mg Premarin 25 -50 mg spironalactone per day for the 1st month or so and gradually increase |
This regimen uses lower than normal doses of recommended estrogen and anti-androgen sources. |
| 7. | 2mg estradiol twice a day Spironalactone 100mg twice a day Proscar 5mg once a dayAdded medoxyprogesterone 10mg daily |
This regimen started with normal doses of estrogen and anti-androgen, then increased the anti-androgen above normal dosage by adding another, less effective anti-androgen. It also includes a hormone-blocker used to prevent hair loss. |
| 8. | Premarin 5mg per day Spironalactone 200mg per day |
This regimen includes normal doses of recommended estrogen and anti-androgen sources. |
| 9. | estradiol valerate 20 mg every two weeks finasteride 20 mg every week progestins 50 mg every month |
This regimen includes an intramuscular injection of a recommended estrogen and a hormone-blocker used to prevent hair loss. Progestins are the class of drug to which Depo-Provera belong; the exact progestin used here is unknown, but based on this dosage, this is possibly IM. The combined dosage of estrogen is probably within recommendations. |
| 10. | Elleste Solo 5mg sublingually twice a day Depo-Provera 150 mg monthly |
This regimen includes a higher than recommended dose of estrogen, and three times the normal dose of anti-androgen. |
| 11. | estradiol 4 mg per day Provera 5 mg orally per day Spironalactone 200 mg per day 1 aspirin per day for clotting |
This regimen includes a normal dose of estrogen, and two sources of anti-androgens: one recommended source and one less effective source. The combined doses of anti-androgens are above normal. |
| 12. | Estrofem 2mg tab, sublingual three times a day Provera 10mg per day |
This regimen includes normal doses of a recommended estrogen and a less-effective anti-androgen. |
| 13. | Estrofem 6mg/day Spiro 100mg/day |
This regimen includes recommended sources of estrogen and anti-androgen at normal doses. |
| 14. | 1 c.c. of estradiol cypionate intramuscular injection every three weeks (5mg/ml), oral estradiol 2mg daily 200 mg spiro 1/4 tablet of Proscar daily(supervised regimen) |
This regimen includes two sources of estrogen: one oral at a low normal dose and one intramuscular injection. Depo-Estradiol, a source of estradiol cypionate, is 5mg/mL, so the dose is probably around 5 mg every three weeks, less than half the recommended dose. The regimen also includes a normal dose of a recommended anti-androgen and a hormone-blocker used to prevent hair loss. |
| 15. | For ten days:estrofem 2 mg spiro 200mg Premarin 1.25 mgFor five days:Nothing |
This regimen includes normal doses of estrogen and anti-androgen from recommended sources, but the regimen is cycled with a resultant lower than normal dose of each substance. |
| 16. | Premarin 2.5 mg Estrofem 4 mg Spirotone 200 mg |
This regimen includes a normal dose of a recommended anti-androgen, and a combination of estrogens resulting in a normal dose. |
| 17. | Two 100 Climara patches per weekTwo Aldactone100 mg | This is probably the recommended .1 mg patch at the recommended dosage of two per day, used simultaneously, as well as a recommended anti-androgen. |
| 18. | Prempro 2.5 mg twice a day | Prempro is a combination of Premarin (a conjugated estrogen) and Cyrin (an anti-androgen) containing a lower than recommended dose of estrogen and either a low or normal dose of anti-androgen (Prempro 2.5 or Prempro 5.0, where the number indicates the number of milligrams of medroxyprogesterone acetate.) |
| 19. | Premarin 2.5 mg/dayEstrofem 4 mg/day | This regimen includes two sources of estrogen, resulting in a normal dose, but no anti-androgens. |
| 20. | Premarin 2.5 mg per day Provera 10 mg per day spironalactone 200 mg per day |
This regimen includes a lower than recommended dose of estrogen, and two sources of anti-androgens with a resultant twice the normal recommended dose. |
| 21. | 40 mg estradiol valerate IM every 2 weeks 200 mg Prometrium per day 50 mg Androcur per day |
This regimen includes a normal dose of estrogen, a low dose of anti-androgen, and a dose of progesterone. No dosage recommendations were available. Several TS internet sources recommend its use to control mood swings, while some individuals reported that it created mood swings. |
Appendix B: Website Hormone Recommendations for FTMs
Testosterone
Recommendations from the “Hormone Therapy for F2M Transsexuals” website
Testosterone
Testosterone Cypionate Pre-op 200-400mg/2-4wks
Post-op 50-200mg/2-4wks
Testosterone Enanthate Pre-op 200-400mg/2wks
Post-op 50-200mg/2wks
Testosterone transdermal film No Pre-op recommendation
Post-op 4-6mg/day (1 film changed daily)
Methyl Testosterone No Pre-op recommendation
Post-op 10-50mg/day
Fluoxymesterone No Pre-op recommendation
Post-op 5-20mg/day
Anti-Estrogens
Danazol Pre-op 200-400mg/day
Tamoxifen Citrate Pre-op 20-40mg/day
Goserelin Acetate Pre-op 3.6mg/month
(3.6mg implant is for 1 month; 10.8 mg implant is for 3 months)
Nafarelin Acetate Pre-op 1600mcg/day (2 sprays into each nostril twice a day)
Leuprolide Acetate Pre-op 3.75-7.5mg/month
Recommendations from the Alamo Boyz “FTM Surgical Recommendation” website
Testosterone Cypionate Pre-op 200-400mg/2-4wks
Post-op 50-200mg/2-4wks
Recommendations from the “Notes on Gender Transition: FTM 101 — The Invisible Transsexuals” website
Testosterone Cypionate and Testosterone Enanthate Pre-op 200 ml/cc, lcc every two weeks
Works Cited
Asscheman H & Gooren LJG. (1992). Hormone treatment in transsexual people. In WO Bockting & E Coleman (Eds.), Gender dysphoria: interdisciplinary approaches in clinical management. New York: Haworth Press.
Asscheman H, Gooren LJ, Assies J, Smits JP, de Slegte R. (1988 Jun). Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrinol (Oxf). Abstract retrieved 19 May 2002 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2978262&dopt=Abstract.
Asscheman H, Gooren LJ, Eklund PL. (1989 Sep). Mortality and morbidity in transsexual patients with cross-gender hormone treatment. Metabolism. Abstract retrieved 18 May 2002 from PubMed. Full text available at http://www.sissify.com/realgirl/mortality.html.
Citkowitz E. (2002 Oct 21). Hypertriglyceridemia. eMedicine Journal. Retrieved 18 May 2002 from http://www.emedicine.com/med/topic2921.htm.
FAQ: Hormone Therapy for M2F Transsexuals. (1994) Exactly what hormones are available? What Are the Details On Popularity, Dosage, Availability, Contraindications, Adverse Effects, Etc.? Retrieved 18 June 2002 from http://www.jennifer-o.com/Hormones/m2f/exactly.htm.
FTM Surgical Information. Alamo Boyz. Retrieved 18 June 2002.
FTM Survey. TMen. Retrieved 18 June 2002 from http://www21.brinkster.com/tmen/survey/index.html.
Futterweit W. (1998). Endocrine therapy of transsexualism and potential complications of long-term treatment. Arch Sex Behav. 27:2:209-226.
Giltay EJ, Hoogeveen EK, Elbers JMH, Gooren LJG, Asscheman H, & Stehouwer CDA. (1998). Effects of Sex Steroids on Plasma Total Homocysteine Levels: A Study in Transsexual Males and Females. The Journal of Clinical Endocrinology & Metabolism. Retrieved 19 May 2002 from http://jcem.endojournals.org/cgi/content/full/83/2/550.
Gooren LJ, Harmsen-Louman W, van Kessel H. (1985 Feb). Follow-up of prolactin levels in long-term oestrogen-treated male-to-female transsexuals with regard to prolactinoma induction. Clin Endocrinol (Oxf). Abstract retrieved 19 May 2002 from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3157511&dopt=Abstract.
Hierl T, Borcsok I, Ziegler R, Kasperk C. (1999 Apr 30). [Osteo-anabolic estrogen therapy in a transsexual man] [Article in German]. Dtsch Med Wochenschr. Abstract retrieved 19 May 2002 from PubMed.
Hormone Therapy for F2M Transsexuals. Retrieved 18 June 2002 from http://www.sexuality.org/l/transgen/f2m.html.
Hyperkalemia. (2001). RxList Medical Terminology. Retrieved 18 June 2002 from http://129.250.146.19/cgi/popupdef.pl?term=hyperkalemia&url=http://www.rxlist.com/cgi/generic.
Isley W. (2002 Jan 7). Hypercholesterolemia, Polygenic. eMedicine Journal. Retrieved 18 May 2002 from http://www.emedicine.com/med/topic1073.htm.
van Kesteren PJ, Asscheman H, Megens JA, Gooren LJ. (1997 Sep). Mortality and morbidity in transsexual subjects treated with cross-sex hormones. Clin Endocrinol (Oxf).
Kovacs K, Stefaneanu L, Ezzat S, Smyth HS. (1994 May). Prolactin-producing pituitary adenoma in a male-to-female transsexual patient with protracted estrogen administration. A morphologic study. Arch Pathol Lab Med. Abstract retrieved 19 May 2002 from PubMed.
Lawrence A. (2000). Some typical hormone regimens. Retrieved 27 June 2002 from http://www.annelawrence.com/regimens.html.
Notes on Gender Transition: FTM 101 — The Invisible Transsexuals. Retrieved 27 June 2002 from http://www.avitale.com/FTM_101.html.
Rauchfleisch U, Barth D, Battegay R. (1998 Sep). [Results of long-term follow-up of transsexual patients] [Article in German]. Nervenarzt. Abstract retrieved 19 May2002 from PubMed.
Reutrakul, Ongphiphadhanakul, Piaseu, Krittiyawong, Chanprasertyothin, Bunnag, & Rajatanavin. (1998 Dec). The effects of oestrogen exposure on bone mass in male to female transsexuals. Clinical Endocrinology. Abstract retrieved 19 May 2002 from http://dx.doi.org/10.1046/j.1365-2265.1998.00614.x
Rohr UD. (2002 Apr). The impact of testosterone imbalance on depression and women’s health. Maturitas. Abstract retrieved 19 May 2002 from PubMed.
Schenenberger D & Knee T. (2001). Hyperprolactinemia. Retrieved 27 June 2002 from http://www.emedicine.com/med/topic1098.htm.
Schlatterer K, Yassouridis A, von Werder K, Poland D, Kemper J, Stalla GK. (1998 Oct). A follow-up study for estimating the effectiveness of a cross-gender hormone substitution therapy on transsexual patients. Arch Sex Behav. 27:5:475-492.
Im a transpinay,a filipino transgender.im only using diane 35 once a day for about 7years now.i lost muscles,but idont gain my breast to the fullest ,same as my hips.but thats fine with me.coz i only want a body of a model.breast of a model and no muscle…my only concern is im taking diane 35 for 7year.its a very low dose regimen but im taking it for so long.is it safe??
I am on microgynon… Also 1 pill daily. And Yes it is safe… I would like to try to take 2 pills daily… Because its necessary to reach 0.05 mg EE daily. And my pill also have only 0.035 mg EE. But I would take Microgynon instead of Diane35… Lori
Hello Mak, I’m also a filipino transgender. Do I need to skip 7 days after cosnsuming all 21 tabs for 21 days? Or just continue taking daily? I don’t have enough info on diane, pls help me asap. you can text on my number (smart)> 0919 896 3961
I’m 41 years old, fit, slim. I started with Microgynon 30 (Levonorgestrel+EE .03), 3 pills/day. Made me hungry all the time, blood pressure skyrocketed, and made me 5 acne in 5 days, and my face is perfectly clear normally. Switched to Novynette 4 pills/day (desogestrel + EE .02). Much better, less hungry, acne are all gone in 48 hours, blood pressure lowered.
U need to b taking ESTROGEN, anti ANDROGEN & Progesterone( helps develop Breasts)
I have a bio-identical Estrogen IMPLANT inserted under the skin( slow release over 3-6months/ no need for daily tablets)cost $105
Also Spironolacton/ anti androgen 25mgs daily- recommended dosage is 300-600mgs daily.
And progesterone 10 days at beginning of every month-
I came to this site when I was doing some research for a friend. I am every glad I joined as I have enjoyed what I have read. I have been on HRT last 3 months. I was very happy ❤️ To me it is my birthday. I have been living full time for last three months.
Anyhow it seems like years ago but I started this journey last year when my 3th marriage failed. I had to fine out why I was so very unhappy and why I had never felt like a man.
Now I am just enjoying my new life and the feeling that I am a real person for the first time in my life. I know that I am a woman and I will live the rest of my life as a woman. I am the sum of all that I have done and gone through.
sir god morning i send this mail kota rajasthan from india i take hrt at this time lynoral 0.01mg 1 year 6 month but after 6 month i take lynoral0.05mg daily so i want this way whate better chnage mtf who is i take better antiandrogen tablet at this time for better transition for male to female please suggest.
Shouldn’t the dosage change depending on the weight of the patient?
Also, is there a bigger concern with overweight or obese patients?
I am currently on 10mg/ml estradiol valerate every two weeks. Would I likely see better feminization if I were switched to weekly injections of the same dose? I’m also curious if weekly injections would help to make me less irritable days before my injections as I take them now. I’d appreciate any insights from people who are/have been on a similar dosage schedule. I am also on a low dose of Spiro 25mg daily, all of which is prescribed by my endocrinologist. Thank you for your time!
Possibly Amy. What concentration is your EV? (10/20/40 mg/mL?) Injecting half your dose weekly will help smooth the “ride,” yes – I did this myself, not because I was feeling low at the end of the two weeks, but because I wanted a steadier level for my redevelopment.
I have commented below on my experience with EV and being able to drop spiro. If you’re on that low dosage, I suspect that you could drop it also (on less medication, and spiro can have some nasty side effects, like “brain fog” and suicidal ideation {like I’ve experience}).
Anyway, since EV is bio-identical / bio-equivalent, you should be able to bring your E2 (serum estradiol) levels well up into the natal female range, and this feels so much better, and from my experience and reports of many other gals, it causes our re-development to blossom: mine has, after two years on patches.
Hope this helps!
Can anyone tell me a place on the internet where I can get testosterone blocker and estrogen without a prescription for a good price? I live in the usa. please help! I need testosterone blocker and estrogen REALLY BAD! I want to feminize my body so much.
I’m one year in and I’m now taking 40mg/2ml estradiol valerate and 500mg/2ml hydroxyprogesterone weekly by I.M injection and 125mg flutamide three times daily.
Finding information regarding transgender HRT that has detailed information from dose to side effects based on medical and non-medication resources is extremely difficult to find. Moreover, it’s difficult to find such information for FtMs as it appears the vast majority of HRT trans-related information is geared more towards MtFs. It was insightful and refreshing. I came across this article while doing an essay in my master’s degree class advanced toxicology.
Hello,
I have been self-medicating for over ten years. It’s not that a doctor won’t help me, or that I can’t pass as female that keeps me away from the medical institutions, it’s a matter of self-respect.
This is personal, I don’t need a psychologist’s approval, I don’t need to play dress-up to get medicine; I don’t need anyone’s permission to change my own body. It’s mine.
If this sounds agnsty, it is because it is. I came to this conclusion while I was a teenager still hiding my dysphoria from my parents. I was seeing an endocrinologist in secret, but that didn’t last. You see, due to my age my doctor felt inclined to to tell my parents and filed my name and medical information on their paperwork. Within a month my secret was out, and my life was in chaos. My doctors encore was to refuse treatment because at the time I smoked cigarettes.
Within two months of starting, my treatment had stopped and I was in a worse position than before.
If I sound bitter, it is because I am. I placed trust in an institution who believes they know how you should conduct your life, and would threaten to withhold something so vitally important as medical treatment if you do not act according to their standards.
Ten years later I still refuse their help. The reassurance that I have done the right thing rests in husband, my daughter, and the life we have created for ourselves, without compromise. We have done what were told was too dangerous, and impractical to attempt.
I don’t claim that this is without risk. I don’t claim that it was better, but it was my choice, on my terms, with my life in my own hands. And given the choice, I would do it again.
There is one purpose to these words, one simple request: Question their authority.
I have a 25yo MTF who had a bad experience with a psychologist and now refuses to try another one. She is now talking about self medicating, this concerns me for her physical health but doing nothing is seriously effecting her mental health. How did you know what to take and the dosage required? I am going to speak to our GP about monitoring her health on an ongoing basis. Any advice would be appreciated.
Hello Karen, You might find these resources helpful:
https://www.trans-health.com/2015/rainbow-health-guidelines/
https://www.trans-health.com/2012/protocols-for-hormonal-reassignment-of-gender/
https://www.trans-health.com/2012/primary-care-protocol/
I hope this helps!
Just a couple thoughts about about HRT for us trans women:
From my experience and from the experience of many other gals I have communicated with, if our estradiol levels can be brought well into the natal female range, say a few hundred pg/mL, then we no longer need an antiandrogen…
…What happens is the estradiol signals our testis to reduce/stop testosterone production via the Hypothalamus-Pituitary-Gonadal axis. This effect is well known, but it is not part of most HRT protocols because those protocols are based on conjugate estrogens such as ethinyl estradiol and Premarin where it is dangerous (to fatal) to try to attain natal female E2 levels. On the other hand, it is becoming increasingly known that with bio-equivalent / bio-identical estradiols such as 17-beta estradiol (in transdermal patches), and Estradiol Cypionate / Valerate (intramuscular injections), it is safe to bring us into normal ranges where this effect kicks-on…
…I experienced this effect when I self-medicated with birth control pills over a decade ago, and I could have transitioned on my dosage, but these days, that much ethinyl estradiol is considered dangerous. Instead, I have found that my testosterone production is brought to nil (< 3 ng/dL) with E2 levels of only 100 pg/mL as delivered through Estradiol Valerate. My E2 levels are normally several hundred these days, and I have very nice re-development of my secondary sex characteristics and general well-being (from having the correct hormones in me). My current dosage is about 1.42 mg/daily (nominal) as produced by a weekly injection of 0.25ml Estradiol Valerate at 40mg/mL concentration. (I am under doctor supervised HRT.)
Estradiol's efficacy seems to vary widely with the person and the particular vehicle: I was on transdermal patches for two years (Vivelle.dot 0.1, 2 patches changed twice weekly – considered a "high" dose of 17-beta estradiol), and my levels mostly stayed around 100 pg/mL, and I needed 100mg spironolactone daily to keep my testosterone down. When I switched to injections of Estradiol Valerate, as I was "titrating up" my testosterone was unmeasurably low at the same E2 level my patches were delivering. (I had decided to drop spiro at the same time due to it's side effects: for me it seemed to be fogging my brain and inducing suicidal ideation.) Increasing the dosage had the effect of adding a cup-size to my breasts after about two months of injections, after two years of HRT, at age 53 and with b-cup breasts already. This story is not unusual in the community, and it led me to try this form of HRT.
Sooo, it's worth talking to your doctor about.
Hope this helps!
Thank you for sharing..
The writers/researchers for this article should really take the time to stay current regarding medications. Some of the MTF meds identified are no longer recommended due to the level of health risks involved. You can certainly find information more current than 1992. I get the feeling that this was a “do once and get it done” project. You would be better off removing the tables.
The injectable estrogen seems to be the safest and most effective. I think there needs to be a tutorial on how much to take. The numbers get confusing. They refer to how much estradiol per ml and how much actual liquid is in the vial. For example–Estradiol Valerate, 100 mg/5 ml is available readily online. So how much liquid do you inject and how often?
Gillian? Join the “Trans HRT Hormone Forum” on Facebook. There is a lively discussion there on the latest in HRT and there are a lot of notes and tutorials there, especially with regard to injectable estradiol and progesterone, dosages, lab measurements, sources and resources.
The point that I’m trying to make is that not allowing us to start hormone therapy at the proper time is a serious human rights violation. Using gnrh instead of estrogens (or testosterone for ftm’s) to delay puberty is certainly a viable option. I wonder if some of the post op suicides is related to difficulty passing.
i am going to start transitioning from FTM. Am wondering whether I should go for Top surgery or start HTR? Is injection the best and safest way for T? How much dosage to start?
There’s no one way to transition, so whether you start with HRT or Top Surgery is entirely up to you. Intramuscular testosterone is the most common delivery method, and also the cheapest. A typical maintenance dose is 100mg/week but dosages vary person-to-person, and some endocrinologists start patients on a low dose. These are all things that you can discuss with your doctor. Hope this helps!
For so long transgenders were forced to jump through so many hoops…..and many still are. The hypocrisy of requiring a mtf trans to live as a woman for anywhere from 6 months to a yearto even take her first hormone pill when compared to abortion on demand is scandalous. A woman’s argument on abortion is, “it’s my body and I will do what I wish with it.” Try that same argument with the doctor when he or she starts telling you what you have to do to just get a scrip for hormones. The Plan B pill is available over the counter for anyone…..even 12 year old girls. I visited Bangkok, went into a pharmacy and bought Oestrogel, Progynova and Estrofem without a prescription. BTW, the cost of Estrogel in the US is about $120.00 per 80g tube. In Bangkok it costs between $7.50 and $15.00 a tube for the real stuff.
I see that this site displays recommendations for using Ethinyl Estradiol (Estinyl) and Conjugated Equine Estrogens (Premarin). As such, this site is recommending outdated regimens from the 90’s, ones which lead to exaggerated cardiovascular risks, and in some cases, substandard feminization effects. Furthermore the site implies that anti-androgens are a required part of MTF hormone therapy. These kinds of outdated and frankly harmful sites are a big problem for trans people seeking up to date information. KEEP LOOKING. One spot you might try is the Facebook forum “Trans HRT Hormone Forum”.
I am now pre-operative, have been since September 1994.
I began treatment at a London clinic as was prescribed 100mcg Ethinyl Estradiol and a Male hormone inhibitor.
Since my op I’m just on 50mcg Ethinyl Estradiol.
im 25 years old and I taking 4 mg progynova and 200 mg spironolactone twice a day
Hello Ladies,
Please advise on the below;
1. I am M2F about to start the HRT with ‘Progynova (Oestradiol valerate) 2mg’ tab and ‘Spiractin 100 (Spironolactone) 100mg’ tab two times a day. That will be total two Progynova and two Spiractin tabs in a day. Is that dose good enough to begin with?
2. Any bloood work should I get done before starting? What should I be looking into the blood report?
3. Other advises on food, drinks etc.?
Just to give some more background.
I am 36 years old, workout 6 days a week and eat moderately. What other precautions or recommendation to follow?
Please help.
-Shehnaaz.
I know that Cyproterone is technically not supposed to be given/taken in the U.S. but from what I’ve read and also experienced personally, the 100-150mg per day listed above seems very high.
I’m certainly not an expert, but you might double check to see if that level is really ok. It is much, much stronger than the alternative of Spironolactone.
Hiii…Im 56 yr old m/f self medicating PREMERIN 1.25 MG TABS DAILY FOR PAST 3 MONTHS.No side affects …breasts growing nicely tho tender….am i taking enough or too much ..???
Hi there. I’m a mtf trans woman. I only started therapy over a year ago, before I was able to see the encrondologist for hrt. I had blood tests done, and various results from that have been very worrying for me. My gamma – glutamyl transferase is 199 H. I enjoy a few drinks at night; and now find I will have to curb this naughty habit. I’m also a smoker ( my other naughty habitat ) and am in the process of cutting down. Have also bought tar guard to Reduce amount of tar from the ciggs. But wait, it gets worse. I’m 50 years old. The prof made me sign an agreement that anols him or the hospital of any form of action I might have against them due to side effects. I have been reading the side effect of possible blindness. Is the risk high? I think I would maybe is suffer my miserable existence, than go blind. I have not started the hormones yet until I see the prof again on the 14th DEC. So anyway, the hrt pills I have are, PREMARIN 0.625 28 tablets, and have also got CIPLA CYPROTERONE ACETATE 50. Also SOLUSPIRIN to obviously thin the blood. So I’m thinkng, let me reduce my smoking and drinking first, before I run the risk of killing myself. Anybody’s thoughts on this, most welcome. Regards, Angela.
DO NOT USE THIS RESOURCE
It is very old, it is full of inaccuracies, and it is dangerously incomplete.
For example (just looking at the information for trans women):
– Flutamide doesn’t inhibit the production of testosterone. It’s a direct androgen receptor antagonist. Author does not understand this drug.
– Flutamide and nilutamide are also highly toxic to the liver to the point where they’re not useful as a component in hormone replacement therapy.
– Article conflates drug ‘potency’ and ‘efficacy’ which is dangerous.
– Article does not mention the markedly increased risks associated with ethenyl estradiol compared to other hormone regimens.
– Article is inconsistent when mentioning side-effects between drugs. For example article mentions DVT as a major side-effect of conjugated estrogens but not ethenyl estradiol.
There are many other less glaring factual errors and omissions. This article is literally from 2002 and was poorly researched, at that. Nobody should be using it anymore and it should not even still be available.
See the Center of Excellence for Transgender Health if you want a resource on hormone dosages and regimens that is produced by actual medical professionals. There is no reason to base your medical decisions on an outdated, low-quality article.
I am ” Transgender ” I self medication and In my country I can not find support So I look for online support
i started taking the medicine But I take one Tablet spironolactone 100 mg in the morning after the food and one Tablet estradiol 2mg in the evening after the dinner. ” knowing that I do not have testicles” – orchiectomy- I self-castration also I feel happiness Especially when hormones were introduced When I did a long and painstaking search In this regard and I am like any other Person needed the support I spent many years of my life looking for treatment even I found information about transgender hormones therapy on YouTube and Google Other than that, I found the treatment I had always dreamed of getting it Finally I go to advances in achieving my dream and my self – Despite the risks ” I will continue ” By the way I do contacted many people and sites related to transgender and some specialized treatment centers such as Transcareteam BC and LGBTQ + groups in my country and also close to my country, but I did not get the required help and sometimes I do not get any response Plus I do not have much money so I can go to any country’s that Progress to me care and support. All I need to know is if I just take estradiol 2mg a day it will be enough and without Spironolactone 100 After the orchiectomy ?
Hi….. please help!!!
I really need advice and will be very grateful if you can help. I am FTM. I live in a country where the tans-gender concept doesn’t even exist yet and is considered illegal. The only form of testosterone that I can buy without prescription is Andriol (Oral Testosterone undecanoate 40mg). I read almost all sources online and there isn’t much detailed info about it. You mention that up to 240mg a day (6 tablets) should be enough. Is this quantity really enough to transition? I know they are weaker and maybe take longer to work. However I really need to know if this quantity (6 tablets per day) can raise serum testosterone to a mans level, enough to induce transition. This is what I am not sure about, because some sites mentioned that the oral form of T gets excreted fast and thus cannot raise serum T enough for to transition effectively. I am currently taking 8 tablets after two meals daily – morning and evening (started with 4, then 6, now 8 tablets). I am in my 3rd month on this oral T. Please if you can give me more detailed info about this oral T and how to use it for maximum results and efficacy. Thank you so much!
I’m sorry that you don’t have access to care. This more recent article from a reputable source also says 160-240mg/day:
https://www.bumc.bu.edu/endo/clinics/transgender-medicine/guidelines/