This article is meant to give a short, concise guide to Hormone Replacement Therapy (HRT), specifically as it pertains to male-to-female (M-t-F) transsexuals, and even MORE specifically, how it was done with me and the  majority of other TS girls I've known and spoken with.

Medical practitioners are governed in treating transsexuals by a set of guidelines known as the Harry Benjamin Standards of Care. The first step set forth in these standards is to undergo 3 months of evaluation by a mental healthcare professional to determine if the patient is a viable candidate for HRT. This is done to eliminate the possibility of Obsessive/Compulsive Disorder or Multiple Personality Disorder and to give the patient time to consider a decision made hastily.

HRT for the female-to-male (F-t-M) transsexuals consists solely of testosterone, received either through dermal patches, shots, or applied creams. As this is about the depth of my experience with this subject, I'll move right along to my main topic.

HRT for the M-t-F is somewhat more complex. There are three different components to HRT for the M-t-F. The first is suppression of testosterone by use of an anti-androgen. The second is estrogen, and the third is progesterone.

Anti-androgens.
The first step of my beginning Hormone Replacement Therapy was to begin an anti-androgen, specifically spironolactone (spiro). Spironolactone is used primarily to treat high blood pressure and hypertension, and in higher doses to treat prostate cancer. It is a potassium-sparing diuretic, making it necessary to carefully watch potassium intake. Impotence and loss of libido are not uncommon. Gynecomastia (development of breast tissue) occurs in more than 10% (in more than half with doses of 150 mg/day) of the treated males.

My personal experience with spiro is that before starting estrogen and progesterone, I simply had no energy. It has made me constantly thirsty, and I need to wake up in the middle of the night to use the restroom. I was started at 50mg of spironolactone, and brought up to 100mg after 2 weeks. After a period of one month, Estrogen was added.

Estrogen (Estrodial or Premarin)
Estrogen is found in many foods, and in both males and females naturally. Estrogen and testosterone fight for chemical receptors in the body. In the past, massive doses of estrogen were given to TSs, but it was found that this was dangerous and damaged the liver function. Using an anti-androgen to decrease production of testosterone creates less stress on the liver.

Estrogen assists in regulating female reproductive function, and is responsible for the female fat placement on the body, and softer skin on females. Recent studies on the effects of estrogen on memory have shown that it plays a key role in both females and males.

I was placed on 1.25mg of premarin, twice a day, and gradually brought up to 3.75mg twice a day over the course of  three months. This may make some of you very uneasy to know, but premarin is a made from pregnant mare urine (PMU). PMU is a medical source of estrogen.

While I noticed some emotional change upon starting spironolactone, I thought it could have been just circumstances, not necessarily the lack of testosterone. When I began estrogen, I noted unmistakable emotional changes. My emotions were hypersensitive. I also noticed tenderness in my nipples and breast area, and softening of my skin. There was also a noticeable heightening in my sense of smell. My most interesting change wasn't physical though, but mental. Aside from occasional emotional upheavals, I found I was much more calm and relaxed. This may have been a psychosomatic effect, but may also have been a response to the available estrogens in my body.

Progesterone (Provera)
The third and final component to HRT is progesterone (or to be very technical, progestin). Progesterone is responsible primarily for regulating the menstrual cycle in females and in breast development during puberty. It is the rise and fall of progesterone levels that cause changes in mood in pre-menstrual females. An intravenous shot of Depo-Provera can be used as a contraceptive in women and is also used to chemically castrate sex offenders.

So, first off, if the side effects of the spironolactone don't kill your sex drive and masculine function, the progesterone should certainly do the job. Testosterone (T) will be at female levels in the HRT patient by this point, and testosterone level is what determines libido in both males and females. Males naturally have T level about 7 times higher than females. Anyone wanting to start HRT should be aware that their sex life may greatly suffer.

I found two days after beginning progesterone that I had hot flashes and raging mood swings. These subsided after a few days (thank GOD!). I was slowly brought up to 5mg twice a day, and must honestly say that ANY fluctuation of progesterone has been followed by emotional disturbance.

I think it fair to look at the worst possible case of what could happen to a person on HRT who is not being treated by a trained professional and having regular blood work done. First… liver damage. HRT should NOT be mixed with alcohol in any major quantity, or any other chemical that taxes the liver… including something as innocent as ibuprofen in larger doses. The single most dangerous possible side effect of HRT is blood clots. These are frequently signaled by cramps in the legs, especially the calves, and can lead to stroke and death. So, obviously, we're not playing around here. Next month I hope to give an overview of the function of testosterone and estrogen in the brain.

Included below are links to various sites used in gathering information for this article.

The International Journal of Transgenderism (Containing The Harry Benjamin Standards of Care)
http://www.symposion.com/ijt/ijtc0405.htm

Spironolactone
http://www.infomed.org/100drugs/spitoc.html
http://onhealth.webmd.com/conditions/resource/pharmacy/multum0/item%2C74377.asp

PMU
http://www.naeric.org/

Estrogen
http://www.sfn.org/briefings/estrogen.html
http://www.druginfonet.com/
http://encarta.msn.com/find/Concise.asp?ti=05149000

Progesterone
http://www.yourlifesource.com/womens-health.htm
http://encarta.msn.com/find/Concise.asp?ti=05B28000

Testosterone, Estrogen, etc.
http://www.neoteny.org/a/testosterone.html
http://www.bradentonherald.com/people/23pharm.htm

 Specifically related to TS
http://www.susans.org/reference/estroeff.txt
http://www.genderweb.org/medical/hormones/horm1.html

Gender.org
http://www.gender.org/

TransgenderGuide
http://www.tgguide.com/