Gender Identity Disorder Ireland

Hormones will have a number of effects on the body and mind. Not only will they change your appearence, but they will change the way you feel and think.

The main positive effects of feminising hormones are as follows:

The main negative effects of feminising hormones are

• There are also some risk factors associated with hormone therapy, the most serious of which is a risk of deep-vein thrombosis (DVT) or pulmonary embolism (PE), which can be life-threatening. The risks appear to be much higher if the patient is over 40 years old, overweight, or a smoker. Patients who smoke should be strongly encouraged to quit.
• Hormone treatment must be discontinued for some time (typically 3--6 weeks) prior to any form of major surgery due to the risk of thromboembolic events. Likewise if the patient suffers an injury resulting in immobilisation, hormones should be withdrawn. In cases of minor surgery it may be safe to continue hormone treatment, but in all cases the advice of the surgeon and anaesthetist should be sought.
• The manufacturer's safety data for the hormone(s) chosen should be consulted for full information; but it must be noted that the drugs companies do not acknowledge the use of these drugs in GID subjects and clinical data specific to GID patients is scarce.
• Fluid retention and/or hypertension may result from hormone treatment. A change in the hormone regime often helps; for example several patients have experienced water retention or hypertension when taking the progestogen levonorgestrel, but have returned to normal when this was replaced by an alternative progestogen such as medroxyprogesterone acetate ('Provera').
• If a particular hormone appears to be producing poor results or side-effects then a change in regime is probably wise: hormone therapy for GID patients is still somewhat 'hit-and-miss' although a consensus does appear to be emerging; much good research has been published by Prof. Gooren of Amsterdam. If no feminisation whatsoever is seen (not even the tender nipples that precede breast growth) after 2--3 months, or if feminisation is very limited over a longer period, then it may be beneficial to refer the patient for a serum androgen level test (testosterone and DHEAS), as some patients overproduce androgens to the extent that feminising hormones have little effect, and perhaps also refer the patient to an endocrinologist experienced in the treatment of male-to-female patients.
• Certain blood tests are advisable on a routine basis for patients undergoing hormonal sex reassignment. Opinions differ as to which checks are required and how often, but as guide, liver function, serum lipids and blood pressure should be checked annually at a minimum. It is advisable to check more frequently if the patient is preoperative (pre-ops require higher dosages, and hence are at greater risk of adverse effects), is also taking antiandrogens, or has any other factor predisposing her to side-effects such as being overweight, being a smoker, being over 40 years old, or having any relevant medical history (e.g. hypertension, liver problems etc).
• Some practitioners also advise the checking of fasting glucose (high dose hormone/antiandrogen treatment may affect carbohydrate metabolism), thyroid function, blood clotting time and prolactin. The necessity or otherwise of checking serum prolactin has been debated recently --- some elevation of prolactin is to be expected under aggressive oestrogen treatment and would not necessarily indicate a problem, conversely there have been reports of pituitary prolactinoma in a few GID patients, which would be detectable by an excessively high serum prolactin level that fails to drop when oestrogens are temporarily discontinued.
• Some practitioners also recommend monitoring the levels of sex hormones in the blood, particularly testosterone for pre-op male-to-female subjects. It is debatable whether this is necessary if the patient reports satisfactory physical development, however if the hormone treatment is producing poor results and it is proposed to prescribe an unusually high dosage of hormones or antiandrogens, then such a test might be indicated. Likewise, if prescribing antiandrogens to an agonadal subject (post-op or post-orchidectomy) is contemplated, such a test is indicated --- it is normally considered unwise to administer antiandrogens to a post-op subject.
• When sex hormone levels are measured, it must be borne in mind that antiandrogens that work as receptor antagonists may skew the results, since the body's response to a given serum androgen level will be depressed relative to a normal subject, even though the measured androgen level may not be much below normal. Normal testosterone levels are typically considered to be 300--1000 ng/dl for a male, 5--85 ng/dl for a female.
• It should also be borne in mind that serum oestrogen levels may be misleading. With an effective dose of oestrogen being administered, there is little reason to perform this test; and the normal test for serum oestradiol is insensitive to ethinyloestradiol and certain other forms of oestrogen anyway, which may cause misleading results.

The main positive effect of masculising hormones are:

• Thickening of the vocal chords and deepening of the voice
• Facial hair growth (moustache and/or beard growth)
• Increased body hair growth (notably on arms, legs, chest, belly, and back)
• Enlargement of the clitoris
• Cessation of periods
• Potential hair loss at the temples and crown of the head, resulting in a more masculine hairline; possibly male-pattern baldness
• Migration of body fat to a more masculine pattern
• Increased activity of the skin's oil glands - skin becomes more oily, which may result in acne
• Increase in red blood cells (RBC)
• Change in cholesterol levels may occur-- the "good" cholesterol (HDL) is likely to go down and the "bad" cholesterol (LDL) is likely to go up.
• Scent of body odours and urine may change
• Skin may become rougher in feeling and/or appearance.
• Increase in sex drive
• The face may become more angular in appearance, with a squarer jaw.
• Increase in size of feet and/or the width/thickness of hands. Some FTMs report going up in shoe size, and some report that their hands become a bit wider. This may be attributed to cartilage, muscle, or connective tissue growth.
• Increase in energy level.
• Increase in appetite.
• Slight decrease in density of the fatty breast tissue.
• 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 transmen 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 aggression, this is not a noticeable effect in most transmen. It is assumed that the effect of the start of physical treatment is such a relief, and decreases pre-existing aggression so much, that even if the testosterone itself causes an increase in aggression, the overall level of aggression actually decreases.

 

The main negative effects of masculising hormones are:

• Sensitivity to androgen could cause epilepsy
• Migraines,
• Sleep apnea or sleep-disordered breathing, is a condition in which breathing is briefly interrupted or even stops episodically during sleep
• Polycythemia (elevated red blood cell count,)
• Cardiac failure, renal failure, or severe hypertension susceptible to salt retention and fluid overload
• Liver disease
• Coronary artery disease or risk factors for CAD
• Increased aggression due to elevated testosterone levels