Progesterone as part of the MtF HRT program

[Jamie D]

This may have been posted before, but I could not find this link as the source for a specific topic.

Should progesterone be used as part of MtF hormone replacement therapy?

This, from T-Vox.org:

Urban Legend #5: You don't need progesterone (MTF)

The Particulars
    Many endocrinologists feel that an exogenous Progestogen is not a necessary for optimal MTF HRT.

The Truth
    It is hardly groundbreaking to observe that progesterone plays an important role in natal-female breast development. Why would this not also apply to MTFs?

    A study published in The American Journal Of Surgical Pathology (Am J Surg Pathol. 2000 Jan;24(1):74-80.) strongly suggest it does. The study involved comparing breast tissue from 14 MTFs undergoing HRT to that of two natal-males who had been chemically castrated as part of cancer treatment. Distinct histologic differences were found --


        [...]Only in male-to-female transsexuals in whom progestative chemical castration is combined with feminising estrogen therapy will full acini and lobular formation occur. Hence, combined progestative anti-androgens and estrogens is necessary for the genetically male breast to mimic the natural histology of the female breast.[...]


    Note that by 'progestative anti-androgens' they mean Cyprotone Acetate specifically, which is generally considered a relatively weak Progestogen (though a strong anti-androgen). Also note that the sample sizes were not what you'd call impressive. However, the study's results are hardly shocking, given that Progesterone is generally considered to be responsible for, among other things, lobular formation in the breast. They basically found what one would expect to find, that certain breast structures do not develop, or develop only poorly, in the absence of a Progestogen.

    How important all of this is to optimal feminisation remains unclear and likely varies from individual to individual. What is clear is that Progestogens do play an important part in, among other things, proper breast development. Given that, and the lack of any compelling reason not to use them, it seems clear that a Progestogen should be a part of any optimal MTF HRT regimen.


Likely Source of Legend
    Ignorance and general medical over-conservatism, especially where anything doctors consider elective is concerned.

[Ms. OBrien CVT]

Does not really surprise me.   There is plenty of anecdotal evidence that it does help.

[Elle]

I've wanted to start P but I'm worried about it making my T levels climb back up and extra body hair growing. I have heard it helps even out mood swings from E dominace and helps with anxiety. Also heard it makes your aerolas bigger.

I wonder if it effects your body fat redistribution since pregnant women gain extra weight on their breasts, hips and thighs during pregnancy.

[Devlyn]

I've wanted to start P but I'm worried about it making my T levels climb back up and extra body hair growing. I have heard it helps even out mood swings from E dominace and helps with anxiety. Also heard it makes your aerolas bigger.

I wonder if it effects your body fat redisturbation since pregnant women gain extra weight on their breasts, hips and thighs during pregnancy.

Mind stuck on your other thread?  <running away>

[Keira]

As far as wpath 7th Edition is concerned (being ONE of the most reliable sources)...

Progestins. With the exception of cypro- terone, the inclusion of progestins in feminizing hormone therapy is controversial (Oriel, 2000). Because progestins play a role in mammary development on a cellular level, some clinicians believe that these agents are necessary for full breast development (Basson & Prior, 1998; Oriel, 2000). However, a clinical comparison of feminization regimens with and without progestins found that the addition of progestins neither enhanced breast growth nor lowered serum levels of free testosterone (Meyer et al., 1986). There are concerns regarding potential adverse effects of progestins, including depres- sion, weight gain, and lipid changes (Meyer et al., 1986; Tangpricha et al., 2003). Pro-gestins (especially medroxyprogesterone) are also suspected to increase breast cancer risk and cardiovascular risk in women (Rossouw et al., 2002). Micronized progesterone may be better tolerated and have a more favorable impact on the lipid profile than medroxyprogesterone does (de Lignie`res, 1999; Fitzpatrick, Pace, & Wiita, 2000).

Basically, try them out...if you have significant problems while on them...stop taking them. I anticipate though that most physicians will want to start with low dose of AA's and Estrogen, or a stronger dose of one of the two. After a couple months they might be more comfortable introducing progesterone. Its all up to your physician or endocrinologist...and only you can convince them if you think they are wrong.

Doctors are people too, treat them with respect and a well informed/good attitude and they will be more willing to help you.

It's mostly about if you want to take them or not. MAAB and FAAB naturally have progesterone, it's just a matter of FAAB people having more than MAAB people.

I'm not a doctor or an expert, take what I have to say with a grain of salt if you wish.

-Skye