-
HRT Self-Medication: Information Accuracy and Risks of HRT
I’m reposting this article – because
a) it is a valuable resource for those contemplating taking hormones without consulting a doctor
b) it is on a web site that has been unavailable for monthsIt is copyright material and you are recommended to visit the original site (if it is working) for more information (including F2M HRT). The original has many hyper links to other references that may be of interest.
http://www.trans-health.com
Source: http://www.trans-health.com/displayarticle.php?aid=62Are you trying this at home? If your medical advisors are other trans people, or you’re just concerned about the medical risks you’re taking on with hormone therapy, you need to read this article.
By Justin Cascio
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.
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.
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.
PhytoestrogensPhytoestrogens 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
ThromboembolismCombined 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).
HyperprolactinemiaIn 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 FunctionCombined 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.
OsteoporosisIn 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 ChangesIn 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 LevelsAn 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.
HyperkalemiaSpironolactone 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.
GlossaryAdenoma – 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
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 from http://www.geocities.com/alamoboyz/Surgical.htm.
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.
-
1 Reply
-
I reccomend that one would look at Amanda’s posting and similar. If you are serious in transforming, you are looking at serious drugs and that requires a serious doctor who has EXPERIENCE and KNOWLEDGE. So I would leave your local GP alone and go to someone who knows, as in a gender clinic.
Everyone responds differently
Dosages moslty vary with a persons size
The age factor
The health factor
Previous health problems
Short term and Long term effects of introducing drugs
Birth defects. Some you may not know aboutBut as I nearly always say. Doctors are not perfect either. If you are serious, do get as much reliable information as you can on the internet so if there are any concerns that you may voice them when visiting the doctor, so you can make a more informed decision.
As I read health magazines and books and see the complexity of the human body and my head starts spinning and may have to read twice or even three times to digest information. The human body is quite complex and changing the current design is heaps of caution.
So don’t let a few words on the internet fool you. There are quite a few sites that will push positive information that favours their product that in most cases have minimal effect and ignore the negative information. Look around for negatives to the product that may have your eyes on and get a more balanced view
My view has not changed a great deal from when I started to use hormones years ago as I did my research reasonabbly well but I will admit there were some who dragged me with their pretty words but certainally not for long.Many drug companies will push positives and ignore negatives as well
Many doctors are favouring certain medicines with kick backsWhat ever you are doing I reccomend that you get some general knowlegde as well, so that you can ask the doctor any questions if there are any concerns.
Not only that, if something doesn’t sound right from the doctor, look into it further. I have had a few eye openers when doing so.YOU HAVE ONE CHANCE TO LIVE YOUR LIFE
I have learned it is me against the world. Even my partners opinion can be flawed, with good will and intentions abound.
We assume what society accepts is true, but really brain washed from marketing companies.
Are soya products really good for you? Look it up
The tie in relationship of butter, margarine, saturated fats, poly unsaturated fats, cholesteral, the brain, free radicals and antioxidents? Look it up. I am for unsalted butter any day in moderation
The list goes on and onBe careful, it’s a mine field
Georgette
