Hormonal Treatment for MTF Transsexuals

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Many male-to-female transsexuals think that hormones are a miracle remedy that transforms us into dream-like creatures, women who sway the most difficult of men and render the most beautiful of biological women envious. Hormones are not harmless products. We don’t take hormones to “have big breasts”, which is more of a fantasy than a thought out transition.

If we decide to take hormones, it’s a definitive personal choice (soon enough, the social consequences become irreversible and the health risks are serious in case we stop). If we decide to take hormones, it’s because we’ve truly decided to live, definitively, as a female or at least to have an atypical lifestyle. We cannot decide to take hormones just because we feel like it, on a whim, or even to fulfill a fleeting fantasy.

Such a choice is not without consequences in our Arab and Muslim society; there are major implications in the social, professional and family life. We must, on the short term at least, when the effects of the Hormone Replacement Therapy (HRT) will be impossible to hide, to come out consecutively to avoid living for long in a nefarious no man’s land and be smoothly integrated into society. In other words, starting a hormone treatment means assuming on the short term one’s trans-identity in one’s entourage, including one’s employer. It’s a decision that must be seriously considered, but which is ultimately taken on your own.

Have you made up your mind? If your physician knows the process and the tests to do before HRT, he can easily provide the necessary follow-up. If he doesn’t, he can contact an organization for trans people where he will be given all the necessary information. It would be easier if you gave him yourself the names and websites of organizations you know.

If your treating physician refuses to follow up with you, it could reflect ignorance (the role of HRT in a transition doesn’t actually exist in medical training), moralizing rejection (there are sexist, homophobic, anti-abortion, or even transphobic physicians), or even worse, they may consider you mentally ill and will send you to a psychiatrist. If he’s a hypocrite, he will send you to an endocrinologist. Be sure that the latter will also send you to a psychiatrist for a psychiatric evaluation and a certificate of “transsexualism” (indexed, in the DSM4 and ICD10, in the list of mental diseases).

Unfortunately or fortunately, there is no official HRT follow-up team for trans people in Lebanon and you will often land at a transphobic psychiatrist, who will make you lose precious time, by subjecting you to mostly useless psychiatric tests.

When you find yourself before a competent physician (don’t worry: many generalists are), be very clear. You’re not mentally ill! So don’t pathologize your talk! Rather ask him to run a complete check-up of your entire health situation, a step that precedes any serious HRT. Schedule another appointment once you receive the results of your tests. He will prescribe you the treatment generally given to menopausal women in addition to an antiandrogen. The myth of the contraceptive pill, “”Diane 35” among others, which many trans people intoxicate their bodies with is unfounded, and exposes them to serious health problems such as breast cancer, thrombophlebitis, diabetes, hypertension, not to mention an emotional state that plunges them in an infernal circle of mood swings and useless depression.

What medications to take?

* Natural estrogens administered topically
* Natural progesterones
* A peripheral or central antiandrogen

Natural estrogens are administered topically to avoid saturating the liver and incurring serious health risks. The ideal HRT in Lebanon uses estrogen 17 β in gel form (or estrodose), applied twice a day because the dosage gives you 0.75 mg per application. The initial dosage (given the time the body needs to get used to it) is in general 1.5 mg/day. If you can tolerate this dosage (which is the case, unless there’s an exception), you can increase it up to 3 mg per day but not more, because it would be useless. In general, 2 mg are enough. No need to push your body, you might just hurt yourself.

The natural progesterone is also in gel form to avoid once again saturating the liver. You can use progestogel. The usual dosage is 5 mg/day (sometimes you can go up to 10 mg/day). This product allows for a better distribution of fat and a more harmonious development of the breasts (which avoids the typical form of trans breasts  that point outwards) and helps reduce frequent cases of depression due to the changes in hormonal percentages in your body (testosterone previously protected us from depression). The urban legend that says that progesterone automatically gives you small breasts is medically unfounded.

As for the antiandrogens, specialists are still torn as to their use and need. The objective of antiandrogens is to stop the production of testosterone or inhibit testosterone receptors such as striated muscles and the skin. Antiandrogens are particularly used in cases of hair loss. They stop hair loss and help hair grow back if the roots are still active. Androcur or cyproterone acetate has long been criticized by health professionals for their use in the chemical castration of recidivist pedophiles in Europe and North America. It has also been attacked for intoxicating the liver – it was even removed from the market for some time. With a good life hygiene and a medical follow up, you can take this medication without major health risks. The usual dosage is 30 and 50 mg/day in one intake. Mind you the inhibition of the production of testosterone, which is accompanied by a halt in the production of sperms, will leave you with an almost immediate azoospermia. The halt in sperm production becomes irreversible within six months of the treatment. If you wish to have children, you must take your precautions, by placing your sperm in a sperm bank before beginning the treatment for example, or taking a peripheral antiandrogen. In Lebanon, that would be Finasteride, the sole function of which is to inhibit testosterone receptors in the body. The usual dosage is 1 mg/day.

HRT is a long-term treatment; you will have to keep taking your medication until the age of 52, except for the antiandrogens, which are stopped after removing the testicles. For a successful treatment, you must have patience and a very good life hygiene. In other words, avoid alcohol, drugs, fatty food and everything that can tire the liver. Mind you we’re not all equal before HRT and the results differ in time and nature from one person to the other. Doubling the dosages won’t change anything and will only endanger your health. The younger you are to start HRT, the better the results.

You will discover new sensations. You will see the world from a different perspective. You will become more emotional, more sensitive. You will cry and laugh for nothing. You won’t see any visible changes immediately, but you will notice that your skin will become softer, you will have a lot less hair, your face will become more feminine, you will lose a lot of your muscular mass and your features will become finer. It will take time. But before you know it, one day the chrysalis will turn into a butterfly, and standing in front of the mirror, you will tell yourself: “Wow, is it really me?” HRT doesn’t stop the beard from growing. Nor does it change your voice. The hormone treatment alone won’t be enough to turn you into the butterfly you dream of becoming, but that’s another subject altogether.

Tags: Health, hormones, transsexual