Hormones

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Please take all of the information written within as more of a guideline, rather than fact. Unless you have researched the sources cited, of course. Use the information in this wiki to base your own research on, and do not use it as an end-all on the subject, or consider it medical fact. This was not assembled by a doctor. Please be careful, and remember to research everything on your own, and ask a medical professional (preferably two!).

This article is currently rather biased toward Male-to-Female transition. If you have some useful Female-to-Male information, please don't hesitate to contribute!

Contents

[edit] What are Hormones?

Essentially, hormones are chemical messengers typically released by cells within your body. They affect other cells and parts of your body and are used for transporting signals to-and-from cells. Generally, there are two types of hormones: Endocrine hormones, which are released into the bloodstream from the cells that produce them, and Exocrine hormones, which are released into a duct, and then transferred throughout the body wherever they need to go. Hormones affect everything from growth, mood, mind, cell death, your immune system, metabolism, emotions, bone-density, and even sex drive.

For the transsexual, the important topic here is sex hormones, otherwise known as "sex steroids" or "gonadal steroids". These are hormones one typically secretes naturally. Although generally, both males and females both secrete some amount of all hormones, the amount differs greatly depending on biological sex, age, menstrual cycles, and more.

Biological males naturally secrete large amounts of testosterone, while biological females secrete large amounts of estradiol, which is otherwise known as estrogen. Females also produce varying amounts of progesterone, depending different factors such as menstruation and pregnancy. As I wrote, however, both males and females secrete all of the above hormones (and more), but in smaller amounts.

In Hormone Replacement Therapy (HRT), the overall goal is to either stop the secretion of, or to inactivate, your biological sex hormones, and replace them with the hormones of your desired sex. If you are a biological male transitioning to become a female, the hormones you will normally take are Estrogen, an Anti-Androgen, which is a medication that stops your body from releasing Testosterone or stops the Testosterone released from affecting your body, and Progesterone. If you are a biological female transitioning to become male, the hormone you take is Testosterone, possibly combined with an Anti-Estrogen. [1] [2]

It should be understood the hormones are medication prescribed for a specific reason. If you want a more androgynous figure only, this is not the road you want to go down. Effects for hormones are not selective and are irreversible for the most part. Hormones also carry definite risks. If you chose to go on hormones, do so with extreme care and plenty of thought. Be safe!

[edit] How are hormones administered?

There are a few different ways to administer hormones. These ways are:

Oral - Basically just swallowing
Sublingual - Allowing the pill/tablet to sit under your tongue until it dissolves.
Injection - Injecting the hormones straight into your blood stream via a hypodermic needle. This is usually done by either Intramuscular Injection (IM), or Subcutaneous Injection.
Creams - A cream containing the hormones is rubbed into the skin

While many medical professionals differ, it is generally accepted that the most effective form of administration is oral. While it does not go straight into the bloodstream like intramuscular injection, it is much more consistent. With injections, your hormone levels dwindle over time which can cause all kinds of negative effects, mental and physical. Intramuscular injections are usually administered once every 2 weeks or so. At the end of those two weeks, according to numerous blood tests, your hormones are essentially back at a cis gender baseline. Not what you want! However, oral dosage is administered every day and is more consistent. This is especially true with a fat-soluble hormone such as Estradiol valerate.

The most widely used forms of administration are Oral and Sublingual administration. While Oral puts somewhat more strain on your liver, it's considered the easiest, and is the route most male-to-female transsexuals go. Most take Anti-androgens and a few others also take Progesterone orally. There is anecdotal evidence that one can take Estrogen sublingually. The idea is that there are a great deal of veins right underneath your tongue, so sublingual administration allows the hormones to be absorbed straight into your bloodstream, therefore bypassing the liver and it's metabolization. This has yet to be proven by any scientific studies.

Creams are a newer way of administration, and seem to have success with many female-to-male transsexuals. Usage of creams among male-tofemale transsexuals remains somewhat low. The negatives are the sheer amount of cream required and the time it takes to absorb. Also, they may rub off onto others.

[edit] What hormones/medications are available?

An amazing amount of hormones are available for you to choose from. However, there are a few that have been singled out as the "best" hormones to take, for various reasons. Some of the available hormones are:

[edit] Estrogen

There are many types of estrogen available, including synthetic and animal harvested. Listed below are some of the more common

[edit] Estradiol hemihydrate

Brand name Estrofem. It comes in 1 mg and 2 mg tablets that are administered sublingually (put under the tongue to dissolve). Estrofem is effective, and administration is painless. The taste isn't universally enjoyed, although it's tolerable. It takes around 2 to 5 minutes to completely dissolve under your tongue.

[edit] Estradiol valerate

Brand name Progynova or Progynova Depot. Progynova comes in 1 mg and 2 mg tablets that are taken orally, whereas Progynova Depot comes in 1 ml ampules that are injected intra-muscularly. Progynova is the standard prescription in most EU-based Male-to-Female hormone regimens. 1 mg tablets are yellow whereas 2 mg tablets are blue. Ampules are fully sealed, machine-blown glass containers that must either be broken or pierced. A wheel-filter is recommend to avoid injecting glass particles.

[edit] Conjugated Estrogens

Brand name Premarin. Usually avoided in a Male-to-Female hormone regimen due to adverse side-effects. Premarin is derived from a pregnant mare's urine and is not vegan.

[edit] Ethinylestradiol

Usually avoided in a Male-to-Female hormone regimen. Ethinylestradiol has been linked to a 20-fold increase in venous thromboembolic disease.


[edit] Anti-androgen

An anti-androgen is vital to a proper MtF hormone regimen and essentially helps lower testosterone levels.

[edit] Spironolactone

Brand name Spirotone or Aldactone. It comes in 25 mg and 100 mg tablets. It's taken orally, simply swallowed with a drink or whatever you wish. It's not harmful to your liver, and generally has a very low amount of side effects. However, Spironolactone is a potassium-sparing agent, which in short, increases the amount of Potassium in your blood stream. If you aren't careful about your Potassium levels, you can suffer from hyperkalemia, or having too much potassium in your body. There are also side-effects such as constipation. Spironolactone is also known to decrease the effectiveness of anti-depressants.

[edit] Licorice root

Licorice root has been commonly used as a dietary supplement for stomach ulcers, bronchitis, and sore throat, as well as infections caused by viruses, such as hepatitis. It is known to increase blood pressure, cause water and salt retention, and low potassium levels. More technically, Licorice root is an: anti-inflammatory, immuno-stimulant, anti-viral, demulcent, expectorant, anti-catarrhal, anti-ulcer (PUD), hepatoprotective, spasmolytic, and, at extremely high dosages, a laxative. [3] [4] Licorice root is absolutely not an effective anti-androgen on its own.

Licorice root, in terms of transgender health, is extremely effective at mitigating the negative effects associated with Spironolactone. [5] Unfortunately, more research needs to be done in regards to proper dosage and regimen for transgender women. A single, anecdotal trial has shown that around 450mg with 100mg Spironolactone in a 170lbs. trans woman was very effective.

The risks associated with Licorice root are also sparsely researched. Pseudohyperaldosteronism is a known risk which happens when too much licorice root is taken. It produces hypertension and hypokalemia. [6]

[edit] Cyproterone acetate

Brand name Androcur. Comes in 50mg tablets. Taken orally, preferably with food. Androcur is a very potent anti-adrogen that is the standard prescription in most EU-based trans programs.

Androcur is considered hard on the liver and dosages are lower than those of Spironolactone. Usual dosage is 50mg per day, 100mg is a high and unusual dosage.

Liver function should be closely monitored while taking Androcur, as even normal dosages have, in some cases, been linked to certain liver problems (hepatitis and hypofunction of the liver). The symptoms for these usually develop only several months after starting regular usage. Symptoms of especially liver toxicity (itching all over the body or yellowish skin) must be taken seriously.

Androcur does not have trade permissions outside the EU, which is why it's hardly ever obtainable by self-medders. Which is probably a good thing, as usage without proper supervision is much more risky than that of Spironolactone.


[edit] Progesterone

Progesterone is another female sex hormone. Despite Progesterone sellers advertising through "trans advice" saying that it might help with breast development, medical evidence shows it may have no positive effects, and may have negative side-effects. Anecdotal evidence from many sources say Progesterone helps depression and increases libido, whereas others say it has PMS-like effects for them. The general rule of thumb is that it is not a necessary component of a male-to-female regimen, but can be a useful addition if it has positive effects for you.

[edit] Micronised progesterone

Brand name Microgest or Prometrium. It comes in 100 mg and 200 mg capsules. Basically, it's Progesterone that has been Micronised (reduced in size), which is this suspended in peanut oil. Progesterone is unable to be absorbed by the body in it's natural form, so it must be reduced in size and suspended in a fatty compound such as Peanut Oil, so it will be digested properly.

[edit] Medroxyprogesterone acetate

Brand name Provera. Easiest-to-find form of synthetic progesterone in the EU. Comes in 2.5 mg, 5 mg and 10 mg tablets taken orally.

Usual dosage is 2.5 mg or 5 mg per day. This is the most commonly prescribed progesterone in EU-based male-to-female hormone regimens. Generally, progesterone that is bio-identical (same as the bodies Progesterone) is preferred as Medroxyprogesterone acetate is known sometimes to have androgenic (masculinizing) effects.

[edit] Testosterone

The primary male hormone. Trans men embarking on a hormone regimen with Testosterone will need a hysterectomy within a few years.

[edit] Oral Testosterone

Testosterone, it's what's for breakfast!

[edit] Transdermal Testosterone

Comes as a patch that is kept on the body. Administers a measured dose throughout the day.

[edit] Injectable Testosterone

Comes as an injectable liquid in an ampule, or a little vial, and is administered by intramuscular injection. Ampules are fully sealed, machine-blown glass containers that must either be broken or pierced. A wheel-filter is recommend to avoid injecting glass particles.

[edit] Anti-estrogen

[edit] Anastrozole

Brand name Armotraz or Arimidex. Anastrozole is a non-steroidal aromatase inhibitor which essentially decreases the amount of estrogen the body produces.

[edit] Progesterone Controversy

Some contest Progesterone is helpful for breast development. A single study shows it to have no measurable positive effect for trans women in their hormone regimen. Anecdotal evidence suggests conflicting conclusions: some may benefit from Progesterone, whereas others so no change at all or even have a negative reaction.

This article formerly advised taking Progesterone, but cited no evidence or studies showing that it helps. Be wary of advice without citations -- drug sellers want to convince you to buy their products and may have edited this article.

[edit] Further Discussion

There are two types of Progesterone: Micronised Progesterone, which is natural Progesterone, micronised and suspended in oil. The other type of Progesterone is actually Progestin, which is synthetic and is not the same as real Progesterone which is secreted by the body.

Progestin has been known to not be handled very well, and has many adverse reactions and side effects. In studies conducted by Women's Health Initiative (WHI), as part of post-menopausal women's HRT, synthetic Progesterone combined with Estrogen (as opposed to estrogen alone) carried an increased risk of breast cancer.

Common anecdotal evidence suggests that Micronised Progesterone has almost no side effects, and is overall good for you. The some purported health benefits are: increased skin elasticity, improved mental performance, improved libido, decreases osteoperosis, and helps in building osteoblasts in bone, teeth, gums, joints, tendons, and ligaments, as well as more things, but there is too much to list. However, only a single scientific study has been performed and released publicly. This study indicated no measurable positive effect.

Do note that use of any type of Progesterone sometimes carries unexpected and unwanted side-effects.

[edit] What dosages should I take of these hormones?

This is a question that truly takes a medical professional going over your blood work to give the best answer.

It is strongly recommended you consult your physician about doses.

[edit] Hormone Dosage Tables

The below tables are a reproduction of Table 12. Hormone regimens in the transsexual persons in the Endocrine Society's Clinical Guidelines regarding Endocrine Treatment of Transsexual Persons. [7]

[edit] Male-To-Female

Route of Administration Type Dosage
Oral Estrogen (oestradiol/estradiol) 2.0-6.0 mg per day
Transdermal (Patch) Estrogen (oestradiol/estradiol) 0.1-0.4 mg twice weekly
Parenteral (Injected) Estrogen (oestradiol/estradiol) 5-20 mg intra-muscularly every 2 weeks
Parenteral (Injected) Estradiol valerate/cypionate 2-10 mg intra-muscularly every week
Oral Spironolactone 100-200 mg per day
Oral Cyproterone acetate 20-100 mg per day
Oral (GnRH agonist) 3.75 mg sc monthly

[edit] Female-to-Male

Route of Administration Type Dosage
Oral Testosterone 160-240 mg per day
Oral Testosterone undecanoate 160-240 mg per day
Parenteral (Injected) Testosterone enanthate/cypionate 100-200 mg intra-muscularly every 2 weeks or 50% every week
Parenteral (Injected) Testosterone undecanoate 1000 mg initially, followed by an injection at 6 weeks, then at 12 week intervals
Transdermal (Gel) Testosterone gel 1% 2.5-10 g per day
Transdermal (Patch) Testosterone 2.5-7.5 mg per day

[edit] Male-to-Female Example

[edit] Female-to-Male Example

Needed.

[edit] Further Discussion

For everyone, dosage will vary. General doses depend on your personal medication, but for the ones listed:

[edit] Estrofem/Progynova

Dosage range is 2mg to 6mg per day. 2mg is a very low dose. 4mg is generally considered the lowest dose that can have results. 6mg is considered a median to high dose, while 8mg is considered a very high dose. High levels of Estrogen in your body is linked to increased chance of carcinoma of the breast, however, so caution should be taken. Take the lowest dose you possibly can, and still get results.

In official treatment programs, dosage starts at 2mg and is usually raised to 4mg after two to four months, then further to 6mg after a few more months, depending on the effects achieved with 4mg. Dosages over 6mg/day can be counterproductive in normal conditions. Don't take more than you reach reasonable results with. Starting low is essential to regulating the developments in the body and avoiding abnormalities.

[edit] Spironolactone

Dosage range is 75mg to 300mg per day. 75mg would be considered a low dose, going up to 100mg to 150mg as normal median doses.

[edit] Androcur

Dosage range is 50mg to 100mg per day. 50mg once a day is a potent starting dose, 50mg twice a day is already a lot. Androcur is hard on the liver and body. Usage without proper monitoring of the liver is extremely dangerous.

[edit] Micronised Progesterone

Dosage range is 100mg to 200mg per day. 100mg being a lower dose, 200mg being a more average median dose. Adverse affects are usually reported at about 400mg+ per day, although lower than that generally has no side effects. Taking either 100mg or 200mg, depending on your body size, is probably a good idea.

[edit] Complications

There is definite risk of complications in undergoing a hormone replacement therapy! Below are tables describing common complications.

[edit] Male-to-Female

  • thromboembolic disease
  • macroprolactinoma
  • severe liver dysfunction
  • breast cancer
  • coronary artery disease
  • cerebrovascular disease
  • severe migraine headaches

[edit] Female-to-Male

  • breast cancer
  • uterine cancer
  • erythrocytosis
  • severe liver dysfunction

It should be noted that once you begin Testosterone you will need a hysterectomy within a few years.

[edit] Recommended Online Vendors for Hormones

The most commonly used and recommend site is Inhouse Pharmacy. They receive tremendous amounts of praise from the transgender community. They are a company located within the United States (they also have a European site), but they ship from various other countries.

I've used them for every shipment I've made, and I cannot say a single thing bad about them. They ship very quickly, the products are genuine, they have an easy payment system, and they have amazing customer service. I sent them an email about one of my orders, and received a response within two hours. Most companies take can take days to respond. They ship my products from Vanuatu, a small country near Australia. However as I wrote, the company is American based.


Another vendor is 4RX. Definitely not as common, but they have more varied shipping options.

I've used them once, not for hormones but for a different medication. They were legitimate and I can't really say anything bad about them. As always, though, your mileage may vary.


Yet another vendor is AllDayChemist. They are more expensive on smaller orders, but much cheaper on larger ones.


There are other legitimate sources out there, however if you absolutely must use another site, please search for some reviews about the website first. Just searching for "______ Reviews" and "_______ Scam" can help prevent you from getting scammed. This is not to say that the products they are selling are genuine, as a significant percentage of pharmaceuticals sold for import are actually counterfeit. Also, check the website with http://www.safeorscam.com/ Try and use a known source like Inhouse Pharmacy first!

If all else fails, post a topic on /cd/.

[edit] What effects can I look forward to?

It all depends on your body, genetics, age, and health. Hormones will not turn a 200lb 6'1" burly man into a 110lb 5'6" skinny female, or vice-versa. If you're 6'1, you will always be 6'1". If you're built big then that's just the way you're going to have to be. This doesn't mean you won't be passable or beautiful, as there are plenty of muscular, big, thick, and heavily built women who are absolutely gorgeous! If you work at it, most of the muscle on your body (in the arms, chest, abs, thighs, etc) can be lost, to have a more feminine appearance.

Testosterone and Estrogen differ in two ways: Testosterone makes you gain muscle mass and lose fat. Estrogen does the opposite, making you lose muscle mass and gain fat. After starting hormones, you can exercise and such to help your muscles transition from masculine to more feminine. The best exercises for a MtF person would be low-impact, high-cardio activity like swimming, biking, etc. A MtF will absolutely want to avoid weight lifting. Of course, a FtM will want to do the opposite! The best way to lose muscle mass is to not use them. Be a couch potato, but try to eat healthy to keep yourself from just getting very fat. For those MtFs who feel like their body just will not shed muscle, or are looking for quicker ways to shed that muscle, they can look into a low protein diet. Intense cardio has also been suggested as a way to lose stubborn muscle.

Overall, the effects of hormones will differ greatly from person to person. Something that may happen quickly for one person, may take many more months for another, or perhaps even won't happen at all. Some girls redistribute fat differently, some girls will grow breasts that are normal for their frame, some even bigger and some less than average for their frame. But as a guideline, don't expect anything. Just allow yourself to accept and enjoy the changes as they go!

[edit] What you can expect

Effects are listed here in no particular order.

You sit there now having no idea, but you'll realize after you start hormones how much Testosterone really does affect your thinking, and how much you really DO think with your penis, whether you know it or not! Some changes reported by transgenders
Usually, a male-to-female will see decreased libido whereas a female-to-male will see increased libido. This isn't a for-sure thing, but many male-to-females do lose their sex drive. Some lose the urge to masturbate as frequently, or at all. They may also have problems maintaining erections. Some male-to-females report an increase in sex drive, whether accompanied by Erectile Dysfunction or not.
A light exercise routine can help mitigate this, but you will lose lots of muscle mass.
Many girls stop ejaculating completely. All that cum you used to spurt out all over the walls, bed sheets, your hands, people's faces, etc (:P) will be gone! You can still orgasm of course, but nothing comes out.
Your breasts will slowly but surely start growing. Just as in a genetic-girl, they go from slightly swelling and being tender (and oh-so-painful), to a slightly raised mound, to growing a little bit every day. You won't notice that today your boobs are 1/100th of an inch bigger than they were yesterday, but over time (months), you'll notice they are definitely growing. It usually takes anywhere from 2 years to 7 years for full breast development, so be patient, and don't expect miracles. The rule of thumb on breast size is one cup less than your genetic female relatives, but it varies from person to person. The younger you start, the more developed your breasts will be at the end. Older transsexuals, especially those starting at 30+, often receive very little, if any, breast development. But there is always surgery for that. However, starting young (late teens, early twenties) can result in developed breasts. Transsexuals who have started earlier than 18 have even reached complete, Tanner Stage V, breast development.
Over time, your body fat will slowly redistribute, from the male fat deposits on the stomach, to the female fat deposits of the upper arms, thighs, hips, and breasts. Over a period of 1 to maybe 2 or 3 years, your body can go from looking very masculine to a female "hour glass figure". But this all depends on body type and genetics, once again.
Your body hair will slowly change, and either disappear completely or turn into vellus hairs (baby hairs, the kind women have). Your body will slowly change towards hairless limbs and trunk, and your pubic hair will redistribute to a female pattern. Male Pattern Baldness will be stopped completely, as it's caused by Testosterone (which you no longer have!), but it can rarely be reversed. Facial hair is sometimes, but not often affected by hormones, generally only slowing the growth of it. Laser hair removal (or another treatment like it) is usually required to completely get rid of it. The general wisdom is to avoid laser hair removal on the chest in favor of the face. After two years all your hair should have turned to vellus hairs, but of course your mileage may vary.

[edit] What's not going to happen

Female hormones will not have any affect on:

Height, skeletal structure, and hands/feet are completely irreversible, aside from very dangerous, extreme, expensive, and experimental surgery for some parts of it! Your Larynx can be surgically reduced. Your voice is completely changeable with practice! It is possible to go from the deepest male voice to a normal female voice. If you are still having trouble, recent developments in voice surgery give you another option. Your face can be made more feminine by Facial Feminization Surgery.

[edit] Starting Age

One thing to remember is that you really can transition at any age. You are not too old, and you will never be too old. It doesn't matter if you're 11, 25, 38, 45, or 62. It's never too late to start transition. I know many people wait until their mid-to-late twenties, early thirties to start. Of course, starting older means you will have more of the negative effects of testosterone. The rule of thumb is that the main age this happens is in the late twenties to late forties, depending on genetics and other factors. Many, many transsexuals transition later in life and end up looking absolutely gorgeous. Just do what you feel is right, regardless of age or looks. You'll thank yourself later!

[edit] Effects Time-line

Below is a time-line of expected effects from hormones, based on clinical observation.

[edit] Female-to-Male

Effect Onset Maximum
Skin oiliness/acne 1 to 2 years 1 to 6 months
Facial/body hair growth 6 months to 1 year 4 to 5 years
Scalp hair loss 6 months to 1 year Prevention/Treatment same as biological men.
Increased muscle mass/strength 6 months to 1 year 2 to 5 years
Fat redistribution 1 to 6 months 2 to 5 years
Cessation of menses 2 to 6 months Menorrhagia requires a gynecologist
Clitoral enlargement 3 to 6 months 1 to 2 years
Vaginal atrophy 3 to 6 months 1 to 2 years
Deepening of voice 6 months to 1 year 1 to 2 years

This table excludes mental effects due to the difficulty in describing them.

[edit] Male-to-Female

Effect Onset Maximum
Redistribution of body fat 3 to 6 months 2 to 3 years
Decrease in muscle mass/strength 3 to 6 months 1 to 2 years
Softening of skin/decreased oiliness 3 to 6 months Unknown
Decreased libido/sex drive 1 to 3 months 3 to 6 years
Decreased spontaneous erections 1 to 3 months 3 to 6 years
Male sexual dysfunction Variable Variable
Breast growth 3 to 6 months 2 to 3 years
Decreased size of testicles 3 to 6 months 2 to 3 years
Decreased sperm production Unknown Over 3 years
Decreased terminal hair growth 6 months to 1 year Over 3 years
Scalp hair No regrowth Stalled familial hair loss
Voice changes None Voice training needed

This table excludes mental effects due to the difficulty in describing them.

[edit] What surgeries should I look into?

If you're reading this, you already know there is one glaringly obvious surgery to include here and that is Sexual Reassignment Surgery! This is the operation that turns your penis into a vagina, also known as a Vaginoplasty.

However, there are numerous other surgeries available as well. These include (but are not limited to):

[edit] Breast Augmentation

Breast augmentation is, obviously, breast implants. Many transgirls do not like their breast development, and seek to attain bigger bust sizes, so they opt for Breast Augmentation. Self-explanatory really. Although girls with no breast development at all will have trouble with Breast Augmentation, and can often times end up with fake looking breasts. The more breast development you have naturally, the better your implants will look.

[edit] Stem Cell Breast Augmentation

There are several downsides to typical breast augmentation surgery. The saline "bag" implanted inside the breast feels uncomfortable and can explode with enough trauma. Stem cell breast augmentation attempts to transplant fat from one area of the body to the breast. Stem cells are used to increase the amount of transplanted fat that survives and thrives. They also are used to encourage growth of more fat cells in the transplant area. The cost of the operation is typically twice that of typical breast augmentation. [8] Stem Cell Breast Augmentation fees estimate between $18000.00 to $22000.00. [9]

[edit] Facial Feminization Surgery

FFS is a series of surgeries designed to make the face look more female. These can include nose jobs, face lifts, lip changes, cheek changes, etc. These are very extensive surgeries, and many MTFs do not bother with them, unless they are one who transitioned much later in life. Generally hormones, with fat redistribution, will make the face look much more feminine anyway.

[edit] Trachea Shave

A Trachea Shave is a surgery that reduces the size of the Adam's Apple. Basically, the surgeon scrape the front of the trachea to reduce it's size. There can be complications with this, but it's usually done as an outpatient procedure.

[edit] Feminization Laryngoplasty

Feminization laryngoplasty is a procedure designed to make a genetic male's voice box smaller and vocal cords shorter in an attempt to raise the comfortable speaking pitch. The surgeon almost always trys to alter the resonance as well by adding in a thyrohyoid elevation at the same time. The thyrohyoid elevation attempts to shorten the pharynx (the throat) to improve the resonance of the higher pitches. In general the procedure cuts off the lower range and sometimes adds a few notes on the upper end of the range and sometimes removes some notes from the upper end. The procedure includes a trachea shave. [10]

[edit] Bilateral Orchiectomy

In short, castration. Also known as an orchidectomy. It's a surgery that simply removes the testes from the scrotum. After removal of the testes, your body will not produce the amount of testosterone it used to. This will allow you to stop taking anti-androgens. However, if you plan on having SRS performed, it is generally not advised to have an orchiectomy as the procedure can cause shrinkage that may interfere with creating enough depth in the neovagina. If this is a problem for you, a good rule of thumb is to have SRS a year after orchiectomy atthe most.

[edit] Sexual Reassignment Surgery

Sexual Reassignment Surgery (SRS), also called Gender Reassignment Surgery (GRS) in the past, is a male-to-female operation that aims to create a vagina from the penis. That's a very simple explanation, so let's go in-depth. There are two main surgeries that go on during SRS. These are Vaginoplasty, or Colovaginoplasty, depending on which route you take (elaborating on that later), and the Labiaplasty. To start, there are two different routes to take for this. Penis inversion Vaginoplasty, which is basically the inversion of the penis to form a vaginal canal. A Colovaginoplasty, as you can guess, uses part of the sigmoid colon to form the vaginal lining. Labiaplasty aims to make the final vaginal canal look like a normal vagina. This roughly involves constructing the labias and setting the urethra in the right position, among other details. [11]

[edit] Penile inversion

Penile inversion is a surgical technique for genital reassignment (sex change) used to construct a neo-vagina from a penis for transwomen, sometimes also for intersex people. It is one of two main sorts of vaginoplasty, along with colovaginoplasty.

The erectile tissue of the penis is removed, and the skin, with its blood and nerve supplies still attached, is used to create a vestibule area and labia minora, and inverted into a cavity created in the pelvic tissue. Part of the tip (glans) of the penis, still connected to its blood and nerve supplies, is usually used to construct a clitoris, the urethra is shortened to end at a place that is appropriate for a female anatomy. [12]

[edit] Colovaginoplasty

With colovaginoplasty, sometimes called a colon section, a vagina is created by cutting away a section of the sigmoid colon and using it to form a vaginal lining.

This surgery is performed on females with androgen insensitivity syndrome, congenital adrenal hyperplasia, vaginal agenesis, Mayer-Rokitansky syndrome, and other intersexed conditions, where non-invasive forms of lengthening the vagina cannot be done and, mostly, on male-to-female transsexuals as an alternative to penile inversion with or without an accompanying skin graft (usually from either the thigh or abdomen).

Due to numerous potential complications (such as diversion colitis) most surgeons will recommend a colovaginoplasty only when there is no alternative. [13]

One other frequently asked question regarding surgery is: "Can they make a clitoris? and can I orgasm post-operation?"

In short: Yes, they can make a clitoris, and Yes, it varies between girls but most definitely possible.

[edit] Your Neoclitoris and You

There are two ways to create a clitoris for a transsexual woman. The most common method is to remove the head or glans of the penis, and use some of that tissue to function in the position of a biological woman's clitoris. Some transsexual women have the entire penis head used as their clitoris. Some transsexual women have had spongiform tissue from the urethra fashioned to function as the neoclitoris.

The success rate for the creation of a clitoris for transsexual women varies greatly.If the relocation of the glans penis is successful then the transsexual woman may have a sensate neoclitoris capable of orgasm.

The glans penis tissue does not resemble a biological woman's clitoris. Most transsexual women's bodies readily accept the relocation of glans penile tissue in the area of a biological woman's clitoris. However, as with all surgeries nothing is perfect and there have been cases of the glans penis neoclitoris bleeding and even falling off entirely.

There are many surgeons who do not attempt any creation of a neoclitoris for their transsexual patients. Instead they allow the transwoman to orgasm with the penile lined vagina. Some surgeons do not agree with using the head of the penis to create a neoclitoris. They prefer to either use urethral spongiform tissue or make no attempt at the creation of a clitoris at all. Some surgeons take the head of the penis and surgically place it inside the body in the position of a cervix. Many transsexual women like the glans penis being inside their bodies because it can be greatly stimulated during vaginal penetration.

The transsexual activist and playwright Kate Bornstein has indicated in her book Gender Outlaw: On Men, Women and The Rest Of Us that her glans penis was placed inside her body in the position of a cervix. She reports enjoying vaginal penetration and that the use of dildos greatly stimulates her now internalized penis head.

[edit] Standards of Care

In order to qualify for Sexual Reassignment Surgery, one must meet certain requirements set by a doctor. These differ from doctor to doctor and locale to locale, depending on what, if any, diagnostic standards are being followed. The most common standard of care is the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC)[14]

Common requirements are letters of recommendation from separate doctors/psychiatrists, prolonged, consistent therapy, and years living as a woman. [15]

SRS is not something you do on a whim. It's a very serious operation, and is completely irreversible. Obviously, one needs to be sure. After SRS, you will need to continue hormones for the rest of your life as you do not have ovaries or a uterus, so you don't produce much estrogen!

Of course, before you ever make a decision about SRS, you may find yourself in the operating room for one of the above surgeries!

[edit] Everything else

Do your own research, and lots of it!

This entire article was not compiled by a medical professional and everything written here was based on personal research and experience. It is not professional medical advice and is merely a guideline to base your own research on. The information comes from Wikipedia, medical research websites, transgender sites, and various forums. If you decide to order medicine online, understand you are taking your health into your own hands in a big way. Read the information your source has available on the medication. Read the manufacturers information pamphlets that are usually included with the medication. Research the medicine everywhere you can find information on it! It's your body and you only get one shot. Taking bad risks and messing up will seriously hurt you in the long run. Try to get medical supervision if possible. Some might argue otherwise, but long-term it really becomes a necessity to have a medical professional on your side, advising you along the way.

Here are some links to various sites, which include information about Transsexuality, and the medical and hormonal procedures with accompany them:

Overall, do what you feel is right. If deep down you believe you are transsexual, don't let anyone persuade you otherwise, even doctors. I hope this guide helped you, even in the smallest bit.

[edit] Non-HRT Feminization Tips

[edit] Hair

Like my hairdresser says, "Bangs are a trans girls best friend!" Find a good hairdresser you trust and try out some bangs. A very versatile hair-style would be side-swept bangs. Ask your hairdresser about different products. Try to use good product (shampoo, conditioner, sprays, salves, creams, etc.) You will probably have to experiment with different ones to find what works. Learn how to properly blow-dry/heat-style your hair.

Beside good product, your shopping list should include a curling iron, a ceramic flat iron, a small cylinder brush with nylon or natural tines, a large cylinder brush with nylon or natural tines, a 'standard' curved brush with those large tines, a comb that does not break your hair, and some butterfly clips. Learn how to use all that. A shower cap is nice too if you want to take a shower but avoid messing up your hair. If you hair is very dry, don't be afraid to skip the shampoo and just use conditioner. If you have naturally oily hair, avoid scrubbing in the conditioner onto your scalp. Instead, lightly put it over the top of your head, and the tips of your hair. Also, keep in mind that longer hair isn't always more feminine!

[edit] Eyebrows

Eyebrows are probably the most important, yet over-looked, element to a feminine appearance! If you have the confidence to go to a professional and get it done, do it. It is very cheap and looks awesome. If you're going in boy-mode, make sure to request they shape and arch them, otherwise you're just going to get very nice looking guy eyebrows. Threading is pretty effective and cheap if you can find a place that does it, but it definitely hurts a bit more. Waxing or sugaring is slightly less painful and is usually done in the salon.

If you want to try and manage them entirely yourself there are lots of tutorials out there on how to do it. Be careful though!

[edit] Makeup

Makeup is very over-hyped. The rule of thumb is to use as little as possible. A great simple combo is a moisturizer, some concealer under the eyes, and an eye-liner. Foundation is a word thrown around a lot by people talking about makeup, and is actually two different things. For one, it's a specific product. More importantly though, it's the foundation you put everything else on. Applying a foundation and then a powder is the most effect and most general way to create your 'foundation'. Beard shadow tends to have a bluish cast to it, so to offset it use warm red or yellow tones, such as a blush, over the foundation. If you overdo it on your make-up you will look at best slutty, or at worst like a drag queen. There are loads of video tutorials out there on how to apply makeup properly!

[edit] Clothes

For the most part, this is personal preference. If I'm going shopping, usually I'm bringing someone I think is fashion-conscious along with me! Generally, boat-neck tops work great for wide shoulders. Unless you happen to look really good in them, you want to stay away from plunging necklines if you have a flat chest. Skinny jeans that fit you well are awesome and they can help accentuate your existing feminine curves. Black is a slimming color and great for a big boxy ribcage, but don't overdo it. If your in a climate where you can layer, do it! Learn about color coordination and the color wheel. A "shrug" or coat is an awesome addition to almost any outfit!

[edit] Body hair

Waiting years for hormones to turn your black body hair to vellus hair is draining, but sometimes a necessary evil. However, there are lots of options for getting rid of it temporarily such as: Waxing, Sugaring, Using an epilator, tweezing, using a depilatory cream like Nair. Getting rid of it permanently will require something like: Laser hair removal, Intense pulsed light hair removal, and Electrolysis.

[edit] Posture

How you hold yourself while sitting, walking, talking, and everything else is a large part of what people see. Your posture tells lots about you. You want to stand and sit up straight with your chin up, your chest out, your shoulders down and back, your elbows in, your thumbs out, and your knees together. While walking, typically use shorter, quicker strides. Always try and be relaxed and do not force it. Don't be stiff, play with your hair and look around. Smile more, but not so much as to be silly. Smiling actually gives a more feminine glow to your face. When laughing or smiling, males typically will show their bottom teeth more while females will show their top teeth.

[edit] Speech

Focus more on variance and resonance, rather than absolute pitch. A typical strategy is to go for valley girl and then tone it down. You want to be polite, as in saying please, thank you, and apologizing for silly little things. Men and womens vocabulary is different, so try not to use "I'll have", "I'd like", and "Please do", and instead use "Could I have", "Would you mind", and "It'd be great if".

CandiFLA has some great speech tutorials:

Also, the Changing Keys Voice Practice Program is great:

Finding Your Female Voice By Deep Stealth Productions is a classic program, but is not free:

How to Develop a Female Voice By Melanie Anne:

[edit] Exercise

Weight Training for MTFs: Stay strong without size

[edit] Other tips

Don't be afraid to be expressive and emotive, let that girl out! Take care of your body, skin, and hair. Moisturize and drink lots of water! Eat healthy. Don't forget to clean any cuts you get properly and then use neosporin and possibly a bandage.

And probably the best tip you'll get: Pay attention to other girls! Pay attention to their fashions and how they work with various body-types; etc.

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