Finasteride on its own as a partial transition?

[annemarie]

Hello I'm a 19 year old pre-everything and I live with my parents. They don't know about my dysphoria so I can't do anything out of the ordinary for a 19 year old teenager yet. For now, is it good for me to just take finasteride for some feminisation?

[Dani]

Finasteride is part of the HRT regimen. Finasteride blocks the conversion of Testosterone into Dihydrotestosterone, which is many times more potent than Testosterone in producing masculine traits.

There are doses for hair loss and different doses for stopping masculine development. We do not mention or recommend any specific doses here on Susan's Place.

What Finasteride would do for you is to slow down any changes such as facial and body hair and muscle growth. Do not expect full feminization until you add an Estrogen to your HRT regimen.

Finasteride would have to be prescribed by a physician here in the US. Your physician will give you the correct dose if you explain why you want to be on Finasteride. Many physicians require a letter from a counselor trained in gender issues before prescribing Finasteride.

[annemarie]

Thank you for your response!

I have been in contact with my doctor and he's aware of my dysphoria and will look into prescribing finasteride. If I just stick to finasteride for the next new years and in the future decide to not go into full HRT, what could I expect?
Will there also be any nasty side effects bearing in mind that I'm only 19 and look very young anyway (probably hit since I hit puberty very late).

[Maybebaby56]

Hi Annemarie,

I think the only thing you may get out of a finasteride-only drug regimen is a smaller prostate, and possibly loss of libido or erectile dysfunction.  At 19 you probably have plenty of circulating testosterone, and little estrogen, so I doubt you will see any signs of feminization or decrease in gender dysphoria.

Use of a 5-alpha-reductase inhibitor like finasteride will actually increase circulating testosterone levels.  In older men, use of finasteride increased the anabolic effects of exogenous testosterone in those with low T levels.

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Musculoskeletal and prostate effects of combined testosterone and finasteride administration in older hypogonadal men: a randomized, controlled trial
Am J Physiol Endocrinol Metab. 2014 Feb 15;306(4):E433-42. doi: 10.1152/ajpendo.00592.2013. Epub 2013 Dec 10.

Abstract
Testosterone acts directly at androgen receptors and also exerts potent actions following 5α-reduction to dihydrotestosterone (DHT). Finasteride (type II 5α-reductase inhibitor) lowers DHT and is used to treat benign prostatic hyperplasia. However, it is unknown whether elevated DHT mediates either beneficial musculoskeletal effects or prostate enlargement resulting from higher-than-replacement doses of testosterone.

We conclude that a higher-than-replacement TE combined with finasteride significantly increases muscle strength and BMD and reduces body fat without causing prostate enlargement. These results demonstrate that elevated DHT mediates testosterone-induced prostate enlargement but is not required for benefits in musculoskeletal or adipose tissue.
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The take-home point is no DHT and plenty of testosterone still allows for significant androgenic effects on your body and is not going to get you where you want to go, if feminization is your goal.

With kindness,

Terri

[annemarie]

Hello Terri,

Thanks for your response.

I was unaware of how my younger age would impact the effects of finasteride and will take this into consideration. However, I have been told in the past that finasteride would raise both testosterone and oestrogen. Since I am MAAB, wouldn't the excess testosterone aromatise into oestrogen? Also, I have always been a boy who seems to have a lack of testosterone due to my lack of muscle and my height (or lack thereof since I'm only 5 foot 6) as well as slight gynaecomastia. What is your or anyone elses input if you take that into consideration?

[Maybebaby56]

Yes, free testosterone can be aromatized to estradiol, but the majority (~99%) of testosterone is bound to sex hormone binding globulin (SHBG) and not available for conversion.

"The fraction of androgen so converted is not large, about 1% of androstenedione [a testosterone precursor] entering the blood de novo is converted to estrogen, and about 0.4% of the testosterone in males and less than 0.2% in females is converted to estradiol."

Conversion of Blood Androgens to Estrogens in Normal Adult Men and Women
The Journal of Clinical Investigation Volume 48 1969 2194-2201.

So what does it all mean?  YMMV.  You might get better results taking spironolactone, which is used as an anti-androgen, and is known to cause gynecomastia as a side-effect.  Bottom line is you need to consult your doctor.

~Terri

[annemarie]

Thank you for your detailed and helpful response again Terri!

That's quite bad news for me though since I've heard that a full anti-androgen like that will definitely cause infertility after a few years. I want to have biological children in the future which is one of the reasons why I wished that finasteride could provide some partial feminisation to help me out rather than fully stop my male fertility. I'll look into what else I can do.