Hormone Replacement Therapy

[Other life style]

HRT - Transgender Hormone Replacement Therapy


( This artical also in my site L.G.B.T.Q info . israelian proud site)
http://god-gender.blogspot.com/2008/01/hormone-replacement-therapy.html


Introduction
A gender reassignment program for male to female transsexuals normally includes the prescription of feminising hormones, oestrogen and progesterone which develop female secondary sexual characteristics. In addition this may be accompanied before surgery by anti-androgen treatment to reduce the effect of the patient's own male sex hormones. There can be risks attached to hormone therapy in both men and women and therefore it is definitely inadvisable to take any form of hormone product unless it is medically prescribed.
Hormones are made up of molecules derived from steroids, proteins or tyrosine (an amino acid). They become active only when bound to a specific receptor on or inside a target cell.
Hormones derived from proteins bind to receptors on the outside of the cell membrane; steroid and tyrosine hormones pass inside the cell and bind to receptors in the cytoplasm or the nucleus.
The manufacturers of oestrogen and progesterone products specify them for medical use in females and do not acknowledge their use for transsexuals, so there is little clinical data available regarding this usage. The effect of feminising hormones varies between patients, but many experience changes within two to three months such as change in skin tone, development of breasts, expansion of the nipples, redistribution of body fat causing fuller cheeks, a more pronounced waist and fleshier hips and buttocks. Body and scalp hair may change in texture but hormone treatment will not inhibit beard growth or improve male pattern baldness. Emotions may be heightened with a greater tendency to mood swings, but in general the transsexual will feel more comfortable with the new self that is emerging. For this reason hormone therapy can be a useful diagnostic tool, as a male who is not transsexual is unlikely to feel this heightened ease with themselves and may become anxious at the drop in their male sex drive. The transsexual on hormone treatment should receive regular check-ups from their doctor. There are various forms of hormone products available and the following is a review of those commonly in use.
*For full details and risks associated with HRT please consult your doctor before taking.
Oestrogens
Oestrogens are responsible for the development of female secondary sexual characteristics, so the main component of any hormone regime for a TS patient will be some form of oestrogen. Typically this is obtained either from combined oral contraceptives or oestrogen tablets intended for HRT in postmenopausal women. The principle natural oestrogen produced from the ovaries in a natural-born premenopausal female is 17 beta-oestradiol. Numerous derivatives and metabolites exist and play specific roles in the female body. While some of the metabolites (e.g. oestrogen, oestriol) may be used successfully in treating menopause symptoms in post menopausal women, they are not suitable for transsexual patients; it is necessary to supply 17 beta-oestradiol or a synthetic replacement for it. Oestrogen therapy must be continued for life in a post-operative subject, otherwise numerous problems can occur. In particular, several very severe case of osteoporosis have been reported in post-ops who have discontinued their oestrogen treatment. Menopause-like symptoms also occur if oestrogen is discontinued.

http://www.transgenderzone.com/research/hrt.htm

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Oestradiol Valerate

This drug is equivalent to natural 17 beta-oestradiol. It is generally well-tolerated, and
clinical data from postmenopausal women suggest it is safer than ethinyloestradiol for
long-term use, with less risk of breast cancer, thromboembolic events, or liver problems. It
is not certain whether this improved safety applies in the high doses necessary for pre-op
transsexuals. This is widely regarded as the oestrogen of choice for long-term
maintenance in post-op TS patients due to its good safety record; typical post-op dose
would be 1-2mg daily, ideally divided into two doses. Oestradiol Velerate appears to be
less effective at inducing feminisation in pre-op subjects than ethinyloestradiol, probably
due to it`s short serum half life-particularly, as it appears tp fare poorly when "in
competition" with endogenous male hormones; adequate results have been obtained with
oestradiol valerate combined with an effective anti androgen. Typical pre-op dose would
be 4-6mg daily in divided doses (1 or 2mg per dose); if menopause-type symptoms
appear (hot flushes, night sweats, etc) this can often be a sign that the dose is not sufficent
to overcome the endogenous male hormones and a switch to ethinyloestradiol would
probably be advisable.
Progynova (Estradiol Valerate, Oestradiol Valerate) 1mg 56 tabs Schering-Plough Used
for "hormone replacement therapy" because it contains the principal oestrogen hormone
that is lost during the "change of life". $44.88
(or Only £24.50!!!)
Progynova (1mg 56 tabs Schering-Plough)

Progynova (Estradiol Valerate, Oestradiol Valerate) 2mg 56 tabs Schering-Plough Used
for "hormone replacement therapy" because it contains the principal oestrogen hormone
that is lost during the "change of life". $73.32
Progynova (2mg 56 tabs Schering-Plough)


Ethinyloestradiol
This drug is a synthetically-produced modification of natural 17 beta-oestradiol. The
modified molecule is eliminated only slowly by the liver, giving it a far greater potency and
much longer half life that other oestrogens. It is generally well-tolerated, but appears to be
less safe in very long-term use that oestradiol valerate. Ethinyloestradiol is widely
regarded as the oestrogen of choice in pre-operative subjects. A dose of 100ug daily in
two doses) is typical; this can be increased to 150ug if necessary. It`s long half life and
potency give it excellent feminising effects. In post-op patients, this drug may still be used,
especially for patients whose feminisation has not completed by the time they have GRS.
For short-term post-op use, the full pre-op dose of 100ug may be used, this is normally
reduced to 50ug after 6-12 months. For long-term post-op use, the full pre-op dose,
oestradiol valerate is probably preferable. It should be noted here that oestrogen
overdosage may paradoxically cause vasomotor symptoms similiar to those produced by
insufficient oestrogen dosage.
This is sometimes seen in post-op patients who are still on pre-op dosage, and if this effect
is suspected then the oestrogen dosage should immediately be reduced to a typical post
-op level. This effect is more likely with ethinyloestradiol than with other oestrogens due to
its high potency, and consideration may be given to an early switch to oestradiol valerate if
the problem persists.
Ethinyl Estradiol (Recommended)
Ethinyl Estradiol 10mcg 100 tabs Novo Nordisk Estrogen replacement therapy in females.
$36.30
(only £20.00!!!)
Ethinylestradiol

Ethinyl Estradiol 50mcg Tabs 100 (10 x 10) INFAR $49.00
(only £26.50!!!)
Ethinylestradiol

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Conjugated Natural Oestrogens (Premarin)

This drug is a mixture of various oestrogenic substances extracted from the urine of pregnant mares. It lacks the potency of ethinyloestradiol, and there is no evidence that it has any advantages over oestradiol valerate. Many patients dislike this drug because of ethical concerns over the manner in which it is produced. It is increasingly regarded as an outmoded treatment for TS patients. It is also more expensive than the synthetically-manufactured drugs. A typical pre-op dose would be 5-7.5mg daily in divided doses, reducing to 1-2.5mg daily post up.
Premarin
One of the world's best selling hormones Premarin is conjugated estrogens tablets, USP for oral administration.
1.25mg Tabs56 (2 x 28) $105.60
(only £60.00!!!)
Premarin


Other Oestrogens
Estraderm TTS 100mcg 8 patches Novartis. Also used to treat osteoporosis (bone loss). $36.00
Estraderm Patches

Estraderm TTS 25mcg 8 patches Novartis Treats the lack of estrogen from menopause or removal of the ovaries. Also used to treat osteoporosis (bone loss).
Estraderm Patches

Estraderm TTS 50mcg 8 patches Novartis Treats the lack of estrogen from menopause or removal of the ovaries. Also used to treat osteoporosis (bone loss).
Estraderm Patches

Estrofem (Estradiol) 2mg 28 tabs Novo Nordisk Used for the treatment of the oestrogen deficiency syndrome. $25.50
Estrofem


Progestogens
Progestogens administered alone do not produce feminisation in a phenotypic male. However, progestogens are generally quite antiandrogenic and will often promote a useful degree of testosterone suppression in a pre-op patient, and more importantly when administered in conjunction with oestrogen, improve the feminisation attained compared to oestrogen-only therapy, particularly in terms of breast weight and texture. One UK endocrinologist has claimed that progestogens have no effect in transsexual patients, however numerous studies both in the UK and elsewhere have demonstrated that this claim is false. Progestogens are now very widely used in conjunction with oestrogens in the treatment of male-to-female transsexualism. Progestogens may also lessen the risk of cancer associated with long-term oestrogen treatment, according to some studies in natural-born females. In addition, some patients report that progestogens affect them psychologically, particularly in terms of maintaining the libido. For all these reasons, it may well be desirable to continue with a low dose of progestogen post operatively, even though there is no absolute need for it. No reliable data exists regarding the incidence of breast cancer in transsexuals. Many are lost to follow-up and conceal their transsexual past after completing their treatment, and any instances of breast cancer in this group are likely to be recorded as occurring in normal women rather than transsexuals. One researcher has claimed to find a significant excess of breast cancers among certain chromosomally-intersexed patients who have been reassigned to female. A few patients experience androgenic effects from some progestogens, possibly including an increase in body hair. If this occurs, a different progestogen should be tried. Similarly, if fluid retention occurs, a switch to an alternative drug will probably resolve it.

[Other life style]

Medroxyprogesterone Acetate
This progestogen (trade name Provera) is normally used for treating irregular menstrual bleeding or endometriosis, and its safety record is good. It is widely regarded as the preferred progestogen, at least when the patient is not using combined contraceptive pills as a low-cost source of oestrogen and progestogens. Some patients, however, report slight virilising effects including, occasionally, a return of some degree of male sexual function even in post-orchidectomy subjects, which can be found disturbing; it appears that a proportion of the drug may be metabolised into testosterone in some patients. Medroxyprogesterone acetate is generally less virilising than the testosterone-derived synthetic progestogens (e.g. norethisterone and levonorgestrel), but more virilising than dydrogesterone. If a patient experiences virilising effects with medroxyprogesterone acetate then a switch to dydrogesterone should be considered. A typical pre-op (or early postop) dose (to maximise feminisation) would be 10mg in two doses; post-op 5mg or even 2.5mg may be sufficient to maintain the patient's libido.
Provera (Medroxyprogesterone) 10mg 30 tabs Pharmica & Upjohn Treats menstrual irregularities, some forms of cancer, and other conditions. $36.00
Medroxprogesterone


Finasteride for Hair Loss
This drug is not suitable as a general antiandrogen, but is mentioned here as it can be useful in countering male-pattern baldness in transsexuals. Classed as an androgen conversion inhibitor, it blocks the conversion of testosterone to DHT. It is generally ftee ftom significant side effects, but does not appear to affect male sex drive. Typical dosage is 5mg daily.
Used for those experiencing hair loss.
FINASTERIDE (finasteride 5mg Tabs 30) (3 x 10) Used for hair loss. $89.76

FINASTERIDE (finasteride 5mg Tabs 90) (9 x 10) Used for hair loss. $158.40

FINCAR (Finasteride, Proscar, Propecia) 5mg Tabs 30 (3 x 10) Used for hair loss. $49.50

FINPECIA (Finasteride, Proscar, Propecia) 5mg Tabs 90 (9 x 10) Used for hair loss. CIPLA $158.40

FINPECIA (Finasteride, Proscar, Propecia), 1mg, 90 (9 x 10) Used for hair loss. $99.00


Natural Progesterone
USP This drug. which is probably unavailable in the UK, has a small but vocal group oftranssexual adherents in the USA, who claim that it is superior to other progestogens. The present authors have been unable to find any clinical data to support this claim; while it appears to be free of virilising effects, first-pass effects are liable to make it relatively ineffective relative to dydrogesterone, which is also non-virilising. The main problem with 'Natural Progesterone' is that it is largely destroyed by the digestive tract and liver upon ingestion, so very large doses (hundreds of milligrams) are used. Since the precise percentage of the drug metabolised in this way is variable and unknown, the actual serum levels obtained are unpredictable.

Synthetic Progestogens
This heading covers substances such as levonorgestrel and norethisterone, which are usually found in combined contraceptive tablets, usually with ethinyloestradiol. Contraceptive pills provide a useful low-cost source of feminising hormones for patients who have to pay for their own medications, but of course the patient is limited to the combinations of substances available, and cannot 'mix and match' as one can with separate oestrogen and progestogen drugs. Care should be taken with some preparations (for example, Brevinor) as they contain too high a ratio of progestogen to oestrogen, so that taking enough tablets to obtain a suitable dose of oestrogen would result in a dangerously high intake of progestogen.
One combined tablet that has been used widely in the treatment of transsexual patients is Ovran; a typical pre-op dose of two tablets daily gives 100ug of ethinyloestradiol and 500ug of levonorgestrel. Most patients tolerate this well, and it generally produces satisfactory feminisation, but levonorgestrel appears (anecdotally) to give more frequent problems with water retention, hypertension and weight gain than medroxyprogesterone acetate. Safety fears have also been raised in the past about levonorgestrel-based contraceptive implants. Some patients experience virilising effects with norethisterone or levonorgestrel, which may impair the feminising effects of oestrogen. If this is suspected then an alternative progestogen should be tried.
http://www.transgenderzone.com/research/hrt.htm

[Other life style]

Hormone Replacement Therapy

No Rx needed No Prescription Required
*For full details and risks associated with HRT please consult your doctor before taking.
http://www.transgenderzone.com/research/hrt.htm

[Other life style]

Pharmacy and Clinic

http://www.nutrichem.com