A quick, basic guide towards Hormone Replacement Therapy (HRT) and its changes for transgender women and other identities

Note: This guide is primarily for transgender women/girls who are looking for gender affirming therapy and resources. However, if any transgender men, non-binary, and other gender identities are reading this, please share this post as you may end up helping someone who is considering transitioning into a woman (or girl). Note that this guide may be uncomfortable to some as I will discuss about topics like gender dysphoria or use a few words that may feel triggering, but never in a transphobic manner. I am trans myself and considering gender affirming therapy. However, my knowledge about this topic is still limited, so please bare with any mistakes that I may end up writing throughout this guide. You are more than welcome to write additional information provided it helps with this guide. Links to sources will be provided at the end of the guide. Use them for more detailed and more accurate information.

Do not use this HRT guide or resources to fulfill some “sissy task” or fetish, nor to harm or discredit trans people.

So, you have tried on the clothing, practiced voice training, applied makeup, etc. You have tried everything you can to “feminize” yourself. But no matter how you look on the outside and feel on the inside, you still see someone different looking at you in the mirror and feel distress to the point where you lose sleep. As much as you hate admitting it, you probably have gender dysphoria. If you’re at this stage, it’s time you start finding gender affirming therapy. The problem is, where do you start?

If you or anyone are looking into transitioning, you may want to read and share this quick guide. Since these resources are mostly US based, I gladly encourage you to add useful resources for trans people if you’re based in a country with notorious wait times such as the UK. Even DIY HRT can help, but only if it’s reputable among trans people. If you have a Reddit account and are thinking about going that route due to lack of resources or very long wait lists for hormones, please check out r/TransDIY as the community there is helpful on recommending the best choices.

TRANS WOMEN: HERE'S SOME SHIT YOUR DOCTOR WONT TELL YOU ABOUT HRT

1. Progesterone: not for everyone, but for many people it may increase sex drive and WILL make your boobs bigger. Also effects mood in ways that many find positive (but some find negative). Most doctors won’t prescribe this to you unless you ask. Most trans girls I know swear by it.

2. Injectible estrogen: is more effective than pill or patch form. Get on it if you can bear needles bc you will see more effects more quickly.

3. Estradiol Cypionate: There is currently a shortage of injectible estradiol valerate. There is no shortage of estradiol cypionate. Functionally they do the same shit.

4. Bicalutamide: This is an anti-androgen that has almost none of the side-effects of spironolactone or finasteride. The girls I know who are on it are evangelical about it.

@euryale-dreams

Are there HRT medications that don’t increase blood clot risk? I’m already at risk because of my blood pressure, and my doctor won’t prescribe HRT that increases clot risk while I’m on the medication - and I may never not be on the medication.

Absolutely.

The concerns surrounding venous thromboembolic events as a side-effect of hormone replacement therapy can mostly be traced back to one particular study known as the Women’s Health Initiative. This study was an enormous undertaking which, unfortunately, demonstrated significant adverse effects of the hormone therapies studied. As a result of this the use of hormone replacement therapy in postmenopausal cis women was dramatically reduced as the medical community began to question whether or not the therapy caused more harm than good.

Naturally, trans women have been suffering from this fall-out ever since.

What physicians seem to fail to recognize is that the study examined a very specific hormone regimen which was, arguably, outmoded at the time the study was conducted: It examined the use of conjugated equine estrogen (Premarin) with or without the use of medroxyprogesterone acetate. Neither of these drugs is regularly used for the treatment of transgender women.

The estrogen most commonly used to treat transgender women nowadays is 17β-estradiol either in pill form or in the form of a sticky patch that you apply to your skin. Esters of estrogen (e.g. estradiol valerate) are also sometimes used either in a pill form or as an intramuscular injection.

Transdermal estradiol patches are the gold standard when it comes to treating women who are at high risk of a venous thromboembolic event. It simply does not increase the risk of developing a venous thromboembolism. The only thing you should keep in mind is that patches are not always well tolerated because of the lifestyle changes required to keep them from falling off and the fact that they tend to irritate the skin.

Fortunately, oral 17β-estradiol appears to be safe, regardless of the increased risk. At least one large study has shown that the use of oral estradiol in trans women is not associated with venous thromboembolic events. An individual woman’s risk would need to be substantial in order to contraindicate the use of oral estradiol.

For those who have significant risk of venous thromboembolism because they have had a previous thromboembolic event, because they are paralyzed, or because of some other factor it is good to know the relative risk between oral and transdermal estrogen. The latest research indicates that the use of transdermal estrogen lowers your risk of a thromboembolism to 80% of what your risk would be using oral estrogens.

It’s difficult to find hard numbers regarding the relative risk of venous thromboembolic events with regards to hypertension. The best I could find after an hour or so of searching was this study regarding VTE in lung cancer patients. Hypertension increased the risk by a factor of 1.8.

However, to put that into perspective being of African descent increases your relative risk for deep vein thrombosis by a factor of 1.3 when compared to Europeans. Europeans are, themselves, at increased risk when compared to Asians and Pacific Islanders by a considerable margin: a four-fold increase.

I should point out that being ‘male’ is also a risk factor for developing a thromboembolism and hormones are likely to be a contributing factor. Also, menopause is another serious risk factor. Given this information it is likely that the use of transdermal estradiol will lower your risk of thromboembolic events significantly.

As far as the anti-androgen is concerned: The primary use for spironolactone for cisgender people is as an antihypertensive.

Even if the risk of thromboembolism was truly significant with modern hormone replacement therapy it wouldn’t justify what your doctor is doing to you. The fact is that mortality in the transgender community from suicide–caused in part due to the lack of access to hormone therapy–is substantial. The quality of life lost when a trans woman is denied hormone therapy is substantial. The fact that your doctor does not appear to be taking this into consideration when they weigh the risk of thromboembolism against not receiving necessary medical care is deeply concerning.

I strongly recommend that you seek a doctor who is more sensitive to your medical needs as a transgender woman.

Edit: Fixed a minor, but embarrassing, error.

oh wow this is so helpful & good info

Everyone who cares about transfem people please reblog this

this was really fucking helpful

I know a lot of trans women dont have acess to information like this and its very helpful.

I’m doing my part for my sisters and those who care about them!

Transitioning didn’t just feminize your body into a soft girl. Your wardrobe is full of leggings and cute tops while your mind now craves the attention of being noticed. Loving these changes affirm your identity as a trans girl. It’s a sign of you growing into your true self.

You look back at your old pics and discard the ones you don’t need anymore. Suddenly, you noticed this pic of a hot girl in leggings. Of course she’s hot, this was you a few months after SRS! How could you forget, this was the night you made out and slept for the first time with your now long-term boyfriend. You can’t believe time has passed so fast since then. But just as you receive an invite from a friend who is hosting an impromptu Girl’s Night event, you send this pic to your partner and save it on your favorites. If you can go back to the past, you will definitely recreate that night. Hopefully he’ll get the memo 😉