Transgender Hormones & HRT (MTF) – Complete Guide

Transgender Hormones & HRT (MTF) – Complete Guide

February 27, 2020 26 By Jose Scott


Oh, hello- were you these this whole time? Well, since you’re here, would you like to
join me for some hormones? They’re very interesting, here, it’s all on
the box, take a look for yourself! What are hormones? When you talk about hormones, you may immediately
think of sex hormones, like estrogen, or testosterone, and you’re right, they are definitely hormones,
but they’re not the only ones- there are over fifty different known types of hormones
in the human body, with more surely to be discovered. The word hormone comes from the Greek word
“hormao”, a word that means ‘I excite or arouse.’ What was meant by this is that hormones send
signals from parts of your body to other parts- in order to cause them to do something or
change in some way. As an example, the feeling of being hungry
is partially caused by a hormone released by your stomach that travels through your
bloodstream and signals to the rest of your body that you should feel hungry. There are many more hormones that do a lot
of different things, but they all work in generally the same way. On the cells in your body there are these
things called “receptors”. Receptors are basically like locks that are
waiting for the right key that can open them. When that key shows up, it activates the lock
and your cell does something because of that. Hormones, in this example, are the keys. When the right hormones are together with
the right cell receptors, it causes a change to happen in the cell. Not all cells have the same receptors, so
some hormones may not do anything to some cells but may do something to others. Also, even if a cell does have a receptor
for a hormone, what that cell does when the hormone activates it is different depending
on what type of cell it is. There’s a lot more to it than that of course,
and I highly recommend reading more about it as it’s very interesting, but for the
purpose of this video that’s generally all you need to know- hormones tell your body
to do stuff. —
Now that you know what a hormone is, let’s talk about sex hormones. Sex hormones are also called sex steroids,
or sometimes even just steroids. You probably know some sex hormones already-
like testosterone and estrogen, they’re both types of sex hormones. There are certain receptors on cells called
androgen receptors and estrogen receptors, and these are the receptors that sex hormones
activate. Testosterone is a type of androgen which is
why it activates androgen receptors, and estrogen of course activates estrogen receptors. While sex hormones are responsible for a variety
of things in your body, we will be focusing on the way they change the development and
expression of sexual characteristics, motivations, and psychology, especially in regard to Male
to Female transgender females and their hormone replacement therapy, which we’ll talk about
later. I’ll be referring to things as being male
or female in regards to average cisgender XX/XY humans unless otherwise stated, it’s
simply easier to talk about this way. First we’ll go into the major sex hormones,
testosterone, estrogen, and some others, then we’ll talk about how hormone replacement
therapy works for male to female transgender females. Testosterone is commonly thought of as “The
male hormone.”, however it is present in both males and females, though the levels
present in males are significantly higher. Testosterone’s role in males is more pronounced,
it is responsible for the development of male reproductive tissues such as the testes and
prostate, as well as male sexual characteristics such as body hair and facial hair, and increased
potential to gain muscle mass. Testosterone is also critical for male sexual
function, including the development and functionality of sex organs, and male sexual motivation-
the elimination of testosterone in males has been shown to reduce sexual motivation. While females do have natural levels of testosterone,
it is significantly less than in males. The purpose of testosterone in females is
not well understood. Some have thought that testosterone could
be responsible for sexual desire in females as well, however research has not proven this
to be the case. While there has been research that has shown
that if females are given enough testosterone to have more than they naturally would, they
do begin to have higher sex drives, no such research has found this to be the case when
women are only given testosterone within the natural female range. There has been some interesting research that
found that polyamorous females and males had higher levels of testosterone than non-polyamorous
people, with the levels in women being nearly as high as the lower levels of natural male
testosterone range, though it’s not well understood why this is the case. Overall, there is a lack of high quality consistent
evidence that testosterone affects female sexual desire unless it is higher than the
typical natural female range. Testosterone also has effects on the brain. Androgens like testosterone are considered
to be responsible for men having greater visuospatial ability- for instance, being able to accurately
rotate objects in your mind or estimating the distance between two objects, however
testosterone is also considered to lower verbal fluency in males, for instance females are
generally better able to find words for categories of things such as types of animals, words
that start with the letter A, that sort of thing. In animals, higher levels of testosterone
are well known to increase aggressiveness, especially when attempting to mate. In human males, the role of testosterone in
aggressiveness is controversial. There is a significant, but not strong relation
between testosterone levels and some aspects of aggressive behaviour in men. Anabolic steroid users, which are for example
weight lifters who use steroids such as testosterone in order to increase their muscle mass, significantly
report mood disorders, manic states of high aggressive energy, as well as various other
psychiatric disorders. There have also been findings that administering
high doses of testosterone to men is associated with increased aggressiveness compared to
the placebo group. There have also been studies that were not
able to find clear increases in aggressive behaviours in men treated with testosterone,
so it should be noted that this is still an area of moderate uncertainty. Estrogen (Oestrogen in the UK) is the primary
female sex hormone, and it is responsible for the development and regulation of the
female reproductive system, as well as the development of female secondary characteristics,
such as the growth of breasts. Though estrogen levels are higher in females,
Estrogen is present in males as well, and it has been found to be important to male
fertility, by regulating processes necessary for the development of viable sperm. Though it should be noted that evidence also
suggests that exposure to too much Estrogen in males does inhibit fertility. Estrogen typically regulates motivation to
engage in sexual reproduction in female mammals, though unlike males, the relationship between
hormones and female sexual motivation is not well understood. Primates such as monkeys and humans are some
of the only animals who mate outside of their fertile period, however- while female primates
are able to mate at any time, research suggests that the desire to seek out sex in female
primates is higher during the periods when they are fertile as well as during pregnancy-
both of which are times when female hormones are at their highest levels. Also, during menopause, when a female is no
longer fertile and thus produces much less estrogen, many women experience a decline
in sexual motivation. Menopause causes the hormones in females to
be lowered drastically. A majority of women experience some change
in sexual function due to menopause, with common complaints including a loss of sexual
desire as well as a decrease in physical response and pleasure. Studies have found that it’s possible to
modestly restore the sexual state of menopausal women to pre-menopause levels through the
administration of estrogen treatments. There’s more to sexual arousal and pleasure
in humans than just hormones, the psychological state of the individual or the social context
they’re in are both important factors for example, however the role of hormones in human
sexuality appears to be undeniably significant. In the brain, estrogen may have a role in
sustaining cognition in old age, and many women experience changes in cognition when
estrogen levels are lowered through menopause or surgically induced menopause such as the
removal of the ovaries. Progesterone is the other main sex hormone
in females. It’s primarily involved in the regulation
of female reproductive system, the menstrual cycle, pregnancy, and lactation. Outside of its role in pregnancy and lactation,
progesterone seems to be mostly insignificant in the development of female sex characteristics. During female puberty, progesterone levels
do not rise significantly until the end of puberty after most development has taken place. While progesterone does prime the body for
pregnancy and lactation, these changes are only temporary by design and disappear when
progesterone levels are lowered. In addition, no research has found progesterone
to improve female sex drives. and there is little to no evidence of progesterone
improving sexual desire in females at this Now you should have a decent idea of the major
sex hormones testosterone, estrogen, and progesterone. While there are other sex hormones, these
are the ones that will be the most important to understand for our next topic- Hormone
Replacement Therapy for MtF Transgender people. So what is hormone replacement therapy? Maybe you already know, but there’s no harm
in being clear. Hormone Replacement Therapy, also called HRT,
is the administration medicine and medical services in order to change the hormonal levels
of a person from one sex to another. For instance, in Male to Female HRT, medicine
is used to raise a person’s estrogen levels and reduce their testosterone levels. In Female to Male HRT the goal is reversed,
and medicine is used to raise testosterone levels instead. The effects this has on a person vary depending
on many factors, such as age or genetics. There are limits to what HRT can and can not
do. We’ll only be focusing on Male-to-female
HRT from here, as FtM hrt deserves its own video. For Male to Female transsexuals, HRT can possibly: Develop the breasts. Reduce male sex drive. Make skin softer. Stall or stop hair loss. Change how body fat is distributed. Reduce muscle mass. In puberty, cause the body to grow on a feminine
path. (Hips etc)
Stop further masculinization from puberty. The timeline for these changes can generally
be expected to happen on the following timeline. Within 1-6 months body fat will redistribute
to be more like female fat distributions, and muscle mass will decrease along with overall
strength. Also during this time, skin will become softer,
sex drive will decrease, erections may become impossible to obtain, and orgasms may be difficult
to achieve. In addition, the ability to produce sperm
will be lost, and as a result infertility will occur. Within 3-6 months, tender breast buds may
start to form, and gradual breast growth and nipple development will possibly continue
for two or more years, though the degree to which the breasts will develop varies greatly
from person to person. Over several years face and body hair will
become finer and will grow slower, though facial hair will change much less than body
hair. HRT may gradually slow or even stop male-pattern
baldness, however it will not regrow hair that has already been lost. Most of these changes are reversible if HRT
is stopped, however breast development is permanent, and it’s possible that the ability
to produce sperm & fertility may not return. Sperm banking is recommended for all mtf trans
females before beginning hrt as it is very likely that it will be impossible to ever
have children otherwise. However, there are many things HRT can not
do, such as: Significantly grow back hair lost due to baldness. Reduce the size of the shoulders, hands, height,
etc. Cause the voice to become higher. Significantly reduce facial hair growth. Reduce Thyroid Cartilage size. Undo changes from puberty. Allow for female reproduction. As you can see, there is a lot that HRT can
do, but it can’t do everything. We’re going to get a bit more in depth about
the changes that can be expected from HRT, then after that we’re going to discuss what
medicines are used for HRT and how they work. Breast development is one of the most noticeable
changes from HRT. Within 3-6 months of starting HRT breast buds
may start to form. The breast and nipples will gradually continue
to develop for anywhere between two years and a decade. In thin MtF females, weight increase may improve
breast development. Typical MtF breast development is not as pronounced
as it is in females, and many MtF females choose to have breast augmentation. It is recommended to allow 18-24 months after
starting hormones before considering breast augmentation. The width of the shoulders and the size of
the rib cage affect how large a person’s breasts appear to be, and because these both
tend to be larger in transgender females, many choose larger implants than those typically
chosen by cisgender females. Under the right circumstances, it is possible
for the breast development of MtF females to allow for lactation and even breastfeeding. The method used to do this is the same as
some adoptive females use to be able breastfeed an adopted infant, and generally requires
a hormone regimen to achieve pregnancy hormone levels in estrogen, progesterone, as well
as prolactin, a hormone required for lactation. In addition frequent breast stimulation is
required, typically using a breast pump. All of this is rather demanding on the body,
and requires medications that are not well studied, so it is recommended to only attempt
to lactate for the purposes of breastfeeding a child and with the assistance and approval
of a doctor. HRT has some effect on the skin, though these
changes are reversible if HRT is stopped. Collagen in the skin decreases, and the skin
becomes thinner, softer, and more transparent. Tactile sensation increases as well. The skin becomes easier to tear and irritate. Oil production on the skin and scalp will
be reduced due to the lack of androgens, and as a result pores may become smaller and skin
may become less prone to acne, though at the cost of it becoming drier as well. Subcutaneous fat, the fat immediately underneath
the skin, increases due to HRT, as as a result cellulite and stretch marks may become more
visible. Hair on the head, face, and body hair are
affected by HRT in different ways. Head hair may change slightly in texture,
color, or curl- partially due to a loss of oil production on the scalp. If balding has already begun, the hair that
has been lost already will generally not be restored to a pre-balding state, though further
hair loss may be prevented. Facial hair is only minimally affected by
HRT, and it’s unlikely a significant reduction in the growth of already present facial hair
will result from HRT, though if HRT is begun in puberty it will prevent further facial
hair development. Facial hair will nearly always need to be
removed through other means, such as laser hair removal and electrolysis. Body hair can see a more significant change,
and it is common to have reductions in body hair present on the legs, thighs, chest, back,
stomach, and arms. However, this is partially determined by genetics,
and the degree to which body hair is changed varies from person to person. It is common for cisgender females to have
body hair as well. The distribution of fat in the body slowly
changes over months and years during HRT. Fat tends to accumulate in more feminine areas,
such as the hips, thighs, buttocks, pubis, upper arms, and breasts. In addition, fat in more masculine distribution
such as the waist, shoulders, and back, may begin to reduce. Subcutaneous fat, fat under the skin, increases
in the cheeks and lips, which may make the face appear rounder, and deemphasize some
masculine aspects of the jaw. Muscle mass tends to decrease towards female
proportions, due to the elimination of androgens following HRT, and new muscle also becomes
harder to gain as well. Bone changes that have already occurred are
not reversed by HRT, though it is possible for them to be prevented if some form of HRT
or androgen-blockers are initiated at a very early age. The majority of changes to the bone structure
of the face occur early in adolescence, and changes to the skeleton, such as the length
of the arms and legs, the size of the hands and feet, the broadening of the shoulders
and rib cage, and total height, are mostly complete by the end of puberty. However, some bones are not finished developing
until around the age of 25, and HRT can affect some change in bone growth if it is started
before then, and this may result in some degree of feminization such as wider hips and feminine
development of the interior of the pelvis. After the age of 25, most of the bones in
the body will have permanently fused, and HRT will no longer have an effect of the structure
of the skeleton. Because most of the bone structure in the
face has already occurred by the time many trans women are able to begin HRT, it’s
common for MtF females to consider Facial Feminization Surgery. Also called FFS, Facial Feminization Surgery
involves a variety of surgical changes to the face in order to achieve a more typically
feminine appearance- including but not limited to removing masculinized bone structure in
the face. In addition, while not part of the skeleton,
the thyroid cartilage, also known as the Adam’s apple, may be removed as part of FFS, or separately
on its own, as thyroid cartilage can not be reduced through HRT either. The voice can not be changed through HRT,
however if administered before changes have occurred, further changes to the voice can
be prevented. If a voice that is satisfactory to the MtF
female can not be achieved through practice, it is possible to have voice feminization
surgery to raise the range of the voice towards more typically feminine levels. Sex drives following HRT are generally reported
to be lowered, spontaneous erections are reduced in frequency, and erections may be impossible
to achieve at all, though this varies from person to person. The reduction in sex drive is often one of
the first changes many trans females notice when they begin HRT. Following SRS or an orcietecmomy- the removal
of the testicles, the testosterone levels of a trans female are often lower than the
testosterone levels of a cisgender female, and some trans females take testosterone in
order to improve their sex drives. However, studies have been unable to show
that testosterone has an effect on females when administered below male levels, and research
in regards to female levels of testosterone present in trans females and its relation
to their sex drive is practically non-existent. Fertility, the ability to have children, is
almost certainly lost at some point after initiating HRT, as the production of viable
sperm is disrupted directly. Though it may be possible for fertility to
be regained if HRT is stopped and no surgeries have been performed, it is not guaranteed,
and many will permanently lose their fertility. As such, it’s important to assume that it
will be impossible to remain fertile once HRT is begun, and it’s likely a good idea
to consider using a sperm bank to preserve sperm in the event that children are ever
desired. The medications used in MtF hormone replacement
therapy have changed over time, and it’s very possible that they will continue to change
in the future. Currently, HRT regimens typically consist
of an Estrogen, an androgen inhibitor, and sometimes a progestin. Regardless of what medicine is used, the goal
is generally the same: To raise estrogen levels to within female range, and reduce testosterone
levels to below male range. We’ll talk about the current medications
used in MtF HRT, and while this information is in line with current clinical guidelines,
it is always preferable to have a doctor determine the correct regimine for each person and monitor
them throughout their transition. Estrogen is the primary hormone in females,
and as such it is also the primary hormone in HRT. There are a variety of available forms of
estrogen as well as methods of administration. In the past, a type of estrogen typically
found in birth control pills called “Ethinyl estradiol” was used, however it is strongly
recommended not to use this medication anymore, as it poses significant health risks , and
there are much better alternatives. While no estrogen therapy is completely without
side effects, transdermal estradiol have been shown to have reduced risk of side effects
compared to oral estradiol. Between patches and injections, patches offer
the most convenience and maintain steadier estrogen than injections. Some trans women believe that injections offer
better feminization, and while some evidence has suggested that injections may possibly
cause feminization to occur faster, in the end the final degree of feminization achieved
through hrt seems to be the same regardless of the method in which estrogen is administered. The type of estrogen used in HRT is mostly
well agreed to be forms of estradiol, which is the most potent naturally occurring estrogen
in the body. The estrogen in patches and pills is recommended
to be estradiol, and in injections it is recommended to use estradiol valerate. While results are typically the main focus
of MtF females seeking HRT, it is important to take health into consideration as well,
as it is possible to optimize for both results and health at the same time. Androgen blockers, or antiandrogens, are medications
used to reduce the levels and/or action of testosterone, and promote estrogen levels. Typically some form of antiandrogen is included
in an MtF hormone regimen, however recent research suggests in many cases an estrogen
only therapy is able possible to achieve testosterone suppression on its own as well. The necessity of antiandrogens and the type
of antiandrogen therapy necessary varies from person to person, and hormones levels will
require monitoring with the assistance of medical professionals in order to ensure that
levels are within female range. There’s a variety of medications used for
their anti-androgenic effects in MtF HRT, and it’s worth discussing the ones that
are most commonly administered at this time regardless of if they are currently recommended
or not. Spironolactone is one of the most commonly
prescribed anti androgens at this time, especially in the USA. Spironolactone works by blocking testosterone
from being able to bind to androgen receptors on cells, it does this by taking up the space
on the receptor that testosterone needs to bind to, making it unable to. Current research has put some aspects of spironolactone
into question however. While spironolactone is able to block testosterone
from activating cell receptors, it does not seem to reduce testosterone production, and
in addition it may make it harder for estrogen to reach desired female levels. Spironolactone use is not intended to be continued
forever. Eventually, most MtFs on HRT are suggested
to have some form of testicular removal, that way testosterone production will cease and
anti-androgens will no longer be needed. Despite all of this, spironolactone may still
be a part of the HRT regimens for many transgender females, ultimately treatment is a highly
individualized process and requires working together with medical professionals to find
the best solution for each person. GnRH modulators work by eliminating GnRH production. GnRH is responsible for the release of two
hormones, follicle stimulating hormone and luteinizing hormone, which are hormones responsible
for controlling sex hormone levels in the body. Because GnRH modulators eliminate the production
of GnRH, FSH and LH are also eliminated, which means sex hormones are no longer produced. GnRH modulators are very effective and they
have fewer side effects than other current antiandrogen therapies. However, despite the benefits offered my GNrH
modulators in HRT, many health insurance providers do not currently cover them. It’s possible that in time more transgender
therapies will include GnRH modulators, and currently GnRH modulators are regularly administered
to transgender youth in order to safely delay puberty. Medroxyprogesterone acetate, also known as
depot medroxyprogesterone acetate, is a synthetic form of progesterone which is sometimes used
as an anti-androgen. Medroxyprogesterone works by lowering the
production of GnRH, however it is much less effective than GnRH modulators at doing so. In addition, medroxyprogesterone is suspected
to increase the risk of breast cancer and as increase the risk of cardiovascular complications. Many other anti-androgen therapies are available
which are potentially safer than medroxyprogesterone, while being potentially more effective as
well. Cyproterone acetate is another type of synthetic
progesterone, like medroxyprogesterone. Cyproterone has about the same effectiveness
as medroxyprogesterone, as well as similar side effects and downsides. Finestride is a medication that is rarely
prescribed to transgender females for HRT. Finestride is generally used to prevent male
pattern baldness, and it does so by preventing testosterone from converting into another
type of hormone called dihydrotestosterone. However, finestride does not prevent the production
or effects of testosterone itself, and because other anti-androgen therapies already suppress
the effects of testosterone, it is very unlikely that finestride will provide any benefit in
MtF HRT, and may in fact cause other problems as it has been linked to side effects such
as depression and anxiety. Progesterone is the secondary female sex hormone,
and its use is mainly to prepare the body for pregnancy & lactation throughout each
menstrual cycle in women. Progestins are synthetic forms of progesterone
that to varying degrees mimic its effects. Occasionally, progesterone & progestins are
used in MtF HRT for their anti-androgenic properties. It is a common belief among MtF transgender
females, that Progesterone or Progestins are responsible for permanent feminizing effects
such as breast development or nipple enlargement, and therefore a necessary part of MtF HRT. However, current research does not agree with
these claims. In females during puberty, progesterone is
not present at significant levels during the majority of bodily feminization and development,
with levels only increasing towards the end of puberty after the majority of feminization
has already occurred. Studies have also looked at people who have
a condition known as complete androgen insensitivity syndrome, a condition which causes genetically
male individuals to be immune to the effects of testosterone since birth. Because of this, their bodies mostly develop
as if they were genetically female, because human bodies are all initially female in the
womb until they are masculinized by androgens such as testosterone. In these individuals, their bodies produce
no natural progesterone, however they do produce a small but significant amount of estrogen. Interestingly enough, during puberty these
people experience full breast development, and often have even more development than
average. This suggests that there is no significant
role for progesterone in the development of permanent breast tissue, and it even might
reduce overall breast development. Additionally, synthetic progestins have been
linked to increased chance of breast cancer. Some individuals mistake the side effect of
progesterone increasing water retention to be breast development, however this is actually
just the body retaining more fluid, a temporary effect that is not actually helping to develop
breast tissue, and which actually causes potential complications such as venus varicoses. While progesterone is responsible for changes
in the breast during pregnancy and lactation, these changes are temporary and will go away
very quickly if progesterone use is not continued. I collected this information to the best of
my ability, and have reached out to medical professionals to help validate the research
I’ve presented. All of this is subject to change, as medicine
is a constantly evolving field. I will be making revised versions of this
video in the future to cover new information as it is made available. Oh! You’re still here! That’s great. Sorry about breakfast thought- I kinda already
ate everything. But you should come back, next time I’ll have
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