women.md 17 KB
% Women
Table of contents
- External links
- Hormone replacement therapy (HRT)
- Self-medicating
- Voice training (feminization)
- Hair removal
- Breast augmentation
- Surgery
External links {#external}
In addition to this page, there is another site (not run by Transit) that has plenty of info for trans women: http://www.tsroadmap.com/index.html - NOTE: it may be a bit outdated, and uses outdated terms like transsexual, etc. TODO: integrate info from there that is missing on Transit, and then remove this link.\ The info on tsroadmap may prove useful to trans women living in USA.
Our own info on Transit is incomplete. TODO: integrate useful information from TA and TSroadmap, onto the transit site. We are not responsible for information on external websites.
Hormone replacement therapy (HRT) {#hrt}
As a trans woman, typically you would (if you were going to transition) take what is called HRT or hormone replacement therapy. This will give you the same estrogen/testosterone balance as a typical cis woman.
With HRT, several things will happen to you (this list is not exhaustive):
- You will probably develop breasts (to the size of a typical cis women) over the course of a few years
- Your hips will probably widen (over the course of years)
- Body hair growth (but not facial hair growth) will be reduced (within 6 months usually). The body hair that does grow will be thinner and less visible. You will stop needing to shave your body as much.
- body fat will redistribute to be more female generally (e.g. more fat in your thighs)
- Body odour will feminize (You'll smell female, not male)
- The size of your testicles will decrease
- Your libido (desire for sex) will seriously decrease
- Emotional changes: your emotions will feel more intense (you're not going to go mad, you'll still be in control and you'll normalise after a while to be more stable). They will change the way that you think, basically.
- Your skin (whole body) will soften, your veins will become less visible
- Decreased muscle mass and strength. E.g. the muscles around your shoulders and upper body will go down
- Decreased acne, skin will become less oily
- You might lose the ability to ejaculate
- You will become infertile
More information is on this Wikipedia article.
Your mileage may vary! Some people don't get changes, while others might only see some of these changes, or they will see them in varying degrees. E.g. some trans women will develop large breasts, some will develop small - or no - breasts. It all depends on your body (and what type of hormones you take, at what dosages, etc). All of this depends on age, genetics, etc. There's no telling what will happen to the individual trans person, you just have to see what happens basically.
We have information about getting HRT on the Transit site. See:\ How to get HRT if you're a child/teenager\ How to get HRT if you're an adult\ Private trans care providers\ How to purchase HRT on the internet
Self-medicating {#diy}
You should also make sure to book an appointment with an endocrinologist, if you can (in the UK, you need a GP referral).
UK residents: you might be able to get help from CliniQ on things like blood tests and so on, to make sure that you're safely taking HRT. They can offer advice. It's a private clinic, but also part of NHS.
You should also test your blood pressure. If you suffer from low blood pressure, you should not take spironolactone for instance (use cyproterone acetate instead, or if you can't get that, take finasteride and a higher estradiol dose). Similarly, if you have high blood pressure, you should get that sorted before starting HRT.
WARNING: cypro causes depression symptoms. Use with care.
You'll see information online about having to lose weight before starting HRT. It's not actually true. It's good to not be overweight, but you can still be and start HRT. Just watch for side effects. This is the same for anyone, regardless of their weight.
Side effects of various medication:
WARNING: cypro causes depression symptoms. Use with care.
Not all of these are serious. Watch out for the serious ones e.g. blood clots, etc. If you get any of the serious side effects, stop taking HRT immediately and seek medical help. This paragraph is not meant to scare you away from taking HRT. You should take it, if you want to. But you are also taking your own health into your own hands, so you need to be more aware of risks.
QUIT SMOKING before you start HRT (e-cigarettes / vapour is fine). Smoking tobacco (or smoking anything, for that matter, including weed) increases clotting risk, which is even riskier with estradiol.
An antiandrogen blocks testosterone. The most popular one is spironolactone, but cyproterone acetate is also popular in Europe. Both are toxic long-term and have different side effects. You should research which one. We recommend using spironolactone, unless you can't use it for some reason, in which case cyproterone acetate would also work. Inhouse and QHI both sell 100mg spironolactone pills and 50mg cyproterone acetate pills.
WARNING: cypro causes depression symptoms. Use with care.
Another alternative to spiro/cypro is flutamide or bicalutamide. bicalutamide is usually taken at 50mg daily, though we're not sure about flutamide. NOTE: the pills are plastic and harder to cut/split. Both affect certain liver enzymes which could be a problem; in extreme cases, jaundice and liver failure. They don't suppress testosterone, but they block its effects, so free flowing testosterone in your body will not actually work. You should be careful when taking this, and get constant blood tests to check for this.
Spironolactine reduces the amount of salt in your body, so you should take in more salt in your diet while using it. It also increases the amount of potassium in your body, so you should lower your potassium consumption in your diet. Some spironolactone pills contain lactose, so if you are lactose intolerent you might have to take your lactase pills. We're not sure if the amount is high enough to warrant this.
Cyproterone acetate reduces iron and B12, so you should take supplements for those while using it. Cypro is an alternative to spiro, which some doctors in Europe prescribe (in USA, cypro is a controlled substance and not currently prescribed by doctors). Avoid alcohol like the plague, while taking cypro, because you can get massive hangovers with much smaller amounts.
WARNING: cypro causes depression symptoms. Use with care.
NOTE: cyproterone acetate on long term usage, depending on dosage, has been known to cause some depression symptoms.
Only use bioidentical estradiol. This is either estradiol valerate (progynova 2mg), or estradiol hemihydrate (estrofem 2mg).
If you've already had vaginoplasty or orchiectomy (genital surgery), then you do not need to take spironolactone, cyproterone acetate or indeed any antiandrogen, because your body no longer produces high amounts of testosterone (your testicles have been removed, after all).
Fun fact: after surgery, some trans women actually have too low testosterone. Cis women have testosterone, just in small amounts. Some women have to actually take testosterone (the same kind that trans men take), but in very very very small doses, to get their testosterone up to female ranges. This page documents some symptoms of low testosterone in women (applies to cis women and post-surgery trans women). Blood tests will show whether your levels are too low (most women are between 0.5 to 1.5 nmol/l testosterone levels).
DHT is what causes hair loss in men, or trans women who waited too long. Hair loss can be reversed, by taking Finasteride which blocks DHT. You can get the 5mg finasteride tablets on inhouse or qhi (use a pill cutter to split them into 2.5mg pills, to be taken every 12 hours). Doctors usually prescribe between 1-6mg of finasteride. If you already have a full head of hair without hair loss, then you don't need finasteride. Finasteride can prevent hair loss, and in some cases can cause lost hair to grow back.
NOTE: patches often contain ethinyl estradiol, which is not ideal. This is not bioidentical to real estradiol, but a synthesized version that is more potent. The clotting risk is higher with this when taking orally. It replaces diethylstilbestrol, which is known to be cancinogenic. We recommend using the Estradot brand of patches (whether 25, 50 or 100mcg variant) because it uses the superior estradiol hemihydrate.
Most good doctors start you off on 100mg spironolactone and 2mg or 4mg oral estradiol (or 1mg/2mg gels or 50mcg/100mcg patches) daily. Start on that first (low dose is recommended, when you first start HRT).
You might need a pill cutter, depending on what dose you take and how you spread it out into the day. Spread your spiro dose into 2 daily doses (every 12 hours), so for instance with 100mg daily spiro you'd split it into 50mg every 12 hours. Split the estradiol dose into 2 doses daily (gels) or 2-3 doses daily.
For patches, you don't need to split anything because the patch stays applied constantly, until you have to put a new one on.
You should use spironolactone and estradiol, usually. If you can't take spiro (e.g. don't respond well to it, side effects, low blood pressure, etc) then you could try cypro instead (50mg daily - some trans women go up to 100 or 150mg). Most doctors would start you off on 50mg if using cyproterone acetate.
WARNING: cypro causes depression symptoms. Use with care.
If you can't or don't want to take an antiandrogen (spiro, cypro, GnRH), you can take estradiol alone, which on its own can block testosterone, but it means that you have to take it at a higher dose than usual. Finasteride is a weak antiandrogen.
In our opinion, GnRH antiandrogen injections are the best T blockers. If you can get this with your doctor, that's great. Otherwise, use spiro or cypro.
Oral estradiol may raise IGF-1, according to some people we've spoken to, which could also assist breast growth. Oral estradiol valerate/hemihydrate is therefore interesting to consider, instead of sublingual. NOTE: there is not a lot of research on the effectiveness of sublingual administration, and not all pills are suitable to be taken this way. We recommend oral method, and if not, use patch or gel. We recommend against use of sublingual method for taking pills. Most doctors do not prescribe sublingual estradiol either.
Patches: if you don't want to take oral estradial, then you can take patches. We recommend Estradot 100. This is 100mcg of estradiol hemihydrate, equivalent to about 2.5mg oral estradiol daily. You wear the patch for 3 days (you can still shower, swim, etc) and replace it after 3 days, wearing each patch for 3 days. You might get marks around the patch, on your skin, but this is just residue from the adhesive. You can remove it. Wear it on your lower abdomen, around your hips on either side, left or right.
Gels: we do not currently have information about estradiol applied via gels. We recommend oral or patch method.
Whatever daily (24h) dose you take, you should split that into 2 doses every 12 hours, or 3 doses to be taken every 8 hours. 3 is better, but 2 is more convenient for most people.
Estrogen alone, in high enough doses, can also block testosterone. In the old days, trans women were given only estrogen, because antiandrogens didn't exist in most trans healthcare.
2 months after you start HRT, get estradiol and testosterone levels checked in a new blood test. Female range is about 0.4 to 1.5nmol/l testosterone, and 400-500 pmol/l estradiol (some trans women go between 500-600). You will start developing breasts and your face will transform, as will the rest of your body. If your T is too high, *and* your estradiol is too low, try increasing your estradiol dose a bit - e.g. from 4mg to 6mg, and check levels again in 2 months. Note that the extra estradiol will also lower T a bit more. If T is still a bit high on the next blood test, try increasing your spiro dose - e.g. 100mg to 150mg. Then try again. If you're taking HRT while getting blood tests, then before each blood test MAKE SURE that you take your dose 1 hours before, assuming that this is 12 hours after your last dose, so that you know roughly what your peak levels are.
We are not responsible for any harm that you may bring upon yourself. Self-medication is usually safe for most people (and most trans women do it, or consider it, in their early transition). If you have some abnormality in your blood results (doctor will tell you) pre-HRT then get checked up with an endrocrinologist if you can (several private ones exist, if you can't use NHS) and ask their approval. They are there to help you. Certain benign brain tumours (prolactinoma) can be susceptible to estradiol too; blood test results can tell you signs (your prolactin will be too high, e.g. 3x higher than normal - there are other reasons that this could occur, not just prolactinoma), and an MRI scan can be used to detect it. You can take a dopamine antagonist which doctors will prescribe, to treat the prolactinoma. If it works, your prolactin levels may drop to normal levels after a month. The antagonists suppress the prolactinoma, making estradiol safe to take in a lot of cases. Your doctor will start you off on a very low dose of estradiol while the antagonists take effect, and then check you later on. If the prolactinoma is suppressed enough, they'll increase your dose. DO NOT SELF MEDICATE *AT ALL* IF YOU HAVE A PROLACTINOMA. USE AN ENDOCRINOLOGIST, GET FREQUENT BLOOD TESTS AND ONLY TAKE HRT PRESCRIBED BY A DOCTOR, UNDER CLOSE MEDICAL SUPERVISION.
Self-medication is always risky, but we also understand that dysphoria is also risky and that delaying HRT can be deadly for some people.
This website (not run by Transit) also has some useful information about HRT for trans women. NOTE: some of the information there is highly experimental.
Blood tests
Get blood tests before you start HRT! Go to your GP and ask for these tests:
- urea and electrolytes
- bone profile
- thyroid function
- C reactive protein
- ferritin
- full blood count
- baseline full blood tests
- random glucose
- FSH
- liver function
- estradiol
- testosterone
- rheumatoid factor
- SHBG
- HDL cholesterol
- TFT1: suspected thyroid disease
- uric acid
- lipids
- LH
- prolactin
- cortisol
- dihydrotestosterone (DHT)
book an appointment with your GP, and ask for the authorisation form, then find the hospital in your area that holds the blood samples taken, and go there to get your blood taken. It\'ll be on the list of blood clinics that your GP will probably give you. Go there, and then they\'ll send the results to your GP usually a week later, and you can go to collect them. If your GP refuses to authorise a blood test, try another GP. Some GPs are assholes.
Every 3 months afterwards, get these tested:
- liver function
- testosterone
- estradiol
- potassium (if taking spironolactone)
- B12 (if taking cyproterone acetate)
- Iron (if taking cyproterone acetate)
Voice training (feminization) {#voice}
During male puberty, your voice deepens. Training can help that.
We have a section for this on the Transit site
Hair removal
You can get your body hair and facial hair permanently removed. We have a section for this on the Transit site
We have a section for this on the Transit site
Breast augmentation
You can get implants inserted into your breasts, to enlarge them.
Surgery
You can get surgery which will give you a fully functional vagina, with (depending on your surgeon and the type of surgery) full sensation and self-lubrication.
We have a section for this on the Transit site
Sex education for trans women
Brazen's Trans Women’s Safer Sex Guide http://librarypdf.catie.ca/PDF/ATI-20000s/26424.pdf
Booklet for trans women that focuses in the UK but is still relevant for everyone: http://www.tht.org.uk/~/media/4653aa766e3f4c1286fc515f17146f32.ashx
Sex education for trans men
Sex education booklet for trans men that focuses in the UK but is still relevant for everyone
http://www.tht.org.uk/~/media/8F7D70D8C3B643109351E3D9A633529A.ashx
Sex education for gay trans men (trans men into into men)