NOTE: The
information on this page and the pages for each medication were
originally published online at www.savina.com in the "FAQ:
Hormone Therapy for M2F Transsexuals" by Confluence
Publications. The aforementioned web site seems to have folded,
however. The new definitive location for the FAQ is www.gender-id.com,
but the following detailed drug information is not included at
the new site. As this information is highly sought after in the
Transgender Community a copy of a portion of that FAQ is being
reprinted here. Information not included in the original has also
been added.
Estrogens
The following
estrogens are popular for treatment of male-to-female transsexuals:
Other prescription
estrogens are available; however, they are mixed with other
drugs, or are intended only for treatment of inoperable cancer,
and are therefore not as suitable for treatment of transsexuals.
The reason
this document specifies estradiol cypionate as potentially less
safe than estradiol valerate is that ec is much stronger and
longer-lived, putting the author in mind of the stimulation
of liver-based enzyme/clotting factors--and attendant thrombosis
risk--when recirculated many times like ethinyl estradiol. Plain
(natural) estradiol is also be considered excellent in safety
if delivered via a non-oral method.
The following
natural sources of phytoestrogens (estrogen-like compounds)
have been identified, but the author is not aware of an effective
course of treatment using them. They work by weakly binding
to estrogen receptors. In males, this may result in a mild feminizing
effect (in females, it may give the opposite result, that is,
a mild androgenic effect, since the phytoestrogens are competing
with endogenous true estrogens for the estrogen receptors).
Since phytoestrogens are not nearly as efficacious as true estrogens,
huge and potentially toxic amounts of these items would have
to be consumed. They are presented in alphabetical order: Black
Cohosh (Cimicifuga racemosa), Blue Cohosh, Borrage, Butterfly
Weed, Caraway, Chaste Tree or Vitex (Verbenaceae species), Dates,
Dill, Dong Quai (Angelica sinensis), False Unicorn root, Fennel
seed, Fenugreek, Ginseng, Goats Rue, Gotu Kola, Licorice root,
Linseed or Flaxseed, Milk thistle, Motherwort, Pennyroyal (Hedeoma
pulegioides), Pleurisy root, Pomegranates, Red Clover Sprouts,
Red Raspberry leaf, Southernwood, Soya Flour, Tansy.
Preparations
advertized to contain "raw ovaries" from any animal have not
been proven to be effective.
Progesterone
and Progestins
The following
progesteronic compounds are popular for treatment of male-to-female
transsexuals and are presented in descending order of preference
in the humble opinion of the author:
Dydrogesterone
and hydroxyprogesterone caproate are both synthetic analogues
of progesterone. This makes them less objectional than other
progestins on the market, which seem to be more closely analogued
to testosterone.
* Dydrogesterone
detail page is not as complete. It was missing on the source
site from which this FAQ was copied. Nonetheless I have done
my best to locate information on this drug and provide a data
sheet on it in similar format to the others. If I ever locate
the missing original page I'll replace mine with it. - GID.info
Editor
The following
natural sources of phytoprogesterones (progesterone-like compounds)
have been identified, but the author is not aware of an effective
course of treatment using them. Since phytoprogesterones are
not nearly as efficacious as true progesterone, huge and potentially
toxic amounts of these unrefined items would have to be consumed.
They are presented in alphabetical order: Suma, Vitex, Wild
or Mexican Yam.
Anti-androgens
The following
anti-androgens are popular for treatment of pre-operative male-to-female
transsexuals. They are presented in descending order of preference
in the humble opinion of the author:
Table
6 Note 1: Although it is not a general anti-androgen, finasteride
coadministered with estrogen, topical minoxidil 5%, and topical
Retin-A, is very helpful to halt--and in some cases, partly
reverse--male-pattern baldness. Many people report that finasteride
also helps to reduce excess body hair because it blocks Type
2 5-Alpha-Reductase activity.
Table
6 Note 2: Dutasteride also is not a general anti-androgen.
Like finasteride it reduces DHT associated with excessive body
hair and male-pattern balding. In clinical studies Dutasteride
has been found much more effective at inhibiting both Type 1
and Type 2 5-Alpha-Reducatase enzymes.
Table
6 Note 3: It was not clear to me if Micronized Progesterone
blocks both Type I and Type II 5-AR or not, but I'm assuming
that it does block both or there wouldn't be a progesterone
receptor on each of those enzymatic isoforms. As one form exists
primarily in skin and the other in organs the method of administration
may be the key to determing efficacy. Oral administration will
effect systemic Type II 5-AR inhibition, while theoretically
transdermal progesterone would target Type I 5-AR inhibition
at the skin level. These are only my guesses, I could not find
any definitive studies.
Table
6 Note 4: Flutamide can be very liver toxic to some people,
especially at high doses and should be used with caution under
a doctor's supervision. Reportedly the newly available Flutamide
Gel is safer because it does not have to first pass through
the liver to enter the bloodstream.
Cyproterone
acetate is a very strong anti-androgen but also causes strong
adverse effects in some people.
Nilutamide
and flutamide have been suggested, but are not entirely suitable
for transsexuals, especially as monotherapy: because of the
way they interfere with normal negative feed-back action of
androgens, they stimulate gonadotropin production and subsequently
androgen production.
Prescription
adrenal androgen production inhibitors are available but not
listed because adrenal androgen production is insignificant
(i.e., about the same as in females) in comparison to gonadal
adrenal production. Adrenal androgens are best ignored, or if
absolutely necessary, countered with finasteride.
Other prescription
anti-androgens are available but not listed because their primary
indication is not as an anti-androgen, and/or because the adverse
effects are dangerous when weighed against the possible benefit.
The following
natural sources of phytoantiandrogens (anti-androgen-like compounds)
have been identified, but the author is not aware of an effective
course of treatment using them. Since phytoantiandrogens are
not nearly as efficacious as true antiandrogens, huge and potentially
toxic amounts of these items would have to be consumed. They
are presented in alphabetical order: Saw Palmetto.
Other Anti-Hormones
(GnRH Agonists)
These pharmaceuticals
can be used to dramatically reduce gonadal hormone production
in both males and females. They are used mainly by pediatricians
to reduce precocious puberty, so it might be difficult to persuade
a doctor to prescribe them for an adult. Also, they are very
expensive. None the less, this type of chemical castration is
worth investigating for those cases when the pre-operative male-to-female
cannot take the hormones of choice because of other health problems
(e.g., hormone dependent tumors or blood clotting disorders),
and cannot yet have the surgery performed (note that such a
problem is quite rare).
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