Hormone Therapy

[Guest]

Anyone who can correct me, that would be appreciated.

My understanding is that the basic principle of hormone therapy is to make the body have quantities of testosterone and estrogen that match that of a woman.

This requires anti-androgens to reduce the testosterone, and estrogen to increase its levels.

I don't see any need for progesterone, however, I've read some feminization therapies include it.

I also read that taking too much estrogen actually results in that estrogen being converted to testosterone.

So my quesitons are really...is everything I said right?

As a side note, I believe most LBs do not take anti-androgens, and some take progesterone, and some take overdoses of estrogen thinking it will make them become more feminine faster; all of these habits being wrong.

Thanks!

[rxpharm]

Ziggy, you have pretty much hit everything on the mark.

There is an excellent website from medical professionals that cover the subject in depth.

Transgender Care - Hormone Treatment in Transsexuals

The one thing that is not mentioned is taking too much estrogen results in conversion to testosterone.

As far as Thai lbs taking hormones - if they are using Diane, cyproterone (Androcur) is part of the formulation so some anti-androgen effect is being exerted.

Many of the Thai lbs I have spoken with tend to overdose their hormone regimen in the belief that more is better and faster to feminize. Unfortunately this can be dangerous.

[Guest]

I've gone through that TGCare in detail, it's a good source.

However, I'm finding conflicting info on 2 things:

1. Progesterone. Shuold LBs take it or not? TGCare says no. Other sites say not bad.

2. After castration. TG Care says you need to keep taking anti-androgens. Inhouse Drugstore says
no need.

It's quite hard to find one site with all the info you need. You have to scan 10s of sites to get it,
and then half of them conflict with each other on some important points.

[stogie bear]

 That would lead me to believe that there are no definitive answers for the questions you have or the authors have been selective in their choice of answers. This can be through either bad research, misinformation or plain bad medicine!

You can juggle the existing 'answers' and draw your own conclusions based on your intuition and common sense and follow up with the alternative options/opinions as an addendum to them.

[Guest]

I was started on estrogen as tablets at first but then put on implants about 5 years ago and since then my balls are really hard to find , my prostate is like a young boy meaning sex only produces water and my dick just sticks out from what little hair there is . my boobs are easy a 'B' size . the regular progesterone works wonders on my nips . i have only a tiny amount of testerone now and that is not produced by my nuts i'm told.i'm very tranquil and my woman is happy and so are the customers

[Guest]

So I'm determined to get the correct answers on these and will consult several doctors along the way, but any 'In The AsianTS House' info is appreciated from professionals or not!

I think this is important because from my mini-study, many LBs in Thailand are doing the wrong thing.

The most blatant I know of is Dr. V in Phuket telling post-op LBs they don't need to take any hormones. Everything I've read says they should keep taking estrogen for life, and anti-androgens.

Similarly, I've found most LBs take progesterone (Proluton), and most web-sites say it is nigh on useless for transgenders. Francis, I'm interested in if you found it really was the progesterone that helped the 'nips'.

Finally, while not unanimous, I found many sites saying that conjugated estrogren (naturally occuring, almost always Premarin), gives headaches and some depression; which I have seen in many LBs. Synthesized (laboratory made) Estradiol (like in Estrace or patches like Climera) does not, and is a much better solution for LBs.

So, I'd like to get this really straight so I can give the LBs accurate info. If there are subjective parts, that's ok, I won't "create" a fact, I'll tell them that that part is not sure.

Also, many LBs overdose on estrogen, which, from one fairly reliable source says that excess estrogen is turned into testosterone thus defeating the whole purpose of taking too much.

For now, my main sources are TransgenderCare, Inhouse Drugstore, 2 books called The Endocrine System, Suzanne Summer's The Sexy Years (not as bad as you'd think), and about 5 other web-sites that have tidbits here and there, like the Minnesota Transgender Health site. I still have a long way to go, but I think I know the right questions now.

Thanks!

[Guest]

Hi Ziggy,

I'm wondering about the need of the anti-androgen (androgen blocker). It seems to be dangerous for some girls.

One of my TS friends got sick from using anti-androgen (Spironolactone) - something about the liver and potassium. Apparently, while blocking androgen to the body, there are side effects which are harmful to the liver(?)

Maybe it's better to just stick with hormones...(the devil you know, etc...)

From what I've learn, injections and dermal patches and better absorb by the body, but they generally cost more than orally ingested Premarin(etc..) The recommendation I've come across is to place any hormone tablets inside the mouth, in between the gums, let it dissolve and be absorb into the body. This is suppose to mimic the injection and patch method, minimizes the hormone being filter out by the liver and/or the kidney-(hormones would be wasted and over loads the organs)

Also, my friends- Post Ops- are taking hormone and will continue to do so, but not anti-androgen.

Incidentally, my TS friends are from here in Canada, under the care of Canadian health care system, which I hope is more reliable and accountable.

I am open to and happy for any corrections and critiques.

Good luck in your research, and thanks for starting the discussion. Always good to know more, and to help those we care about.

Ronin

[Guest]

Well, all sites recommend highly anti-androgens, spironolactone and finasteride being 2 noted.

All the hormones have side effects in the liver because they all go through there when taken orally. The only difference in anti-androgens is that they are generally designed to fix something else, i.e., they weren't designed for LBs (nor were estrogen drugs). I think its spironolactone that its main purpose is a diuretic, and thus a side effect of making LBs pee more!

Transdermal and injections require doses 1/10th to 1/20th of oral, to get the same effect, so that's got to be good.

I don't see anything good in the Canadian health care system. While it's hard to believe if you haven't been to hospitals here, my experience (I'm Canadian) is that the foreigner aimed hospitals here are 100 times better than Canadian hospitals, and the doctors in them. I've been more than 30 times to hospitals here. Now I refuse to go to a Canadian hospital anymore.

BTW, can u find out what estrogens your friends take? Also, did any of them see an endocrinologist? I just got back from Canada, and my sister-in-law is a nurse. She said there are no endocrinologists in Sarnia hospitals, not even one! So I'm curious if that is an anomaly.

Thanks for the comments.

[Guest]

Dear Ziggy I have just found your lastest reply. The real answer is what you want to achieve . The spironolactone and finistride work to switch off male sex drive and have minor feminization . Estrogens aren't really changed in important amounts to testosterone but they cause the balls to schrink FOREVER and it means have enough if you stay on low doses long enough--certainly after a year there is no going back. progesterone matures the tits and makes them more firm but also they are more tender . i get yearly mammograms. the ladyboys who are on the overdoses of estrogens all have tiny balls which are only for display in most of them.I don't understand how they can get hard unless they have some testosterone shots . Usually the cum is thin and watery . these ladyboys are forever sterile . they are always going to recieve rather then enjoy giving sex . if you want to put my letter to you in --do! francis

[Guest]

Sorry Francis, but I have to disagree with you on one point.

I know many, many girls who took hormones for years, stopped, and erections and ejaculation returned. In fact, this is a common 'technique' to stop, get it back, get some different kind of guys they may have lost, then maybe go back on the 'mones. I've never checked the balls returning to normal shape, but there's zero doubt on erections and ejaculation (my girlfriend did just that, and she has normal sized balls).

Also spironolactone and finasteride stop testosterone converting to DHT and thus reduce virilizing (masculinizing). As you say, this reduces sex drive, but so does estrogen as I understand it, so I don't think the anti-androgens are solely responsible for reducing sex drive.

The ladyboys who overdoes on estrogen don't have tiny balls. I can think of a few just now like that. It may be that the difference is how many years they do it, but I know a few having done it several years.

I double-checked with May and she says she doesn't know any ladyboy taking anti-androgens, despite most foreigner web-site saying it should be taken (Anne Lawrence, Transgender Care, Transgender Zone). I'm wondering why that is???

[Guest]

Hi Ziggy,

Most of my friends are on Premarin.(Thai girls as well) More of an economical choice, it's cover by Health Care in Canada. They would prefer to have injections, but they have to pay for it themselves. (They reside in BC)

They are under their family doctors' care, and also include endocrinologists.

I've had heart surgery recently in BC. Since I'm under HealthCare, everything was covered; if I was anywhere else in the world, I'd been in debt till god knows when. Public health care system covers a lot of the population, that may be why it moves so slow.

About the lack of endocrinologist in Sarnia- It may be due to brain drain out of Canada, or Sarnia is simply too small to warrant an endocrinologist. Maybe there are some in the nearby cities?

Hope this helps.

Ronin

[Guest]

Interestingly, I just read on the Anne Lawrence site, see under hormone regimens that she strongly recommends against injections. I don't understand why. Transdermal seems to be the way to go, but I'm not sure how costly it really is. I'll be finding out soon as May and I go to look at the options in Thailand.

[rxpharm]

(ziggystardust @ Aug. 12 2006,00:56) I've gone through that TGCare in detail, it's a good source.

However, I'm finding conflicting info on 2 things:

1. Progesterone. Shuold LBs take it or not? TGCare says no. Other sites say not bad.

2. After castration. TG Care says you need to keep taking anti-androgens. Inhouse Drugstore says
no need.

It's quite hard to find one site with all the info you need. You have to scan 10s of sites to get it,
and then half of them conflict with each other on some important points.

Ziggy, as I have mentioned before there are not very many good scientific studies regarding hormones especially in transgender patients as the drug companies do not see much profit potential in it.

Regarding Transgender Care comments about anti-androgens, their guidelines have been developed for the treatment of North American transgender patients. Typically they present at a much older age than Thais - so when they write - antiandrogens may be continued post surgery either SRS or castration if more feminization is desired - this does not mean it has to be lifelong, and in the case of the late treatment transgender patients they may want more feminization post surgery. Using antiadrogens will counter the very small amount of androgen produced by the adrenals post surgery and may allow estrogen treatment to be more effective and/or use lower doses which are safer.

Patients who start younger may not need to.

The use of progesterone is something that is not clear due to good studies. I have read some articles by medical professionals that state progesterones help breasts develop in a more "mature" feminine manner than estrogens alone. However, I have seen good results in estrogen only transgender patients as well. I have noticed that some lbs have very well developed areola/nipples while some do not. It would be interesting to know if those with better developed areola/nipples have used progesterones (Proluton injection).

With regard to the lack of antiandrogen use by Thai lbs, it likely is due to a economic matter. Anti-androgens like Proscar and Androcur are expensive. Spironolactone might be an alternative, but the side effects are probably not worth it for them.

Francis, I would be interested to know more details about the implants in your balls. I have not read any literature about estrogen implants - the only implants I have found information about are progesterone which are not implanted in the balls, but usually in the arms.

[rxpharm]

(ziggystardust @ Aug. 14 2006,22:54) Interestingly, I just read on the Anne Lawrence site, see under hormone regimens that she strongly recommends against injections. I don't understand why. Transdermal seems to be the way to go, but I'm not sure how costly it really is. I'll be finding out soon as May and I go to look at the options in Thailand.

Ziggy, check your pm, I sent you information regarding Climera costs in the Far East Pharmacy on Sukhumvit Road.

[Guest]

The best place to put the implant is beneath the skin usually below the bikini line but it depends on how much fat there is . Mine is put in my ball sac as it is not used as balls live further up. Also easy to play with. A progesterone implant could be put in but often there is a lot of nausea and that would last for years. Once the implant is in then you can forget about it but it can be removed while an injection cann't . There is always the risk of clots and getting it out may be important. The anti-androgens only cancel the androgens and have no real feminization effects which is why some like them.