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HRT -
Transgender Hormone Replacement Therapy |
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*For full details and risks associated with HRT please consult your
doctor before taking.
NO PRESCRIPTION REQUIRED NO RX
CERTIFICATE NEEDED
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[Abstract] Full Text [PDF]
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Introduction
A gender reassignment program for male to
female transsexuals normally includes the prescription of feminising
hormones, oestrogen and progesterone which develop female secondary
sexual characteristics. In addition this may be accompanied before
surgery by anti-androgen treatment to reduce the effect of the patient's
own male sex hormones. There can be risks attached to hormone therapy in
both men and women and therefore it is definitely inadvisable to take
any form of hormone product unless it is medically prescribed.
Hormones are made up of molecules
derived from steroids, proteins or tyrosine (an amino acid). They become
active only when bound to a specific receptor on or inside a target
cell.
Hormones derived from proteins bind to
receptors on the outside of the cell membrane; steroid and tyrosine
hormones pass inside the cell and bind to receptors in the cytoplasm or
the nucleus.
How Hrt is absorbed
Click
to enlarge
The
manufacturers of oestrogen and progesterone products specify them for
medical use in females and do not acknowledge their use for
transsexuals, so there is little clinical data available regarding this
usage. The effect of feminising hormones varies between patients, but
many experience changes within two to three months such as change in
skin tone, development of breasts, expansion of the nipples,
redistribution of body fat causing fuller cheeks, a more pronounced
waist and fleshier hips and buttocks. Body and scalp hair may change in
texture but hormone treatment will not inhibit beard growth or improve
male pattern baldness. Emotions may be heightened with a greater
tendency to mood swings, but in general the transsexual will feel more
comfortable with the new self that is emerging. For this reason hormone
therapy can be a useful diagnostic tool, as a male who is not
transsexual is unlikely to feel this heightened ease with themselves and
may become anxious at the drop in their male sex drive. The transsexual
on hormone treatment should receive regular check-ups from their doctor.
There are various forms of hormone products available and the following
is a review of those commonly in use.
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Oestrogens
Oestrogens are responsible for the
development of female secondary sexual characteristics, so the main
component of any hormone regime for a TS patient will be some form of
oestrogen. Typically this is obtained either from combined oral
contraceptives or oestrogen tablets intended for HRT in postmenopausal
women. The principle natural oestrogen produced from the ovaries in a
natural-born premenopausal female is 17 beta-oestradiol. Numerous
derivatives and metabolites exist and play specific roles in the female
body. While some of the metabolites (e.g. oestrogen, oestriol) may be
used successfully in treating menopause symptoms in post menopausal
women, they are not suitable for transsexual patients; it is necessary
to supply 17 beta-oestradiol or a synthetic replacement for it.
Oestrogen therapy must be continued for life in a post-operative
subject, otherwise numerous problems can occur. In particular, several
very severe case of osteoporosis have been reported in post-ops who have
discontinued their oestrogen treatment. Menopause-like symptoms also
occur if oestrogen is discontinued.
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Ethinyloestradiol
This drug is a synthetically-produced
modification of natural 17 beta-oestradiol. The modified molecule is
eliminated only slowly by the liver, giving it a far greater potency and
much longer half life that other oestrogens. It is generally
well-tolerated, but appears to be less safe in very long-term use that
oestradiol valerate. Ethinyloestradiol is widely regarded as the
oestrogen of choice in pre-operative subjects. A dose of 100ug daily in
two doses) is typical; this can be increased to 150ug if necessary. It`s
long half life and potency give it excellent feminising effects. In
post-op patients, this drug may still be used, especially for patients
whose feminisation has not completed by the time they have GRS. For
short-term post-op use, the full pre-op dose of 100ug may be used, this
is normally reduced to 50ug after 6-12 months. For long-term post-op
use, the full pre-op dose, oestradiol valerate is probably preferable.
It should be noted here that oestrogen overdosage may paradoxically
cause vasomotor symptoms similiar to those produced by insufficient
oestrogen dosage.
This is sometimes seen in post-op
patients who are still on pre-op dosage, and if this effect is suspected
then the oestrogen dosage should immediately be reduced to a typical
post-op level. This effect is more likely with ethinyloestradiol than
with other oestrogens due to its high potency, and consideration may be
given to an early switch to oestradiol valerate if the problem persists.
Ethinyl Estradiol (The recommended hormone of
choice for gender specialists, with 50mcg being a common
recommendation)
LYNORAL ( Estinyl, Generic Ethinyl Estradiol ) 10mcg Tabs 100 (10
x 10) INFAR Estrogens (ES-troe-jenz) and progestins (pro-GEST-ins) are
female hormones. They are produced by the body and are necessary for the
normal sexual development of the female and for the regulation of the
menstrual cycle during the childbearing years.
$42.24

LYNORAL ( Estinyl, Generic Ethinyl Estradiol ) 50mcg Tabs 100 (10
x 10) INFAR Estrogens (ES-troe-jenz) and progestins (pro-GEST-ins) are
female hormones. They are produced by the body and are necessary for the
normal sexual development of the female and for the regulation of the
menstrual cycle during the childbearing years.
$52.80

Myralon ( Generic Desogestrel/Ethinyl estradiol ) It
contains 2 hormones, a progestin and an estrogen.

Estrofem
( Generic Estradiol ) 2mg 84 (3x 28)Tabs Novo Nordisk Medical
Information: Estrofem® was especially developed and indicated for the
treatment of oestrogen deficiency symptoms in women without a uterus,
with effective symptom relief and good tolerability (continuous therapy
with calendar pack of 28 tablets containing 1mg 17b-oestradiol). As
there is no increased risk of developing cancer of the uterus lining in
women without a uterus, they need not to take an additional progestogen.
The drug is available in different dosages because a standardised unique
dose is not optimal for every woman. Studies have demonstrated that
after four weeks of treatment there is a significant reduction in hot
flushes and other menopausal complaints. The administration of Estrofem®
results in a significant increase of bone density.
$69.28

Estrofem ( Generic Estradiol ) 2mg 28 Tabs Novo Nordisk
$44.32


This drug is equivalent to natural 17
beta-oestradiol. It is generally well-tolerated, and clinical data from
postmenopausal women suggest it is safer than ethinyloestradiol for
long-term use, with less risk of breast cancer, thromboembolic events,
or liver problems. It is not certain whether this improved safety
applies in the high doses necessary for pre-op transsexuals. This is
widely regarded as the oestrogen of choice for long-term maintenance in
post-op TS patients due to its good safety record; typical post-op dose
would be 1-2mg daily, ideally divided into two doses. Oestradiol
Velerate appears to be less effective at inducing feminisation in pre-op
subjects than ethinyloestradiol, probably due to it`s short serum half
life-particularly, as it appears tp fare poorly when "in
competition" with endogenous male hormones; adequate results have
been obtained with oestradiol valerate combined with an effective anti
androgen. Typical pre-op dose would be 4-6mg daily in divided doses (1
or 2mg per dose); if menopause-type symptoms appear (hot flushes, night
sweats, etc) this can often be a sign that the dose is not sufficent to
overcome the endogenous male hormones and a switch to ethinyloestradiol
would probably be advisable.
Progynova (Estradiol Valerate,
Oestradiol Valerate) 1mg 56 tabs Schering-Plough Used for "hormone
replacement therapy" because it contains the principal oestrogen hormone
that is lost during the "change of life".
Hormone replacement therapy to relieve
symptoms of the menopause.Second-line option for preventing osteoporosis
in postmenopausal women who are at high risk of fractures and cannot
take other medicines licensed for preventing osteoporosis.
$38.72

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Conjugated
Natural Oestrogens (Premarin)

This drug is a mixture of various
oestrogenic substances extracted from the urine of pregnant mares. It
lacks the potency of ethinyloestradiol, and there is no evidence that it
has any advantages over oestradiol valerate. Many patients dislike this
drug because of ethical concerns over the manner in which it is
produced. It is increasingly regarded as an outmoded treatment for TS
patients. It is also more expensive than the synthetically-manufactured
drugs. A typical pre-op dose would be 5-7.5mg daily in divided doses,
reducing to 1-2.5mg daily post up.
Premarin
One of the world's best selling hormones
Premarin is conjugated estrogens tablets, USP for oral
administration. ( Cenestin, Enjuvia, Ogen, Gynodiol, Femtrace,
Menest, Generic Estrogen )
0.3mg 84 tabs Wyeth Ayerst $33.44

1.25mg 84 tabs Wyeth Ayerst $47.52

1.25mg Tabs 56 (2 x 28) WYETH

$110.88 Estrin ( Cenestin, Enjuvia, Ogen, Premarin,
Generic Conjugated Estrogen ) 0.625mg 180 (6 x 30 Tablets) Cipla
Pharmaceuticals Ltd This medication is a female hormone and is usually given to women
who no longer produce the amount of estrogen they produced before
menopause. It is a very effective treatment for reducing a common
menopause symptom (intense feelings of warmth and sweating known as hot
flashes). If you need treatment only for vaginal menopause symptoms
(e.g., vaginal dryness), products applied directly inside the vagina
should be considered before medications that are taken by mouth,
absorbed through the skin, or injected.Certain estrogen products may
also be used to prevent bone loss (osteoporosis) in people at high risk
who cannot take non-estrogen drugs. There are several other medications
(e.g., raloxifene, bisphosphonates such as alendronate) that are safe
and effective to prevent or treat bone loss. These medicines should be
considered for use before estrogen treatment. Certain estrogen products
may also be used to treat certain cancers in men and women (e.g.,
certain types of metastatic breast cancer, prostate cancer)
$145.47

Estrin ( Cenestin, Enjuvia, Ogen, Premarin, Generic Conjugated
Estrogen ) 0.625mg 30 Tablets Cipla Pharmaceuticals Ltd
$34.91

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Other
Oestrogens
Diane-35 ( Generic Cyproterone acetate/Ethinylestradiol ) -
Product Origin: EU (Turkey) 2/0,035 mg 21 tabs BAYER Product Origin: EU
Diane-35® meanwhile contains two female hormones, estrogen and
progestin. These are similar to the natural hormones women produce in
their ovaries. <P>The pituitary gland is not able to distinguish the
hormones contained in Diane-35® from those produced by the ovaries. It,
therefore, stops inducing the natural hormone production by the ovaries
and eventually the process of egg growth and release. This hormonal
feedback mechanism is based on the same principle which blocks the
maturation and release of further eggs during pregnancy. <P>How does
Diane-35 clear your skin?<P>Suitable treatment for acne in women,
Diane-35® has a clearly recognizable effect on the reduction of sebum
production by blocking the effect of androgen (male sex hormones) on
your skin. Thus, Diane-35® also reduces the formation of new spots and
blackheads.After about three months your acne clears. You may then
choose to stop using Diane-35® as an anti-acne treatment or to continue
using it as your contraceptive Pill of choice.<P>Diane-35 ® is a 21-Pill
regimen that provides contraceptive protection starting from the first
day of your period, when the Pill should be taken. Contraception remains
effective on the 7-day Pill-free period. As an advice, keep an extra
pack of Diane-35® handy so you won't run out of Pills when you want to
start your new pack. <P>More about the Pill -<P>The Pill is a
contraceptive that is mainly used to prevent pregnancy.
$49.04

Estraderm TTS 100 ( Generic
Estradiol ) Estraderm® (estradiol transdermal system) 'patches'- Product Origin: EU (Turkey) 8mg 16 ( 2 x 8 ) Patches
Novartis Product Origin: EU (Turkey)<P>This product is able to be
sourced and supplied at excellent prices because of favourable cross
border currency conversions. All products are authentic brand names and
will include a product information insert in English.
$60.00

Estraderm TTS 25 ( Generic
Estradiol ) - Product Origin: EU (Turkey) 2mg 18 ( 3 x 6 ) Patches
Novartis Product Origin: EU (Turkey)
$56.00

Estraderm TTS 50 ( Generic
Estradiol ) - Product Origin: EU (Turkey) 4mg 18 ( 3 x 6 ) Patches
Novartis Product Origin: EU (Turkey)
$66.16

FEMILON ( Apri, Alesse, Aviane, Cyclessa, Demulgen, Desogen,
Genora, Seasonale, Kariva, Mircette, Ortho-Cept, Generic Estrogen/Progestogen
) 20mcg/150mcg Tabs 63 (3 x 21) INFAR Oral contraceptives (birth-control
pills) are used to prevent pregnancy. Estrogen and progestin are two
female sex hormones. Combinations of estrogen and progestin work by
preventing ovulation (the release of eggs from the ovaries). $44.00

FEMILON ( Apri, Alesse, Aviane, Cyclessa, Demulgen, Desogen,
Genora, Seasonale, Kariva, Mircette, Ortho-Cept, Generic Estrogen/Progestogen
) 20mcg/150mcg Tabs 21 INFAR Oral contraceptives (birth-control pills)
are used to prevent pregnancy. Estrogen and progestin are two female sex
hormones. Combinations of estrogen and progestin work by preventing
ovulation (the release of eggs from the ovaries).
$26.40

NOVELON ( Ortho-Cept, Primera, Desogen, Generic Estrogen/Progestogen
) .15/.03mg 63 (3 x 21) INFAR Oral contraceptives (birth-control pills)
are used to prevent pregnancy. Estrogen and progestin are two female sex
hormones. Combinations of estrogen and progestin work by preventing
ovulation (the release of eggs from the ovaries).
$36.96

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Progestogens
Progestogens administered alone
do not produce feminisation in a phenotypic male. However, progestogens
are generally quite antiandrogenic and will often promote a useful
degree of testosterone suppression in a pre-op patient, and more
importantly when administered in conjunction with oestrogen, improve the
feminisation attained compared to oestrogen-only therapy, particularly
in terms of breast weight and texture. One UK endocrinologist has
claimed that progestogens have no effect in transsexual patients,
however numerous studies both in the UK and elsewhere have demonstrated
that this claim is false. Progestogens are now very widely used in
conjunction with oestrogens in the treatment of male-to-female
transsexualism. Progestogens may also lessen the risk of cancer
associated with long-term oestrogen treatment, according to some studies
in natural-born females. In addition, some patients report that
progestogens affect them psychologically, particularly in terms of
maintaining the libido. For all these reasons, it may well be desirable
to continue with a low dose of progestogen post operatively, even though
there is no absolute need for it. No reliable data exists regarding the
incidence of breast cancer in transsexuals. Many are lost to follow-up
and conceal their transsexual past after completing their treatment, and
any instances of breast cancer in this group are likely to be recorded
as occurring in normal women rather than transsexuals. One researcher
has claimed to find a significant excess of breast cancers among certain
chromosomally-intersexed patients who have been reassigned to female. A
few patients experience androgenic effects from some progestogens,
possibly including an increase in body hair. If this occurs, a different
progestogen should be tried. Similarly, if fluid retention occurs, a
switch to an alternative drug will probably resolve it.
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Finasteride
for Hair Loss
This drug is not suitable as a
general antiandrogen, but is mentioned here as it can be useful
in countering male-pattern baldness in transsexuals. Classed as
an androgen conversion inhibitor, it blocks the conversion of
testosterone to DHT. It is generally ftee ftom significant side
effects, but does not appear to affect male sex drive. Typical
dosage is 5mg daily.
Used for
those experiencing hair loss.
FINPECIA ( Propecia, Proscar, Generic Finasteride ) 1mg 30
(3 x 10) CIPLA Finpecia treating certain types of male pattern
hair loss (androgenic alopecia) in men. Finpecia is a steroid
reductase inhibitor. It works by reducing the amount of the
hormone dihydrotestosterone (DHT) in the body. This may block
certain types of hair loss in men. Finpecia is used for:
Treating male pattern baldness on top of the head and the
anterior mid-scalp area IN MEN ONLY.Finpecia is a remedy for
baldness in men with mild to moderate hair loss on the top of
the head and the front of the mid-scalp area. It increases hair
growth, improves hair regrowth, and slows down hair loss. It
works only on scalp hair and does not affect hair on other parts
of the body.
$25.60

FINPECIA ( Propecia, Proscar, Generic Finasteride ) 1mg 200
(20 x 10) CIPLA Finpecia treating certain types of male pattern
hair loss (androgenic alopecia) in men.Finpecia is a steroid
reductase inhibitor. It works by reducing the amount of the
hormone dihydrotestosterone (DHT) in the body. This may block
certain types of hair loss in men. Finpecia is used for:
Treating male pattern baldness on top of the head and the
anterior mid-scalp area IN MEN ONLY.Finpecia is a remedy for
baldness in men with mild to moderate hair loss on the top of
the head and the front of the mid-scalp area. It increases hair
growth, improves hair regrowth, and slows down hair loss. It
works only on scalp hair and does not affect hair on other parts
of the body.
$96.00

FINPECIA ( Propecia, Proscar, Generic Finasteride ) 1mg 100
(10 x 10) CIPLA Finpecia treating certain types of male pattern
hair loss (androgenic alopecia) in men. Finpecia is a steroid
reductase inhibitor. It works by reducing the amount of the
hormone dihydrotestosterone (DHT) in the body. This may block
certain types of hair loss in men. Finpecia is used for:
Treating male pattern baldness on top of the head and the
anterior mid-scalp area IN MEN ONLY.Finpecia is a remedy for
baldness in men with mild to moderate hair loss on the top of
the head and the front of the mid-scalp area. It increases hair
growth, improves hair regrowth, and slows down hair loss. It
works only on scalp hair and does not affect hair on other parts
of the body.
$59.20

FINPECIA ( Propecia, Proscar, Generic Finasteride ) 1mg 60
(6 x 10) CIPLA Finpecia treating certain types of male pattern
hair loss (androgenic alopecia) in men. Finpecia is a steroid
reductase inhibitor. It works by reducing the amount of the
hormone dihydrotestosterone (DHT) in the body. This may block
certain types of hair loss in men. Finpecia is used for:
Treating male pattern baldness on top of the head and the
anterior mid-scalp area IN MEN ONLY. Finpecia is a remedy for
baldness in men with mild to moderate hair loss on the top of
the head and the front of the mid-scalp area. It increases hair
growth, improves hair regrowth, and slows down hair loss. It
works only on scalp hair and does not affect hair on other parts
of the body.
$52.80

Propecia ( Proscar, Generic Finasteride ) - Product Origin:
EU (Turkey) 1mg 28 Tablets MERCK SHARP DOHME Product Origin: EU
(Turkey)This product is able to be sourced and supplied at
excellent prices because of favourable cross border currency
conversions. All products are authentic brand names and will
include a product information insert in English.Medical
Information:PROPECIA is indicated for the treatment of male
pattern hair loss (androgenetic alopecia) in MEN ONLY. Safety
and efficacy were demonstrated in men between 18 to 41 years of
age with mild to moderate hair loss of the vertex and anterior
mid-scalp area. Propecia is a remedy for baldness in men with
mild to moderate hair loss on the top of the head and the front
of the mid-scalp area. It increases hair growth, improves hair
regrowth, and slows down hair loss. It works only on scalp hair
and does not affect hair on other parts of the body.
$93.84

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Natural
Progesterone
USP This drug. which is probably
unavailable in the UK, has a small but vocal group oftranssexual
adherents in the USA, who claim that it is superior to other
progestogens. The present authors have been unable to find any clinical
data to support this claim; while it appears to be free of virilising
effects, first-pass effects are liable to make it relatively ineffective
relative to dydrogesterone, which is also non-virilising. The main
problem with 'Natural Progesterone' is that it is largely destroyed by
the digestive tract and liver upon ingestion, so very large doses
(hundreds of milligrams) are used. Since the precise percentage of the
drug metabolised in this way is variable and unknown, the actual serum
levels obtained are unpredictable.
Synthetic Progestogens
This heading covers substances such as
levonorgestrel and norethisterone, which are usually found in combined
contraceptive tablets, usually with ethinyloestradiol. Contraceptive
pills provide a useful low-cost source of feminising hormones for
patients who have to pay for their own medications, but of course the
patient is limited to the combinations of substances available, and
cannot 'mix and match' as one can with separate oestrogen and
progestogen drugs. Care should be taken with some preparations (for
example, Brevinor) as they contain too high a ratio of progestogen to
oestrogen, so that taking enough tablets to obtain a suitable dose of
oestrogen would result in a dangerously high intake of progestogen.
One combined tablet that has been used widely in the treatment of
transsexual patients is Ovran; a typical pre-op dose of two tablets
daily gives 100ug of ethinyloestradiol and 500ug of levonorgestrel. Most
patients tolerate this well, and it generally produces satisfactory
feminisation, but levonorgestrel appears (anecdotally) to give more
frequent problems with water retention, hypertension and weight gain
than medroxyprogesterone acetate. Safety fears have also been raised in
the past about levonorgestrel-based contraceptive implants. Some
patients experience virilising effects with norethisterone or
levonorgestrel, which may impair the feminising effects of oestrogen. If
this is suspected then an alternative progestogen should be tried.
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ANTIANDROGENS, GnRH
AGONISTS AND ORCHIDECTOMY
Hormone treatment in
pre-operative male-to-female subjects is normally supplemented
by some form of antiandrogen treatment. While oestrogens and
progestogens are to some extent antiandrogenic in themselves, a
number of other methods exists to suppress the effects of
androgens and make the feminising hormones more effective
without having to administer the latter in unreasonably high
doses. These treatments also, of course, cause a significant
reduction in male sex drive (and indeed sexual function), which
is generally considered highly desirable by transsexual
subjects. There are three approaches to antiandrogen treatment:
1. Antiandrogen drugs.
2. GnRN (Gonadotropin-releasing-hormone) agonists. 3. Bilateral
orchidectomy (castration).
These treatments are not
applicable to patients who are post-operative, as their bodies
will, by definition, be incapable of producing gonadal
androgens. Adrenal androgens are produced in small amounts by
both sexes, and no attempt should be made to suppress them
unless a serum androgen test has indicated significant
overproduction, as in cases of adrenal hyperplasia. In general
it is considered unwise to administer antiandrogens to
post-operative subjects (and indeed to severely hypogonadal
subjects such as certain intersexed patients), as the small
amount of adrenal androgens remaining in such subjects are
necessary for normal functioning.
Antiandrogen Drugs
These drugs either inhibit
gonadal androgen production, interfere with androgen receptor
sites, or both. Most are likely to produce some side effects in
effective doses; some patients cannot tolerate some or all
antiandrogen drugs, in which case bilateral orchidectomy is
likely to be a preferable treatment. The effect of these drugs
on fertility and male sexual function is reversible to an
extent, however (like feminising hormones) irreversible
infertility may ensue after some months of treatment. All
antiandrogen drugs, like feminising hormones, must be withdrawn
prior to major surgery This may lead to a degree of reversion
towards masculinity, which may be pronounced and disturbing in
some patients.
Casodex ( Generic Bicalutamide ) -
Product Origin: EU (Turkey) 50mg 28 Tablets ASTRA ZENECA Product
Origin: EU (Turkey) Medical Information: Bicalutamide is an
antiandrogen. It works in the body by preventing the actions of
androgens (male hormones). Bicalutamide is used in the treatment
of prostate cancer. Nonsteroidal antiandrogens are used to treat
cancer of the prostate gland. The prostate gland is present only
in males; therefore, females do not get prostate cancer. CASODEX
50 mg daily is indicated for use in combination therapy with a
luteinizing hormone-releasing hormone (LHRH) analogue for the
treatment of Stage D2 metastatic carcinoma of the prostate.
$296.00

Androcur Cyproterone Acetate
This drug (brand names Androcur,
Cyprostat) is widely regarded as the antiandrogen of choice by
practitioners in Europe (it is not approved in the USA). It is
an androgen receptor antagonist and weak gonadal androgen
production inhibitor;
normal dose is 50mg daily, which may be increased to 100 or in
exceptional cases 150mg daily if required. In these doses there
are some risks associated with the drug, particularly a
heightened risk of thromboembolic disease or liver damage.
Carbohydrate metabolism changes are also reported; patients
should receive regular blood tests (LFT and fasting glucose) and
BP checks. Possible side effects include severe lassitude, loss
of concentration and depression, also weight gain and nausea.
Anecdotal reports suggest that the side effects can be lessened
by taking the drug after meals; opinions differ as to the best
time of day to take a single dose to minimise the tiredness
effect: patients are best advised to experiment for themselves,
though after lunch or after the evening meal seem to be the
usual choices.
Flutamide
This is a relatively new drug
which has been used with success in some transsexual patients,
particularly those who have experienced unacceptable side
effects with cyproterone. There is relatively little clinical
data available for this drug in transsexual patients. It is a
strong androgen receptor antagonist. Like cyproterone it can be
hepatotoxic, it can also have significant adverse haematological
effects (reduced platelet, leukocyte or erythrocyte count) or
cause hypertension, and it can also produce less serious side
effects such as fluid retention. Regular LFTs and blood checks
are advisable when using this drug. This drug also produces
psychological side effects which can be severe in some patients.
Depression, anxiety or nervousness can be extreme, and patients
should be made aware of this possibility Lassitude, insomnia and
gastrointestinal disturbances have also been reported. Typical
dose is 250mg to 750mg daily (one to three 250mg tablets).
Spironolactone
This drug was originally
developed as an antihypertensive/diuretic; it is also a weak
androgen receptor antagonist. It is much less effective as an
antiandrogen than cyproterone or flutamide, but can find use in
patients who have hypertension or severe fluid retention, either
pre-existing or as a result of hormone treatment. Side effects
may include lassitude, loss of concentration, and various
gastrointestinal problems. There is a risk of potassium
retention. Doses range typically from 100 to 400mg daily.
GnRH Agonists
These drugs take a different
approach to antiandrogens: they act on the pituitary, initially
overstimulating it and then rapidly desensitising it to GnRH.
The effect of this is that over a period of weeks, gonadal
androgen production is greatly reduced. Their principal
advantages are that they are generally fullly reversible in
their effects, which makes them a useful treatment in adolescent
subjects where it is desired to stall the changes of puberty but
not desired to induce permanent feminisation until the subject
is older; and that they do not carry the risks of thromboembolic
disease associated with antiandrogens. This can be particularly
useful when hormones/antiandrogens are withdrawn prior to
surgery - GnRH agonist treatment can be used to minimise the
reversion to male biochemistry that many transsexual subjects
find deeply disturbing. GnRH agonists do carry risks of
significant side effects and should be used with great caution.
There is as yet relatively little clinical data on the use of
these substances in transsexual subjects, particularly in
long-term use.
Nafarelin
Acetate Normally administered
as a nasal spray (typical dosage 1600l.tg daily). May cause
depression, insomnia. skin problems and other side effects.
Being administered daily, the drug can easily be withdrawn
should side effects occur.
Goserelin Acetate
Administered as a depot (i.e.
time-release) injection (typically 3.6mg monthly). Reported
adverse effects include heart failure, obstructive pulmonary
disease and severe allergic reactions as well as more minor side
effects such as lethargy and nausea. In view of the fact that it
is a depot injection, this drug should be treated with caution
as it cannot be rapidly withdrawn should problems occur.
Leunrorelin Acetate
Similar to Goserelin Acetate,
with a typical dose of 3.75mg every 4 weeks. This drug has been
used to good effect in adolescent subjects. Allergic reactions
and other side effects have been reported.
Bilateral Orchidectomy
Orchidectomy offers several
advantages over antiandrogen or GnRH-agonist therapy: After
orchidectomy, the patient is endocrinologically equivalent to a
post-operative subject. This has clear safety advantages
especially in patients thought to be at elevated risk of
thromboembolic events. Some patients report transient lethargy
as their body adapts to the loss of androgens, but all the side
effects associated with antiandrogens or GnRH agonists are
eliminated. There are some disadvantages to orchidectomy such as
irreversibility and shrinkage of scrotal tissue. Bilateral
orchidectomy normally requires a referral from a psychiatrist;
some surgeons may require a second opinion from an independent
psychiatrist.
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| FTM
- FEMALE TO MALE Transgender Men - TESTOSTERONE MALE HORMONES |
Male hormones produce speedy results. It only takes a few injections
fortnightly, of Sustanon 250 for periods to cease. At around 4 months
your voice should start to become more masculinised, and will continue
to change for the first 12 months. This is irreversible so a great deal
of thought should be considered before entering into such a regime -
speak to you family doctor and preferably a specialist in gender
identity disorders before undertaking this.
Common dosage:
First 3 to 5 years: Sustanon 250 every 14 to 21 days (depending upon
build)
Post-Hysterectomy, or after 5 years: Sustanon 100 every 10 to 14 days,
or Sustanon 250 every 3 to 4 weeks.
Citation: Free University of Amsterdam

Sustanon Amps 250mg 250mg 1 Amp 1ml
Schering-Plough Sustanon 250 is an oil-based injectable containing four
different testosterone compounds: testosterone propionate, 30 mg;
testosterone phenylpropionate, 60 mg; testosterone isocaproate, 60mg;
and testosterone decanoate, 100 mg.The mixture of the testosterones are
time-released to provide an immediate effect while still remaining
active in the body for up to a month. As with other testosterones,
Sustanon is an androgenic steroid with a pronounced anabolic effect.
$46.00

Sustanon Amps 250mg 250mg 5 Amps 1ml
Schering-Plough Sustanon 250 is an oil-based injectable containing four
different testosterone compounds: testosterone propionate, 30 mg;
testosterone phenylpropionate, 60 mg; testosterone isocaproate, 60mg;
and testosterone decanoate, 100 mg.The mixture of the testosterones are
time-released to provide an immediate effect while still remaining
active in the body for up to a month. As with other testosterones,
Sustanon is an androgenic steroid with a pronounced anabolic effect.
$184.00

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