#estrogen therapy for females

[rejuvenatehrt]

The benefits of HRT for women may include relief from symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness, as well as improved bone density and cardiovascular health. RejuvenateHRT also emphasizes the importance of healthy lifestyle habits, such as exercise and nutrition, to support overall health and wellness.

[femcelbassmentdweller]

Overview of My First Year of HRT (2021-2022)

Hi, my name is Sylvie, and I'm transfemme! I started hormone replacement therapy on September 25th, 2021 and I've been through quite a lot on my journey to a year of HRT so I'm making two separate posts: this one focusing on the medical side and physical changes, and another that will focus on the social side of transitioning. So, here we go!

I realized I was trans the last week of August 2021, then September 9th I came out publicly, September 15th I had my first appointment with Plume, and I received my first Estradiol script September 24th, but consider my official "first day" of HRT the 25th.

I started HRT on sublingual Estradiol pills, 2mg twice a day (morning and night). Psychologically, taking the first pill hit me like a psychosomatic lightning bolt, and the first meaningful change estrogen granted me was an opening of my feelings- I could suddenly experience a "true range" of emotion, I experienced ambivalence for the first time. Physically, within the first week, I was experiencing tingling in my chest/nipples and by three weeks they actively ached, and after about two months my nipples looked different (darker, larger), and my chest started to stick out (36" to 37")

At 2 months my Estradiol was increased to three times a day and Progesterone 100mg (at night) added. By two months, my body's sensitivity had reached astronomical levels, particularly in areas that weren't sensitive before: for me, this was my nipples, armpits, and butt. My skin overall became more sensitive, slight touches made me quiver and my pain tolerance dropped sharply. During my second month my body's smell changed too and my sweat production cut back.

At 3 months, Spironolactone 50mg once a day (morning) was added and during this month my nipples had noticeably expanded and become dark enough to see through shirts, and my chest had grown enough to be noticeable small mounds in a tight shirt (38"). Also by 3 months, random erections completely stopped happening, whether asleep or awake.

Between months 3 and 5 a lot of things happened in my life; the stress and inactivity caused me to lose 50 lbs. As a result, I lost a ton of muscle mass. My thighs, upper arms, and butt became soft and jiggly, I could not lift things I could before, even with great effort.

3 month bloodwork results: E @ 133 and T @ 320

At 4 months, I asked my doctor for Finasteride, which is a DHT blocker- DHT is an androgen created by testosterone and an excess of DHT is related to hair loss, as well as some research I read back then relating to DHT and thicker/darker body hair. Since starting Finasteride, I have only shaved and used Nair on my body itself and I have experienced 75%-80% body hair loss, and much of what hair remains is now vellus hair (light, short, soft).

Between months 4 and 5, I started experiencing sexual dysfunction. Even if aroused, it was a 50/50 shot of whether I could get hard or not. Likewise, I began producing much less semen. This was when I started experimenting with different forms of masturbating too (i.e. using a vibrator).

Between months 5 and 6 I started gaining weight again, and this was when my breast growth was the greatest, going from 38" to almost 41". However, in the growth it seems I lost the sensitivity I had in the early months- my nipples and armpits are still erogenous zones, but not as potent. Additionally, I noticed fat redistribution caused my hips and waist to take a more stereotypically feminine, almost hourglass appearance (and increased from 32" and 34" respectively to 35" and 38" by 10 months).

6 month bloodwork results: E @ 258 and T @ 22

Months 7, 8, and 9 saw only slight breast growth (41 1/2") due to losing weight again from stress, but at this point I have very little body hair left, and even areas which were full before (armpits, groin) thinned out significantly over time- the most astounding of all being my butt, which the cheek hair just disappeared without me doing anything, like the hair just fell off.

Somewhere during months 8 and 9, I completely lost the ability to become erect without medication (doctor prescribed me Sildenafil, aka viagra) and no more ejaculating. Reaching orgasm became a concentrated effort instead of something that came easily, and very little clear liquid would come out during.

9 month bloodwork results: E @ 57 and T @ 28

For some reason my levels dropped between 6 and 9 months, and during that time I became very mentally and emotionally unwell due to the hormone imbalances. My doctor suggested a few things: me not waiting/letting the pill dissolve long enough in my mouth or the pill just not having the same potency on me anymore. So...

At month 10 I started injections and almost immediately started feeling much better. There is a hormonal low day for me every week, the day before I do my injection again, but it's not hard to deal with. I feel like myself!

Now months 11 and 12, nothing really noteworthy to update except I'm desperately trying to eat more so I can gain weight to grow my boobs. Just stopped taking Spiro though, but I use Tgel to maintain my girldick because I'm a Switch.

Lastly, I'd like to say I'm open to any questions anyone might have, and I'll do my best to answer them. You can DM me, email me secretly from a fake account (bellatrixnovus@gmail.com is my email), whatever! I just hope this information is of some value to someone out there!

[badger-with-a-boa]

Not me making a meme in celebration of my girlfriend telling me she'll most likely be able to start taking Estrogen soon

[catboybiologist]

“As a biologist, the terms biological woman and man don’t make any sense to me” okay then you’re an idiot and a terrible biologist. I swear to god, morons like you only become biologists just so you can hold it over others, when in reality, if biology deniers like you can become biologists, then being one really doesn’t mean much anyway. But this probably just gave an autogynophile like you a boner to read, anyway.

Oh fun! Haven't gotten one of these in a while. Disregarding the fact that you somehow think the qualification for being a biologist entirely hinges on defining womanhood, I do need to ask some clarification. I know I'm feeding the trolls here, but here we go: does your definition of "biological woman" mean:

Sociological woman? Eh, context dependent, I'm not fully out of the closet, but oftentimes, I am and present femme. So let's call that one 50/50.

Psychological woman? Because I am one.

Neurological woman? Because I am one [1].

Physical woman? My soft tissue redistribution is handling that well.

Hormonal woman? My blood tests are within cis female ranges.

Transcriptional woman? As a signalling molecule, the downstream effects of estrogen have broad transcriptional effects, completely changing the profile of gene expression and functional genomics of my cells. [2]

Genetic woman? I mean, see my above point- as far as my genes that are actually active, I have all of the same transcripts being produced, controlling which genes are expressed.

Karyotypic woman? I actually have a few signs pre-HRT that might point to a non-XY chromosome pair, but I haven't had a karyotype. We'll put that down as unknown. And hell, even if its XY, there's plenty of cis women who are karyotypically XY, with suppressed sry or complete androgen insensitivity. Interestingly enough, a completely androgen insesitive woman can go her whole life without knowing- and functionally, is very similar to a trans woman, actually. Fancy that. [3]

Reproductive woman? I can't produce an egg cell, but neither can significant fractions of cis women. Also, this is all gonna change soon, which is fun. [4]

There's also a lot of understudied aspects to the biology of HRT and even pre-HRT that are emerging, largely demonstrating widespread cellular and genetic remodeling of trans individuals undergoing hormone therapy. The field is a bit behind due to constant political pressure to revoke funding, but a lot of the results are extremely exciting in both testosterone and estrogen hormone therapies. I'm sure that, as a self professed biology As someone who presumably has a lot of expertise in biology, I'm assuming that you're aware of all of this cutting edge research, and are keeping up with modern papers, including but not limited to these cool findings:

Trans men on HRT exhibit significant genetic and transcriptional changes that make them biochemically male. [5][6]. It's a good hypothesis that the same happens with estrogen treatment, but those studies don't exist yet- I'm sure you're reserving judgment until more publications exist, of course.

Trans men on HRT develop male cell types and tissues. [7]

Trans women experience muscular and blood cell changes that align with cis women moreso than cis men [8]

And many, many more! This is an exciting, underserved, and groundbreaking field of research, and I'm sure you're keeping up with the latest in scientific journals about it.

I'm sure, of course, that you understand that it becomes impossible to draw a distinct line anywhere in here, and that words like "woman" are shorthand for the myriad of traits that invisibly synthesize in our mind and in society to represent a concept? I'm sure you understand that science is fundamentally descriptive, not prescriptive? I'm sure that you understand that these findings, while really cool and interesting, actually don't mean jack shit about what the word "woman" means or not?

As someone who is the ultimate decider in what a biologist is, I'm sure you know that bioessentiallism is a childish mindset that completely ignores and disregards the constantly changing, dynamic nature of biological systems, something that extends well beyond biological sex and its relation to gender.

I'm sure that also, that you understand that beyond just this, that the role of science in society is to advise how to achieve our moral principles, not create moral principles in themselves. And I'm sure that understanding means you know that trans affirming healthcare and supportive societal treatment leads to reduced mortality and increased happiness for everyone, right?

So great to talk to someone who is surely a scientist on this. You are a biologist, if you're talking like this, I assume? I assume you're not going to spit complete misreadings of scientific language from the background sections of these papers that only reveal you've never read a scientific paper in your life if you're thinking this way? I assume you have experience interpreting data like this?

Also, imagining my genitalia while writing this? Ew. Please stop projecting your fetishes into my inbox.

Works cited:

Kurth F, Gaser C, Sánchez FJ, Luders E. Brain Sex in Transgender Women Is Shifted towards Gender Identity. J Clin Med. 2022 Mar 13;11(6):1582. doi: 10.3390/jcm11061582. PMID: 35329908; PMCID: PMC8955456.

Fuentes N, Silveyra P. Estrogen receptor signaling mechanisms. Adv Protein Chem Struct Biol. 2019;116:135-170. doi: 10.1016/bs.apcsb.2019.01.001. Epub 2019 Feb 4. PMID: 31036290; PMCID: PMC6533072.

Gottlieb B, Trifiro MA. Androgen Insensitivity Syndrome. 1999 Mar 24 [Updated 2017 May 11]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1429/

Murakami, K., Hamazaki, N., Hamada, N. et al. Generation of functional oocytes from male mice in vitro. Nature 615, 900–906 (2023). https://doi.org/10.1038/s41586-023-05834-x

Pallotti F, Senofonte G, Konstantinidou F, Di Chiano S, Faja F, Rizzo F, Cargnelutti F, Krausz C, Paoli D, Lenzi A, Stuppia L, Gatta V, Lombardo F. Epigenetic Effects of Gender-Affirming Hormone Treatment: A Pilot Study of the ESR2 Promoter's Methylation in AFAB People. Biomedicines. 2022 Feb 16;10(2):459. doi: 10.3390/biomedicines10020459. PMID: 35203670; PMCID: PMC8962414.

Florian Raths, Mehran Karimzadeh, Nathan Ing, Andrew Martinez, Yoona Yang, Ying Qu, Tian-Yu Lee, Brianna Mulligan, Suzanne Devkota, Wayne T. Tilley, Theresa E. Hickey, Bo Wang, Armando E. Giuliano, Shikha Bose, Hani Goodarzi, Edward C. Ray, Xiaojiang Cui, Simon R.V. Knott, The molecular consequences of androgen activity in the human breast, Cell Genomics, Volume 3, Issue 3, 2023, 100272, ISSN 2666-979X, https://doi.org/10.1016/j.xgen.2023.100272. (https://www.sciencedirect.com/science/article/pii/S2666979X23000320)

Xu R, Diamond DA, Borer JG, Estrada C, Yu R, Anderson WJ, Vargas SO. Prostatic metaplasia of the vagina in transmasculine individuals. World J Urol. 2022 Mar;40(3):849-855. doi: 10.1007/s00345-021-03907-y. Epub 2022 Jan 16. PMID: 35034167.

Harper J, O'Donnell E, Sorouri Khorashad B, McDermott H, Witcomb GL. How does hormone transition in transgender women change body composition, muscle strength and haemoglobin? Systematic review with a focus on the implications for sport participation. Br J Sports Med. 2021 Aug;55(15):865-872. doi: 10.1136/bjsports-2020-103106. Epub 2021 Mar 1. PMID: 33648944; PMCID: PMC8311086.

[drjgodo]

Have you had Your hormones checked lately?

What The Latest Science Tells Us Dr. Lindsey Berkson has made a career of studying hormones. She is the author of over 21 books and teaches physicians how to assess and prescribe hormones. I attended a course she taught to over 100 doctors and was overwhelmed by the latest science related to hormones. Dr. Berkson shared that hormone therapy can be used safely in older women. Hormones are a…

[pillarsalt]

hi! i was wondering your opinions on how hrt affects the body? i hold a lot of radfem beliefs but i am trans (taking testosterone). would being a woman to you have to be completely about chromosomes? for example, trans men years on T do not have the same genetic makeup as cis women. same with trans women on E, their genetic makeup would be very different to cis men, and would more correlate to cis women. does this factor in who you consider female/male or having experience as women?

Hi there, thanks for reaching out.

Firstly, I think you may be a bit confused. Taking exogenous hormones does not affect your genetic makeup. Your dna will stay the same unless you're exposed to something extreme like radiation - this is a good thing because dna mutation is bad for you and causes cancer! Your genetic sex is immutable, a person with XY chromosomes cannot have their dna altered to have XX chromosomes instead.

Hormones will affect the expression of your genes, for example turning on facial hair production in women who are taking testosterone. This is why those patterns of facial hair, even in women, differ from person to person. The genes for it were already there, but hormone replacement therapy uses the endocrine system to change what signals get sent to your genes to tell them what features to express.

Beyond chemically induced genetic expression, there are particular physical features in males that do not occur in males, and vice versa. This is a feature of the /ancient/ evolution of sexual reproduction. Despite the variety of metaphysical beliefs about identity and personhood, the truth is that humans evolved to reproduce between two sexes, and human beings cannot change sex. Every cell of your body has your sex encoded within it. This affects us physically in many ways. I and most feminists believe that this fact should be irrelevant to any person's ability to pursue their passion, be themselves, and love who they love. Even so, recognition of biological sex is something important. This is really critical in a medical context. For example: men who receive a blood transfusion from a pregnant or recently pregnant woman have an increased risk of death by transfusion-related lung injury. Another example: tracheostomy tubes differ in size depending on sex due to dimorphism in average tracheal diameter. A women who is reported as a male risks considerable injury by having a male sized tracheostomy tube forced into her windpipe. A considerable amount of medications differ in dose effectiveness and side effects based on biological sex. Something as straightforward as a heart attack has different symptoms depending on if the patient is female or male. Denial of biological sex is dangerous, and as it stands, medical science has not advanced enough to change the biological sex of an individual. If you are born male, you will stay male for your entire life. You say that a transwoman who has taken estrogen is more genetically similar to a woman, I'm sorry but that simply isn't true. A male person will always be more genetically similar to other males than to a female person.

Determination of sex is very simple, it's about the easiest genetic test to do. They have kits for high school classrooms to try out ffs. We need to leave the "meaningful sex change is possible through medical intervention" thing in the past, all we accomplish with that is giving people false hope and an unattainable goal to fixate on. Sex is real and immutable, I wish it didn't matter, but it does.

And why it matters is, maleness and femaleness have become inseparable from certain stereotypes and assigned qualities by societies in human history. Overwhelmingly, the male people subjugate the female people. Since men, male humans, discovered womens' ability to give birth could be taken advantage of, it was capitalized upon. And this is the foundation of patriarchal society. Religions were founded to justify this as the will of god. To deny that women have historically been persecuted due to their sex is, well, misogynistic. There is no "woman feeling" that makes us targets for child marriages, FGM, trafficking/prostitution, and other horrors from the minute we're born and even before. No, it's the sex we were born with that makes the world think it can decide our fate. In fact, the way that people treat male children differently from female children is so different so early, that we are genuinely unable to study human behaviour unaffected by gendered expectations. This is what feminists are talking about when they discuss "socialization". There is not a single man on the planet who knows exactly what it's like to see the world from a woman's eyes, no matter how feminine that man is. Womanhood isn't something you can achieve or acquire through effort: you were either born a woman or you weren't, just like you were either born with detached earlobes or not. It's so simple.

All that to get to my final point: Yes, I believe the definition of womanhood comes down to biology, because anything beyond that is a meaningless stereotype. Women can do anything, be anyone, look any way they want, go through any experience they do. The one thing they have in common is that they are female adult human beings. There is not way to fail at being a woman or do it wrong, you just are. Womanhood is the experience of having been a female person in this world, and nothing else. There are certain things only female human beings need, like abortion and female contraceptive rights, access to spaces where we can be safe from our subjugators (male human beings), and the ability to define ourselves and fight for our collective rights.

(At this point you may object and point out that male people who identify as trans women are also subject to violence and scorn from men: unfortunately that is often the case, but this does not make male people who identify as women, well, female. We need solutions for them that do not involve requiring women to sacrifice our comfort and safety for the sake of a particular subset of men, because of the inherent risks involved and the fact that women do not owe men anything even when those men have it bad.)

One last thing: my opinion is that prescribing exogenous cross-sex hormones is unethical (so are all elective cosmetic medical procedures but that's a post for a different day). I understand the distress that gender dysphoria inflicts on people, however the ill effects of hrt are too numerous to condone. The huge increase in risk of stroke with estrogen, heart disease and uterine atrophy with testosterone, and the way that trans medicine studies are notorious for losing followup with patients after a year or less... it's short sighted and frankly, financially motivated. The amount of trans patients who are prescribed hormones without access to an endocrinologist, it's honestly infuriating. People deserve the best care possible, not lab rat bullshit where they cut you loose when it's not working out. I won't judge anyone for what they do to themselves to cope with distress, but I want everyone, especially girls, to be aware of the lifetime effects medical decisions may have, and that you also can find happiness within yourself without hurting your body.

Thanks again for your question, be well ✌️

[readingbibooks]

“I desired men but just could not see how man-on-man sex could happen for me. Although I had the inner urge, it would not work in my assigned gender. The answer turned out to be that I’m really a woman and I want hetero sex. After hormone replacement therapy, when estrogen had worked its womanly mysteries on my body and mind, when men began to express sexual desire for me, then I could really see it happening. In my case, I needed gender transition to actualize my bisexual potential… many MTF [male to female] women tell similar stories about themselves. I’m a typical transsexual in this respect.”

- Sister Jannah, Getting Bi: Voices of Bisexuals Around the World

[im-not-an-object-ok]

For three months this year, I bled nearly every day. My doctor doesn’t know why. Google doesn’t know why. The condition is simply called “postmenopausal bleeding,” and medicine’s best guess as to the cause is that the postmenopausal hormone-replacement therapy I started last November suddenly made my endometrium, the lining of the uterus, “unstable.” All scientific knowledge added up to “If it’s still happening in six months, get back in touch.” (I’m still bleeding intermittently, and I don’t know why.) This is the kind of massive medical shrug that anyone with female anatomy has probably encountered.

Despite major advances for women over the past 100 years—the invention of the contraceptive pill, greater access to safe abortions—much of female biology is still woefully underserved by science. There are reasons for this, most notably the historical exclusion of women from medical and pharmaceutical trials, partly because our awkward hormone cycles were thought to skew results. There’s also the fact that some scientists still project findings from research on men onto women, seeming not to realize that women aren’t just small men: Women are different down to the cellular level, meaning that many of our immune responses, experiences of pain, and symptoms (including, for instance, those that accompany a heart attack) may be different from men’s. Are you having a nasty, unexpected side effect from your medication? That could be because most drugs were developed with male bodies in mind. A 2020 review of 86 common medications, including antidepressants, cardiovascular drugs, and painkillers, found that women were likely routinely overmedicated and suffered adverse reactions nearly twice as often as men.

The lagging science is particularly apparent when it comes to periods and female hormones more generally—the subject of the anthropologist Kate Clancy’s new book, Period, a scientific and cultural history that purports to tell the “real story of menstruation.” Clancy’s book makes clear that a lack of data is to blame for many of the ills that women and girls face concerning their reproductive health, like doctors’ failure to diagnose painful conditions such as endometriosis.

My severe endometriosis was discovered only when I was 41, accidentally. For decades, I had been given prescription-strength painkillers, and my doctor never seemed to wonder whether the amount of pain I was in was abnormal. When I published an essay about my menopausal depression in 2018, a deluge of women wrote to tell me that when they were going through something similar, their doctors had told them they were imagining their brain fog or panic attacks, or had put them on antidepressants that didn’t work because many depression drugs are inadequate to treat the symptoms of fluctuating estrogen.

[befemininenow]

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?

Diagnosing Gender Dysphoria and recognizing its signs

As I have stated in one of the guides I reblogged in the past, it is not necessary to have gender dysphoria to be transgender. However, many transgender people deal with this distress and it can detrimental to their overall health. For instance, if you’re dressed as a girl and feel like a girl, but you see someone in “drag” looking back or focus on signs of “masculinity”, you will definitely feel uncomfortable and have feelings of “impostor syndrome”.

Some signs of gender dysphoria include, but not limited to, hiding any facial and body hair, dislike towards your “assigned parts”, dysphoric when presenting as a male (or other assigned gender different from preferred identity), etc. If you have more than two of these signs and recognize them, you most likely have gender dysphoria and should start looking for help ASAP. Untreated gender dysphoria can escalate towards more detrimental consequences, such as neglect, isolation, depression, anxiety, and even $ui(ide. If you’re suffering from the latter symptom and are not under any form of care, please stop reading this article and call your nearest lifeline center now!

That being said, if you’re experiencing some signs of gender dysphoria even after socially transitioning and desire to feminize your body, the best solution will be taking hormone replacement therapy.

What is Hormone Replacement Therapy (aka HRT)?

Hormone Replacement Therapy, short for HRT (this, is a type of medical solution given to patients who lack sufficient estrogen or testosterone levels due to a hormonal imbalance caused by menopause or due to surgeries such as a hysterectomy. [1] HRT is also provided to transgender individuals as a way to help their physical body adapt to their gender identity. Known as feminizing hormone therapy, the transitioning person will develop secondary sex characteristics typical of cisgender females with the help of various types of medication. [8] Gender specialists typically (but not always) use gender dysphoria as a main reason to provide the patient with gender affirming therapy.

Why do transgender people take HRT?

The point of HRT is that it helps transgender people develop physical traits that are more in line with their gender identity when the right hormones take place in the body. In the case of transgender females, taking HRT will feminize their physical characteristics into that of of their cisgender female relatives. Not only does transitioning decrease the trigger of gender dysphoria, but it also boosts the mental health of trans people as they become more comfortable with their body aligning into their gender identity. In fact, a study done by a team of researchers based on Stanford University School of Medicine found that the earlier trans people commence their transition, the less likely they are to develop characteristics of their assigned birth gender since their puberty cycles become more active during adolescence. Those who commence transition into adulthood are more likely to fall into bad habits, mental issues, and social isolation. The researchers concluded after finishing of survey of over 20,000 participants that the best treatment towards gender dysphoria is to take HRT as some of the participants felt their livelihood vastly improve once they received hormone therapy. To summarize, HRT is the only effective solution for trans people to finally feel comfortable with their bodies once they develop their gender identity’s characteristics.

The different types of HRT medication

Once you’re deemed eligible to receive gender-affirming therapy, you will definitely want to celebrate your new milestone. Now it’s time to identify the different forms of medication you may be provided for your transition.

Pills: This one is the most common type that is prescribed for transgender people due to its affordable cost and ease to make. However, taking oral medication requires you to take daily as the feminizing effects are slower and less evenly-distributed.

Injections: This one is the most effective form since the hormone medication goes directly to the bloodstream and rarely comes with the side effects of hormone pills. However, it is more expensive to produce and purchase, as well as being the most difficult to ingest as it involves piercing your skin with a needle.

Patches: By far the most convenient and very effective method of hormone medication as it fluctuates less in hormone distribution and evens it out throughout the body. You are only required to change patches every 3 to 4 days. Unfortunately, HRT patches aren’t convenient if you have experienced irritation with patches in the past. Consult your physician if HRT patches are right for you.

Here are the types of feminizing hormones you will be provided by your physician and/or medical provider. Each one is crucial to your transition:

Estradiol: Used among cisgender women for causes such menopause and hysterectomy, it is also used among transgender women/girls to promote physical changes on their appearance. This results in their bodies to develop a feminine appearance in line with cisgender women. Depending on their hormone levels, trans women usually take 2mg of Estradiol to take effect of their feminization.

Anti-androgen: This medication is a testosterone blocker and is very helpful to one’s transition if their hormone levels indicate a high level of testosterone. Although it doesn’t completely deplete all of your testosterone, anti-androgens help neutralize your levels to an acceptable rate. Estradiol cannot be effective without balancing your hormone levels. Spironolactone is the most common form of anti-androgen.

Progesterone: This medication is used in later stages of transition. Once your therapist and/or physician see your estrogen levels reach a certain level, progesterone is added as an estrogen booster. This will promote other feminizing changes, such as increasing breast volume, tissue softening, and allegedly, mental changes. This medication, however, is controversial since modern endocrinologists have found the alleged effects of progesterone being almost ineffective. In part, this is due to advancement of medicine and better access to effective solutions. Despite this, several physicians still prescribe progesterone to transgender women/girls as an option.

DHT blockers: For those who produce more testosterone to the point where it converts into a stronger androgen called dihydrotestosterone (DHT), these medications are necessary. There are two types of DHT blockers used: Finasteride and Dutasteride. Both medications are vital for your transition as they block excess androgen, reduce scalp hair loss, and may thin out facial and body hair. Check with your insurance provider as this medication may not be covered by them.

Cause and effect of HRT

This is where many people want to know the effects of feminizing therapy among trans women and trans girls. Keep in mind that a transition is that: a timeline of several changes that occur within a period of time. Most trans women/girls take about a year to notice any change in their appearance, but it wouldn’t be until 2 to 3 years until they notice a drastic change on their timeline.

The following changes are what trans women and trans girls physically experience during transition:

Skin: Your skin would start to soften a bit within 3 to 6 months, but its maximum effect varies by individual. Your skin will glow and oil will reduce while color tone may even change to that of a cisgender girl.

Legs and feet: Muscles will start to atrophy while body fat will be more retained. Your legs will start to slender while your foot size may shrink due to the thinning of the cartilage. This process takes around 3 to 6 months to take effect.

Hair: Scalp hair will start becoming voluminous while body hair will start to thin out and fall off. Process takes 6 to 12 months. Facial hair may thin, but will still retain even after months on HRT. Electrolysis will be required if you desire to eliminate any remaining facial and body hair.

Arms and hands: Upper arms start atrophying about 3 to 6 months and hands and arms thin out to a more feminine shape. Nails become more brittle while arm hair may even fall off.

Breasts: Areolas and nipple area start expanding while bust starts to enlarge. Process usually takes at least a year to see any effect and maximum growth can take up to 5 years.

Genital area: Penile length and testicles shrink and atrophy within 6 months and infertility may occur even sooner.

Body fat: Estrogen will increase the amount of body fat you will store and will be noticeable in the thighs, back area, and waist.

Height: This factor may vary on the individual. Based on a few testimonies, trans women usually lose an inch or two (~5cm) from their pre-transitioning height. This is due to the thinning of the feet’s sole and possibly the arching of the back. This process takes up to even 2 years before it becomes noticeable.

Body odor: Your body odor starts to change after a few months under HRT. Your body odor starts smelling sweeter and more metallic, similar to a cisgender woman.

Here are areas where transition may not change your physical appearance and traits:

Voice: Despite popular belief, HRT does not alter the voice at all. While you may experience a slight change in pitch, hormones do not feminize the voice of trans women in the same manner hormones masculinize the voice of trans men. The best solution is to take voice feminizing therapy through exercises. Voice feminizing surgery is also a consideration, but has its own risks.

Bone structure: Unless HRT is taken at a younger age, preferably during puberty, there is no way to change your skeletal system without costly and risky surgeries. Hip surgeries exist to expand the narrow hip area while HRT may promote a shrinking height as pointed earlier. Unfortunately, there is no effective surgery to reduce broad shoulder length.

Remaining body hair: While HRT may reduce the amount of body hair, it does not eliminate facial hair and some body hair may remain after thinning. Electrolysis is required if you desire to permanently eliminate any type of body hair and is costly and time-consuming.

Other changes where HRT may provoke a change is also present in the way we think. Here are some of the mental changes we may experience under HRT:

Emotions: You become more sensitive to feelings and are more prone to cry under certain circumstances. For instance, you may take a small compliment either to heart or feel offended while a dramatic scene in a movie may feel very heartbreaking.

Sleep: It becomes much easier for you to fall asleep while waking up becomes more energetic. This is due to a boost of melatonin present in estrogen. Sleep depravation is surprisingly common among trans girls and trans women prior to transition.

Mood swings: There will be occasions where you may experience nausea and even feelings similar to hot flashes.

Smell: You become more sensible to smell and some odors become either very pleasant or very intolerant.

Sexuality: This one is more controversial. There have been cases where HRT affects one’s sexuality, not just by sexual orientation/attraction, but by function. For instance, you may find your interests shift into that of a heterosexual cisgender woman while your expressions become more receptive. You may not even find any changes at all under HRT. Many argue that it’s not HRT that affects your sexuality, but rather by accepting your inner, true feelings and detecting gender envy.

Social changes during transition (non-HRT related, but very important)

This process is a very challenging stage for transgender people of all identities and is one that prevents many from ever coming out. As someone who is still in this stage, I sympathize with many of you. As unfortunate as it sounds, here are some of the challenges you may end up facing as a trans woman or trans girl:

Acceptance: This is perhaps, the most difficult stage of one’s coming out. You’re not just coming out of the closet to your family members, but to friends, neighbors, co-workers, colleagues, etc. Do not be surprised if anybody from this list does not accept you. We’re currently living in a time where transphobia is being heavily promoted among social circles who attempt to persuade the neutral or uninformed into believing false stereotypes of trans people. The best you can do should you face an unaccepting member is to cut them off until they are ready to accept you.

Legal document changes: This varies depending on the country or region you live. Although name changes are usually allowed, gender or sex markers are much more difficult to change. You can live in a place like Washington State where changing your marker from M to F can be a breeze while states like Oklahoma bar you from changing your marker at all. [3] Some countries like the UK can take years to change your marker while some countries of Asia do not allow any sex marker change unless you submit documents verifying a sex change (i.e. SRS). [4]

Appearance and adaptation: Adapting yourself as a trans woman in today’s world can have variable results. While some areas such as San Francisco are accepting of anyone LGBTQ+, transphobia still exists in those areas. Whether it’s the bathroom or even outside your home, you always want to make sure you are safe from any transphobic attack. One effective way to prevent that is by “passing”, which is the process of presenting yourself as your internal gender as close as possible. Many trans women make the effort to feminize their appearance through clothing, movements, voice training, makeup, and even interests. Not only does it help trans women appear more feminine outside, but it also gives them a sense of gender euphoria, a feeling of happiness and peace where they see and feel like themselves. If you know anyone supportive of your transition, especially a woman, don’t be afraid to ask for any tips on how to present yourself, how to apply the right blush, and other things that may benefit with your social change.

Surgeries to consider

After a certain amount of time, there is a chance you want to improve the look of your body to a certain degree. As powerful as HRT can be, it won’t remove the thing down there nor would it blow your chest to a D-cup unless your female family members are bustier than that. Whether its to help your gender and/or body dysphoria, whatever options you choose should make you feel great. It’s recommended you have at least 24 months under HRT before commencing these surgeries. Here are the options for feminizing surgery:

Breast augmentation: Let’s face it: we’re never going to get a nice pair of boobs unless our genes defy it or if our mom or female cousins also have big breasts. Many cisgender women also have that trigger of not having a desirable size on their chest. Breast augmentation is an option for those who want to increase their size without resorting to placebos or who are tired of wearing breast forms all the time.

Hip and butt enlargement: Most trans women have an inverted triangle body shape. Because of that, their hip area is not as wide as they desire to be. In some cases, you may not even have a large bum and want to grow bigger. Hip enlargement is available for those who desire a curvier look and the results are very pleasant. However, you can only stretch the hip area to a limit. As for the bum, there are surgeries that help enlarge and feminize the appearance. The most popular is the Brazilian Butt Lift (BBL). If you’re going that route, I highly recommend looking for a professional surgeon as many BBLs tend to look botched after a certain period.

Lip Filler: This surgery is made to enhance your lips to a more feminine appearance. Although HRT may alter your lip shape, it won’t make you look like Kylie Jenner either. This is done through a form of injections and will help your appearance look more feminine. This is recommended for those who only want to feminize their lips and are not interested in the following procedure.

Facial Feminization Surgery (FFS): This is one of the most common surgeries done when undergoing transition. It not only involves lip enhancement, but also involves reshaping the jawline, removing most of the brow ridge, slight enlargement of the eye area, reducing Adam’s apple, and nose reduction. This surgery can be very painful and requires extensive care for about two weeks before showing signs of healing. The benefits will outweigh the cons, however, if your aim is to feminize your appearance.

Sexual Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS): This is by far, the most notable surgery when it comes to feminizing transition. SRS/GRS is a process that involves reconstructing the trans woman’s penile area into a functioning neovagina. SRS/GRS is a life-changing surgery for trans women and in many cases can alleviate genital dysphoria. It can also improve sex life and makes it easier for trans girls to fit into garments and clothes without the need of gaffs and tucks. However, it is not without its drawbacks. Not only is SRS/GRS a difficult surgery to perform, but it’s also a very costly surgery to pay for and recover from. The amount of time it takes for a trans woman’s new organ to fully heal can take up to a year and involves constant dilation therapies that are painful and time-consuming. If not done right, it can even be life threatening. Although many trans women are comfortable living with a male organ, some states and countries do not allow you to change your gender/sex marker without performing this surgery.

Electrolysis (aka. Hair removal): Unlike the previous surgeries, electrolysis does not require you to be under HRT. This is a type of surgery that you can get even before starting transition. Electrolysis is highly recommended if you are planning to eliminate any excessive or thick body hair or if you’re planning to remove facial hair.

Where to find HRT

There are many ways someone can find HRT to commence their transition. However, many resources are currently being threatened by politicians, zealots, and transphobes around the world. It is very important you find the proper help as some spots that promise “HRT” are either placebos or medication that may even harm you! For those living in the US, here are some of the resources I found for those looking for HRT:

Planned Parenthood: This is the most accessible spot to receive gender affirming therapy and may even be free if your healthcare provider is compatible. Almost anyone is eligible and very safe compared to other resources. There are a few cons, however. Not every state has these centers and some are either too far away or may not even provide HRT at all. Sometimes, those that do provide HRT may not have enough medication to provide and are placed on a waiting list. The best solution I can give is to either contact your closest Planned Parenthood for available HRT medication or look up at this link below to see where you can receive the nearest help: https://www.plannedparenthood.org/get-care/our-services/transgender-hormone-therapy.

Online providers: For those that live outside of public health centers, online providers for HRT is another solution. The most popular sources are Plume and Folx. Each plan provides you a checkup of lab tests, gender evaluation, and access to clinical care. Some have their advantages and cons that make them different. While Plume offers letters of references to doctors and physicians, Folx offers quarterly lab checkups that are crucial to your feminizing transition. The big drawback is that both are not covered by healthcare providers and require you to pay a monthly free of 100 US dollars. They are also not available at every state.

DIY: Although I don’t recommend DIY HRT, this is a route many trans girls and trans women often take due to a lack of resources around their area, as well as the attack on HRT therapy on states such as Florida. It is very important you connect with a close circle knowledgeable in obtaining safe HRT alternatives. There are many blogs here on Tumblr that sell you hormones, but they are questionable due to their varying levels of estrogen that may either be incompatible with your body or may even affect you. If someone approaches you with a message selling you HRT, whether it’s here or on any social site, avoid them at all costs, especially those whose blog’s main target are “sissies, traps, femboys, transvestites, etc.” You may end up buying ashwagandha in high doses, which is not only a testosterone booster, but can even cause irreversible harm if taken for too long.

Resources and support

As much as I would love to be a help, not everyone has the same outcome when it comes to transition. Some of us have circumstances that prevent us from transitioning, such as lack of medical resources, unsupportive peers such as family, persecution and/or lack of protection, economic problems, health issues, questioning, etc. This is where a few solutions can be provided to you.

In the US (and Canada to some extent), Trans Lifeline is a beneficial resource for those who are in need of support, especially in these harsh times. Trans Lifeline is a non-profit run by trans people and aims as a safer alternative to other resources who are more likely to invalidate or even oust gender identities to authorities. If you would like to know more about Trans Lifeline, click on this link here. If you or someone else you know is trans are in deep need, call/save this number: US Hotline (877) 565-8860. Canada Hotline (877)  330-6366⁣.

For those outside the US, if you live in a situation where your life may be in danger for being trans or any identity under the trans umbrella, check out Rainbow Railroad as they are a non-profit whose main objective is to provide safe sheltering for anyone who identifies as LGBTQ+. Although they are based in the US and Canada, they have presence in various parts of the world and can help you relocate to a safer spot, as well as provide resources to put you on track. Click on this link if you would like to learn about Rainbow Railroad or share it to someone in need

Conclusion

I hope this guide gave you an idea of what MTF hormone therapy is and what to expect of its effects. HRT is a very helpful method for transitioning people when done effectively through medical help and emotional support. Even if you’re not looking to transition under HRT or may not even be trans yourself, it’s very important we have at least a clear knowledge of what trans people are going through and what we can do to help without subjecting them to prejudice. Please give a like and/or reblog as you may never know if one basic guide like this can be a great help for someone in need. If you’re looking to research more about transgender hormone therapy and resources, I left a few links on the sources below as they are much more insightful than what I provided. If you have any questions, find blogs and sites specialized in transgender help such as Trans Lifeline or even blogs such as Reddit’s r/asktransgender. Thank you!

Sources:

https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/hormone-replacement-therapy-hrt

https://www.plannedparenthood.org/planned-parenthood-great-northwest-hawaii-alaska-indiana-kentuck/patients/health-care-services/hrt-hormone-therapy-for-trans-and-non-binary-patients?gclid=EAIaIQobChMI5eSPucLUgAMV_izUAR1uYAEyEAAYAiAAEgIuoPD_BwE

https://www.lgbtmap.org/equality-maps

https://med.stanford.edu/news/all-news/2022/01/mental-health-hormone-treatment-transgender-people.html

https://ourworldindata.org/grapher/right-to-change-legal-gender-equaldex

https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map

https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy

https://www.folxhealth.com/gender-affirming-care

https://www.mayoclinic.org/tests-procedures/feminizing-hormone-therapy/about/pac-20385096

https://www.rainbowrailroad.org/

https://translifeline.org/

https://transcare.ucsf.edu/transition-roadmap

[mewvore]

Dyou know someone who went on hrt but didn't want to be referred to as female or didn't care? I've kinda recently started not like who I am and I wanna be prettier and there are some things that hrt would give me that sound nice but I dunno if it would be weird or disrespectful to go on it just for that. I've just kinda been seeing a lot of trans girls on my timeline and I can relate to a lot more of their experiences than I would've thought but I don't really want to be a woman and some of the other things hrt gives you don't sound like they're for me. I dunno if the feeling will go away but I hate seeing 5 o'clock shadow on my face, and the thought of being male or female or anything gives me an uncomfortable feeling in my chest and I don't know how to end this ask. If you have no idea how to answer this you can just delete it, thank you.

I don't want to make too many assumptions but this sounds like you might be nonbinary. Nonbinary is being neither male nor female. To answer your question specifically, yes I know quite a few nonbinary people on HRT who prefer presenting less like their assigned gender at birth, and despite using estrogen or testosterone dont consider themselves men or women and just refer to themselves by they/them

Theres a lot you can do via aesthetics to mitigate the dysphoria you feel that doesn't involve hormones in order to look a bit more androgynous (body hair removal, weight loss/gain, changing wardrobe, cosmetics) so I'd always recommend those before immediately trying HRT but its worth looking into if after a bit of a lifestyle change you still feel a little less comfortable as your assigned gender. An endocrinologist could prescribe an anti androgen to start.

Even if you do try HRT and aren't a fan of how it makes you feel and want to stop, you can. It's your body. You're exploring and looking for the best way to be you. People do the therapy to feel better in their own skin, its a personal journey so its impossible to "disrespect" anyone else with your reasons for seeking personal fulfillment and nobody will hold that against you

[couldtransitionsaveher]

CHARLES EYLER from HELLO CHARLOTTE

JUSTIFICATION:

"He writes a self-insert fanfic with a genderswapped main character. He uses a female name as his online handle. He has effectively constructed a universe where there are dozens of characters who are in some aspect a reflection of himself, and those characters are nearly all female. Transition alone wouldn't save him, you'd need a hell of a lot of therapy and some antipsychotics for that, but taking both some estrogen and the name of his self-insert OC really couldn't hurt." - @euniversecat

Reminder: Submissions are always open! Submit here!

Did you make your daily click today?

[forcefeminizationblog]

How to be a proper sissy training training for experienced and newbies

I do most of my training real time, but I have used my experience in sissy training to create an online monitored program to develop the woman inside of you

Be aware that this program is not merely "fun and games." This program will feminize you irrevocably.

Program elements include:

Wardrobe conversion: You will be guided through the replacement of your male wardrobe with effeminate and then feminine garments. In short order you will replace all of your undergarments with Panties and Bras, and socks with hosiery. Depending on your career we will replace your male jeans with tighter female jeans or your business suits with women's business suits. Over time, your wardrobe will be completely feminine.

Feminine Grooming is also on the agenda as you grow your hair, add highlights, arch your eyebrows, do your nails, and add piercings to your ears. Over time you will appear more and more feminine and in public others will begin to misgender you and call you MIss or Maam.

Feminine Movement and Gestures: Through Video training classes Jl you will be trained to move, walk, sit, and use hand gestures as a woman.

Chastity is a requirement, as I will hold the key to a continually evolving collection of cages which will over time be reduced in size

Resexualization: No longer able to gain sexual satisfaction through your caged "clit", you will begin to stretch and sensitize your "love canal" with a set of plugs which will increase in size. Masturbation will henceforth be with vibrators and through penetration.

Hormone Therapy: We will begin with natural estrogens and you will be given instructions on how you will begin prescription estrogens and anti-androgens. Through this process, your body hair will diminish, your fat distribution and shape will change, and your genitals will shrink.

Female Self-Image: Our work will be in vain if you do not internalize that you have changed into a woman. Hypnosis is the key to changing one's self-image and through a progressive set of hypnosis programming tapes, you will learn to accept yourself, first as a sissy and then as the woman you have become.

Penetration: Now that you have accepted yourself as female, now that you look female, now that your sexuality has been retrained to yearn penetration and your brain has been bathed in estrogens, you will naturally begin to think more and more of cock. At this stage my role will be to help you accept this inevitable transition. You will be trained in how to orally service and how to give pleasure when being penetrated.

Progress Tracking: Through daily tracking of your feminization process, video training such as walking classes, chastity key holding, hypnosis programming and makeup tutorials.

Those that enroll in this program will realize their true Sissy side and embrace it.

For more information and questions on how to join the program send in your message on telegram

@prettysissyacademy1

[catboybiologist]

So y'all may have noticed I've been posting a lot about progesterone lately. I'm at the point on HRT (just passed the 9 month mark [with the asterisk that my levels didn't get good until 7 months or so]) where I'm actively considering it. I'm waiting a bit more for a couple reasons, but its still on my mind a lot.

And it bothers me how much the "no compelling evidence for progesterone" line is floated around. And this is true, for the exact case of breast size in transgender women. And yeah, maybe this study has been done.

But I have two things that I think should be said about this:

1, there will never be a clinical study that studies the exact niche case of person that you are. That's why thinking about when results can be translated from a different group that has been studied, to your group. In my opinion, most information about cis female hormones can be translated to trans women. There's far less of a physiological difference than people think, and most of those differences are dictated by hormones anyways.

2, progesterone has an enormous number of effects beyond breast development, in both cis and trans women.

Why do I bring these up?

Take a look at this review paper (if you can meaningfully read it):

This is a review paper that I somehow only just stumbled upon that summarizes a lot of my thoughts about progesterone that I developed from other sources.

It primarily uses data from cis women, but also supplements with data from trans women when applicable, about the effects of progesterone. And, as can be seen just by the sheer number of topics addressed, it finds a diverse set of functions that it regulates and improves. At that point, any breast growth that may or may not occur is a happy side effect.

Progesterone is part of normal female physiology, just like estrogen. So why the hell is it not standard practice with HRT the same way that estradiol is? It just needs to be applied later. That's pretty much it.

[religion-is-a-mental-illness]

By: PITT

Published: Sep 30, 2023

Our son recently started graduate school. He began hormone therapy during his final year of undergraduate education. Because he began to identify as a lesbian, transgender woman at 20 and showed no sign of gender dysphoria before that, we never had a chance to reflect – or advise him – on his choices. Going through the published medical research on the effects of estrogen made me aware that psychologically, excess estradiol in the serum causes depression among males, and physiologically, there are potentially much more severe side effects, including some impacting the brain and the immunological system. More of that in a minute.

Fast forwarding to the present day, before our son left for graduate school at a University with one of the country's most renowned medical schools. I decided to write to their student health center and share the studies I had found and, more relevantly, the psychological history of our child. What follows is the text of the letter and, after deleting potentially identifying information, the response from a high-ranking official within the health center. They are, for the lack of a better phrase, quite revealing.

First, my letter (I have not disclosed the name of the university and have changed the name of our child here, with apologies to the real Jonathans of the world; furthermore, apologies for the triggering usage of pronouns – I did not want to be dismissed as the “usual, hateful, bigoted transphobe”; rather, I wanted to be considered as the deadly serious parent who would do anything in their power to prevent their child from coming to harm):

-

Dear Apex University Health Center,

Our child, Jonathan, who is joining the graduate program at Apex University this Fall, identified themself as transgender during their sophomore year in college (2021) and started estrogen therapy in early 2023. Since every one of these interventions is off-label, I have been looking up the peer-reviewed literature on the effect of estrogen and whether there are any risks that our child needs to be aware of as they continue on this path. My findings, which I summarize below (and link to the sources), have been alarming. Several endocrinologists – some who publish extensively – have told me they were unaware of the new literature. I have also been in touch with the Endocrine Society, and their response heightened my alarm.

While we respect our child's identification with their gender identity, we felt that they exhibited several psychological symptoms right before identifying as a lesbian, transgender woman (Jonathan was assigned male at birth and did not show any inclinations to identify as female before April 2021), and these co-occurring symptoms were not considered at all before he started on the prescribed medicines. Most tellingly, just before identifying as transgender, Jonathan's romantic advances were rebuffed by the woman of their affection. Subsequently, Jonathan also lost every friend they had, thereby remaining completely alone in their dorm room for the greater part of their last two years of undergraduate education. However, these psychological symptoms were never explored. Jonathan was recommended to start on estradiol and spironolactone immediately, which they did – and their physical and mental health symptoms have deteriorated since. Jonathan is also quite depressed, spending all their time without emerging from their room.

That is not surprising since, when it comes to the recent research on estrogen in natal males, excess estrogen in the serum in natal males has been associated with depression – studies among adult men and adolescent boys show that. Clinical studies (i.e., studies that recruit actual subjects and follow them clinically rather than rely on anonymous, online, non-probability surveys) that promote gender medicine fail to show any improvement in psychosocial outcomes among natal males. For example, the New England Journal of Medicine study from early 2023 concluded that hormone therapy is psychologically beneficial for transgender youth. However, in the main text, the study finds no improvement in depression, anxiety symptoms, or life satisfaction among natal male youth (the relevant paragraph is at the bottom of page 244 of the journal issue).

Thus, psychologically, there is ample evidence that excess estrogen is associated with depression among natal males. Physiologically, recent research shows that estrogen might have far more deleterious effects. A study showed that 12 months of estrogen treatment among transgender women leads to a decrease in serum BDNF levels. That is significant because a separate study shows that this decrease in serum BDNF level is associated with increased risks of developing MDD (or major depressive disorder).  Lower levels of brain BDNF levels have also been associated with neurodegenerative disorders and found in the brains of patients with Alzheimer's, Parkinson’s, MS, and Huntington’s disease.

A high-quality rodent study shows that estrogen therapy among adult male rats leads to changes in their brains that resemble the changes in the brains of trans women. (There have been several other studies (2 links) among trans women that have shown these changes, but the rodent study indicated the mechanism by which these changes occurred in the brain.) Specifically, estrogen seemingly reduced the water content in the astrocytes and thereby disturbed the delicate homeostasis in the brain by increasing the relative concentration of glutamate (the brain's most abundant excitatory neurotransmitter), leading to glutamate excitotoxicity. As the Cleveland Clinic informs us, an increase in glutamate in the brain is associated with higher risks of neurological disorders like Alzheimer's disease, ALS, and many other diseases like multiple sclerosis. The research also showed that estrogen decreased brain cortical thickness and volume (which other studies have linked to patients with schizophrenia and bipolar disorder and lower levels of general intelligence). Furthermore, it was found to reduce cortical white matter integrity (which is related to cognitive instability). There is also empirical evidence of the lowering of cognitive abilities among transgender women that was presented at the EPATH conference in April 2023 (in Killarney, Ireland) - the researchers noted this decline among long-term patients at Amsterdam's famed gender clinic.

Research in the last few years shows that estrogen therapy among trans women has been associated with higher risks of various autoimmune diseases, from multiple sclerosis (recall, too, the association of MS with an increase in glutamate) to rheumatoid arthritis and many others in between. It has been associated with increases in the risks of prostate cancer and breast cancer. It increases risks of cardiovascular diseases (2 links), often by as much as tenfold compared to their cisgender counterparts.

Empirically, we see a much higher incidence of many of these physical and neurological diseases in the transgender population. It is perhaps not a coincidence, therefore, that population cohort studies (2 links) show that trans women, on average, die decades earlier than either cisgender men or women.

When I approached the Endocrine Society with what I had found and pointed out that many of these findings came out after the publication of their guidelines in 2017, I received an email from their Director of Clinical Practice Guidelines that they are currently fast-tracking a revision of those guidelines. She also mentioned that their evidence evaluation criteria have changed since the guidelines were published and that they now use the GRADE criteria for evaluating evidence. This is encouraging, but I have no idea how long it will take for the new guidelines to appear.

I point all of this out because Jonathan has the chance to start afresh and be reevaluated at Apex University's healthcare system. We increasingly see them stumbling with their memory, something that we could not even think of a year earlier – Jonathan used to have a photographic memory ever since they were a child. Having heard so much about Apex's medical school, we have high hopes that Jonathan's evaluation at Apex University's medical system will be more thorough than it has been so far. Let me be clear: We have no doubt about their gender dysphoria or their intense discomfort in their traditional gender role – we worry about that all the time. It is just that we have observed that medicalization has not brought them any balm so far – in fact, just the opposite. While the absence of any upsides (and the possible significant downsides) in the literature – psychological or otherwise – heightens our alarm.

After all, it is not only a lone voice like ours, but even mainstream media like the Economist (their April 5 issue with the cover story “The evidence to support medicalized gender transitions in adolescents is worryingly weak” comes to mind) and storied institutions like the British Medical Association and the systematic reviews of the literature from national medical associations of very transgender-friendly countries like Sweden, Finland, Norway, the UK, and (most recently) Denmark that are raising the alarm on the lack of high-quality evidence of any benefits from hormone therapy. (And these reviews I mention above cover only the evidence of the psychological effects of the hormones – they do not even consider the long-term physiological consequences.)

If all the evidence from the past few years is to be believed, there is now quite a body of evidence of genuine harm from administering estrogen to the natal male body (I have not researched the effects of excess testosterone on the natal female body, and so I cannot comment on that.)

As one of the world's leading lights in healthcare to nudge society toward better outcomes through research, Apex University will be well placed to lead the march for evidence-based care in gender-affirming care.

Thank you very much for reviewing the evidence that I have found and considering our child's health as they start their journey at Apex University. Please let me know if you have any questions. I look forward to hearing back from you.

With warmest regards,

XXX

-

A few days later, I got their response. I have highlighted the relevant portions of their email and annotated them within brackets [all formatting mine]. As I said, it’s quite revealing.

-

Dear XXX:

Thank you very much for sharing your concerns about your child with us.

…Apex U's Student Health Center (Apex SHC) is not directly affiliated with Apex Medical School and we do not provide care under the umbrella of the hospital. [Is the respondent making sure that the medical school is not implicated if something goes wrong with our son?] However, we do collaborate closely with our colleagues at the hospital and medical school, including in the management of our student receiving gender affirming care.

…

Gender affirming care is a unique process in medicine in that we are not aiming to treat and eliminate a disease process. [Ah, an admission that there is no real goal of treatment through this care. Finally! But read on…it gets better.] Instead, we are using the tools of medicine to help individuals achieve very personal and sometimes nebulous [nebulous? WTF? After all these years of "settled science," all we have is “nebulous?”] physical and emotional goals. Success is not based on a clinical metric but usually involves a better quality of life balanced with potential risks including morbidity and mortality. [So, finally, an explicit admission – success is not based on any clinical metric. That makes complete sense to us inconvenient parents. After all, how can there be? There never have been any metrics, ever. At. All. All we have are some "nebulous" ideas of "better quality of life" – as decided by the patient right now, with no consideration of what might happen in the future as a result of the free dispensation of off-label medication. And oh, by the way, that "better quality of life" includes morbidity factors and dying much faster.] We at the Apex SHC make every effort to ensure that our patients are well-informed [in other words, make sure that they have signed the informed consent forms!] about each decision that they make and have time to consider these impacts without pressure [The irony of the sentence – “have time to consider these impacts without pressure.” Wow! really?]

Should your child decide to engage with us in care, our commitment to them is to prioritize their safety [oh, the irony, once more!], the elements of their well-being that we can support [the rest – whether caring for them for the rest of their lives or paying for their illnesses and hospitalizations, with a big fuck you to your dwindling retirement funds – is up to you, you bigoted parents!], and to help them make a bright future for themselves.

Very best,

AAA

-

As I read and re-read the email, all I could think was – Wow! What an amazing letter! AAA has no qualms admitting that there are no clinical goals of treatment when it comes to gender-affirming care. This is really quite convenient if you think about it—if there are no aims, any outcome is fine! No wonder these physicians get all flustered when we inconvenient parents ask them about clinical goals and outcomes.

All that these caring physicians want to achieve are some nebulous (which the dictionary defines as unclear, vague, or indefinite) goals. Oh, and please remember – once again – that those are personal goals, so please don’t ask about evidence of well-being. (An inconvenient question, though – why should such personal goals be funded by others, whether it is the government or private insurance?)

And what if, as a result of those nebulous goals, the patients go through psychological, emotional, and physical distress for the rest of their lives, as detailed in the medical literature? Really, shame on you, you bigoted parents! Always such a nag! Always the party pooper. Why do you have to ask such inconvenient questions? Haven’t these caring physicians already made it clear that these are personal goals and that it really doesn’t matter that young children who are distressed might have no idea how to make a rational choice about the future? Who cares if they become hyper-fixated about something, as young children are wont to?

But then again, really, there is no pressure. No pressure at all. These kids are otherwise well-adjusted grown adults who know exactly who they are. Probably from the time they were toddlers. (What? You want evidence? This is getting really tiring. Give it a break, will you?) These are kids who are not immersed online, who do not gulp down narratives about “gender euphoria.” They are stable, rational human beings with a very clear idea of what the future holds.

All these well-meaning saints – these gender-affirming physicians – want is to give these kids a bright future: a future so bright that it will probably include that intense bright light these pitiable young men will see when they die decades earlier than their non-medicalized peers. Who are you parents to stand in their way?

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This is quite a remarkable admission. If there are no metrics and the objectives are "nebulous," then that's the very definition of not-scientific, not-medical. How can this be "necessary," and even "life-saving" if it's also "nebulous"? God is both real and undetectable?

How can it be "settled science"?

You're letting people self-diagnose and self-prescribe in order to chase something nebulous? What the hell?