On Hormone Therapy

Gender Bender
By Kiki Mura

When Bryce C. underwent her MTF (male to female) sex reassignment surgery in 2007, everybody thought that “THAT, automatically, made me a woman,” she says.  And while admitting that, “yes, it did, in its way, what not many people know is that the transsexual (TS) transitional process (largely involves) hormone treatments, what with hormones effecting most of the changes in the body.”

And this, indeed, is how we transition – through hormone therapy (HT, though also known as hormone replacement therapy or HRT), which involves taking estrogen and testosterone.

Why the need for HT?

As succinctly stated by the Harry Benjamin International Gender Dysphoria Association (Healthcommunities.com, as adapted from Standards of Care for Gender Identity Disorders, 2001), “Hormones are produced by the endocrine system, which is made up of glands that release chemical hormones into the bloodstream. Among other functions, hormones control sex characteristics, like breast development, facial hair, and reproductive systems. Both men and women produce these hormones, but biologically, women produce more estrogen while men produce more testosterone. Transgender (TG) people use hormones during the anatomical and psychological transition to another sex and gender. Hormones allow transgender people to look like the other sex and to feel comfortable; they improve their functioning and limit the potential for depression and anxiety.”

Estrogen has feminizing effects on MTF transsexuals; and testosterone has masculinising effects on female transitioning to male (FTM) TSs – though, “this point’s important, hormones are not magic (potions), so that it will take years before a TG is satisfactorily transitioned,” Bryce C. says.  “I still do not see myself the way I believe I could (transition).”

MTF

The effects of estrogen include: Breast development (though full development takes several years, stresses Healthcommunities.com), loss of ejaculation, loss of erection, shrinkage of testicles, and sterility. 

“The use of estrogen,” says Bryce C., “is important because there are changes (of the body) that are reversible (can be undone) when the therapy is stopped.”

For Healthcommunities.com, these include: Decrease in acne, decrease in facial and body hair, decrease in muscle mass and strength, skin becomes softer and smoother, slowing of balding pattern, and the redistribution of fat from abdominal area to hips and buttocks.

“Suffice it to say, you will start looking like a man again,” Bryce C. says.

FTM

The effect of testosterone include: Atrophy of the uterus and ovaries (resulting in sterility), baldness (hair loss, especially at temples and crown of head), beard and moustache growth, deepening of the voice, enlargement of the clitoris, increased growth of body hair, and sterility.

Similar to estrogen use in MTFs, stopping testosterone use, adds Healthcommunities.com, reverses the temporary changes among FTMs using HT.  These include: Behavioral developments associated with testosterone production during male puberty (e.g. aggression and increased libido), development of acne (similar to male puberty), increased muscle mass and strength, increase in number of red blood cells, and redistribution of fat (from breasts, hips, and thighs to abdominal area).

FULL CARE

HT is not completely safe – “Yet another point, an extremely important one, to remember,” says Bryce C.  For MTF, the risks include benign pituitary tumors, gallbladder disease, hypertension (high blood pressure), hypothyroidism, liver disease, migraine headache, tendency for blood to clot (causing related conditions, like aneurysm, deep vein thrombosis or DVT, and pulmonary embolism), weight gain, and worsening of depression (if present, with the increased sensitivity to stress).   And for FTM, the risks include breast cancer, cancer of endometrium, diabetes, high cholesterol, hypertension, and liver disease.

Obviously, not all TGs can (or would want to) become TSs – the Harry Benjamin International Gender Dysphoria Association enumerates the following eligibility and readiness criteria for transgender adults seeking reassignment surgery:

Eligibilty

• Legal age of majority (age 18 in the United States)
• 12 months of prior continuous hormone therapy (HT), unless medically contraindicated
• 12 months of successful, continuous, full-time, real-life experience
• Regular, responsible participation in psychotherapy, if required by the mental health professional
• Demonstrable knowledge about surgical cost, length of hospitalization, complications, and rehabilitation
• Knowledge of different competent surgeons

Readiness

• Patient has made demonstrable progress in consolidating gender identity.
• Patient has made progress in improving or continuing stable mental health (implies control of sociopathy, substance abuse, psychosis, and suicidal tendencies).

Obviously, similarly, not all TGs and TSs are recommended to seek HT, since eligibility and readiness are also needed (e.g. of legal age, demonstrable knowledge of what hormones can and cannot medically do and hormone benefits and risks, and either real-life experience of at least three months living in the desired role or a period of psychotherapy, according to Healthcommunities.com).

Kiki Mura is a “budding” transgender who makes the rounds and is in the know of the five Wives (in newsmen terminology, the important Ws to ask when interviewing, i.e. Who, What, When, Where and Why) and one Husband (for the one H, i.e. How) for everything transgender in the Philippines . “Besides,” she said, “even if I didn't know, my dear, my circle is wide enough to fill in the rest of those that I missed or simply don't know!”