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Some people opt not to combine hormone therapy with the equivalent binary social transition, or to socially transition in order to access hormone therapy from [[gatekeeper|medical gatekeepers]], then later 'de-transition' or 're-transition' to their preferred social role or presentation. This may also occur as an unplanned consequence of following whichever aspects of [[transition]] best minimize both social and physical [[gender dysphoria]].
 
Some people opt not to combine hormone therapy with the equivalent binary social transition, or to socially transition in order to access hormone therapy from [[gatekeeper|medical gatekeepers]], then later 'de-transition' or 're-transition' to their preferred social role or presentation. This may also occur as an unplanned consequence of following whichever aspects of [[transition]] best minimize both social and physical [[gender dysphoria]].
   
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== Puberty blockers ==
== Suppression of natural hormones ==
 
 
=== Puberty blockers ===
 
   
 
''See main article: [[puberty blockers]].''
 
''See main article: [[puberty blockers]].''
   
 
Puberty blockers are drugs that postpone or temporarily suspend puberty in children and teenagers. They are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016}}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016}}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 }}</ref>
 
Puberty blockers are drugs that postpone or temporarily suspend puberty in children and teenagers. They are used for [[transgender]] children, including those who identify as [[nonbinary]], to stop the development of features that they consider to mark the wrong sex,<ref name=":0">{{Cite journal|last=Stevens|first=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref><ref>{{cite web |url=http://www.washingtontimes.com/news/2016/mar/12/looking-at-suppressing-puberty-for-transgender-kid/ |title=Looking at suppressing puberty for transgender kids |publisher=Associated Press |date=March 12, 2016}}</ref><ref>{{cite web |url=https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/ |title=Transgender Youth Using Puberty Blockers |publisher=[[KQED]] |date=August 19, 2016}}</ref> with the intent to provide transgender youth more time to explore their identity.<ref name=":1">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|issn=2327-6924}}</ref> the studies that have been conducted indicate that these treatments are reasonably safe, and can improve psychological well-being in these individuals.<ref name="lancet_pubertyblockers">{{cite journal | last=Mahfouda | first=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 | ref=harv|quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref>{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |accessdate=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> In 2019, a study in the journal ''Pediatrics'' found that access to pubertal suppression during adolescence was associated with a lower odds of lifetime suicidality among transgender people.<ref>{{cite journal |last1=Turban |first1=Jack |title=Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation |journal=Pediatrics |date=February 2020 |volume=145 |issue=2 |page=e2019172 |doi=10.1542/peds.2019-1725 |pmid=31974216 |url=https://pediatrics.aappublications.org/content/145/2/e20191725 |accessdate=11 February 2020|pmc=7073269 }}</ref>
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== Transfeminine hormone therapy ==
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Regular male-to-female hormone replacement therapy (HRT) has the goal of reducing testosterone and increasing estrogens until the level of an average AFAB body is reached. This is done through the administration of estrogens, which also reduce testosterone, allowing for physical feminisation, and sometimes with antiandrogens or progestrogens, which decrease testosterone in case the estrogen therapy wasn't enough on its own. Medications like estradiol in their full doses cause full feminisation (including breast development), and some nonbinary people might not mind these changes. This article, however, will deal with transfeminine transition where a fully feminine development is not desired.
   
 
=== Testosterone deprivation ===
 
=== Testosterone deprivation ===
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* Selective estrogen receptor modulators (SERMs) will reduce bone density loss and osteoporosis risk. However SERMs will also increase testosterone production in AMAB bodies with low T production (not taking into account HRT).<ref>{{Cite journal|last=Trost|first=Landon W.|last2=Khera|first2=Mohit|date=July 2014|title=Alternative Treatment Modalities for the Hypogonadal Patient|url=http://link.springer.com/10.1007/s11934-014-0417-2|journal=Current Urology Reports|language=en|volume=15|issue=7|pages=417|doi=10.1007/s11934-014-0417-2|issn=1527-2737}}</ref>
 
* Selective estrogen receptor modulators (SERMs) will reduce bone density loss and osteoporosis risk. However SERMs will also increase testosterone production in AMAB bodies with low T production (not taking into account HRT).<ref>{{Cite journal|last=Trost|first=Landon W.|last2=Khera|first2=Mohit|date=July 2014|title=Alternative Treatment Modalities for the Hypogonadal Patient|url=http://link.springer.com/10.1007/s11934-014-0417-2|journal=Current Urology Reports|language=en|volume=15|issue=7|pages=417|doi=10.1007/s11934-014-0417-2|issn=1527-2737}}</ref>
 
* A low-dose estrogen supplement is much safer than SERMs, but the dose required to avoid bone density loss is enough to cause full feminisation.<ref>{{Cite journal|last=Hadji|first=P.|last2=Colli|first2=E.|last3=Regidor|first3=P.-A.|date=December 2019|title=Bone health in estrogen-free contraception|url=http://link.springer.com/10.1007/s00198-019-05103-6|journal=Osteoporosis International|language=en|volume=30|issue=12|pages=2391–2400|doi=10.1007/s00198-019-05103-6|issn=0937-941X}}</ref>
 
* A low-dose estrogen supplement is much safer than SERMs, but the dose required to avoid bone density loss is enough to cause full feminisation.<ref>{{Cite journal|last=Hadji|first=P.|last2=Colli|first2=E.|last3=Regidor|first3=P.-A.|date=December 2019|title=Bone health in estrogen-free contraception|url=http://link.springer.com/10.1007/s00198-019-05103-6|journal=Osteoporosis International|language=en|volume=30|issue=12|pages=2391–2400|doi=10.1007/s00198-019-05103-6|issn=0937-941X}}</ref>
 
=== Suppressing masculinizing and feminizing hormones in adults ===
 
 
Possible options for folks who want to suppress both masculinizing and femininizing hormones at the same time are described in the [https://madgenderscience.miraheze.org/wiki/Experimental_non-binary_HRT#Sex-hormone_antagonists_alone Mad Gender Science Wiki].
 
 
== Feminizing hormone therapy ==
 
Regular male-to-female hormone replacement therapy (HRT) has the goal of reducing testosterone and increasing estrogens until the level of an average AFAB body is reached. This is done through the administration of estrogens, which also reduce testosterone, allowing for physical feminisation, and sometimes with antiandrogens or progestrogens, which decrease testosterone in case the estrogen therapy wasn't enough on its own. Medications like estradiol in their full doses cause full feminisation (including breast development), and some nonbinary people might not mind these changes. This article, however, will deal with transfeminine transition where a fully feminine development is not desired.
 
   
 
=== Prevention of breast development ===
 
=== Prevention of breast development ===
There are some specific ways to avoid breast development while allowing for the rest of the feminisation process to happen. Possible options for feminizing hormone therapy without breast growth are described in detail in the [https://madgenderscience.miraheze.org/wiki/Experimental_non-binary_HRT#Selective_Estrogen_Receptor_Modulators_.28MTX.29 Mad Gender Science Wiki].
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There are some specific ways to avoid breast development while allowing for the rest of the feminisation process to happen:
   
 
* SERMs (mentioned in the section above) will completely block breast development.
 
* SERMs (mentioned in the section above) will completely block breast development.
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It's worth noting that most AMAB people will not experience a marked breast development regardless of medication. Likewise, breast development will stop and might even withdraw if the treatment is stopped.<ref>{{Cite book|url=https://linkinghub.elsevier.com/retrieve/pii/B9780323359559000076|title=The Breast|last=Mancino|first=Anne T.|last2=Young|first2=Zachary T.|last3=Bland|first3=Kirby I.|date=2018|publisher=Elsevier|isbn=978-0-323-35955-9|pages=104–115.e5|language=en|doi=10.1016/b978-0-323-35955-9.00007-6}}</ref>
 
It's worth noting that most AMAB people will not experience a marked breast development regardless of medication. Likewise, breast development will stop and might even withdraw if the treatment is stopped.<ref>{{Cite book|url=https://linkinghub.elsevier.com/retrieve/pii/B9780323359559000076|title=The Breast|last=Mancino|first=Anne T.|last2=Young|first2=Zachary T.|last3=Bland|first3=Kirby I.|date=2018|publisher=Elsevier|isbn=978-0-323-35955-9|pages=104–115.e5|language=en|doi=10.1016/b978-0-323-35955-9.00007-6}}</ref>
   
== Masculinizing hormone therapy ==
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== Transmasculine hormone therapy ==
 
{{incomplete|section=yes}}
 
{{incomplete|section=yes}}
 
Possible options for masculinizing hormone therapy without some potentially undesirable effects, such as acne, are described in the [https://madgenderscience.miraheze.org/wiki/Experimental_non-binary_HRT#Selective_Androgen_Receptor_Modulators_.28FTX.29 Mad Gender Science Wiki].
 
   
 
=== Preventing periods ===
 
=== Preventing periods ===
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Methods for permanently stopping menstrual bleeding which are not a form of hormone therapy include [[uterine ablation]], in which the inside of the uterus is cauterized to prevent it from developing or shedding uterine lining, and [[hysterectomy]], the surgical removal of the uterus. Neither of these necessarily prevent other symptoms of menstrual cycles, such as mood swings during premenstruation.
 
Methods for permanently stopping menstrual bleeding which are not a form of hormone therapy include [[uterine ablation]], in which the inside of the uterus is cauterized to prevent it from developing or shedding uterine lining, and [[hysterectomy]], the surgical removal of the uterus. Neither of these necessarily prevent other symptoms of menstrual cycles, such as mood swings during premenstruation.
 
   
 
==See also==
 
==See also==
 
*[[Transition]]
 
*[[Transition]]
*[[Surgery]]
 
 
*[[Nonbinary healthcare (UK)]]
 
*[[Nonbinary healthcare (UK)]]
   

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