frequently asked questions

The following faqs were culled from various sources, including online research and reports from other trans people, as well as my own experiences. They should not be considered medical advice and I recommend doing your own research as information may have changed over time.


Hormones and their effects

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[3] SRS, transition & miscellaneous Questions

Q: By far the most frequently asked questions are about hormones and their effects.

The effects of hormones depends on several factors including genetics, age when starting hormones, weight and your body's receptivity to estrogen. Generally, the younger one is the more dramatic the changes. The ideal time to start HRT (Hormone Replacement Therapy) is in one's teens during puberty to early 20s. I started at 23 and the effects were dramatic, to say the least! Estrogens bind with the estrogen receptors in your body and put you through a second puberty.

No matter at what age you start it should be remembered that it takes 5 to 7 years for a genetic female to go through puberty. The changes will take place, though slower than we usually like. The temptation to try to 'speed things up' by taking higher doses should be avoided.

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Q: What effects will I notice after the first 2 weeks, one month, 6 months, etc?

In the beginning most of the changes are internal. Estrogen is creating millions of new female cells and can interact with genes! Depending on your body's receptivity to estrogen and age, you can see changes in as little as one month that includes breast development and soreness, skin softness, fat distribution in the lower body and face, a change in body odor and hair texture. There are psychological and emotional changes, as well.

If you don't see noticeable changes in 4 to 5 months have your hormone (estrogen & testosterone) levels checked. Estrogen should be within the 200 - 400 range, testosterone 50 or less (normal male is 400 - 800). You may need to adjust your dosages or try another hormone. It can take up to a year for your body to get the idea you want it female. If you start young enough you may be able stop some, or most, beard growth.

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Q: What are the best hormones?

There are no best hormones. The best hormones are the ones that work for you. It may take some experimentation with different types and dosages to find out what produces the best results. The more popular estrogens are Premarin (conjugated hormones), Estrace (estradiol) , Estinyl (ethinyl estradiol) and Estrofem. Some refuse to take Premarin because it's made from the urine of pregnant mares (hence Pre-mar-in) and have concerns about the treatment of horses.

You may get better results from injections. They are easier on the liver since the estrogen is injected into the muscle, usually your gluteus maximus, bleed directly into the blood and bypass the digestive system and liver. The downside is your estrogen level will go way up, then taper off. Estrace is often taken sublingually (under the tongue) that also allows by-passing the disgestive system.

If you're taking Provera (or the generic medroxyprogesterone) I recommend switching to natural progesterone (micronized progesterone or Progesterone USP), or Prometrium, because their molecular structure are closer to the progesterone produced in a natal female's body. Provera has been linked to depression in trans women.

mail order hormones and suggested dosages

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Q: I have heard that applying estrogen cream to a band aid and placing them over your nipples helps in quicker nipple development/projection. Is this true? If it is, what creams would you recommend? Also, how long does it take to become sterile.

Estrogen, or progesterone, creams do nothing internally since the amount absorbed through the skin is insignificant. When I tried a progesterone cream all I noticed was a softening of the skin with some temporary breast plumpness, though that could've been from the wet look of the cream on my skin. The progesterone creams are usually made from the wild yam; save your money for prescription pills.

As for sterility, I'd estimate anywhere from 6 months to a year.

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Q: Does fat redistribute in the facial region?  If so, does it help in facial feminization at all?  How was your experience?

Yes, facial fat will develop and redistribute, usually moving to the lower half of your face making it look rounder and more feminine. Your lips may become fuller and your whole facial shape may change, but again, this varies and depends on genetics and the age you started.

Q: What is cycling and how does it work?

Cycling is going off and on hormones for a certain period each month. For example, three weeks on and one week off. The theory behind cycling is it's similar to a genetic female's own hormone cycles and is supposed to give faster development. However, a natal female's hormone levels fluctuate within a certain range and don't stop completely. Some people say it works. I've noticed no difference when I've tried it and there can be unpleasant side effects when you stop hormones.

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Q: What is the average monthly cost of prescriptions?

$50 - $200 month. Do whatever you can to have your hormones covered by insurance! Unfortunately, most insurance policies have exclusions written into their contracts excluding medicines and procedures related to gender identity. Some doctors will use hormone imbalance as your diagnosis to get around this. Medica insurance in the Minneapolis/St. Paul, Minnesota area covers SRS, HRT and gender identity counseling. Minnesota's state health insurance, from what I've heard, also covers SRS and HRT.

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Q: Can I take hormones and still function as a male?

Yes and no. It depends on the dose and length of time one is on hormones. You can take a moderate dose and remain functional for years. If you feel they're suppressing your function too much you can take a break and your libido should return. Estrogen is an effective birth control in men and sterility is possible with longterm use, as well as tissue atrophy. See Hormones by mail and suggested dosages.

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Q: Since I am of Mediterranean descent and have a hairy chest and back, what can I look forward to in HRT?  Will the hair diminish?  If so, would all of it, part of it, etc?

Estrogen does have some effect on body hair, making it softer (the reduction in the diameter of the hair shaft makes it softer) and reducing male pattern hair growth, like on the chest, but this also depends on your genetics. What really helps getting rid of male pattern hair, especially chest hair, is an anti-androgen like Spironolactone, Proscar or Eulexin. You may still need some electrolysis or laser on body hair to completely get rid of it.

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Q: The information that you covered was fantastic, my story is very similar to yours and it makes me very happy that I am not alone. I have visited a lot of T-sites, but you seemed more natural and down to earth than the others, sort of how I want to be (you're my inspiration!). Do you have any advice on phytoestrogens such as Feminol and Evanesce from the Phoenix Project?

Thanks for your kind words! Herbal phyto-estrogens and anti-androgens produce minimal results at best. I've heard of no more than a small A cup. There are many herbs that have anti-androgenic, or mild estrogenic, properties such as chasteberry (from monks who took it to suppress their libidos), saw palmetto, black cohosh, hops, etc. If you're going to be on herbals for any length of time don't waste your money on Feminol, Evanesce, etc. Buy herbs in bulk from herb shops or health food stores. Get some gelatin capsules -- local or online -- and encapsulate them yourself. You'll save money.

Encapsulators can be bought for a few bucks online or at some health food stores, though I found doing one at a time took about the same time. An electric coffee bean grinder does a good job of grinding up herbs that aren't already in powder form.

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