For a male to female transsexual, hormone treatment provides a medically derived second puberty that is crucial for the development of feminine characteristics. As with natural puberty, hormone-induced puberty is a slow process taking up to five years to complete. It is common during this time for a male to female transsexual to have sexual reassignment surgery or an orchidectomy, which allows for lower estrogen intake after the surgical removal of the testicles.
Meet with a Therapist
A transsexual who is considering hormone therapy in order to feminize the body must undergo psychological evaluation before beginning treatment. Once an evaluation has been completed and the individual is diagnosed as transsexual, hormone treatment may be prescribed. This diagnosis is not automatic and typically takes a minimum of three months, although it is not uncommon for the evaluation period to take longer.
After hormone therapy has been prescribed, the patient must then undergo a medical physical in order to determine initial estrogen and testosterone levels for benchmarking purposes. The physical is also necessary in order to provide a complete medical background for the physician who will be monitoring the ongoing hormone-therapy treatment plan for complications.
Estrogen hormone therapy
Estrogen, which is considered the female hormone, plays the most important role in the transition from male to female. Although estrogen is available in patch form and as injections, oral estrogens are most commonly used, provide satisfactory results and are relatively inexpensive.
Initial estrogen dosing for pre-operative male to female transsexuals may include either 6 to 8 mg of estradiol (Estrace or Estrofem) daily, 6 to 8 mg of estradiol valerate (Progynova) daily, or possibly 5 mg of conjugated equine estrogens (Premarin) each day. In certain instances, half of the dosage amount may be sufficient or the amount may need to be increased. It is important for a physician to monitor the hormone levels and make any necessary adjustments in dosage. Additionally, because estrogen can increase the risk of blood clots, taking 81 mg of aspirin daily may be added to the hormone-therapy regimen.
The second component in changing from male to female includes the reduction of testosterone in the body. Adding an anti-androgen can help to lower testosterone to normal female levels, while also allowing for lower doses of estrogen, which may be recommended depending on the individual circumstance. Either 100 to 300 mg of spironolactone (Aldactone) or 100 to 150 mg of cyproterone acetate (Androcur) should be taken each day.
At times, progestins are added to a hormone regimen to increase breast development. There is conflicting evidence on the success of progestins, and they are considered unnecessary by some physicians. If progestins are recommended, a typical daily dose of medroxyprogesterone (Provera) is 5 to 10 mg. Another possibility is 100 mg twice daily of micronized progesterone (Prometrium).