Hormone treatment

Hormone treatment 

Men who want to make the transition to women usually receive anti-androgen medication (usually Androcur® at 12,5 mg/day) that stops the production of testosterone (male hormones) and stimulates the release of oestrogens (female hormones).

The effects are:

• shrinking testicles
• decreased ejaculation (semen)
• reduced body hair growth and increasing baldness.

Possible side effects are fatigue, lethargy, muscle weakness, infertility and loss of libido.

Oestrogens suppress the production of testosterone and stimulate female characteristics. Oestrogens are prescribed in pill form for younger people and in patches for older individuals.

The effects are:

• breast growth
• softer skin
• changed fat distribution in the body
• feeling more emotional (mood swings)
• changing perception of sexuality 

Possible side effect: risk of thrombosis (blood clots) mainly in women who smoke, which is why transgender women are advised to quit smoking.

Hormone therapy does not affect the voice and often speech therapy is needed to remedy this.

People at risk of serious cardiovascular and liver disease (uncontrolled high blood pressure, thrombosis, blood clots[KW3] ) must not take oestrogens.

Ethinylestradiol, the synthetic oestrogens in the contraceptive pill (e.g. Diane 35), is no longer prescribed because of the risk of cardiovascular disease. Discuss alternative medication with your doctor.

Androcur® is discontinued after you had a vaginoplasty and replaced by oestrogens for life.

Hormones and sex work

Transgenders who take hormones may suffer erection problems, which may cause problems for your work. That is why people often use erection aids such as Viagra or Kamagra. Oestrogens and erection pills have an impact on your cardiovascular system. You should always talk to your doctor about and before taking these medicines.

Poppers, cocaine and other drugs have a strong impact on your cardiovascular failure.

The combination of hormones, erection aids, poppers and coke is dangerous and can lead to arrhythmia, blood clots and cardiac arrest.

Medical follow-up

Many trans sex workers get their hormones through friends, on the internet or buy them without a prescription in the pharmacy because they find the doctor too expensive, too far away, unavailable or medical advice unnecessary.

However, medical guidance is recommended because:

• a doctor can regularly check the functioning of your heart and liver.
• a doctor can adjust the hormone dose if you have erection problems.
• if your friends provide you with the hormones, you may not know what you are taking and end up with the wrong dose or even with dangerous products.
• a doctor can advise you on the use of the drugs and substances and warn you for possible dangerous combinations.

Taking additional hormones on top of your prescribed dose does induce faster or more visible feminisation but can lead to thrombosis and other serious side effects.