Talk:Hormone replacement therapy (trans)

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[edit] Sources?

Obviously this article is well-researched, but what are its sources? Are they at the listed "External Links"? It'd be nice to get cites and a proper reference list in there. DanB†DanD 19:58, 26 August 2006 (UTC)

I wrote much of this article (a good while back.) The sources of pretty much all of it is in the copylefted book I subsequently co-wrote (Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers) which was cited at the end of this article by someone after the fact. The original sources are in the book, and if I had the time I would try to clean this article up with regard to citations, but 1) I am not going to bet smacked around for original research and citing my own work and 2) don't have the time to do it with the original sources I used. :( Sorry. NickGorton 06:11, 3 November 2006 (UTC)

[edit] HRT effects on youth

How about including the special case of HRT used in youths? HRT in youths precents most undesired secondary sexual charactoristics and better developed desired charactoristics. Also, it is common to block the onset of puberty "buying time" before starting HRT.

LexieM 01:53, 18 January 2006 (UTC)


[edit] Penis size

Does the HRT change the size of the penis and the testicles or just the testicles?


Depending on how much testosterone is suppressed, the testicles will decrease in size anywhere from 25-50% of their original size. Because fat starts to accumulate in the pubic region during HRT, that can make the penis appear to be slowly shrinking. I also suspect that there is an atrophy of the spongy tissue due to much less frequency in erections rather than the penile skin atrophying which may be why the penis, when fully erect (as it can get post-HRT, that is), is not as large as it once was. But then again it might be the skin and spongy tissue as well or just the skin. I'm just speculating... -- WiccaIrish 02:45, 20 May 2006 (UTC)


[edit] Casodex warning

Can Kiral please provide the source for his or her claims under Cardiovascular. Such as a study from PubMed or another reliable source, as the link given in the paragraph does not say anything about DHT, cortisol, etc. It also refers to 150mg tablets, however bicalutamide is very effective at a low dosage (even as low as 12mg) and has a long half-life. Most of the transwomen I've seen taking it use 12-50mg dosages, not 150mg. Also, I'm assuming what you are refering to is an Addisonian crisis, although those are typically caused by a withdrawal of corticosteroids. I've been searching on Google and PubMed but cannot find anything about a build up of DHT causing hypocortisolism upon withdrawal of using androgen receptor antagonists that would be reliable. I did, however, find one discussion board on an intersex website where one member says, "if your DHT levels get too high while taking an androgen receptor antagonist, you can have an adrenal crisis (hypocortisolism) when the antiandrogen wears off." They go on to say that they used Avodart to prevent such from happening. source

Since you do not have a talk page I cannot reach you directly, please consider becoming a member so others can contact you on your talk page. Thanks! -- WiccaIrish 19:41, 21 May 2006 (UTC)


Reply: See here for a study of the effect of DHT on the adrenal gland and the ability of antiandrogens to block this. It is true that casodex approval was withdrawn specifically because of the deaths, rather than heart failure or adrenal problems, but those are known side effects. Perhaps these could be listed in separate sections if you don't feel they belong together. BTW half-life is somewhat misleading when dealing with lipophilic drugs. Since they are stored in fat cells, food intake can significantly affect serum concentrations. -- Kiral 11:21, 22 May 2006 (UTC)


Would you say that a DHT inhibitor would still be recommended even on a low dosage of bicalutamide (12-50mg)? What if another anti-androgen (spiro or cypro) is taken concurrently? -- WiccaIrish 22:31, 22 May 2006 (UTC)


I haven't seen any studies comparing the side effects of bicalutamide at different dosages. In theory though, low doses might actually be more dangerous. The problem is that bicalutamide is lipophilic with a low aqueous solubility (see [1]) which is why it has such a long half-life. What can happen is that due to food intake, nearly all of the bicalutamide can get bound up in fat cells, resulting in the androgen receptors getting temporarily un-blocked. The sudden influx of DHT when the androgen receptors get un-blocked is what messes up the adrenal glands. I doubt this problem could happen with spironolactone. Spiro isn't very lipophilic, plus it blocks testosterone/DHT production. Besides, spiro has a fairly good safety record, and people obviously aren't dying from it. Cyproterone acetate creates a different sort of adrenal problem due to its blockade of 21-hydroxylase, which is the primary concern for adrenal insufficiency with cyproterone. But cyproterone is lipophilic, although not as bad as bicalutamide, so the potential for the DHT problem is there too. -- Kiral 01:06, 23 May 2006 (UTC)


As far as spiro blocking production of testosterone/DHT, spiro does not inhibit the formation of DHT. Although while it does decrease testosterone levels, it is my understanding that it doesn't take much testosterone to make plenty of DHT. By the way, the link to the pdf file didn't work but the link to an HTML version provided by Google did work so I fixed the link for those wanting to read that. -- WiccaIrish 11:41, 23 May 2006 (UTC)


Well at least one study indicated that spiro lowers DHT. -- Kiral 00:46, 24 May 2006 (UTC)


I've rewritten this paragraph to include more references. I think the issue of adrenal problems is relevant, but if it's too controversial then we can take it out. I didn't include the bit about Avodart since these studies only tested bicalutamide with LHRH or orchiectomy. That doesn't mean Avodart isn't effective - it probably is - just that there aren't any formal studies of casodex + avodart. I'd also like to find a better citation for the stuff about fat solubility, since as you pointed out, the original pdf seems to have disappeared. -- Kiral 03:01, 24 May 2006 (UTC)


Thanks for including the references. I posted your first comment and the link to Health Canada on two different hormone lists and there was some skepticism regarding it, which is why I thought it would be a good idea to back it up with references. Not only to provide sources for the article, but also whether or not I should be recommending those who take bicalutamide to take either finasteride or dutasteride along with it. -- WiccaIrish 04:55, 24 May 2006 (UTC)


I really can't make a recommendation about adding finasteride or dutasteride to casodex. Note that the discussion you cited was also talking about cyproterone acetate. Cyproterone acetate suppresses testosterone production, leaving DHT as the primary androgen remaining. Studies of hirsutism have shown that adding finasteride to CPA/EE treatment results in an improvement over CPA/EE alone. (summarized here) So there is good reason to believe that adding finasteride to cyproterone acetate will result in better overall androgen suppression. There is no such evidence with bicalutamide. Bicalutamide does not reduce testosterone production, so it's unclear whether blocking DHT will have much practical effect, since testosterone levels remain high. I looked up the study by Iversen et al. (the one cited by Health Canada) and under exclusion criteria it says "Therapy with a 5-α reductase inhibitor allowed." I'm not sure whether that means they were excluded or exempt from exclusion, but in any event the combination of Casodex and 5α-reductase inhibitors was not studied. Studies of cortisol suppression by androgens suggest that there are multiple mechanisms by which this occurs and show effects from both T and DHT.[2][3][4] There appears to be some genetic variation too, as the experiment in mice showed effects much sooner in one strain of mice than another. So honestly it's not clear under what circumstances finasteride or dutasteride might be sufficient to protect against adrenal dysfunction caused by antiandrogen withdrawal. --Kiral 03:45, 18 June 2006 (UTC)

[edit] Interesting Research Questions/Sourcing

Question for the forum: While the chemical activity of common preperations of estrogen and anti-androgens are known; the effects observed effects of these hormone regimens is mostly studied via patient reporting. Should this verifiable lack of direct experimental evidence be more throrough noted within the wikipage?

Can the user who created:[5] section. Please provide sources for all claims therein. Note: While researchers have been able to isolate a "suspected" pheramone from male sweat, it is unclear if olefactor aroses or otherwise stimulates people who describe themselves as atracted to men.


This is anecdotal and observational. Once on HRT transwomen, or atleast the ones I've come across and myself included, seem to smell a particular odor from males that wasn't there prior to HRT. Even if the males have recently showered. All have described it as an unpleasant odor, regardless of her orientation. -- WiccaIrish 22:44, 11 August 2006 (UTC)


Can the user who created:[6] Please provide sources for the section. In particular, is there research positively correlating metabolic processes to sex hormornes in natal women and/or in males who recieve HRT? Note: I removed replaced the "tends" clause with "may" or "may be correlated."


Which are you referring to? The 'Metabolic' section under FtM or MtF? If FtM, that is up to Nick or Alex. -- WiccaIrish 22:44, 11 August 2006 (UTC)


Can the user who created:Gland Development:Mammary Gland Development Please provide sources. Is it clear that the breast and nerve tissue development that natal males expierence with hormone thearpy -- is the same as what commonly occurs in natal women? Note: Most research sources report that breast development in Natal Males who undergo HRT tends to take place over the 18-24 months. Reference the external link. [7] Also Note: Is there evidence showing that HRT patients who undergo breath augmentation tend to choose larger implants? --Sarah 00:23, 11 August 2006 (PST)


Doctors treating MtFs have usually downplayed or rejected the role that a progestogen would play in HRT. Most older MtFs were never given progesterone and sometimes not even enough estrogen to reach full potential maturation of the breasts. There is no reason why a transwoman (especially a young one) when given adequate doses of bioidentical estrogen within her first several years of HRT along with progesterone (or hydroxyprogesterone) and sufficient suppression of testosterone wouldn't develop as much as the average cissexual female. One should keep in mind whether the subjects in any study addressing breast development were given adequate doses of estrogen for an adequate amount of time, whether progesterone or hydroxyprogesterone was included, and whether there was sufficient suppression of testosterone before one can come to a reasonable conclusion. As per the breast implants, that is also based on observation. -- WiccaIrish 22:44, 11 August 2006 (UTC)

[edit] MtF Hormone Effects - Bone - Tendons

I've never heard this before: "the hips will rotate slightly forward due to changes in the tendons so hip discomfort is not uncommon." - is there any sourcing for this? --Marumari 21:33, 14 August 2006 (UTC)

I was wondering that too... I hope this is true. Isn't there a hormone released in pregnant females that causes the pelvis to stretch and open more? What if transsexual women took this hormone? Would anything happen? Has this been experimented before?

[edit] Testim and Androgel

If we supply a link to one branded formulation, we shouldn't refuse to supply the link to others.

Also, does anyone know what's available out of the US? I confess to being ignorant of that.

NickGorton 06:00, 3 November 2006 (UTC)

[edit] Moved from article page

HRT does not usually cause facial hair growth to be impeded; or the voice to change. - Will whoever edits this page say if there is a way for that to be done?- —Preceding unsigned comment added by 72.64.63.200 (talk • contribs) , posted in good faith


When testosterone levels are suppressed and/or androgens prevented from binding to androgen receptors, any further *new* hair growth would most likely be halted. Any follicles producing terminal hairs that currently exist would most likely have to be killed with electrolysis/laser (a bit more success with electro over laser), although this isn't always the case (those in their teens, for instance). Also, hair regrowth will likely be slower.

Any further drop to the voice would likely be halted as well (this applies to those still in puberty of course). -- WiccaIrish 03:13, 12 July 2007 (UTC)