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Now let’s talk about treatments. Cross gender hormone therapy for transwomen may include three different kinds of medicines: estrogen, testosterone blockers and progesterones.
Estrogen is the hormone responsible for most female characteristics. It causes the physical changes of transition and many of the emotional changes. Estrogen may be given as a pill, by injection, or by a number of skin preparations such as a cream, gel, spray or a patch.
Pills are convenient, cheap and effective, but are less safe if you smoke or are older than 35. Patches can be very effective and safe, but they need to be worn at all times. They could also irritate your skin.
Many transwomen are interested in estrogen through injection. estrogen injections tend to cause very high and fluctuating estrogen levels which can cause mood swings, weight gain, hot flashes, anxiety or migraines. Additionally, little is known about the effects of these high levels over the long term. If injections are used, it should be at a low dose and with an understanding that there may be uncomfortable side effects, and that switching off of injections to other forms may cause mood swings or hot flashes.
Contrary to what many may have heard, you can achieve the maximum effect of your transition with relatively small doses of estrogen. Taking high doses does not necessarily make changes happen quicker it could, however, endanger your health. And after you’ve had genital surgery or orchiectomy—removal of the testicles—your estrogen dose will be lowered. Without your testicles you need less estrogen to maintain your feminine characteristics and overall health
There are a number of medicines that can block testosterone and they fall into two categories. Those that block the action of testosterone in your body and those that prevent the production of it.
The blocker most commonly used, spironolactone, can cause you to urinate excessively and feel dizzy or lightheaded, especially when you first start taking it. It’s important to drink plenty of fluids with this medication. Because spironolactone can be dangerous for people with kidney problems and because it interacts with some blood pressure medicines, it’s essential you share with your doctor your full medical history and the names of all the medications you’re taking. A rare but potentially dangerous side effect of spironolactone is a large increase in the production of potassium, which could cause your heart to stop, so while on this medication you should have your potassium levels checked periodically.
Finasteride and dutasteride are medicines which prevent the production of dihydro-testosterone, a specific form of testosterone that has action on the skin, hair, and prostate. These medicines are weaker testosterone blockers than spironolactone but have few side effects, and are useful for those who can not tolerate spironolactone. It is unclear if there is any added benefit to taking one of these medicines at the same time as spironolactone.
Though it’s commonly believed to have a number of benefits, including: improved mood and libido, enhanced energy, and better breast development and body fat redistribution, there is very little scientific evidence to support these claims. Nevertheless, some transwomen say they experience some or all of these benefits from progesterone. Progesterone may be taken as a pill or applied as a cream.
The risk of things like blood clots, strokes and cancer are minimal, but may be elevated.
We believe your risk of prostate cancer will go down but we can’t be sure, so you should follow standard testing guidelines for someone your age.
Your risk of breast cancer may increase slightly, but you’ll still be at less of a risk than a non-transgender female. When you’ve been on hormones for at least 2-3 years, it is recommended you begin breast cancer screenings depending on your age and risk factors after discussion with your doctor.
Since there is not a lot of research on the use of estrogen in transwomen, there may be other risks that we won’t know about, especially for those who have used estrogen for many years
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