Cross-sex hormone treatment in female-to-male transsexuals annihilation of female characteristics
The effects of estrogens on physical characteristics cannot be annihilated by antihormones. Antiestrogens administered to eugonadal women stimulate gonadotropin and subsequently ovarian hormone secretion. Theoretically, LHRH antagonists could be used. The objections have been mentioned earlier. Transsexuals very much appreciate that their menstrual periods are terminated. This can be accomplished by progestagens with their antigonadotropic properties: medroxyprogesterone acetate (ProveraR, FarlutaiR) 5 mg 1 ~ 2 tablets/day or 150 mg intramuscularly/3 months, lynesterol (OrgametrjiR) 5 mg or norethisterone (Primolut NR) 5 mg both 1 or 2 tablets/day. Androgens to be discussed in the next section have in high dosages also antigonadotropic action. There is no clear advantage in the combination of the two hormones unless androgens alone suppress menstrual bleeding in-sufficiently.
Induction of male characteristics
Androgens exert a powerful effect on the virilization process but completion may take as long as 24 years and sometimes even longer. The individual outcome depends on genetic factors both familial and racial. The degree of hairiness of siblings is a fair predictor of the virilization process. To be used are testosterone esters 200-250 mg/2 weeks intramuscularly. Their brand names vary from place to place (SustanonR, TestovironR). As oral androgens testosterone undecanoate can be mentioned (AndriolR) 160-240 mg/day, not available in the USA. With the latter preparation, menstrual bleeding is insufficiently suppressed in 50% of the patients and addition of a progestagen is required. The use of oral androgens with an alkyl group in the 17a position of the molecule is obsolete due to its hepatotoxicity. Oral androgens as mesterolone and fluoxymesterone are too weak for the induction of virilization. In approximately 50-60% of the female-to-male transsexuals acne will occur. In 10-15% it is rather serious requiring dermatological treatment. It is now certain that androgen treatment has an unfavorable effect on the lipid profile. It places female-to-male transsexuals in the risk category of men. Therefore they must be advised not to smoke, to exercise moderately and to prevent over-weight and high blood pressure.
Effects
The feminizing effects of estrogen and the masculinizing effects of testosterone may appear after the first couple of doses, though it may be several years before a person is satisfactorily transitioned.
Females transitioning to males (FTM) may experience the following permanent effects of testosterone:
Atrophy of the uterus and ovaries, resulting in sterility
Baldness; hair loss, especially at temples and crown of head
Beard and mustache growth
Deepening of the voice
Enlargement of the clitoris
Increased growth of body hair
Sterility
Temporary Changes
Temporary changes, which are reversible after HT is stopped, include the following:
Behavioral developments associated with testosterone production during male puberty:
Aggression
Increased libido
Development of acne, similar to male puberty
Increased muscle mass and strength
Increase in number of red blood cells
Redistribution of fat from breasts, hips, and thighs to abdominal area
Associated Risk
Risks associated with FTM testosterone therapy include the following:
Breast cancer
Cancer of endometrium
Diabetes
High cholesterol
Hypertension
Liver disease
Tobacco increases a person's risk for disease and complications. A general medical checkup is necessary before treatment, as well as a review of patient and family health history.