Perhaps the biggest question I had while beginning my transition was: "How is switching to female hormones going to affect me, and how much how fast?" Changing your set of sex hormones is a huge deal, as I knew, and getting them from most external sources-- as opposed to glands-- carries risks.
Sex hormones are powerful, magical beasts, and switching (even partly) affects many body processes considerably. The effects of doing this are far from completely known, but there are certain more obvious effects that are desirable and therapeutic to us transsexual folks.
Estradiol isn't a miracle drug [It's close! -- Ed.], but it is a powerful steroid hormone, the most powerful of the estrogens. The other female sex hormone is progesterone.
In pre-op women, hormones are generally begun three months or longer after seeing the gender therapist for the first time. The first order of the day is usually increasing the level of estrogen in the body dramatically. It's available in pills, injections, patches, and creams.
Speed in change is desired, and the estrogen has to "fight" the remaining testosterone, which should decrease to normal female levels in a matter of months. So, typically, pre-op doses are several times (up to eight!) the standard dose. The health risk this brings is not high, but is significant. Remaining at pre-op levels for much more than 3-4 years is considered dangerous and discouraged by most physicians.
Next up in the MtF pharmacy is something to help combat further testosterone poisoning. One common agent is spironolactone, a diuretic that also acts as dummy testosterone, without the nasty side effects. As estrogen and spiro take over, the testes see that there's enough sex hormone in the blood already, and they stop producing all that T. Yay!
Another rather expensive antiandrogen, not available by prescription in the US, is Androcur. It's a bit like building a brick wall to stop a draft, in this writer's opinion.
Finally, we add the other female sex hormone, progesterone. More often than not, a synthetic progestin like Provera is used instead. To my experience, it does seem to promote breast growth, but this is debated, and some doctors don't prescribe it to transsexual women. I disagree with that, as "unopposed estrogen" treatment is being found dangerous anyway. ["Unopposed Estrogen" is also the name of my future grrl band. Hee! -- Ed.]
Even after having met other transwomen and seeing just how much changing hormones is capable of, I'm extremely happy with what they're doing for me after just over a year of taking them. Hormonal changes take about 5-7 years to fully complete, but I've read that by and large, it takes 2.5 years.
In the final installment, we'll go over some of the more obvious effects.
Certainly, our completely hypothetical transgurl was much happier starting from the moment of her very first dose of estrogen, wasn't she? Now, a few months later, her lab results are in, and she's certified hormonally female. Let's observe what becomes of her now.
Figure 14.3: Scientifically computer-rendered diagram of completely hypothetical transgurl at various phases of development. Click for enlargement.
Zero hour: Hormones administered to grateful (albeit completely hypothetical) transgurl while she drives home from her endocrinologist. Joy follows for several weeks.
Two weeks: A slight change in fat distribution. Backside and hips feel a bit rounder and better padded, and face slightly thinner. Skin feels different.
Three months: Eyes visibly larger, face definitely on way to becoming more wedge-shaped. Skin feels softer and much less oily. Feels calmer, less aggressive, and less "edgy", but emotions seem somewhat amplified otherwise. Fat distribution changes even more apparent, especially in chest areas. Thighs seem rounder. Breasts begin to form. Tendency towards shamelessness, overdressing when presenting as female. (Diagram regarding tight stretch capris somehow lost.)
Six months: Transgurl now full-time. Feels far less guarded and restricted in general, especially in public. Skin becoming much thinner and smaller all over; quality dramatically improved all around. Muscles start losing mass, albeit very slowly. Testes, now somewhat smaller, no longer producing sperm (irreversible), and androgen production now at female levels (reversible). Breasts now somewhat pronounced. Insists upon wearing fuchsia leopard spaghetti tanktop and pink stretch corduroys in public.
Eight months: At this stage, our hypothetical transgurl is hopefully looking much more feminine. Belly has begun to lower, and waist is rising and becoming smaller. By now, muscle mass enlarging upper body, ribcage, and back has visibly reduced, but much remains. Arms, shoulders, neck, and legs look rounder and more feminine. Curves very definite but still underdeveloped. Upper leg and hindquarter regions 68.45% more wiggly-jiggly.
One year, two months: Transgurl starting to pass very well in public as member of true gender. Body appears very feminine and curvy overall despite male-proportioned pelvis and shoulder blades. Belly much lower, and narrower in front. Muscle mass reduction faster. Body hair thinner, sparser, and of a somewhat lighter color. Subject got more back than average.
Transgurl's average facial expression continues to improve. The experiment continues!
Transsexualism, like other intersex conditions, is something that just happens in some sexually reproducing animals. We humans now have a more-or-less effective way of dealing with that.
But the notion of "becoming a woman" or "becoming a man" can, in various ways, lure individuals who are largely comfortable and happy with their assigned genders into transitioning. This usually pans out to be a Bad Thing for all involved.
To help prevent misguided people from doing irreversible damage to their lives and bodies via ill-advised gender transitions, there are now a number of safeguards in place. By far, the most commonly used system for safer transition is the Harry Benjamin Standards of Care. The HBSoC protocol provides guidelines for therapists and gender specialists in helping patients cope.
So the network of caretakers in gender therapy have mostly mutually agreed on these guidelines. As such, surgeons and endocrinologists require written recommendation "letters" from therapists and psychologists before they will provide hormones or surgery.
The guideline for beginning hormones is a minimum of three months therapy or full-time living. My therapist also required dressing as my true gender in group, and a couple of outings in public as myself. (Which were quite interesting, hee!) One letter is required.
For surgery, two letters (or signatures) are generally required. One year of living full-time as yourself, a significant, documented amount of volunteering, employment, or schooling, and a legal name change will probably be expected by your therapist. At minimum. This is collectively known as the Real Life Test. [Your Humble Narrator will have completed this by the end of the year. She has already been living full-time for exactly one year.]
The HBSoC is not by any means a legal requirement, but to help prevent fiascoes and lawsuits, the vast majority of the trans caretaker network mutually enforces it. This is very much a Good Thing, because otherwise, there'd be a much larger number of very unhappy, litigious men with neo-vaginas about.
I don't mean to turn this into a "Milla's Sexuality This Week" blog, but it turns out I really was bisexual after all. Um, oopsie.
I've been running low on my testosterone blocker, spironolactone, having misjudged how much I had left. I likely won't get the new med shipment we ordered until Monday, so I've been on much less than my usual dose (50-75mg instead of 200mg daily) for a week or two. With my T-level rising to a normal female amount, my libido gradually returned and I became more responsive to C again.
While I definitely didn't mind having next to zero sex drive (common among us pre-op transwomen), I have to admit it's been kinda nice to have it back just for a little while. I plan to take more "spiro breaks" in the future.
Although the relationship between C and me didn't change very much throughout the whole "Milla's straight" ordeal, it's still undecided as to what we plan to do now. You'd think one's own sexuality wouldn't be so hard to figure out! Sigh.
Today's questions come from reader Katie. She writes:
I'm a 35yo, MTF, who hasn't started hormones yet. Your photos look very dramatic, so I'm wondering what type of regimen you're on. [...] Also, I'd like to get your opinion on something. I work in a very, very, (did I say very?), conservative office environment. So, I'm wondering, how long do you think (in your opinion) I could start taking hormones without people noticing?
Thanks for the questions, Katie!
I'm on 2mg of estradiol valerate (Estrace) twice daily, 100 mg spironolactone (Aldactone) twice daily, and 5mg Provera in the evening. I've been on that regimen for most of my transition.
On a regimen like mine, you can probably go six to eight months before you'd have to start wearing a tight sports bra. After about a year or so, I'd reckon that people might start to wonder anyway, depending on your weight/build, style of dress, and how observant your coworkers are. I've read over and over that one can hide the effects of HRT indefinitely, but my own experience would suggest otherwise.
These are of course only guesses, as I went full-time at around 4 months on HRT. I was fairly thin then, for me (a size 14), and nobody at the musician's store I worked at suspected anything. If getting "caught" will be a problem at work, there is the option of slowing the changes by omitting meds or reducing doses. This, I'm told, won't harm the final result.
Hormones change you psychologically as well, and Provera especially can make you really PMS-y or otherwise moody and irritable, so be careful to take them exactly on time!
----
Y'know, I kind of dig being sort of a tranny agony aunt. So, whether you're just a curious bystander, thinking about MtF transition, or still in the trenches (like yours truly), don't be afraid to email me questions, or just post them as comments!
Also, I'm working hard on categories. I just kind of added them over time. But never went back and assigned them to older entries. So now I'm doing just that! Woo!
My left leg still hurts. But this is good news. For a change, lately.
Today I switched from oral estrogen supplements (Cenestin®) to intramuscular Delestrogen®. It was something I've wanted to do for some time. Not only because of the much lower long-run cost, but it's harder to miss doses, so PMS will (hopefully) be a rare thing indeed.
Intramuscular injection sounds scary, but it really wasn't a big deal for me. I even did it myself.
Under the guidance of a nurse, I put a special dosing needle on an IM syringe, and cleaned off the opening to the vial with an alcohol pad. Carefully, I slurped out exactly a half a milliliter of tranny dope, being sure to push out all the air pockets and bubbles to the point that a drop came out of the needle tip. Then I put the original IM needle back on the syringe.
The hardest part about the whole thing was actually poking this long metal thing straight down into the top of my left thigh. For the first time. I was a little nervous about it, but the nurse assured me that most people say "Hey, that's not so bad." I did.
I backed the syringe up just a little to make sure I was injecting into a muscle and not a blood vessel (that would be bad), and then slowly pushed the plunger down until all the girly goodness was in my leg muscle. It started to get pretty sore. She said this was normal. I left the building with a slight limp and a smile.
I go back to see the nurse in two weeks to make sure I'm able to do the procedure myself correctly. In the meantime, much fewer pills.
Unless I screw up and hit a blood vessel or two, this tiny, expensive vial (about the size of a very large grape) will supply me with gradually released sex hormone for 20 full weeks.
Perhaps the biggest question I had while beginning my transition was: "How is switching to female hormones going to affect me, and how much how fast?" Changing your set of sex hormones is a huge deal, as I knew, and getting them from most external sources-- as opposed to glands-- carries risks.
Sex hormones are powerful, magical beasts, and switching (even partly) affects many body processes considerably. The effects of doing this are far from completely known, but there are certain more obvious effects that are desirable and therapeutic to us transsexual folks.
Estradiol isn't a miracle drug [It's close! -- Ed.], but it is a powerful steroid hormone, the most powerful of the estrogens. The other female sex hormone is progesterone.
In pre-op women, hormones are generally begun three months or longer after seeing the gender therapist for the first time. The first order of the day is usually increasing the level of estrogen in the body dramatically. It's available in pills, injections, patches, and creams.
Speed in change is desired, and the estrogen has to "fight" the remaining testosterone, which should decrease to normal female levels in a matter of months. So, typically, pre-op doses are several times (up to eight!) the standard dose. The health risk this brings is not high, but is significant. Remaining at pre-op levels for much more than 3-4 years is considered dangerous and discouraged by most physicians.
To be continued...
Posted in hormones by Milla | Comments (2)
Next up in the MtF pharmacy is something to help combat further testosterone poisoning. One common agent is spironolactone, a diuretic that also acts as dummy testosterone, without the nasty side effects. As estrogen and spiro take over, the testes see that there's enough sex hormone in the blood already, and they stop producing all that T. Yay!
Another rather expensive antiandrogen, not available by prescription in the US, is Androcur. It's a bit like building a brick wall to stop a draft, in this writer's opinion.
Finally, we add the other female sex hormone, progesterone. More often than not, a synthetic progestin like Provera is used instead. To my experience, it does seem to promote breast growth, but this is debated, and some doctors don't prescribe it to transsexual women. I disagree with that, as "unopposed estrogen" treatment is being found dangerous anyway. ["Unopposed Estrogen" is also the name of my future grrl band. Hee! -- Ed.]
Even after having met other transwomen and seeing just how much changing hormones is capable of, I'm extremely happy with what they're doing for me after just over a year of taking them. Hormonal changes take about 5-7 years to fully complete, but I've read that by and large, it takes 2.5 years.
In the final installment, we'll go over some of the more obvious effects.
To be continued...
Posted in hormones by Milla | Comments (2)
Certainly, our completely hypothetical transgurl was much happier starting from the moment of her very first dose of estrogen, wasn't she? Now, a few months later, her lab results are in, and she's certified hormonally female. Let's observe what becomes of her now.
Figure 14.3: Scientifically computer-rendered diagram of completely hypothetical transgurl at various phases of development. Click for enlargement.
Zero hour: Hormones administered to grateful (albeit completely hypothetical) transgurl while she drives home from her endocrinologist. Joy follows for several weeks.
Two weeks: A slight change in fat distribution. Backside and hips feel a bit rounder and better padded, and face slightly thinner. Skin feels different.
Three months: Eyes visibly larger, face definitely on way to becoming more wedge-shaped. Skin feels softer and much less oily. Feels calmer, less aggressive, and less "edgy", but emotions seem somewhat amplified otherwise. Fat distribution changes even more apparent, especially in chest areas. Thighs seem rounder. Breasts begin to form. Tendency towards shamelessness, overdressing when presenting as female. (Diagram regarding tight stretch capris somehow lost.)
Six months: Transgurl now full-time. Feels far less guarded and restricted in general, especially in public. Skin becoming much thinner and smaller all over; quality dramatically improved all around. Muscles start losing mass, albeit very slowly. Testes, now somewhat smaller, no longer producing sperm (irreversible), and androgen production now at female levels (reversible). Breasts now somewhat pronounced. Insists upon wearing fuchsia leopard spaghetti tanktop and pink stretch corduroys in public.
Eight months: At this stage, our hypothetical transgurl is hopefully looking much more feminine. Belly has begun to lower, and waist is rising and becoming smaller. By now, muscle mass enlarging upper body, ribcage, and back has visibly reduced, but much remains. Arms, shoulders, neck, and legs look rounder and more feminine. Curves very definite but still underdeveloped. Upper leg and hindquarter regions 68.45% more wiggly-jiggly.
One year, two months: Transgurl starting to pass very well in public as member of true gender. Body appears very feminine and curvy overall despite male-proportioned pelvis and shoulder blades. Belly much lower, and narrower in front. Muscle mass reduction faster. Body hair thinner, sparser, and of a somewhat lighter color. Subject got more back than average.
Transgurl's average facial expression continues to improve. The experiment continues!
Posted in hormones by Milla | Comments (5)
Transsexualism, like other intersex conditions, is something that just happens in some sexually reproducing animals. We humans now have a more-or-less effective way of dealing with that.
But the notion of "becoming a woman" or "becoming a man" can, in various ways, lure individuals who are largely comfortable and happy with their assigned genders into transitioning. This usually pans out to be a Bad Thing for all involved.
To help prevent misguided people from doing irreversible damage to their lives and bodies via ill-advised gender transitions, there are now a number of safeguards in place. By far, the most commonly used system for safer transition is the Harry Benjamin Standards of Care. The HBSoC protocol provides guidelines for therapists and gender specialists in helping patients cope.
So the network of caretakers in gender therapy have mostly mutually agreed on these guidelines. As such, surgeons and endocrinologists require written recommendation "letters" from therapists and psychologists before they will provide hormones or surgery.
The guideline for beginning hormones is a minimum of three months therapy or full-time living. My therapist also required dressing as my true gender in group, and a couple of outings in public as myself. (Which were quite interesting, hee!) One letter is required.
For surgery, two letters (or signatures) are generally required. One year of living full-time as yourself, a significant, documented amount of volunteering, employment, or schooling, and a legal name change will probably be expected by your therapist. At minimum. This is collectively known as the Real Life Test. [Your Humble Narrator will have completed this by the end of the year. She has already been living full-time for exactly one year.]
The HBSoC is not by any means a legal requirement, but to help prevent fiascoes and lawsuits, the vast majority of the trans caretaker network mutually enforces it. This is very much a Good Thing, because otherwise, there'd be a much larger number of very unhappy, litigious men with neo-vaginas about.
Posted in hormones, surgery, transition by Milla | Post a Comment?
I don't mean to turn this into a "Milla's Sexuality This Week" blog, but it turns out I really was bisexual after all. Um, oopsie.
I've been running low on my testosterone blocker, spironolactone, having misjudged how much I had left. I likely won't get the new med shipment we ordered until Monday, so I've been on much less than my usual dose (50-75mg instead of 200mg daily) for a week or two. With my T-level rising to a normal female amount, my libido gradually returned and I became more responsive to C again.
While I definitely didn't mind having next to zero sex drive (common among us pre-op transwomen), I have to admit it's been kinda nice to have it back just for a little while. I plan to take more "spiro breaks" in the future.
Although the relationship between C and me didn't change very much throughout the whole "Milla's straight" ordeal, it's still undecided as to what we plan to do now. You'd think one's own sexuality wouldn't be so hard to figure out! Sigh.
Related entry
Posted in hormones, sexuality by Milla
Today's questions come from reader Katie. She writes:
Thanks for the questions, Katie!
I'm on 2mg of estradiol valerate (Estrace) twice daily, 100 mg spironolactone (Aldactone) twice daily, and 5mg Provera in the evening. I've been on that regimen for most of my transition.
On a regimen like mine, you can probably go six to eight months before you'd have to start wearing a tight sports bra. After about a year or so, I'd reckon that people might start to wonder anyway, depending on your weight/build, style of dress, and how observant your coworkers are. I've read over and over that one can hide the effects of HRT indefinitely, but my own experience would suggest otherwise.
These are of course only guesses, as I went full-time at around 4 months on HRT. I was fairly thin then, for me (a size 14), and nobody at the musician's store I worked at suspected anything. If getting "caught" will be a problem at work, there is the option of slowing the changes by omitting meds or reducing doses. This, I'm told, won't harm the final result.
Hormones change you psychologically as well, and Provera especially can make you really PMS-y or otherwise moody and irritable, so be careful to take them exactly on time!
----
Y'know, I kind of dig being sort of a tranny agony aunt. So, whether you're just a curious bystander, thinking about MtF transition, or still in the trenches (like yours truly), don't be afraid to email me questions, or just post them as comments!
Also, I'm working hard on categories. I just kind of added them over time. But never went back and assigned them to older entries. So now I'm doing just that! Woo!
Posted in ask_a_tranny, hormones, transition by Milla
Today I switched from oral estrogen supplements (Cenestin®) to intramuscular Delestrogen®. It was something I've wanted to do for some time. Not only because of the much lower long-run cost, but it's harder to miss doses, so PMS will (hopefully) be a rare thing indeed.
Intramuscular injection sounds scary, but it really wasn't a big deal for me. I even did it myself.
Under the guidance of a nurse, I put a special dosing needle on an IM syringe, and cleaned off the opening to the vial with an alcohol pad. Carefully, I slurped out exactly a half a milliliter of tranny dope, being sure to push out all the air pockets and bubbles to the point that a drop came out of the needle tip. Then I put the original IM needle back on the syringe.
The hardest part about the whole thing was actually poking this long metal thing straight down into the top of my left thigh. For the first time. I was a little nervous about it, but the nurse assured me that most people say "Hey, that's not so bad." I did.
I backed the syringe up just a little to make sure I was injecting into a muscle and not a blood vessel (that would be bad), and then slowly pushed the plunger down until all the girly goodness was in my leg muscle. It started to get pretty sore. She said this was normal. I left the building with a slight limp and a smile.
I go back to see the nurse in two weeks to make sure I'm able to do the procedure myself correctly. In the meantime, much fewer pills.
Unless I screw up and hit a blood vessel or two, this tiny, expensive vial (about the size of a very large grape) will supply me with gradually released sex hormone for 20 full weeks.
Posted in hormones by Milla | Comments (3)