Faq

I have heard that one of the uses of hormone replacement therapy is to see if the individual accepts or rejects the treatment. In your experience (or in other documented sources) where there was a rejection, what are the responses?

First of all, keep in mind that a referral for hormone replacement therapy is made with great caution. Individuals are not only evaluated for severity of gender variance but they are educated to the effect the hormones will have on them. Most of the people I see come in very aware of the effect HRT will have on their secondary sex characteristics but few are aware of the general health risks and the psychological effects they will experience. For example, I explain to all my clients MTF clients that paradoxically taking estrogen will diminish not only their libido, it will diminish their need to crossdress. I know that is counterintuitive but it is a fact.
I also warn them that getting on estrogen can result in a sense of well being that leads to a strong desire to continue taking it. They had better be prepared for that consequence. A similar feeling of well being is reported by FTMs on testosterone.

I am not aware of any documented study of people rejecting HRT but an informal review of four of my colleagues show that out of the 1500 plus people we have collectively seen over the last 20 plus years, there have only been a handful of people who have stopped HRT once they have started. Two of us had patients who stopped because they complained that it reduced their libido and it decreased their desire to crossdress. Two of us report where a client has been frightened off after their breasts began to develop. One of my clients eventually had an orchiectomy and had his small breast development removed surgically and continues to live in the male gender role. One of my colleagues reports a similar experience with his client also having a double mastectomy.

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What does hormone therapy involve?

Male-to-female patients treated with estrogens can expect to experience: breast growth, some female-like redistribution of body fat, softening of the skin; a decrease in body hair, decreased upper body strength, decreased fertility and testicular size, less firm and harder to achieve erections. More importantly, most individuals report a relief from their gender dysphoria and a feeling of well-being.

Female-to-male patients treated with testosterone also report a relief from their gender dysphoria and a feeling of well-being. They can expect the following permanent changes: a deepening of the voice, clitoral enlargement, appearance of facial and body hair, and depending on their age the possibility of male pattern baldness. Reversible changes include: stopping of menses, weight gain, increased upper body strength, increased libido, decreased hip fat, courser, oily textured skin and mild acne at least at first.

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I am considering trying female hormones and would like to know if the shrinking of the male genitalia is permanent or not. If I choose not to continue towards changing sex from male to female, are there any permanent effects using female hormones?

First of all, this is a question you should be asking your therapist and/or endocrinologist. Do not take hormones unsupervised! However, I will say this, when a genetic male takes estrogen he will experience permanent breast growth almost immediately. He will also experience minor shrinking of the penis and the testes if he takes it for an extended period. All other hormonal changes are reversible.

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How will hormones affect the emotional state of someone undergoing transition?

Hopefully in a positive way. That is the whole idea. When estrogen is given to a gender dysphoric genetic male and testosterone to a gender dysphoric genetic female the usual result is an overwhelming feeling of well-being and an often dramatic increase in ability to function.

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I heard that most surgeons require that their MTF patients go off all HRT a few weeks prior to surgery. Is that true? If so why?

Yes it is true. In the one to two years (and in some cases longer) period leading up to surgery, genetic males require very large doses of feminizing estrogens in order to overcome the androgenic effects of their testicles. Estrogens even in the low doses commonly given to menopausal women are widely known to be a possible cause of blood clots. By having the individual go off HRT for a short period prior to surgery reduces the risk of the formation of clot's that might form during the surgery. If blood clot's form, there is the danger that one or more will get into the blood stream where they can migrate to other areas of the body causing serious ancillary damage such as a stroke.

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