Perhaps the greatest single area of interest expressed in comments I receive from visitors to this site is summed up in one word -- HORMONES.
Visitors ask about the use of hormones. Why do they need a doctor? How will hormones affect them? How fast do hormones work to change the body? Will hormones even work for them since they are older?
There are a number of excellent descriptions about hormones and hormone use on the Internet. Just ask anyone posting to the several Internet news groups, public or private. There are FAQs and professional discussions. Although I've delayed writing this page, the questions keep coming. So, I am writing my personal views, as a non-medical professional.
Why Hormone Therapy?
The hormone therapy stage of transition enforces an artificial, second puberty on the body of the transsexual. These changes cause the transsexual's body to change and mature, as the body would during a natural puberty, to more closely appear correct for the true gender. The levels of hormones are high. For male-to-female transsexuals, the levels of estrogen in the body is equivalent to those of a woman at the height of her menstrual period. The levels of testosterone are lower than found in a woman.
As with a nature induced puberty, the period of hormone therapy lasts maybe four or five years maximum. Note that word -- maximum. While many transsexuals have sexual reassignment surgery approximately three to four years after beginning transition, not all do. For those transsexuals who wait longer, or who decide to remain non-operative, they must decide how to handle the hormone situation. For example, it is not uncommon for a male-to-female transsexual to decide to have an orchidectomy. Having an orchidectomy allows for lower estrogen intake -- usually via an estrodiol patch -- without a need to further suppress the body's production of testosterone.
Why involve a doctor?
Following the initial evaluation period (a minimum of three months, yet possibly longer), the therapist will okay the use of hormones for those individuals diagnosed as transsexual. That approval does not mean immediate use of hormones. Instead, the transsexual is given a full physical. Hormones are not something that anyone should begin taking without both an evaluation of their medical condition and a few initial benchmarks as to estrogen and testosterone levels.
Why a physical? I've know several people who either encountered problems after starting to take hormones or already knew of potential problems. The transsexual (female to male) who made the silver wedding rings Allison and I exchanged when we were legally married knew there were potential problems in his taking testosterone. Another friend spent two weeks in a San Francisco hospital because of problems encountered in taking estrogen.
A doctor, knowing your individual medical condition, carefully watches for complications as you slowly begin taking an increasing level of hormones -- either testosterone (for female to male transsexuals) or estrogen (male to female transsexuals). During this period the doctor will typically test for estrogen and testosterone levels. After several months of increasing dosages while checking for problems, your doctor will then prescribe a full level dose of hormones. Do NOT skimp on these medical precautions.
How fast do hormones work?
Ah! The quest for immediate results.
Anyone starting the use of hormones must remember that what they are initiating is a second puberty. The first puberty didn't occur over night and this one won't either. The full changes, regardless of age, will probably take four or five years.
During that period, changes will be occurring constantly. To the individual, it will seem as though there are no changes. Yet to friends who see you at infrequent intervals, the reality of those changes will be much more apparent.
Many transsexuals (male to female) who begin taking estrogen claim an immediate relaxing affect. Personally, I doubt that occurs. Instead, I believe that relaxing affect is really an emotional relaxation from having reached yet another stage of transition. Another stage of understanding and an acknowledgement of their true self.
I'm older. Will hormones work for me?
Answering in one word - YES. Again, immediate results do not occur. Instead, the process of the second puberty is slow, yet progressive, during the four to five year period. Do not expect results immediately.
Also, the transsexual must remember that the changes that will occur in their body are already part of the genetic make up. These changes are what would have occurred to their body, had that body been correct initially. If male to female, the end result will be typical for other women in their family (mother and sisters). If female to male, those changes will be typical to what they see in their father or brothers.
If you seek a more 'medical' description of hormones, you might want to check "Hormone Treatment in Transsexuals".
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Moss-Fritch. All rights reserved.