HRT
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Hormone Replacement Therapy, also known as as Hormone Therapy, is intended to emulate the natural levels of sex hormones of either gender. For MtF's, this therapy is usually a combination of an estrogen and an anti-androgen. For FtM's the therapy usually includes testosterone.
MtF Therapy
As mentioned in the introduction, Hormone Therapy for MtF's includes both an estrogen and and anti-androgen. The estrogen is to emulate the natural levels of estrogen found in a woman. The anti-androgen is to combat the testosterone that is present. This is discontinued after an Orchiectomy or GRS, due to the lack of naturally produced testosterone.
It doesn't undo the existing masculinising effects of tesstosterone, but does cause the development of female secondary sex characteristics, such as breast growth and typical female fat distribution. It also carries with it a number of side effects and risks.
Common Drugs Used
- Estrogens:
- micronized estradiol
- estradiol acetate
- estradiol valerate
- estradiol cypionate
- estradiol enanthate
- conjugated estrogens
- esterified estrogens
- ethinyl estradiol
- Anti-Androgens:
- Spironolactone
- Cyproterone acetate (More commonly used outside of the US.)
Effects of HRT
- Skin
- Hair
- Adipose tissue distribution
- Mammary gland development
Side Effects and Risks
There are many possible side effects related to HRT. Some are related to the estrogens, some to the anti-androgens. This is be no means an exhaustive list, but it does cover all the basics.
- Cardiovascular
- Increased blood clotting due estrogens. This leads an increased risk for thromboembolic diseases such as deep venous thrombosis and pulmonary embolism.
- It is accepted that smoking and age are likely to increase the chances of DVT.
- Oral estrogens are also more likely to cause DVT, rather than implantable, injectable or transdermal estrogens.
- Urogynecological
- The Bladder atrophies
- The Prostate atrophies
- The perineal raphe, line that runs down the underside of the penis and down the middle of the scrotum, will darken.
- Minor water retention is likely
- There is sometimes a reduction in libido, depending upon the dosage of anti-androgens.
- Spontaneous and morning erections decrease in frequency significantly, however some who have had an orchiectomy still experience morning erections.
- The testes atrophy by as much as 50%, depending on anti-androgen dosages.
