Originally Posted by
ReineD
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!