Hormone Therapy

Hormone therapy is one of the most important aspects of transition.  To many, it represents the very essence of going from one existence to another.  Indeed, for some it is the final destination with no future intent for sex reassignment surgery ( SRS).  My approach is based on research of the current literature and knowledge based on twenty years of practicing medicine.  My basic principles are to use the lowest dose of the appropriate hormone to ensure a safe and effective transition.  There is very little research in this area with much anecdotal and personal belief injected into many hormone therapy protocols.   The action of hormones in human beings is very complex.  We really do not understand all the ramifications and effects of these powerful chemicals on the human body.  The good news is that there is enough practical experience in the worlds literature to list some reasonable protocols for transitioning from one gender to another provided one accesses good medical care.  I am aware of the availability of hormones over the internet.  One must honestly ask oneself would you do your own dental surgery or brain surgery.  It does not make sense to take hormones without informed medical direction and understanding the risks and benefits.

The following is a PowerPoint presentation  that was given at the Esprit Conference in May, 2002

I will be adding to it and updating it with recent information as time allows.  Be aware there is a lot of new information out there with the recent release of the Women's Health Initiative Study (HERS)  from the National Institutes of Health.  There is an increased risk of breast cancer, heart disease, and Strokes when on estrogen and progesterone.  The Women's Health Initiative Memory Study (WHIMS) a subsidy of the Women's  Health Initiative Study conducted in women age 65 and older showed a doubling of the rate of dementia in women on premarin and progesterone.   I do not recommend the use of progesterone under any circumstances.  I strongly recommend the use of a baby aspirin (81 mg.)
a day to prevent stroke and heart attack.  I strongly recommend monthly self breast exam and yearly physician breast exams and mammograms to reduce breast cancer. The second half of the 
HERS study which deals with post hysterectomy females on estrogen only probably more closely
approximates what happens to genetic males on estrogen.  There appears to be an increased incidence of stroke and breast cancer.  There is some evidence that estrogen may alter the immunity to cancer.

My rough data on 260 MTFs suggest that there is an increased risk of  heart attacks and throat cancer in patients who use estrogen and have or are smoking.   I am now recommending that patients stop smoking before going on estrogen if possible and have risk stratification for heart disease if there are multiple risk factors for heart disease.  This might include cholesterol measuring, possible exercise EKG treadmill testsand control of blood pressure.  Out of roughly 260 MTFs,  I have had five heart attacks,  three of them fatal, two throat cancers, one lung cancer, one melanoma,  and  one pituitary tumor that so far has not required surgery.   The overwhelming factor in all of these except the melanoma is the use of tobacco.  It is futile to transition only to die.

A more recent concern of mine is the possibility of osteoporosis.  I have had four patients, ages 37, 41, 47, and 51 all MTF with significant osteoporosis (thinning of the bones).  One patient age 37 actually had a fracture of the wrist from osteoporosis.  I am at the beginning stages of trying to research this further


PowerPoint Presentation of Hormone Therapy

Hormone Treatment in Transsexuals

Hormone Therapy in Transsexuals by Gooren

Thomas Waddell Clinic Protocols

The following are PowerPoint Presentations from the IFGE Conference in Austin, Tx., and the Esprit Conference in Port Angeles, Wa.

PowerPoint Presentation of Male to Female Hormone Therapy

Power point Presentation of Female to Male Hormone Therapy

I have received good reviews from colleagues that the links below is an
excellent resource for inexpensive medications including hormones