MTF Feminization Regimen

mtf feminization

MTF feminization therapy is generally a safe process, and the likelihood of being physically able to undergo hormonal reassignment is very good. But to assure your well being and that the hormonal process will produce the utmost results, a medical evaluation is very important, and periodic blood monitoring is a necessity.

Medical Evaluation

The physical evaluation should include a health history, diagnostic laboratory (blood and urine) testing, and physical examination. Most individuals are in generally good health and can comfortably begin a hormonal regimen without compromising their health status. And if one is in good health, additional flexibility may be possible when receiving transgender treatment.

Often one’s primary care physician (or local physician contacted) may likely oversee general health care matters during transition provided that hormonal management is obtained elsewhere. During the course of managing our extended transgender medical program—treating patients literally coast-to-coast, we have often found that our patients had easy local access to general health care. However the local/primary care physician was typically not comfortable with directly prescribing as this was not their area of expertise. But the local/primary physician was comfortable in providing indirect transgender care—providing a baseline of the person’s health status (e.g., initial physical exam, etc.) and overseeing routine health care matters without directly prescribing.  In such a case, our gender program would medically coordinate by periodically reviewing laboratory data via ordering necessary blood testing and prescribe the appropriate MTF feminization regimen.

But when other medical conditions are present, such as hypertension, heart disease, obesity, diabetes, and liver disorders, amongst others, transgender medical care must be addressed with additional caution. Other important factors include alcohol, drug and tobacco use.

By fully and accurately disclosing all other medications currently being taken, your hormonal management will not interfere with other medical therapies you may be undergoing. Through the use of drug interaction software, your physician will be able to analyze multiple types of differing medication being taken for potential side effects or adverse reactions.  And combined with regular diagnostic review, good health can more effectively be maintained throughout one’s entire transition. Keep in mind that completion of your physical transition is not the end, but the beginning of a new lifestyle. Your future physical well-being will play a vital role in fully enjoying the years ahead.

The Process of Hormonal Reassignment

Male-to-female hormonal therapy is a crucial therapy in the transition process. The process of MTF feminization, while essential, is one that nature does not permit to be unduly rushed or accelerated. Given the best of techniques, the genetic male’s full response to feminizing therapy appears over a matter of years; this process can be akin to a second puberty.

The bodily processes that are about to be undermined and redefined have been in place since birth. Because of the altering effects of testosterone, not all of the masculine physical characteristics can be hormonally reversed. Many characteristics such as height, the bones that comprise the hands and feet, as well as facial bones have been well defined before the time of hormonal adjustment. And as well, one’s genetic makeup is male, so tissue response to feminizing factors for the male may not be as efficient as the genetic female.

However, many more changes will likely be in store than are usually anticipated. The musculature of hands and feet will diminish. While the bones comprising these appendages remain unchanged, often the reduction in musculature reduces ring and shoe size. The skin’s appearance will also change markedly. Facial contour will be redefined by hormonal influence, and much of the angularity and fullness in the lower face will disappear due to electrolysis beard removal.

Fat distribution will redefine the general body shape, consistent with the typical hour-glass shape of the genetic female. Also, medical and hormonal therapies will restore, partially or fully, the fullness and pattern of scalp hair that may have diminished due to the effects of testosterone and DHT.  While MTF feminization has little effect on beard hair, bodily hair will likely diminish to a large extent.

For hormonal and related medical therapies to be successful for the whole person, body as well as spirit, one should realize that there is only a fine line of demarcation between a successful feminizing/beautifying process and a life of endless physical preoccupation, continually focusing on physical imperfection. As daunting as the physical process may appear at the onset of transition, the real obstacle for many is failing to fully realize the emotional growth that this undertaking may require.

The Drug Regimen

While the overall process of MTF feminization is somewhat straightforward, a variety of factors contribute to the wide range of outcomes; certain medical conditions may require special attention, testosterone levels vary over a wide range in normal healthy males, and one’s response to the drug therapy will additionally vary significantly. And as such, tailoring specific medication regimens and dosing schemas requires beginning with a thorough understanding of the individual’s health along with monitoring throughout the process. With consideration given to these variances, the overall process can be examined.

MTF feminization therapy consists of administration of a highly estrogenic component and anti-androgens. Therapy usually begins with oral estradiol (17-Beta Estradiol often branded as Estrace tablets), which is the most potent estrogen available. While the reader will naturally focus on the estrogenic component, the other important factor considered in drug therapy is its administration, or more precisely, the route of administration. The path by which the hormone is introduced into one’s system, such as, taken orally, injected into muscle, or transferred through the skin in the form of a medication skin patch affect the process.

The second category of medication, equally important to the traditional hormonal preparations that produce a direct estrogenic effect, is anti-androgens. These compounds aid in the overall MTF feminization effect by lessening or reversing the previous masculinizing effects produced by the presence of testosterone and DHT. With the aid of anti-androgens, the available estrogens are also able to produce more desirable effects while using less medication, allowing the male form to more readily morph into a female form.

But all anti-androgens are far from a panacea. One should realize that the bulk of these preparations used in transgender medicine are comprised of drugs that produce an anti-androgenic effect incidental to their designed purpose. The anti-androgens that some transgender patients are taking, are being taken by many others for a variety of very different medical conditions that include anti-hypertensive treatment (reducing high blood pressure), treating prostactic cancer, prostatic enlargement, and fungal conditions, amongst others. And as common sense would dictate, these drugs with their wide scope of uses may also produce a wide variety of potentially serious side effects. For example, a particular drug when used in treating cancer may work within acceptable limits of overall risk, even though it produces a certain stain on the liver. But when the same drug is used to add a mild anti-androgenic (de-masculinizing) effect to an otherwise healthy individual, are the mild feminizing effects of this mediation worth the potentially serious health risks associated with its use? This is the question the transgender patient should consider, and naturally, the physician entrusted with the care of that individual is also considering.

But anti-androgens’ risk-to-benefit ratio is not bleak for all potential medications. Certain anti-androgens, when used reasonably, will greatly increase the MTF feminization process with minimal risk. Two such medications, spironolactone and finasteride, are relatively benign and produce desirable effects when given within normally acceptable dosing limits.

A third category is the progestin. These drugs are derivative of the normally occuring substance progesterone found in both males and females.  Amongst treating physicians, there is uncertainty as to whether progestin products have any positive effect for the transgender individual.

The most common preparation seen in this category is medroxyprogesterone acetate, often branded as Provera. The wisdom of adding a progestin can be linked to mimicking the female hormonal cycle. Additionally, naturally occurring progesterone aids in breast development in genetic females. A decreased incidence of cervical cancer is also noted when a progestin is added into the estrogen replacement regimen. But transgender women do not have a cervix, and the role of progestins in breast development is debated.

Progestins are also known to produce mildly androgenic (masculinizing) effects and can compete with the actions of estrogens, reducing their effect.  Progestins also may produce negative reactions in the form of weight gain, edema and phlebitis, but without notable feminizing effects. Some may also experience mild depression and mood swings.

With these counterposing factors considered, progestins may be introduced in the regimen in a minimal way, or possibly altogether excluded.

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