Has HRT become safer?

[Lucy Ross]

I was surprised when I made my first posting here that many advised me to give a brief low dosage hormone regiment a try, I'd been under the impression that hormones of whatever stripe couldn't be administered without possible permanent or immediately deleterious effects - that it was nothing to fool around with, even briefly.  My sources were a bit out of date, it seems.  Have the quality of the hormones improved in the 21st century, or are they being more carefully dosed? 

[Dena]

Under the treatment of a doctor with regular blood testing, hormones can be pretty safe. Estrogen can be taken for a couple of months without much in the way of changes taking place though that's long enough to feel the mental effects. Testosterone is another matter. It pretty powerful and the changes that take place mostly aren't reversible. MTFs have it better better off when it comes to surgery but FTMs have it better off under hormone treatment.

[KayXo]

Bio-identical estrogen can even be beneficial in many ways.

[Dani]

Julie,

Medical research is always improving, due to published papers in medical journals and widespread dissemination primarily by the internet.  This is the information age. When a researcher makes a new discovery, they can publish and many times the results of the study are accepted as the new standard of care.

When I first started working as a Pharmacist, some 40 years ago, birth control pills were new. Birth control pills are not bio-identical hormones and some women started having blood clots. With further research, age and  smoking tobacco were found to be contributing factors. Fast forward to the 1990's and new research in bio-identical Estradiol found that this was not a problem. In fact bio-identical Estradiol is found to be very safe and poses no greater risk than our bodies natural hormones.

[LexiDreamer]

Another thing to consider...

Some doctors and medical centers might be more knowledgeable about new techniques and medications for transgender care, while others may follow older protocols.
Consider the debate about prescribing Progesterone for MtF HRT... some doctors are for it, while others are against it.

The place I go to, Evergreen Health Services (an extension of the Pride center in Buffalo, NY), while being very trans-friendly, blindly adhere to the Callen-Lorde protocols of transgender care.

While this can be helpful, they are un-willing to even consider other medications that are not listed within the  Callen-Lorde literature, much to my frustration.
i.e. The only anti-androgens they will prescribe are either Spironolactone or Finasteride.

An educated patient will breed the best results. Do your research... Know your options and your risks.

Don't leave it up to your doctor to figure it out for you!

[Lucy Ross]

The book Trans Bodies Trans Selves mentions dutasteride, are there others?  The book only mentions the CL center, are the protocols strictly a NY thing?  They sound like a force for progress so it's really a shame that they're keeping you from getting the medication that's best for - spiro sounds like it can really wreck havoc.  I came across a passing reference to it being really nasty to taste or smell, too.  Fun fun fun.

[SadieBlake]

Julie,

First off, I happen to be quite lucky that IM estradiol valerate at a dose that's 1/4 what would be 'normal' transition dose not only affords me feminine estrogen levels and pre op also fully suppressed testosterone so I took myself off of spironolactone right away.

Spiro does have health effects and potassium balance is a touchy thing to be influencing. However, for most patients, the alternative would be very high doses of estrogen (anecdotally IM estrogen is better at suppressing T but I don't have any peer reviewed resources to hang that on). Before the availability of various anti androgens, that was the only option and taken orally, the implications to stress on the liver are significant, alternately, femininization was slow when you couldn't hit target levels of E, T.

I think the even more important element is availability of bio-identical hormones. Estradiol valerate provides the same net chemistry as natal females experience, micronized progesterone is by all accounts equally good. 20 years ago you were looking at conjugated estrogens derived from horse urine and medroxyprogesterone , both of which had significant health implications for many women (cis and trans). All of this results from far more sophisticated biopharmaceutical manufacturing processes (I've worked in pharma manufacturing research and can speak to what a revolution has already happened, to say nothing of what we'll see in the coming years.

Since I haven't needed finasteride, duasteride, I haven't researched those.

[KayXo]

femininization was slow when you couldn't hit target levels of E, T.

On ethinyl estradiol or Premarin, there was no point measuring E levels as estrogenic effects were also in part exerted due to the actions of ethinyl estradiol and equine (horse) estrogens. I believe other hormones used back then were hexestrol and DES. Estradiol valerate IM was also actually used by Harry Benjamin and a few others (i.e. Germany) in high doses and also, Proluton-Depot (17 alpha hydroxyprogesterone caproate).

[Lucy Ross]

Thanks, Sadie.  I've been reading a lot of books/journals published in the 20th century and they all make reckless HRT sound like a likely death sentence, with good reason it seems.  I thought something game changing had occurred.

[LexiDreamer]

The book Trans Bodies Trans Selves mentions dutasteride, are there others?  The book only mentions the CL center, are the protocols strictly a NY thing?  They sound like a force for progress so it's really a shame that they're keeping you from getting the medication that's best for - spiro sounds like it can really wreck havoc.  I came across a passing reference to it being really nasty to taste or smell, too.  Fun fun fun.

There are other anti-androgens out there. Some aren't even available to be prescribed in the US.
The Callen-Lorde center is located in New York City, where by statistically, probably has the largest trans population in the US considering it's the largest city in the US.

Spiro has been around for a long time and has been prescribed for HRT for a long time and I think that's why it is so common.

The issue at hand is that none of these drugs were developed with transgender HRT in mind. Most of the anti-androgens are used to treat prostate issues and other "male" type ailments where the side effects of the drugs are more tolerable than the disease.

[Lucy Ross]

Transition must be a hundredth of the market for treating female hirsutism or acne, never mind the uses for men.