MTF Transgender Hormone Therapy for “my attraction and behavior is like a female”


Dear Nancy,

Good afternoon Nancy,

Yes, we do transgender hormones.  A letter of therapy clearance is required by a licensed
therapist with a doctoral degree.  Our fee is 250 for consultation, and 600
per year to follow you with needed lab tests, office visits, prescriptions,
counselling, numerous telephone calls, and medical records documentation.
The 600 fee is billed 3 months after your initial visit.

Lab tests are an out of pocket expenses as is the medication.  We may
recommend a laboratory, but you can have them done at a nationally recognized
laboratory of your choice.

(courtesy of TransCare, TransGender Health.CA)…

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 booklet 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 Trans Care Gender transition Hormones: A guide for MTFs Already sure you want to start hormones? The booklet Getting Hormones, available from the Transgender Health Program (see last page), explains the process. 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 booklet 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. For medical professionals who are involved in prescribing hormones or are looking after the health of someone who is taking hormones, there is a detailed set of guidelines for doctors and nurses available from the Transgender Health Program (see last page). How Hormones Work 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 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 works in “typical” women’s bodies. We keep these terms in quotes to emphasize that they are artificial and imperfect concepts. look and feel less “masculine” and more “feminine” – making your body more closely match your identity. What Medications Are Involved for MTFs? 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. 1. Estrogen 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. 3 2. Anti-androgens (also known as androgen blockers or androgen antagonists) 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. 3. Progestagens 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, or • as a replacement for estrogen if there are concerns about estrogen’s side effects or health risks, or • 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.


Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami


Image result for image male breasts on estrogen

Transgender MTF Hormone Therapy Effect


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