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Hormone therapy: Difference between revisions
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Testosterone deprivation is not recommended by itself, because it will result in estrogen deficiency (because estradiol is produced from testosterone). Estrogens are necessary for both male and female bodies, and a deficiency of this hormone will eventually develop osteoporosis, as well as hot flashes, mood and sleep issues, sexual dysfunction, and accelerated skin ageing. The risk of weight gain, type 2 diabetes, cardiovascular diseases, and dementia is also increased. There are some ways to avoid these risks: | Testosterone deprivation is not recommended by itself, because it will result in estrogen deficiency (because estradiol is produced from testosterone). Estrogens are necessary for both male and female bodies, and a deficiency of this hormone will eventually develop osteoporosis, as well as hot flashes, mood and sleep issues, sexual dysfunction, and accelerated skin ageing. The risk of weight gain, type 2 diabetes, cardiovascular diseases, and dementia is also increased. There are some ways to avoid these risks: | ||
* Selective estrogen receptor modulators (SERMs) will reduce bone density loss and osteoporosis risk. | * 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> | ||
=== Prevention of breast development === | |||
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. | |||
* Topical non-aromatisable androgens (i.e. that can't be converted into an estrogen) applied to the breast will also block breast development, but it's not as effective as SERMs. There is also a risk of the androgen being distributed to other parts of the body and therefore causing masculinisation elsehwere.<ref>{{Cite journal|last=Kuhn|first=J-M.|last2=Roca|first2=R.|last3=Laudat|first3=Marie-Hélène|last4=Rieu|first4=M.|last5=Luton|first5=J-P.|last6=Bricaire|first6=H.|date=October 1983|title=STUDIES ON THE TREATMENT OF IDIOPATHIC GYNAECOMASTIA WITH PERCUTANEOUS DIHYDROTESTOSTERONE|url=http://doi.wiley.com/10.1111/j.1365-2265.1983.tb00026.x|journal=Clinical Endocrinology|language=en|volume=19|issue=4|pages=513–520|doi=10.1111/j.1365-2265.1983.tb00026.x|issn=0300-0664}}</ref> | |||
* [[Mastectomy]] (i.e. surgical removal of breasts) will of course prevent breasts from developing. This is an irreversible option. | |||
* Exposing the breasts to radiation is an irreversible process that might block breast development, although it's not as effective as SERMs.<ref>{{Cite journal|last=Viani|first=Gustavo Arruda|last2=Bernardes da Silva|first2=Lucas Godói|last3=Stefano|first3=Eduardo Jose|date=July 2012|title=Prevention of Gynecomastia and Breast Pain Caused by Androgen Deprivation Therapy in Prostate Cancer: Tamoxifen or Radiotherapy?|url=https://linkinghub.elsevier.com/retrieve/pii/S0360301612000806|journal=International Journal of Radiation Oncology*Biology*Physics|language=en|volume=83|issue=4|pages=e519–e524|doi=10.1016/j.ijrobp.2012.01.036}}</ref> This treatment may increase the risk of breast cancer.<ref>{{Cite journal|last=Aksnessæther|first=Bjørg Y.|last2=Solberg|first2=Arne|last3=Klepp|first3=Olbjørn H.|last4=Myklebust|first4=Tor Åge|last5=Skovlund|first5=Eva|last6=Hoff|first6=Solveig Roth|last7=Vatten|first7=Lars J.|last8=Lund|first8=Jo-Åsmund|date=May 2018|title=Does Prophylactic Radiation Therapy to Avoid Gynecomastia in Patients With Prostate Cancer Increase the Risk of Breast Cancer?|url=https://linkinghub.elsevier.com/retrieve/pii/S0360301618302207|journal=International Journal of Radiation Oncology*Biology*Physics|language=en|volume=101|issue=1|pages=211–216|doi=10.1016/j.ijrobp.2018.01.096}}</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> | |||
== Transmasculine hormone therapy == | == Transmasculine hormone therapy == | ||