This site is not intended to provide medical advice, diagnosis, treatment, or prevention.
The products, information, services, and other content provided on and through this Site, including information that may be provided on the Site (directly or via linking to third-party sites by a healthcare or nutrition professional, are provided for informational purposes only.
Please consult with your physician or another healthcare professional (collectively, “Healthcare Professional”) regarding any medical or health-related diagnosis or treatment options.
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Information sources and citations:
© February 2006 Vancouver Coastal Health, Transcend Transgender Support & Education Society and Canadian Rainbow Health Coalition
Part of the content on this website was written by Olivia Ashbee and Joshua Mira Goldberg as part of the Trans Care Project, a joint effort of Transcend Transgender Support & Education Society and Vancouver Coastal Health’s Transgender Health Program.
We thank the Canadian Rainbow Health Coalition and Vancouver Coastal Health for funding this project.
We also thank Jacqueline Allan, Fionna Bayley, Dr.Marshall Dahl, Emily Hodge, and Sam Larkham for their input.
Web: http://www.vch.ca/transhealth
The Transgender Health Program is an anonymous and confidential free
service for anyone in BC who has a trans health question or concern.
Services for trans people and loved ones include:
• Information about trans advocacy, medical care, hormones, speech change, and surgery
• Help to find health/social services, and help to navigate the trans health
system
• Non-judgmental peer counseling and support
• Information about trans community organizations and peer support
groups
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Estradiol Pills (Progynova)
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Spironolactone (Aldactone)
Androcur
Estradiol Patches (Climara Forte)
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Male To Female Hormone Transition Guide
While there are some health risks involved with hormone therapy, it can have positive and important effects on trans people’s quality of life.
Knowing what you can expect will help you work with your health care providers to maximize the benefits and minimize the risks.
The purpose of this website is to:
• explain how hormones work
• describe the changes to expect from MTF1 hormones, and outline risks and possible side effects
• give you information about how to maximize the benefits and minimize the risks
1. We use “MTF” as shorthand for a spectrum that includes not just transsexuals, but anyone who
was assigned male at birth and who identifies as female, feminine, or a woman some or all of
the time.
Some non-transsexuals (androgynous people, drag queens, bi-gender and multigender people, etc.) may also want hormone therapy, and may not identify or live as women.
For this reason, we use the term MTF instead of “trans women.”
This website is written specifically for people in the MTF spectrum who are considering taking hormones.
It may also be a helpful resource for partners, family, and friends who are wondering how hormones work and what they do.
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How Hormones Work For Male To Female Transitioning
Hormones are chemical messengers produced by one part of the body to
tell cells in another part of the body how to function, when to grow, when
to divide, and when to die.
They regulate many functions, including growth, sex drive, hunger, thirst, digestion, metabolism, fat burning, and storage, blood sugar and cholesterol levels, and reproduction.
Sex hormones regulate the development of sex characteristics – including
the sex organs that develop before we are born (genitals, ovaries/testicles,
etc.) and also the secondary sex characteristics that typically develop at
puberty (facial/body hair, bone growth, breast growth, voice changes, etc.).
The three categories of sex hormones that naturally occur in the body are:
• Androgens: testosterone, dehydroepiandrosterone (DHEA),
dihydrotestosterone (DHT)
• Estrogens: estradiol, estriol, estrone
• Progestagens: progesterone
Generally, “males” 2 tend to have higher androgen levels, and “females” 2
tend to have higher levels of estrogens and progestagens.
There are various types of medication that can be taken to change the
levels of sex steroids in the body. Changing these levels will affect fat
distribution, muscle mass, hair growth, and other features that are
associated with sex and gender.
For MTFs this can help make the body.
2. The binary terms “male”, “female”, “masculine”, “feminine”, “masculinizing”, and “feminizing” don’t accurately reflect the diversity of trans people’s bodies or identities.
But in understanding how hormones work for trans people, it is helpful to understand how testosterone works in “typical” (non-intersex, non-trans) men’s bodies, and how estrogen and progesterone work in “typical”
women’s bodies.
We keep these terms in quotes to emphasize that they are artificial and
imperfect concepts.
What Medications Are Involved for MTFs?
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Various kinds of medication can be used to change the levels of sex
hormones in your body.
Some work on the part of your brain that stimulates sex hormone production, some work on your testicles (which produce testosterone), and some work directly on the cells in your body that respond to sex hormones.
Some of these medications are also hormones, and some are another type of chemical.
Typically MTF hormone therapy involves estrogen, medication to block
testosterone or a combination of the two. Sometimes a progestagen is
added to the mix.
Estrogen For Male to Female Transition
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Estrogen is the main hormone responsible for promoting “female”
physical traits.
It works directly on tissues in your body (e.g., makes breasts develop) and also indirectly suppresses your testosterone.
Estrogen can be taken in different ways:
• pill (oral application)
• skin patch or gel (transdermal application)
• injection (intramuscular application)
For reasons that aren’t understood, estrogen seems to cause blood clots
less when it is taken through the skin rather than by pills or injections.
For this reason, transdermal estrogen is usually recommended to anyone
who is over age 40, a smoker, or otherwise at risk for blood clots.
Transdermal estrogen also tends not to elevate triglycerides (a type of fat
in the blood) as much as estrogen taken by pill/injection, so it is
recommended if you are at risk of heart disease or stroke.
There are different chemical formulations of estrogen. Usually 17-betaestradiol (patch = Estradot®, Estraderm®, or Oesclim®; pill form =
Estrace®) is used because it has the least health risks.
Conjugated estrogens (e.g., Premarin®) and ethinyl estradiol are not recommended because studies of non-trans women have shown them to increase the risk of some types of health problems.
Anti-androgens; also known as Testosterone blockers, Androgen blockers, or androgen antagonists
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Anti-androgen drugs work by blocking the effect of testosterone.
This reduces “male” physical traits and has a mildly “feminizing” effect.
For example, they will help slow “male”-pattern baldness, reduce growth of
facial hair, and stop spontaneous/morning erections.
There are different types of anti-androgens.
The ones most typically prescribed to MTFs are spironolactone (Aldactone®) and finasteride (Proscar®).
Cyproterone (Androcur®) can be used, but risks include depression and liver enzyme elevation so spironolactone is generally preferred.
Anti-androgen drugs are often prescribed in addition to estrogen, as the
two have effects that complement each other.
Taking anti-androgens reduces the amount of estrogen you need to get the same effects, which minimizes the health risks associated with high doses of estrogen.
Antiandrogen drugs can be prescribed alone for MTFs who want to reduce
“masculine” characteristics for a more androgynous appearance, as it’s
less “feminizing” than estrogen.
Progestagens
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There are mixed opinions about using progestagens (e.g., Prometrium®,
Provera®) for MTFs.
Most trans health programs around the world don’t
use progestagens due to the lack of clear evidence that they are important
in “feminization,” and the known side effects (which include depression,
weight gain, and changes to blood fats).
Other doctors use progestagens:
• To supplement estrogen if estrogen isn’t working even at the maximum dose.
• As a replacement for estrogen if there are concerns about estrogen’s
side effects or health risks
• Because they believe that progestagens help with nipple development
As with estrogen and anti-androgens, balancing possible risks and
benefits of progestagens is a decision between you and your health care
provider.
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