Category:Feminization

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[+] Feminization Overview
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The Feminization category contains a list of all our pages relevant to the phenomenon of feminization, which can be useful for people wishing to research ways to feminize themselves as well as those who wish to understand more about how puberty feminizes the body.

This page also has a summary of some of the currently guidelines used to induce feminization through hormone replacement therapy.

If you wish to add a new article to the feminization category you can do so simply by adding [[category:feminization]] to the bottom of the page.


Feminizing HRT Guidelines
Feminization.svg

The following tables are compiled from our article on the Endocrine Society Guidelines and were originally transcribed from The journal article "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". Which is an up to date review on the clinical practice guidelines for the treatment of gender dysphoria.

Feminizing Effects in Transgender Females[1][2][3][edit]

Effect

Onset

Max

Change in body fat distribution

3–6 mo

2–3 y

Decrease in muscle mass and strength

3–6 mo

1–2 y

Softening of skin / decreased oiliness

3–6 mo

Unknown

Decreased sexual desire

1–3 mo

3–6 mo

Decreased spontaneous erections

1–3 mo

3–6 mo

Male sexual dysfunction

Variable

Variable

Breast growth

3–6 mo

2–3 y

Decreased testicular volume

3–6 mo

2–3 y

Decreased sperm production

Unknown

>3 y

Decreased terminal hair growth

6–12 mo

>3 y a

Scalp hair

Variable

b

Voice changes

None

c


a Complete removal of male sexual hair requires electrolysis or laser treatment or both.
b Familial scalp hair loss may occur if estrogens are stopped.
c Treatment by speech pathologists for voice training is most effective

Abbreviations: Unk, Unknown.

Feminizing Effects in Transgender Females[1][2][3][edit]

Effect

Onset

Max

Change in body fat distribution

3–6 mo

2–3 y

Decrease in muscle mass and strength

3–6 mo

1–2 y

Softening of skin / decreased oiliness

3–6 mo

Unknown

Decreased sexual desire

1–3 mo

3–6 mo

Decreased spontaneous erections

1–3 mo

3–6 mo

Male sexual dysfunction

Variable

Variable

Breast growth

3–6 mo

2–3 y

Decreased testicular volume

3–6 mo

2–3 y

Decreased sperm production

Unknown

>3 y

Decreased terminal hair growth

6–12 mo

>3 y a

Scalp hair

Variable

b

Voice changes

None

c


a Complete removal of male sexual hair requires electrolysis or laser treatment or both.
b Familial scalp hair loss may occur if estrogens are stopped.
c Treatment by speech pathologists for voice training is most effective

Abbreviations: Unk, Unknown.

Medical Risks Associated With Sex Hormone Therapy

Transgender female: estrogen[edit]

Very high risk of adverse outcomes
  • Thromboembolic disease
Moderate risk of adverse outcomes
  • Macroprolactinoma
  • Breast cancer
  • Coronary artery disease
  • Cerebrovascular disease
  • Cholelithiasis
  • Hypertriglyceridemia

Transgender female: estrogen[edit]

Very high risk of adverse outcomes
  • Thromboembolic disease
Moderate risk of adverse outcomes
  • Macroprolactinoma
  • Breast cancer
  • Coronary artery disease
  • Cerebrovascular disease
  • Cholelithiasis
  • Hypertriglyceridemia



Baseline and Follow-up Protocol During Induction of Puberty[4][edit]

Every 3–6 mo
  • Anthropometry: height, weight, sitting height, blood pressure, Tanner stages
Every 6–12 mo
  • In transgender males: hemoglobin/hematocrit, lipids, testosterone, 25OH vitamin D
  • In transgender females: prolactin, estradiol, 25OH vitamin D
Every 1–2 y
  • BMD using DXA
  • Bone age on X-ray of the left hand (if clinically indicated)

BMD should be monitored into adulthood (until the age of 25–30 y or until peak bone mass has been reached). For recommendations on monitoring once pubertal induction has been completed, see Tables 14 and 15.

Abbreviation: DXA, dual-energy X-ray absorptiometry

Protocol Induction of Puberty[4][edit]

Induction of female puberty with oral 17b-estradiol, increasing the dose every 6 mo
5 μg/kg/d
10 μg/kg/d
15 μg/kg/d
20 μg/kg/d
Adult dose = 2–6 mg/d
In postpubertal transgender female adolescents, the dose of 17b-estradiol can be increased more rapidly:
1 mg/d for 6 mo
2 mg/d
Induction of female puberty with transdermal 17b-estradiol, increasing the dose every 6 mo (new patch is placed every 3.5 d)
6.25–12.5 μg/24 h (cut 25-μg patch into quarters, then halves)
25 μg/24 h
37.5 μg/24 h
Adult dose 5 50–200 μg/24 h

Protocol Induction of Puberty[4][edit]

Induction of female puberty with oral 17b-estradiol, increasing the dose every 6 mo
5 μg/kg/d
10 μg/kg/d
15 μg/kg/d
20 μg/kg/d
Adult dose = 2–6 mg/d
In postpubertal transgender female adolescents, the dose of 17b-estradiol can be increased more rapidly:
1 mg/d for 6 mo
2 mg/d
Induction of female puberty with transdermal 17b-estradiol, increasing the dose every 6 mo (new patch is placed every 3.5 d)
6.25–12.5 μg/24 h (cut 25-μg patch into quarters, then halves)
25 μg/24 h
37.5 μg/24 h
Adult dose 5 50–200 μg/24 h



Hormone Regimens in Transgender Persons[edit]

Transgender females a
Estrogen
Oral
Estradiol
2.0 – 6.0 mg/d
Transdermal
Estradiol transdermal patch
0.025 – 0.2 mg/d
(New patch placed every 3 – 5 d)
Parenteral
Estradiol valerate or cypionate
5 – 30 mg IM every 2 wk
2 – 10 mg IM every week
Anti-androgens
Spironolactone
100 – 300 mg/d
Cyproterone acetate b
25 – 50 mg/d
GnRH agonist
3.75 mg SQ (SC) monthly
11.25 mg SQ (SC) 3-monthly

Abbreviations: IM, intramuscularly; SQ, sequentially; SC, subcutaneously.

aEstrogens used with or without antiandrogens or GnRH agonist.
bNot available in the United States

Hormone Regimens in Transgender Persons[edit]

Transgender females a

Estrogen
Oral
Estradiol
2.0 – 6.0 mg/d
Transdermal
Estradiol transdermal patch

(New patch placed every 3 – 5 d)
0.025 – 0.2 mg/d
Parenteral
Estradiol valerate or cypionate
5 – 30 mg IM every 2 wk
2 – 10 mg IM every week
Anti-androgens
Spironolactone
100 – 300 mg/d
Cyproterone acetate b
25 – 50 mg/d
GnRH agonist
monthly
3.75 mg SQ (SC)
3-monthly
11.25 mg SQ (SC)

Abbreviations: IM, intramuscularly; SQ, sequentially; SC, subcutaneously.



aEstrogens used with or without antiandrogens or GnRH agonist.

bNot available in the United States


Monitoring of Transgender Persons on Gender-Affirming Hormone Therapy:[edit]

Transgender Female[edit]

  1. . Evaluate patient every 3 mo in the first year and then one to two times per year to monitor for appropriate signs of feminization and for development of adverse reactions.
    1. Serum testosterone levels should be ,50 ng/dL.
    2. Serum estradiol should not exceed the peak physiologic range: 100–200 pg/mL.
  2. For individuals on spironolactone, serum electrolytes, particularly potassium, should be monitored every 3 mo in the first year and annually thereafter.
  3. Routine cancer screening is recommended, as in nontransgender individuals (all tissues present).
  4. . Consider BMD testing at baseline (160). In individuals at low risk, screening for osteoporosis should be conducted at age 60 years or in those who are not compliant with hormone therapy.


References[edit]

  1. 1.0 1.1 Price TM, Blauer KL, Hansen M, Stanczyk F, Lobo R, Bates GW. Single-dose pharmacokinetics of sublingual versus oral administration of micronized 17b-estradiol. Obstet Gynecol. 1997;89(3): 340–345.
  2. 2.0 2.1 Asscheman H, Gooren LJ, Assies J, Smits JP, de Slegte R. Prolactin levels and pituitary enlargement in hormone-treated male-to-female transsexuals. Clin Endocrinol (Oxf). 1988;28(6):583–588.
  3. 3.0 3.1 Gooren LJ, Harmsen-Louman W, van Kessel H. Follow-up of prolactin levels in long-term oestrogen-treated male-to-female transsexuals with regard to prolactinoma induction. Clin Endocrinol (Oxf). 1985;22(2):201–207.
  4. 4.0 4.1 4.2 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V, Montori VM; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–3154.