Hrt

[Georgette_USA]

It can seem to the casual observer that it is the AAs that reduce male potency, but as far as I have understood, it is the changed balance between male and female hormones that has this effect.

In the 70s, neither my partner nor I had any AAs just Premarin (Estrogen) and later Provera (Progesterone). Can't talk to dosage as I didn't keep records. My partner never had much sex drive to begin with, and even less after. I was not interested in any male potency, so the reduction in that was a relief. We were only on HRT for 2 years till SRS, I think that more changes in body stuff accelerated after that.

[ReineD]

Reine,
If I may ask a question about needing more information to assume understand it better , have you any information on how HRT and other medication affect women ?

No. I know nothing about any form of HRT, other than what I've observed in publicly transitioned FtMs or videos I've seen on youtube. They appear to grow beards, although I don't know if the amount of beard growth is consistent with everyone, their voices sound deep, and as to their muscle mass, I don't know if this is caused by HRT or a good workout routine. I know they need to have mastectomies to remove breasts. I don't know what is HRT's effect on ovulation or the abililty to orgasm. I don't know if for FtMs, there is such a thing as anti-estrogen in addition to the testosterone treatments.

But, since the vast majority of members in this forum is MtF, I was hoping to keep the discussion to this area.

IMO, yes, although their reaction to those changes is likely to be radically different.

It makes sense he wouldn't be happy about it.

[Barbara Ella]

Again, the caveat that I am not a trained Doctor, but I did stay at a Holiday Inn Express and read a lot of articles.

Reine, in answer to the questioned posed about the "male" being force fed HRT. NO, he would not experience the psychological changes a trans person would. We all agree that there are varying degrees of dysphoria. This comes from the fact, as being borne out by brain imaging, that in fetal development, for whatever reason, the brain development and the physical development become imbalanced. The resulting "female wiring" in the brain and its desire for a chemical balance that matches what it expects, and the male physical appearance produce the dysphoria. THe HRT brings the actual chemical balance closer to what is expected, relieving the disparity between the two entities controlling our well being, physical and mental. THe "male" having no imbalance would not feel the relief a trans person does. I wonder if this new imbalance would cause him emotional crises of another sort.

I believe, because the brain can develop to varying degrees of "being female" that varying degrees of HRT dosages could possible produce the desired relief. For an extremely dysphoric person, I would not expect low dosages to be effective mentally. I would not expect a lightly dysphoric person( have not heard of one really) to benefit physically from low dose HRT that relieves her dysphoria.

COnfused yet? lol

In my case, I started HRT for the dysphoria, and have been on pills and finasteride for over 3.5 years. Had Spiro, but it lowered my blood pressure too much. My Dr. has monitored my levels, and has kept them where a woman of my age would be expected. At 70 (yes, no need for AA at this time) I am most definitely post-menopausal with medical treatments appropriate, which means my levels are quite low for T and high for E now. I saw little physical change early on, but over the past year, they have been quite obvious and rather quick appearing, inmho. Breast growth, hair loss on body, skin softenng, fat redristibution. My dysphoria relief was immediate.

Just my thoughts and experience.

Hugs to all

Barbara

[LeaP]

Reine, see responses in red, inline.

1. Is there such a thing as "mild" estrogen for people who don’t want to transition (if they don’t want to mess up the ability to present as a male) or who want to keep their male sexual functioning intact for their wives? If so, how much feminizing does a "mild" dose accomplish. Would there be enough for breast growth and softening of skin, and what about muscle mass reduction. And if there is barely an effect, then what would be the point.

There is, and it's probably more often prescribed than full-dose HRT. It has a mild calming effect for many. The sex hormones are not primarily psychotropic drugs, but estradiol is known to have this effect in some people, male or female, and it's near immediate - hours - with longer-term effects on emotions at higher dosages typically taking years to fully manifest. Most of what's commonly-attributed to E during the early months of HRT is psychosomatic.

The gene-expression (meaning how a cell responds and changes) effects of estradiol depend on your genes, of course, but also the number and sensitivity of your E and T receptors. THAT, in turn, varies with (among other things) whether you are E or T dominant, as receptors up and down-regulate accordingly ... except when they don't (a YMMV factor). And since cell response takes place within complex, inter-related feedback and control systems, exactly what will happen in which part of the system and to what degree is unpredictable. One possible response to a low-dose E regimen, for example, would be for your system to simply eliminate it.

.... All of which reduces to this: Chances for most individuals are that low doses of E, especially without taking anti-androgens, will do little or nothing by way of feminization. Nor should such a regimen tank anyone's libido or sexual functioning. E alone can make one estrogen dominant, reduce T, and feminize, but only in massive doses. Common adolescent "feminization" (i.e., gynecomastia) is the result of a bit of E in the system, but usually prior to major T production and the establishment of T dominance.

The point? That's a question for the person's therapist.



2. Is there a "stronger" course of estrogen if they do want softening of skin, maybe some breast growth, muscle mass reduction, etc, again without losing male sexual functioning and if so, would they also need to begin thinking about regulating their male hormones.

Stronger doses will more likely result in some feminization over a long period of time (years and years). Estradiol is quite powerful - by itself in "not quite low" doses, it may even tank someone's T significantly over time. Short-term, again, probably no particular impact on sexual functioning, or on the other things you mention. Whether one or any of them would happen at all, long-term, is a complete crapshoot.

The question of "regulating" male hormones in such a scenario is definitely a question for an Endo. As would be the entire idea. Putting yourself in an out of balance hormonal position is not a great idea. By contrast, TS MtF HRT aims at a reasonable facsimile of an adult female's hormone levels ... not a bit of this and a compensation for that. The person would rapidly find out how difficult it is to do such a thing.

3. If someone wants to feminize their body, do they need androgen blockers along with estrogen, or will the estrogen be sufficient. I assume it is the androgen blockers that diminish male sexual functioning. I’ve read many times that on HRT, testicles shrink, the penis size shrinks, eventually there is no more ejaculate, and it is difficult to maintain an erection. Is this all caused by androgen-blockers?

HIGH dosages of E would be sufficient (because it effectively functions like an anti-androgen at that point) and was once the norm. Very high doses of E are correlated with cancer risk, however. The approach is very rarely used any longer. All the effects you mention are T-related, though not necessarily due to low T from anti-androgens. They can occur when the testes substantially loses their ability to create their own testosterone. Steroids of all sorts can do that ... and sex hormones are steroids. In fact, taking supplemental testosterone can do it!

Your questions suggest a desire for feminization with full male anatomy and functionality. That sounds nonsensical to me both logically and medically.

So … how does it all work. Please forgive my ignorance on this topic, considering all the years I’ve been here. But, if we get enough responses and if you don’t mind, when the topic comes up elsewhere, I’d like to link to this thread rather than have people make assumptions. Also, this thread might be useful for prospective new members?

HRT works by substituting one type of sex hormone dominance for another, which requires overcoming both the body's natural production of sex-specific and sex-dominant sex hormones as well as supplementing with the non-dominant sex hormone. Pretty safe when monitored. In the very long-term, taking anti-androgens may be riskier than the estradiol.

Feminization for a male-bodied person is a mish-mash conceptually. Softer skin, for example, is conceptually a passive effect. T thickens and coarsens skin. It's lack, whether in a male or female, results naturally in thinner, less oily (usually), and softer skin. Breast growth is an active, gene expression effect. Loss of strength and muscle mass atrophy are partly passive and partly by choice. While few females can achieve male type superior-range muscularity, they CAN build significant muscle mass and strength. Atrophy of reproductive anatomy is essentially damage when (and if) it becomes permanent. There's nothing "feminine" about a shrunken penis and testicles.

And last, I’ve read enough to know that mileage may vary per individual, but I’m just looking for general guidelines, the sort a doctor would start with when beginning a transitioner on a course of HRT.

In general, doctors target some interpretation of female (Mtf) hormone levels and leave results to the powers that be. There are two notable exceptions to that, at least for MtF patients: First, efforts to maximize feminization by cycling estradiol and progesterone. Second, efforts to mature (not necessarily enlarge) breasts by simulating pregnancy levels of hormones - including to the point of lactation. Most doctors will prescribe the former, either as their normal approach to HRT or on request. Conversely, most will refuse to prescribe the latter. The best breast maturity most MtF individuals can achieve is Tanner stage IV. Some use the pregnancy levels strategy in an attempt to reach the fully mature stage V. (I'll note in passing that many, many natal women do not reach Tanner stage V.)

There are a few doctors who focus more on reducing T or overweighting E. Doctors' preferences differ as to administration type, selection of anti-androgens, and ramp-up periods and starting regimens. Some will only prescribe - at all - if the patient intends to transition. Some will only continue a full feminizing regimen for so long without SRS or an orchiectomy. Some require a therapist's letter, others on the basis of so-called "informed consent." Almost ALL doctors will require periodic monitoring VI's blood tests. And, of course, many people self-medicate, either with drugs acquired illegally in the US, or by importing them. The nuttier fringe (my opionion!) will pursue plant-based sources of estrogens.


Thank you!

[PretzelGirl]

I really want to emphasize something. I know people that pretty much get no physical effect from HRT. There are no guarantees. It should only be measured in mental changes. If anyone infers you *will* get physical changes, they are flat out wrong and doing the person a disservice.

[LeaP]

Not only that, Sue, but psychological effects aren't always what people think, nor due to the things people assume. A lot of the MtF psychological relief comes from reducing T. Stress from T, however, is only one side of GD. The other side - the need for body and mind to match (or better match) - isn't really addressed by taking E. In fact, it often makes that aspect of it worse.

[Zooey]

I wish people would stop talking about the psychological effects purely in terms of this "immediate relief" that some people feel. IMO, it's mostly placebo. The psychological effects that I think are most interesting come from, over time, remapping the inputs our brain receives and the connections/associations that change based on then. It's like knowing how to play a video game, but then somebody remaps what all the buttons do without telling you.

[ReineD]

Thanks again everyone!

Lea, I'm wanting to clarify a few details:

Most of what's commonly-attributed to E during the early months of HRT is psychosomatic.

Just to be clear (this was in the "mild" estrogen part of the response), by phychosomatic do you mean all in the mind? Or if someone is hopeful that a mild dose of estrogen will yield visible changes in the not too distant future, they will feel happy, calmer, etc, and they will attribute this to the hormone's direct effect on beginning to feminize their brain?

THAT, in turn, varies with (among other things) whether you are E or T dominant, as receptors up and down-regulate accordingly ... except when they don't (a YMMV factor).

Assuming you refer strictly to MtFs, are there MtFs who are E dominant prior to HRT and does this mean they would approach women's E levels? Is it even possible for a male body to be E dominant (assuming the male body is average in terms of primary and secondary sexual characteristics)?

There are hormone level comparison charts on this page for estradiol and testosterone (among other things). For estradiol, it's complicated due to the phases of the menstrual cycle but for females, the median is much higher than is the median for males. For testosterone, the lowest male level is 3 times higher than the highest female level, with the median 10 times higher in males than the female median.

Not only that, Sue, but psychological effects aren't always what people think, nor due to the things people assume. A lot of the MtF psychological relief comes from reducing T. Stress from T, however, is only one side of GD. The other side - the need for body and mind to match (or better match) - isn't really addressed by taking E. In fact, it often makes that aspect of it worse.

To clarify, you're suggesting that because the body and mind match isn't really addressed by taking E, this may cause the stress from T to be worse?

It's like knowing how to play a video game, but then somebody remaps what all the buttons do without telling you.

Gosh, please don't tell me that cognitive functions or logic were dimished. I'll feel insulted. lol. But seriously, earlier when you said you processed just about everything differently, did you mean emotions - things like slower to reach anger, and faster to reach tears? Or you would have expected yourself to react a certain way based on past life habit only to discover different reactions, so you sort of went through a period of bewilderment?

I won't get into it here, but the thinking in the scientific community is changing about the differences in male and female brains. They're finding more overlap than differences in emotion processing, although females and males are socialized differently in terms of how much they allow themselves to show emotion. Or something like that. I'd need to read the articles again.

[Zooey]

Gosh, please don't tell me that cognitive functions or logic were dimished. I'll feel insulted. lol. But seriously, earlier when you said you processed just about everything differently, did you mean emotions - things like slower to reach anger, and faster to reach tears? Or you would have expected yourself to react a certain way based on past life habit only to discover different reactions, so you sort of went through a period of bewilderment?

First of all, no - nothing to do with logic or cognition. If anything, I'm clearer than I've ever been in that regard.

No, it's about how my brain processes things, both emotional and otherwise. My ability to compartmentalize and "resolve" problems change, so I had to change the way I deal with issues. I'm much better at actually processing issues now, but I can't let them pile up as high or it gets more overhwleming than it used to. My response to things like fear, danger, or anxiety has changed dramatically. My sense of smell changed noticeably, but the most significant effect of that was not flowers smelling stronger. It's the fact that women no longer smell like anything to me, and men smell GOOD. I remember the first time I was aware of it, and I told my friend, "I didn't know swarthy was a smell" (she just chuckled). All of those things, and more like them, lead to a big holistic change in the way I process the world now.

I won't get into it here, but the thinking in the scientific community is changing about the differences in male and female brains. They're finding more overlap than differences in emotion processing, although females and males are socialized differently in terms of how much they allow themselves to show emotion. Or something like that. I'd need to read the articles again.

I don't think my brain physiology actually changed. Our brains are malleable though, and I believe I've changed so much of the environment (my body) in which it operates that it's like having to learn a new set of controls. my old strategies for things don't work anymore, and developing new ones was overwhelming at a couple points in the first year. I've become much better st self-care as a result.

[LeaP]

IMO, it's mostly placebo.

This is well established, Zooey. For example, see this link:

http://link.springer.com/article/10.1007/BF02088099

Bullet number three is of particular interest as it is talking about a portion of the brain that is known to be closer to natal female anatomy in TS.

[Kate T]

My sense of smell changed noticeably, but the most significant effect of that was not flowers smelling stronger. It's the fact that women no longer smell like anything to me, and men smell GOOD. I remember the first time I was aware of it, and I told my friend, "I didn't know swarthy was a smell" (she just chuckled). All of those things, and more like them, lead to a big holistic change in the way I process the world now.

The smell thing is quite marked and dramatic. I can actually identify antibiotics by smell now, even the subtle differences between two similar but different antibiotics in the same class. Just yesterday I had to ask one of my nurses to actually go and get a mint to suck on because the cigarette smell on her was literally making me have to hold my breath as I was concentrating quite hard on a fairly difficult surgery.

Males definitely smell more, I'm afraid though I don't get "swarthy" all I get is testosterone. So much testosterone sometimes it is just about unbearable!

It's like knowing how to play a video game, but then somebody remaps what all the buttons do without telling you.

Definitely. Good analogy Zoey. And some of the buttons still do the same things just SOOOOO much bigger / brighter / stronger.

[LeaP]

Again, answers inline, Reine.

Lea, I'm wanting to clarify a few details:

Just to be clear (this was in the "mild" estrogen part of the response), by phychosomatic do you mean all in the mind? Or if someone is hopeful that a mild dose of estrogen will yield visible changes in the not too distant future, they will feel happy, calmer, etc, and they will attribute this to the hormone's direct effect on beginning to feminize their brain?

I mean that the placebo effect (which Zooey mentioned) is in full force for most people when they start hormones - far in excess of the actual mood effects. Things typically smooth out pretty rapidly in a few weeks, but there's a real high when you start. Beyond even that, people report all kinds of thoughts and emotions that simply aren't correlated to the short-term effects of estrogen.

Assuming you refer strictly to MtFs, are there MtFs who are E dominant prior to HRT and does this mean they would approach women's E levels? Is it even possible for a male body to be E dominant (assuming the male body is average in terms of primary and secondary sexual characteristics)?

I'm the last person to say that something isn't possible. That said, the chances are exceedingly low for a male-bodied person who doesn't have a condition that prevents the production or metabolism of testosterone. Even in that scenario, most will never produce enough E to approach natal female levels. The mechanisms simply aren't there.

To clarify, you're suggesting that because the body and mind match isn't really addressed by taking E, this may cause the stress from T to be worse?

No, I'm saying that tanking your testosterone and taking estrogen can throw the problem into high relief. It did to me.


.

[Kate T]

Thanks again everyone! Is it even possible for a male body to be E dominant (assuming the male body is average in terms of primary and secondary sexual characteristics)?

This is actually possible to an extent. There are a few intersex conditions where genetic and even anatomic males are E dominant. The Androgen Insensitivity Syndromes (AIS), Complete,partial and mild, are individuals who are genetically XY but are physiologically and anatomically female to varying degrees including on rare occasions the development of a uterus however most have a blind vagina. Most of these individuals tend to have a female gender identity.

5 alpha reductase deficiency is possibly more like what you are thinking. These individuals are genetically male and have testes however a deficiency of the hormone that converts Testosterone to Dihydrotestosterone means that they are often phenotypically very similar to girls until puberty when increased levels of Testosterone produce enough DHT to masculinise the individual. Interestingly most of these individuals identify as male, even in cultures where there is little or no educational concept of "gender identity".

[ReineD]

Thanks again Lea, and everyone else.

Yes, Kate it makes sense that intersex conditions are exempt from my question.

[ElvenPrincess]

Thanks for the wonderful discussion! As a pre-everything MTF I find it really amazing.

I identify myself as a lesbian transgender, and by being married to a woman I too would like to preserve my genital "active male capacities".

I heard from another MTF transgender that has more than 10 years of HRT that using testosterone supplements really allow her to maintain full erection and perform normally sexual intercourse.

LeaP (below) also mentioned supplements.

So I really would like to hear what do you think of it.

[LeaP]

I think you misunderstood my comments on supplementation.

[Mirya]

I started HRT about a year ago through my health care provider, and I still have the consent forms I had to read and sign prior to getting the prescriptions. I decided to read it all again because of this thread. I'll list here the descriptions of all the changes I was told would/could/might happen:

• growing breasts
• hair on my body and face will get thinner, smoother and grow slower
• skin gets softer
• fat moves to different places on my body (less on tummy, more on hips and thighs)
• smaller muscles with less strength
• drop in sex drive
• fewer morning or unexpected erections
• harder to get and keep an erection
• problems making healthy sperm and problems making someone pregnant
• testicles shrink 25-50%
• slowing or stopping hair loss

The consent form also warned prospective patients about the possible increased risk of:

• blood clots in the legs, lungs, or brain
• high cholesterol, especially triglycerides
• gaining weight
• liver inflammation
• gallstones or gallbladder disease
• heart problems (such as heart attack)
• high blood pressure
• high levels of prolactin
• changes in electrolytes in the blood (spironolactone can cause too much potassium which can lead to deadly heart problems)
• developing Type 2 diabetes
• breast cancer

There is nothing in there about any mental changes. Nor do I recall my doctor discussing with me any potential mental changes prior to beginning HRT. So I find it interesting how so many trans women talk about the sometimes profound mental changes they experience on HRT. You'd think if it were so impactful and so commonplace, that the multi-page consent form I had to read and sign would mention it somewhere, even in passing. But it didn't. Not at all.

[jentay1367]

I agree on the mental change thing. I think it's a lot of wishful thinking on most people's part. I've been on HRT for 6 months now and can say for me personally, I've really experienced no change to that effect. If I have, it's been so insidious, I simply can't tell. Skins a little softer, nipples hurt, hair grows a little slower, fingernails turned to absolute rubbish, body odor disappeared and my cats seem to think I'm catnip or something. These are the demonstrable things I've noticed of a physical nature. I will say my dysphoria has lessened, but god knows I still have my days. Mental changes though? Meh....

[Rianna Humble]

I identify myself as a lesbian transgender, and by being married to a woman I too would like to preserve my genital "active male capacities".

I'm sorry, that is not consistent with transition from male to female. However, you might find some support in the Non Binary Forum.

[ElvenPrincess]

I'm sorry, that is not consistent with transition from male to female. However, you might find some support in the Non Binary Forum.

Thank you for your opinion.
I've already seen some posts on non-binary forum and regarding what I've read I'm sure this is not the way I think or I feel about myself.

I am not a man. My inner self is just a girl!
Lots of lesbian women assigned female at birth would love to have a male organ so they could please better their partners. But they don't feel male or less woman because of that. Think about it.

If a lesbian girl wants to be active on a sexual relation and she has means for it, she would have to give it up and substitute it for a rubber accessory just to reaffirm she is a girl?

By these reasons, I'm sorry I have to disagree with you, Rianna.

[Zooey]

Lots of lesbian women assigned female at birth would love to have a male organ so they could please better their partners. But they don't feel male or less woman because of that. Think about it.

LOL... How many actual lesbians have you talked to about that? Frankly, the lesbian women I know would find your phallocentric view of sexual satisfaction amusing at best. Believe it or not, lesbians are not interested in penises, regardless of whether they enjoy penetrative play.

If the non-binary forum was not for you, you may find a different forum helpful.

[jentay1367]

Believe it or not, lesbians are not interested in penises

Oh...I don't know about that, a lesbian friend of mine has a drawer full of the things next to her bed L.O.L.

[Zooey]

Just in case you're not being sarcastic... Those are not penises, jentay, no matter what shape they are.

[jentay1367]

being a total smartaleck. Fully aware of the fact, Melissa.

[Mirya]

ElvenPrincess, with all due respect, this is a forum for binary transsexual women who are fully transitioning from male to female. Please don't derail this thread by starting an argument over an unrelated issue.

I encourage everyone to stop replying to this pointless argument about transgender identities and instead go back to the topic at hand (HRT), so that we can have a fruitful, educational discussion for all.