Hrt

[ReineD]

There have been a few mentions elsewhere in this forum about HRT, which I think is unfortunate, since most members who are on HRT post here, and so members elsewhere cannot gain from their experience. So if you don’t mind, I have a few questions.

Without getting into any dosages …

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.

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.

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?

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?

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.

Thank you!

[Starling]

Reine, you omit the mental effects of HRT, the release from emotional dissonance, the calmness, the feeling of "rightness." These are as important as the physical effects, and especially in older women can be the most salient.

:) Lallie

[ReineD]

Thanks Lallie. Are you speaking of just mental well-being without any visible feminization of the body that a very mild dose of estrogen with no androgen-blockers might produce? Like a placebo? Or would the body change eventually even with mild estrogen (and no androgen-blockers), except it would take more time? I really don't understand how it all works.

Is it even healthy to take estrogen with no androgen-blockers? I do know that androgen-blockers are no longer necessary after SRS or an orchiectomy, for obvious reasons.

[Georgette_USA]

Not sure on effects of mild Estrogen dosage.

Estrogen alone was used for many years before the use of Androgen blockers. My partner and I used combo of Estrogen/Progesterone for years. But we had SRS after 2 years so none would have been needed after that.

The emotional mental well being is not something that can be measured in everyone. I was 25-35 when taking HRT, my partner was about 40-50 for same.

[grace7777]

I am just going to comment on "3".

I have been on HRT for a little over a month and I am just on estradiol. From what my endocrinologist has told me, estradiol will feminine the skin and shrink the penis and testicles. Also from what I understand it will shift fat to the hips. I have to see her (endocrinologist) around the beginning of February and have lab work done the beginning of January, so maybe blockers could be added if the estradiol does not prove to be enough, but on the last visit she never even talked about blockers.

Right now I am on pills, but will switch to injections when the injectable estrogen becomes available. Hopefully this happens very soon.

Also, I am 52, so the effects may not be as big for me compared to someone 30 years younger.

I am definitely hoping the effects will be significant for me. I hope that my breast growth eventually will at least fill a C cup. Also I hope that the penis and testicles will shrink a lot. In the next few years I hope to have bottom surgery.

[Zooey]

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 are two factors - the elimination of testosterone, and the presence of estrogen. Many of the feminizing results of HRT are actually in large part related to the absence of testosterone, rather than a high presence of estrogen. Assuming the testosterone is reduced or suppressed sufficiently, there's not really such a thing as a "low dose" with limited effects. Either the estrogen receptors are activated or they're not, and similarly with the androgen receptors. It's not really "how much change", it's "change" or "no change". Higher dosages, once the right receptors are actually active and responding (and the wrong ones aren't), do not actually produce more (or faster) results.

An absence of a dominant sex hormone with active associated receptors can cause serious health problems, including low bone density and host of other more nefarious issues. Taking an anti-androgen without taking estrogen is a very bad idea in the longer term.


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.

See above.


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?

In the absence of surgery, both are generally necessary (see above), and both contribute to a loss of sexual function, with estrogen actually being the dominant force. Antiandrogens (such as spiro) do not necessarily directly reduce the amount of testosterone in the body - they prevent the androgen receptors from activating in response to it, negating the effects. Estrogen dominance leads to the atrophy and eventual shutdown of the male sexual organs and the associated production of testosterone, causing the effects you're talking about.

With respect to mental changes, for me they have been profound, and it's not just related to feeling "relieved" or "calm" after transition. I've literally had two minor meltdowns because my brain no longer works the way it used to, and my old strategies for processing things no longer worked for me. I had to learn new ones. I would struggle to name something I DON'T process radically differently than I used to before transition. I process fear and anxiety radically differently than I used to. My sexuality flipped due to changes in my sense of smell and my pheromone response. The list goes on and on.

Medical transition, including HRT, is serious business. Estrogen is not the "boobs and soft skin pill" that a lot of people here are looking for, especially at the average age of members here, and you definitely don't get to pick and choose the "side effects". If you're a woman who was born male, be a woman and medically transition. If you're not, stay away for your own sake.

[ReineD]

Thanks so much everyone!



With respect to mental changes, for me they have been profound, and it's not just related to feeling "relieved" or "calm" after transition. I've literally had two minor meltdowns because my brain no longer works the way it used to, and my old strategies for processing things no longer worked for me. I had to learn new ones. I would struggle to name something I DON'T process radically differently than I used to before transition. I process fear and anxiety radically differently than I used to. My sexuality flipped due to changes in my sense of smell and my pheromone response. The list goes on and on.

Medical transition, including HRT, is serious business. Estrogen is not the "boobs and soft skin pill" that a lot of people here are looking for, especially at the average age of members here, and you definitely don't get to pick and choose the "side effects". If you're a woman who was born male, be a woman and medically transition. If you're not, stay away for your own sake.

Thanks Zooey. So if estrogen isn't just a "boobs and soft skin pill", then it also isn't just a "mental well-being" pill? Would it have been possible for you to experience all the profound mental changes without having the estrogen receptors activated and the androgen receptors deactivated, which also affect everything else?

Some years ago there was a member who participated in this section (no longer active), who said the only benefit derived from HRT was mental. She said she felt much calmer. This particular member was in a DADT situation at home and presented as male to preserve her marriage. I may have been wrong, but I privately assumed she was on a very low dose of estrogen that wasn't all that effective, believing as you say, that either the estrogen receptors are on or off and estrogen does not follow a path down the body, affecting the mind first, the boobs next, the skin next, the hip fat redistribution next, and the shrinking testes and penis last. In other words, if there is a significant effect in one area, it will also generally be evident in other areas? Or, she may not have been on HRT but said she was. Who knows. I would never have mentioned this if she had been active here in the last few years.

[Kate T]

Zooey nailed most of it. The only thing I can contribute further is the mental aspect. Personally I was highly skeptical that HRT would cause marked psychological changes. In a way it hasn't for me. It is just that now everything is FAR more intense and real.
I was also slightly surprised by the smell and taste thing. Smell is a massively increased. Unfortunately this now means that I find most men in particular very odorous and not in a good way (no change to my attraction to females). Fortunately it does now mean that I understand why really good chocolate is almost as good as sex!!

[Heidi Stevens]

You have gotten some great insights to HRT, Reine. I have been on estradiol and blockers for about 20 months. I have been taking the long road approach on my doseage levels. Over time, the doctor has added more estradiol. The blocker has done its job from day one. Mentally, things couldn't have been better. Even at the low doses of the first 6 months, I've felt much more calm and confident about myself. The physical effects have materialized as time and doseage has increased. Most ladies by now would be in planning for total transition, but I have special circumstances that doesn't put pressure on me to go farther.
If you bring up HRT to the doctor, they should have seen you enough to have a handle if HRT is right for you. In my case, the psychologist brought it up first. She must have seen things that said I should use it. So if the doctor or psychologist thinks your ready to handle it, you are probably ready for it. It's your call though, if you're going forward.

[Pat]

Zooey has stated it well. I'd only note that at UMass Medical Center they adjust estradiol to put you into a specific range appropriate to your life situation (e.g. being older, they strive to put me in the post-menopausal range.) They don't adjust dosage for effect. If you are or aren't getting the results you're after it doesn't really effect their treatment protocols. I assume that's the same elsewhere, but don't know.

If a male were to take T-blockers only, they would gradually feminize. This is a known side-effect of the primary use for Spironolactone as a blood pressure medication.

In res the "calming effect" I have never seen that listed in a description of the medical effects of estrogen. It's widely testified to on this forum and I don't doubt that people are experiencing it but my sense is that it's a side-effect of noting the changes from HRT rather than a direct, chemical effect. I would never recommend (and I doubt a doctor would go along with) using estrogen for mind-calming effects alone.

[jentay1367]

As has been stated, there is no one way to do this nor is there any kind of linear homogenized result. I know of other women that are taking large amounts of IM valerate and are not on any androgen blockers at all. The efficacy is obviously quite good as their t levels are nil or at least in the proper place to meet general guidelines and their E is at accepted transitional levels. Different people react differently and there are different ways to skin a cat.There is no one way to do this thing.
Specifically, this site doesn't allow dosages and for good reason. All this apocryphal information can get real confusing and real fast. The home alchemist with a mind to feminize themselves can get themselves into real trouble, real fast. Hence the reasoning I suppose, which is not to lead people to believe they can do this stuff on their own. I will say if you are trans, the number one benefit to this stuff .....and that is of course if it's the correct decision for you, is that it really helps to turn off the internal diatribe that causes so many of us so much consternation. As far as the physical results go, it seems unless you're very young or very lucky or very, very delusional, you need to settle in for the long, long haul. Years long as best as I can tell. The more hypercritical you are of yourself, it seems the longer you will have to wait. As has been said, they don't work miracles. But they do, OTOH, do a great deal to help you slip over to the other side and help you be who you know yourself to be.
It seems most doctors try to get most women's T & E at accepted guideline levels. Though I must say, I know of others who have gone a different route and are running regularly on scary levels of estrogen in their blood. Some, three times the amount that a woman may show during ovulation. Some would argue this is dangerous, though they apparently are doing it under a doctor's care and seemingly with no deleterious effect. Go figure. As I said, there seems to be no universal way to do this thing. So to Reine's original question, there are guidelines, but massive deviation of dministration and types of vehicle across the board. i.e. ....it's crazy! No one way to do it and for no single reason. So no easy way to make this a linear thing to be made a ton of sense of.

[Zooey]

Thanks Zooey. So if estrogen isn't just a "boobs and soft skin pill", then it also isn't just a "mental well-being" pill? Would it have been possible for you to experience all the profound mental changes without having the estrogen receptors activated and the androgen receptors deactivated, which also affect everything else?

I doubt it. It's been such a holistic change that I don't think it's possible to separate things out like that.


I may have been wrong, but I privately assumed she was on a very low dose of estrogen that wasn't all that effective, believing as you say, that either the estrogen receptors are on or off and estrogen does not follow a path down the body, affecting the mind first, the boobs next, the skin next, the hip fat redistribution next, and the shrinking testes and penis last. In other words, if there is a significant effect in one area, it will also generally be evident in other areas? Or, she may not have been on HRT but said she was. Who knows. I would never have mentioned this if she had been active here in the last few years.

So, age and genetics can absolutely have an impact on efficacy and to what extent certain changes manifest. There is also the very real possibility of the "calming" placebo effect being about "doing something" about your gender issues. That said, I suspect you're right about their actual situation, and no, changes definitely do not happen in isolation.

[KellyJameson]

Here are a couple of links you may find interesting Reine.

https://www.youtube.com/watch?v=lnlEvJ_l4Yw

http://www.pathologystudent.com/?p=5355

[Teresa]

Jentay,
I wonder if you mind being more specific on your comments of internal conflict.
I've always called it a gut feeling or a consistent need which I've had when it all happened at about 8-9 years old, I just shrugged it off and tried to get on with life and just thought I'm not that different to anyone else but that feeling never goes away.
In a recent conversation with a TS who has had full SRS she suggested I should go to a gender clinic and get assessed , somehow it feels like we were talking about a different person possibly because I might be trying to avoid the issue.

[jentay1367]

Hi Teresa,
Are we speaking about some comment I've made in this thread or may it have been something I'd written in some other thread. I'm not quite sure which comment you're alluding to?

[PretzelGirl]

With all these comments, there is one important thing to be emphasized. You cannot *ever* say "if you take this, this will happen". It is a 100% crapshoot and is different for every person. Someone wants some effects but wants to stay potent? Pick which is more important because you may not get both. If you ever insinuate that a person take a certain drug course to achieve a result physically, you are doing a dangerous disservice. This is where we all admit that we don't know instead of trying to sound like experts. HRT is to align your mind with your identity. It isn't "take a little to get some effects". It is "Shit or get off the pot".

[Contessa]

I can't add to much to what others here have said. Except what I did when beginning my own journey. I was placed on spironolactone by my first endocrinologist. He reasoning for not placing me on estradiol was that he feared me developing blood clots due to my age. Then I was age 60. I stayed on spirono for a year but switched endos to a female and was put on estradiol. I will have been on estradiol for four years in March. I prior to taking spironolactone was on Zoloft. I can report losing my libido while on Zoloft, as I took it for reasons of depression prior to my beginning transitioning. I was on spiranolactone plus zoloft I have high blood pressure. There different reasons for placing some one on a low dose of estrogen(estradiol). The effects are different for all the same effects will just take time. If one doesn't want to loss of sex characteristics best to not take any estrogen and/or anti androgen.

[Rianna Humble]

Hi Reine, I will preface my replies with the fact that none of us is a medical professional having consulted with a patient on these questions. As such we can only speak of our own experience and observations of fellow transpeople.

According to WPATH, differing degrees of Gender Dysphoria may respond to different levels of Hormone Replacement. However, it does seem (from my own experience and from what I have read here or discussed with others) that an increase in the proportion of E compared to T in the blood will have some effect on the sexual functioning. In England, it is fairly common to start with E and only add AntiAndrogens if the E on its own is not sufficiently effective. Other clinicians may have a different approach.

In my case, I was originally put on low doses to allow the clinicians to check for negative side effects and to gauge the optimum doses. IIRC, in that early stage I experienced some physical effects along with the calming effect of finally acting.

The endocrine system is a fine balance and different people will need different balances, but I am not aware of anyone who can have the feminizing effects whilst retaining 100% male capabilities.

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.

[Teresa]

Jantay,
The middle of paragraph two in reply #11 in this thread.
You refer to it as internal diatribe causing the consternation.

[jentay1367]

Hi Teresa,
a diatribe is not a conflict, which is what you mentioned in the earlier post. The diatribe I allude to is the one where your true self is asking you how much longer you'll keep up the charade of the social role of male that we feel were trapped in. It all becomes quite exhausting, sometimes to the degree that many have panic attacks or nervous breakdowns. The hormones, either through a placebo effect or actual physical mechanism causes that behavior to cease. This, I think would be the feeling of constant need you speak of. If that's there, I think your friend is right and you should explore your feelings with a therapist. You certainly sound like someone who is possibly TS. Some can manage to live life as a male, though I couldn't manage it any longer. My personal feeling is that if you can manage without intervention....do. This is not something to take on lightly. Wish you the best on your journey and I hope that clears up my feelings on the issue to you. Lisa

[Suzanne F]

I just want to reiterate that this isn't a pick and choose situation concerning effects. There is no such thing as just a little bit of HRT. For me the changes were gradual over the 13 months I was on Spiro and Estrogen patches. Since I had SRS in May the estrogen seems to be affecting me more. I have gained weight in different places and my face has softened some. I don't know that I am calmer but I am different. Yes I am glad I did this for me. Make no mistake though, it is a serious step not to be taken lightly.
Suzanne

[Miss Mandy]

I started taking estrogen and spiro back in May. The biggest changes have been mental for me. My wife says I am much more pleasant to be around and personally, I feel calm to a degree to which I have never felt. I don't feel like I am in competition with everyone, especially other males. I was admittedly a very type A guy...Army officer, grad school, guns, trucks, etc. But deep down in inside, there was alway cause for dissonance- I had a very feminine side.that I buried and was pretty much an ass to everyone because of it.

The physical have been mild so far- Some body hair suppression, breast growth, etc.

[ReineD]

Thanks again so much, everyone!



According to WPATH, differing degrees of Gender Dysphoria may respond to different levels of Hormone Replacement.

Thanks Rianna, but how can HRT have differing effects on people, based on levels of Gender Dysphoria. I always took it that all medications behave differently in individuals, based on their own individual chemical compositions, but they do still have considerable effect. As an analogy not related to GD, for clinical depression, one class of anti-depressants will be effective on one person, while an entirely different class will be more effective on someone else. And if a healthy individual should take antidepressants, they would still experience increased social behaviors plus all the side effects.

So to take this to a bit of an extreme, if a non-gender-dysphoric male (with no desire to express a gender opposite his birth-sex) should be force-fed HRT by some evil scientist in a lab, would he not experience the changes that TSs undergo when receiving a similar treatment?

[Teresa]

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 ?

I wonder how the effects vary between the genders ?

Maybe to get a total picture it might be of interest to discover what effects F/Ms go through in the reverse process .

To touch on the subject of anti-depressants, after using them once long term and more recently a much shorter term, I'm not convinced they are ideal for Cders/ TGs/TSs. To me they caused a greater conflict but that may have been in my personal circumstances with my DADT situation.

[Zooey]

According to WPATH, differing degrees of Gender Dysphoria may respond to different levels of Hormone Replacement.

I am not a doctor, but from where I sit, this may as well read "Some people who claim gender dysphoria are effectively treated with an ineffective placebo".


So to take this to a bit of an extreme, if a non-gender-dysphoric male (with no desire to express a gender opposite his birth-sex) should be force-fed HRT by some evil scientist in a lab, would he not experience the changes that TSs undergo when receiving a similar treatment?

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

[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. :p

[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 (http://www.hemingways.org/GIDinfo/hrt_ref.htm) 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. :clap:

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. :thinking:

[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 (http://www.crossdressers.com/forums/forumdisplay.php?99-TG-Gender-Non-Binary).

[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 (http://www.crossdressers.com/forums/forumdisplay.php?99-TG-Gender-Non-Binary).

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 (http://www.crossdressers.com/forums/forumdisplay.php?1-Male-to-Female-Crossdressing) 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.

[Nigella]

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

I identify myself as a lesbian transgender ...


Elven

You have the right to respond to any forum/thread you have access to, however, just so you are aware, this forum is quite clear on it's definitions (http://www.crossdressers.com/forums/showthread.php?233034-TS-Forum-definitions) for the TS forum.


...and by being married to a woman I too would like to preserve my genital "active male capacities".

This statement alone is enough for the TS membership to question if you are Transexual. I have yet to find any M2F transexual who wants to keep any male capacities in the genital department.

[Kate T]

Really Nigella?? What about Melissa (BadTranny), though she hasn't been around for a while.

We already have TS Safe Haven for those who are solidly identified as transwomen, the TS forum is where those who aren't quite sure yet have an opportunity to ask questions and work out if it really is how they identify.

Elven, I think you should feel free to explore. As others have mentioned, learn about yourself. Listen as well. Zooey has a point, female attracted cisgendered women don't want a penis. If they did they would be Trans or at least leaning that way.

Many TS women have NOT had GRS for a variety of reasons. And yes, some of us will still use our anatomy for physical intimacy involving penetration for our partners. However it usually becomes a convenient tool, at least on my part, sort of like a biologic toy that my partner enjoys. Its use doesn't really do it for me. You will have to work out between yourself and your partner exactly how that is going to evolve for you guys.

But then again I might just be a worse tranny than Melissa :p

[LeaP]

I'll stay out of this little mud puddle other than to say that there's a difference between an enthusiastic non-op and what I may well as call an "in-op." ... one of which describes me pretty well ...

[Zooey]

But then again I might just be a worse tranny than Melissa :p

At least people don't accuse you of being a TERF like me. I'm not a TERF, but to be fair, I also think of a lot of transpeople are full of crap. Not coincidentally, they're usually the ones comparing me to TERFs. ;)

Interestingly, I'm also a Melissa. Something about that name makes for badness, lol.

[jentay1367]

I can't imagine anyone accusing a TS Woman of being a TERF when by their very definition, you are excluded. Regardless of your radical feminist leanings, that kind of ignorance doesn't even dignify a response.

[ElvenPrincess]

Hi, girls.
First of all sorry about the mess i created. I will just post some last reflexions of mine to end my active participation on this topic:

1. The definition Nigella mentioned is "Transsexual (TS) - An individual who is changing their assigned birth gender permanently to that of the opposite" and according to the latest recommendations of the major part of doctors and associations, the SRS is not a requirement for one to be transexual; so I understand one can permanently change their assigned birth gender with or without penis.
I've met MTF transexuals who do think useful to preserve genital "active male capacities". If we don't close our eyes they are there. And they are not less women because they are different of you, as you are not less women because you are different than ciswomen.

2. When I refer to lesbian having a penis, I just meant a bodily mean to penetrate the partner, among all other means of obtaining pleasure. Not being phallocentric here. I mentioned it because I indeed met some female attracted cisgendered women that used to say it would be very convenient to have a penis. But maybe I was taking the individual opinion of a couple of girls as something bigger. My mistake.


Kate T, thank you very much for your kind response. I think yours was the only direct reply that didn't seem to me somehow aggressive and full of "gender authority".


One more time, I'm awfully sorry about the derail on this thread. It really wasn't my intention.
I just asked about supplements (topic related) and replied to direct comments.

I thought you transgirls - more than everybody else - would be more sensitive about human sexuality and not closed-mind on your own views of the world. Again my mistake.


I second Mirya and encourage everyone to go back to the topic at hand (HRT) and have a fruitful, educational discussion for all.

[Georgette_USA]

I've met MTF transexuals who do think useful to preserve genital "active male capacities".


I get that question all the time from some thinking about SRS. They are afraid that SRS will make them less likely to have an active sex life. I guess it is a little better to have what you know then uncertainty. Don't know what the current success is of having vaginal sex and orgasm. Most I knew back in the 70s, that wasn't much of a concern.

For me it didn't matter as I never could imagine have M to F sex before SRS.