Hormone replacement therapy HRT of the female-to-male FTM type is a form of hormone therapy and sex reassignment therapy that is used to change the secondary sexual characteristics of transgender and transsexual people from feminine or androgynous to masculine. It is one of two types of HRT for transgender and transsexual peoplethe other being male-to-femaleand is predominantly used to treat transgender men.
Some intersex people also receive this form of HRT, either starting in childhood to confirm the assigned sex or later if the assignment proves to be incorrect. The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sexsuch as voice deepening and a masculine pattern of hair, fat, and muscle distribution.
It cannot undo many of the changes produced by naturally occurring pubertywhich may necessitate surgery and other treatments see below. The medications used in HRT of the FTM type include, mainly, androgens namely testosterone and GnRH analogues. While HRT cannot undo the effects of a person first pubertydeveloping secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoriaand can help the person to “pass” or be seen as the gender they identify with.
Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity. Several contraindications to androgen therapy exist.
The two primarily used forms in the United States are the testosterone esters testosterone cypionate Depo-Testosterone and testosterone enanthate Delatestryl which are almost interchangeable. These testosterone esters are mixed with different oilsso some individuals may tolerate one better than the other. Testosterone enanthate costs more than testosterone cypionate and is more typically the one prescribed for hypogonadal males in the United States.
Testosterone cypionate is more popular in the United States than elsewhere especially amongst bodybuilders. Other formulations exist but are more difficult to come by in the United States. Testosterone undecanoate is also much more expensive as it is still under patent protection. The adverse side effects of injected testosterone esters are generally associated with high peak levels in the first few days after an injection. Some side effects may be ameliorated by using a shorter dosing interval weekly or every ten days instead of twice monthly with testosterone enanthate or testosterone cypionate.
This benefit must be weighed against the discomfort and inconvenience of doubling the number of injections. Injected testosterone esters should be started at a low dose and titrated upwards based on trough levels blood levels drawn just before your next shot. Both testosterone patchescreams and gels are available.
Both approximate normal physiological levels of testosterone better than the higher peaks associated with injection.
Testosterone Treatments: Why, When, and How? – American Family Physician
Both can cause local skin irritation more so with the patches. Patches slowly diffuse testosterone through the skin and are replaced daily. Transdermal testosterone is available throughout the world under the brand names Andromen Forte, Androgel, Testogel and Testim.
Testosterone Deficiency, Erectile Dysfunction, and Testosterone Replacement Therapy
Transdermal testosterone poses a risk of inadvertent exposure to others who come in contact with the patient’s skin.
This is most important for patients whose intimate partners are pregnant or those who are parents of young children as both of these groups are more vulnerable to the masculinizing effects of androgens. Case reports of significant virilization of young children after exposure to topical androgen preparations both prescription and ‘supplement’ products used by their caregivers demonstrates this very real risk.
Implants, as subcutaneous pellets, can be used to deliver testosterone brand name Testopel. This must be done in a physician’s office, but is a relatively minor procedure done under local anesthetic. The primary advantages of Testopel are that it gives a much more constant blood level of testosterone yet requires attention only four times yearly. Oral testosterone is provided exclusively as testosterone undecanoate. It is available in Europe and Canada, but not in the United States.
Once absorbed from the gastrointestinal tracttestosterone is shunted at very high blood levels to the liver where it can cause liver damage albeit very rarely and worsens some of the adverse effects of testosterone, like lower HDL good cholesterol.
In addition, the first pass metabolism of the liver also may result in testosterone levels too low to provide satisfactory masculinization and suppress menses. Because of the short terminal half-life of testosterone, oral testosterone undecanoate must be administered two to four times per day, preferably with food which improves its absorption.
Sublingual testosterone can also be made by some compounding pharmacies. Testosterone is absorbed through the oral mucosa and avoids the ‘first pass metabolism’ in the liver which is cause of many of the adverse effect with oral testosterone undecanoate. The lozenges can cause gum irritation, taste changes, and headache but most side effects diminish after two weeks.
The lozenge is ‘mucoadhesive’ and must be applied twice daily. Synthetic anabolic-androgenic steroids AASlike nandrolone as an ester like nandrolone decanoate or nandrolone phenylpropionateare agonists of the androgen receptor AR similarly to testosterone but are not usually used in HRT for transgender men or for androgen replacement therapy ART in cisgender men.
Although many AAS are not potentiated in androgenic tissues, they have similar effects to testosterone in other tissues like bonemusclefatand the voice box. Also, many AAS, like nandrolone esters, are aromatized into estrogens to a greatly reduced extent relative to testosterone or not at all, and for this reason, are associated with reduced or no estrogenic effects e. For the sake of clarification, it should be noted that the term “anabolic-androgenic steroid” is essentially synonymous with “androgen” or with “anabolic steroid”and that natural androgens like testosterone are also AAS.
Dihydrotestosterone DHT referred to as androstanolone or stanolone when used medically can also be used in place of testosterone as an androgen. In all people, the hypothalamus releases GnRH gonadotropin-releasing hormone to stimulate the pituitary to produce LH luteinizing hormone and FSH follicle-stimulating hormone which in turn cause the gonads to produce sex steroids.
In adolescents of either sex with relevant indicators, GnRH analoguessuch as leuprorelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction.
GnRH analogues work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced.
There is considerable controversy over the earliest age, and for how long it is clinically, morally and legally safe to do this.
The sex steroids do have important other functions. The high cost of GnRH analogues is often a significant factor. Antiestrogens or so-called “estrogen blockers” like aromatase inhibitors AIs e.
In addition, in those who have not yet undergone or completed epiphyseal closure which occurs during adolescence and is mediated by estrogenantiestrogens can prevent hip widening as well as increase final height estrogen limits height by causing the epiphyses to fuse. However, they may also slow or reduce a few aspects of masculinization, such as facial and body hair growth and clitoral enlargement. Depo-Provera depot medroxyprogesterone acetate, or DMPA may be injected every three months just as it is used for contraception.
Generally after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy. In those who have not yet undergone or completed epiphyseal closure, growth hormone can be administered, potentially in conjunction with an aromatase inhibitor or a GnRH analogue, to increase final height.
The most commonly cited reason for this is that their voice may reveal them. Facial changes develop gradually over time, and sexual dimorphism physical difference between the sexes tends to increase with age.
Within a population of similar body size and ethnicity: Frequently the first sign of endometrial cancer is bleeding in post-menopausal women. Transgender men who have any bleeding after the cessation of menses with androgen therapy should have an endometrial biopsy and possibly an ultrasound done to rule-out endometrial cancer.
A number of skeletal and cartilaginous changes take place after the onset of puberty at various rates and times.
Sometime in the late teen years epiphyseal closure in other words, the ends of bones are fused closed takes place and the length of bones is fixed for life. Consequently, total height and the length of arms, legs, hands, and feet are not affected by HRT. However, details of bone shape change throughout life, bones becoming heavier and more deeply sculptured under the influence of testosterone. Many of these differences are described in the Desmond Morris book Manwatching.
The psychological changes are harder to define, since HRT is usually the first physical action that takes place when transitioning. This fact alone has a significant psychological impact, which is hard to distinguish from hormonally induced changes. Most trans men report an increase of energy and an increased sex drive.
Many also report feeling more confident. While a high level of testosterone is often associated with an increase in aggressionthis is not a noticeable effect in most trans men.
HRT doses of testosterone are much lower than the typical doses taken by steroid-using athletes, and create testosterone levels comparable to those of most cisgender men. These levels of testosterone have not been proven to cause more aggression than comparable levels of estrogen.
It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that the overall level of aggression actually decreases. Some transgender men report mood swings, increased anger, and increased aggressiveness after starting androgen therapy. Many transgender men, however, report improved mood, decreased emotional lability, and a lessening of anger and aggression.
During HRT, especially in the early stages of treatment, blood work should be consistently done to assess hormone levels and liver function. Before oophorectomy, it is difficult and frequently impractical to fully suppress estrogen levels into the normal male range, especially with exogenous testosterone aromatizing into estrogen, hence why the female ranges are referenced instead.
In post-oophorectomy trans men, Israel et al. See the table below for all of the precise values they suggest. From Wikipedia, the free encyclopedia. Part of a series on. Conservative Management of Sports Injuries. European Journal of Endocrinology. Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts.
Ergogenic use of anabolic steroids. Hormone replacement therapy transgender. Testosterone derivatives: Androstenediol dipropionate. Dehydroepiandrosterone DHEA androstenolone, prasterone. DHEA enanthate prasterone enanthate. Testosterone ester mixtures DeposteronaOmnadrenSustanon. Dihydrotestosterone derivatives: Bolazine capronate.
Dihydrotestosterone DHT androstanolone, stanolone. Drostanolone propionate dromostanolone propionate. Metenolone acetate methenolone acetate. Metenolone enanthate methenolone enanthate. Oxabolone cipionate oxabolone cypionate.
Trenbolone hexahydrobenzylcarbonate trenbolone cyclohexylmethylcarbonate. Progesterone derivatives: Medroxyprogesterone acetate. Androstenedione immunogens: Androvax androstenedione albumin. Certain anabolic-androgenic steroids e. Estradiol hemisuccinate estradiol succinate. Estradiol pivalate trimethyl estradiol acetate. Estropipate piperazine estrone sulfate. Diethylstilbestrol monobenzyl ether benzelstilbestrol. Dimestrol diethylstilbestrol dimethyl ether.
Mestilbol diethylstilbestrol monomethyl ether. Methestrol dipropionate promethestrol dipropionate. Mixed mechanism of action: Danazol. Algestone acetophenide dihydroxyprogesterone acetophenide.
Flugestone acetate flurogestone acetate. Gestonorone caproate gestronol hexanoate. Sex steroid antagonists via disinhibition of the HPG axis : Antiandrogens e. Sex steroids via negative feedback on the HPG axis : Androgens incl. Others mixed mechanisms of action : Danazol. Retrieved from ” www.florencecardinal.com?
This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed.
All Natural Treatment For Low Testosterone
WebMD explains how testosterone replacement therapy can be used to treat erectile dysfunction.
TESTOSTERONE MEASUREMENT. Laboratory measures of testosterone include total testosterone, free testosterone, and steroid hormone-binding globulin.
An interview with Abraham Morgentaler, M.D. It could be said that testosterone is what makes men, men. It gives them their characteristic deep voices, large muscles.