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HORMONE THERAPY: FEMALE-TO-MALE HRT

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As the author of this site is not personally interested in being male, HRT for that purpose is not something that is of great interest, so information in that regard is a bit lacking on this site (sorry).

Pharmcological Management of Low Tesosterone

Otherwise referred to as "Testosterone Replacement Therapy" or TRT. This information was not obtained from a resource on F2M HRT but for males and intersexed persons with diminished testosterone.

DRUG CATEGORIES

Aromatase Inhibitors:

[these prevent the Aromatase Enzymes from converting Tesoterone or Testosterone-like steroids into Estrogen]

  • aminoglutethimide (Cytadren, Orimetene) - can NOT be self-administered
  • Anastrozole (Arimidex)
  • Weight Loss - probably the most overlooked way to reduce aromatase enzyme. The enzyme only exists in "adipose" (i.e., fatty) tissues within the body. Reduction of fat subsequently reduces the amount of enzyme available to catalyze testosterone into estrogen.

Androgen Alternates that do not Aromatize:

[When they cycle the hormones to prevent building up a tolerance, these are ones that don't get converted into Estrogens by Aromatase Enzymes at all. However, these do not prevent existing androgens from being "aromatized."]

  • oxymetholone (Anadrol)
  • norethandrolone (Nilevar)
  • Methenolone (Primobolan)
  • stanozolol (Winstrol)
  • dromostanolone (Masteron)
  • oxandrolone (Anavar)
  • mesterolone (Proviron)
  • stenbolone (Anatrofin)
  • trenbolone
  • DHT (excessive use can cause prostate swelling)

Androgens that DO Aromatize:

[A portion will be converted to estrogens. The percentage is determined by the concentration of aromatase enzymes.]

  • Testosterone
  • methandrostenolone (Dianabol)
  • boldenone (Equipoise)
  • fluoxymesterone (Halotestin) [only to be used in low doses anyway]

Anti-Estrogens/Estrogen Receptor Blockers:

[These are used to prevent the Estrogen that IS present from having any effect on body tissues]

  • tamoxifen (Nolvadex)
  • clomiphene (Clomid/Omifin)
  • Cyclofenil
  • Raloxifene (Evista)

Drugs which are inadvisable:

[These are popular "body building" drugs which are counterproductive to TRT management]

  • Nandrolone decanoate (aka Deca Durabolin or nortestosterone)
    Popular alternate when cycling hormones, but is actually a potent PROGESTIN, not an Androgen.
  • Human Chorionic Gonadotrophin (HCG)
    Boosts BOTH Estrogen and Testosterone levels significantly. HCG only stimulates natural testicular output briefly [a few days. Chronic use of HCG may shut down natural testosterone production by negative feedback signalling and thereby blocking the brain-pituitary gland production of LH.

SIDE EFFECTS

General Potential side effects and risks of undergoing TRT treatment:

  • Increase in skin conditions (scarring acne, premature skin aging, or skin cancers)
  • Increased libido (i.e., "sex drive")
  • Male pattern baldness
  • Increase in lean muscle mass
  • Decrease in fatty tissues
  • High blood pressure (hypertension) for those predisposed to it.
  • Increased risk of stroke or heart attack if dosages are high
  • Increased risk of testicular or prostate cancers (obviously not for F2Ms)
  • Potential testicular failure (again, obviously not for F2Ms)
  • Increased aggression or violent mood swings for those prone to emotional disorders
  • Reduction of HGL (i.e., "good") cholesterol, requiring alteration to diet
  • Insomnia for those predisposed to sleep disorders
  • Sweating spells (i.e., "Hot Flashes") at the beginning and/or end of each therapy cycle

POSSIBLE TRT REGIMENS

For Androgen Replacement (with common side effects):

Anadrol - This is an anabolic steriod! It will not be converted into estrogen within the body, but has the potential for liver failure or hemorrhaging. Blood lipid changes caused by Anadrol lead to atherosclerosis and coronary heart disease with sustained use. Jaundice, with or without pruritus, can also occur. Prostatic hypertrophy is also common among biological males, this obviously wouldn't be a concern for F2Ms.

Testosterone (most likely topical or transdermal for biological males, usually via intramuscular injection for F2Ms) - Male pattern baldness, excessive body hair growth, significant increase in acne with the potential for permanent scarring. Also common are an increase in blood pressure, prostate swelling (again, pertains only to biological males) with accompanying difficulty urinating, extreme mood swings, and severe changes in libido. Large doses can lead to yellowing of the eyes or full juandice. On the plus side it increases lean muscle mass and boosts energy levels. There are different options for this part of TRT therapy:

Androderm, Testoderm - transdermal patches

Testosterone Enathate (Delatestryl) plus many generic makers -intramuscular injection. Schein/Steris Pharmaceuticals stopped making this, which has limited the supply to generic makers as well, btw.

Testosterone Cypionate (Depo-Testosterone) another injectable with the price affected by the Shein/Steris discontinuation, but still available from other makers. It is an "ester" of testosterone that acts on the body like the real deal (apparently).

Enathate and Cypionate are essentially the same effectiveness as Depo-Testosterone, according to the Physician's Desk Reference (PDR).

All of the above are considered the same as endogenous testosterone. The "synthetic" available is:

Methyl Testosterone (Testred or Verilon)

For Enzyme Inhibiting (with common side effects):

The following may be included if male pattern balding is a problem or if body and facial hair is too excessive.

Arimidex - (inhibits Aromatase Enzyme conversion of Testosterone to Estrogen). Side effects often include some of the following: dizziness, fainting spells, nausea, vomiting, loss of appetite, headache, skin rashes, gastrointestinal pain, diarrhea, fatigue, sleeping disorders, and depression.

Finasteride (Propecia) - (inhibits 5alpha-reductase enzyme conversion of Testosterone to DiHydroTestosterone, DHT). Common side effects include a decreased libido, decreased volume of ejaculate, impotence, and breast tenderness or enlargement.

For Estrogen Agonist/Antagonist (with common side effects):

Tamoxifen (Nolvadex)- headaches, vertigo, blood thinning, leg pain and swelling, shortness of breath, blurred vision

Arimidex - primarily prescribed for enzyme inhibition, but also has an anti-estrogenic effect.

Alternates may be selected from the listing above IF there is any allergic reactions or to see if side-effects of the first choice were severe and were less severe or absent using a less desireable alternate.

OTHER F2M TRT RESOURCES

For detailed information on hormone replacement therapy for F2M transsexual people, please refer to the Hormone FAQ at the following URL:

Specific Drug Info

http://www.gender-id.com (off site link)

Also see:

Male Hormone Replacements (off site link)

http://www.trans-health.com (off site link)

Transsexual HRT Study (PDF file on this site)

HRT Regimens by Dr. Anne Lawrence (PDF file on this site)

HRT Regimens by Dr. Thomas Waddell (PDF file on this site)
Note: F2M specific information is on pages 11 & 12

HRT Regimens by Dr. Jamie Feldman (PDF file on this site)
Note: Refer to Table 4 on page 2
More info: Minnesota Medical Association (off site link)

Hormonal Sex Reassignment by LJG Gooren (off site link)

 

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