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Frequently Asked Questions? FAQs

How long does it take, if at all, to determine a reaction from hormones?

There is ALWAYS a reaction to taking cross sex exogenous hormones. If the individual has a history of gender dysphoria or as I would prefer to call it, Gender Expression Deprivation Anxiety, the primary reaction is a relaxing one. That is the individual experiences feelings of well-being as the anxiety is relieved. If a non gender dysphoric person is exposed to cross sex, exogenous hormones, the opposite occurs; a state of anxiety is induced that goes away once the hormones are no longer being taken. The time period for all of this to occur is very short, ranging from hours to no more than a few days.

The other, more physical changes take longer and are not easily reversible. If a genetic male takes estrogens, he will start to notice tenderness in his nipples in a matter of weeks as the first signs of breast development. The rest of the feminization will gradually happen over the rest of the period he continues to take the hormones. Depending on the person's age and level of male development at the start of the process, it usually takes six to twelve months before the changes are so advanced that friends and acquaintances would notice and may start to inquiry about your appearance. Of course, a spouse or lover would notice much sooner.

In genetic females that take androgens, the physical changes are far more profound and happen very quickly. Menses stop within the first or second scheduled periods and there will be a strong and profound increase in libido. Within the first few months beard growth, body hair and voice changes begin to be obvious to the casual observer. FTMs often speak of experiencing general body pain as male pattern muscles start to develop.

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I am a TV/CD with feelings of being TS. I recently learned that I have minor Obsessive Compulsive Disorder (OCD) tendencies. Is there a connection with being OCD and being TS? If so will medicines to help being OCD at least reduce my TS feelings?

Although in the past I have worked with one or two individuals who had clinically severe OCD along with TS feelings, the conditions are not generally associated with each other. I know that it may seem that your need to crossdress is a bit compulsive and perhaps you obsesses over wanting to be the opposite sex, but that is not really the same as obsessing over everyday factors such as germs on your hands or if you shut off the stove 20 times a day. Whatever the level of OCD, medication (usually an SSRI antidepressant) has not been shown to have any appreciable effect on reducing TS feelings.

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I am 53 years old an am struggling to come to terms with being a transsexual. I was reading a web site that said you had written an article about confronting one's gender issues "before it is too late". I looked for it on your web site but couldn't find it. Could you direct me to it, please?

I am not at all certain as to what essay the author of the web site was referring to. Although I think I know what the author means, I would never advise anyone to transition "before it is too late". First of all I have never advised anyone to transition. That is a decision only the individual can make. If a client of mine decides to transition then I am there to help him or her through it. I can, however, tell you that the median age of my current client load of MTFs is about 48. As you might expect, the problems a 48 year old MTF has far exceeds those of someone younger who has not had the time to become so heavily invested (family and career obligations) in being male.

Other than that, if I recall correctly, there is a section in the following essay of mine that deals with mid-life issues. Check it out. http://www.avitale.com/developmentalreview.htm

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One question for my wife. She would like to know --after we read your entire site - if antidepressants could help make a TS happy enough to not care whether they are TS, or need to transition. Basically it's become a life or death issue for me. I know I can't continue living like I am. Its taking it's toll on my mental well-being. I know we are grasping at straws, and I'm sure we are not the first to ask this, but is getting on zoloft, welbutrin, or any other antidepressant a viable option? Has it been tried? Does it work?

Your question regarding antidepressants (SSRIs) is very common. Antidepressants-- usually prescribed by a primary care physician these days-- is usually the first thing most males try before they come into see me or any other gender specialist. No doubt SSRIs have some mitigating effect on mood but they are, at best, a Band-Aid. Since depression in gender dysphoric males is secondary to their gender issue, the underlying problem continues to persist. We know that to be true because estrogen (which is something of an antidepressant itself), even in moderate doses, routinely resolves both the dysphoria and the depression while SSRIs alone do not. I know this answer leads to further concerns but that is an issue that needs to be addressed in person between you and a therapist. I hope this has led to some clarification.

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I have read your web site and the FAQ. There is much to consider and understand. I think that I have some form of GID. Sometimes I want to be a woman, and sometimes I really love being a man. I often tell people that if I had a choice between male and female I would choose neutral, the qualities of both sexes. Why can't I be both? Or maybe, how can I be both? Is this like trying to have your cake and eat it too?

Millions of people live their lives somewhere other than at the extremes of the male/female binary. This includes people you pass on the street each day. Legally you have to choose one or the other-- male or female-- but privately, where it really counts, just do what comes naturally. It is a little discussed fact but because cross sex hormones effect the brain so drastically, it is exactly the state everyone who transitions will come to find themselves in. They may look like the gender they had aspired to--and that is very satisfying-- but in reality they have become a being who is now both male and female, free to express as much of each side as they like. In effect they do indeed have their cake and eat it to (at least as far as gender expression goes).

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Nothing on this site should be viewed as providing therapeutic advice. No formation of a client/therapist
relationship with Dr. Vitale is intended or to be implied or inferred. The information provided in this site is for educational
purposes only. I attempt to keep the information current but make no representation or warranties in that regard. You should
not rely upon this information as a substitute for consul with a qualified mental health professional.