GENDER TRANSITION
HORMONE THERAPY
If medical treatment is started, hormone therapy is often the first step (before any surgical approaches). Hormone therapy includes treatment of both male-to-female (MTF) and female-to-male (FTM) transitions. In MTF transitions, usually estrogens (and sometimes progesterone, both female steroid reproductive hormones) are given (orally or by injection), frequently together with spironolactone, a testosterone antagonist - the mechanism of action of which is not fully understood - taken orally. These hormones lead to a phenotypically female appearance, including gynecomastia (growth of breasts), reduction of hair growth, rearrangement of fat deposits to the hips, legs and face, and softening of the voice. FTM transitions normally involve taking testosterone (a male steroid reproductive hormone), which can be administered orally or in the form of injections. This hormone causes a more phenotypically male appearance, such as loss of breast tissue and fat deposits, increased muscle strength and hair growth and deepening of the voice. Either hormone treatment can have significant effects on the reproductive system and potentially reduce fertility or even cause infertility. Moreover, they can have certain other risks and side effects (such as stroke, blood clots, or blood pressure issues) which should be known in order to make an informed decision.
Feminizing Hormone Therapy
Feminizing Hormone Therapy (male-to-female transition) usually includes taking the female reproductive hormone estrogen, sometimes in combination with progesterone (also a female reproductive hormone), which enhance a phenotypically female appearance (breasts, hips, fuller face, less hair growth higher-pitched voice). Furthermore, the testosterone blocker spironolactone is often given in addition to these hormones, to counteract the effects of testosterone on the body. Spironolactone pharmacodynamics are not well understood but are believed to involve several mechanisms of action, including competitive androgen receptor binding (inhibition) in the body and brain (which decreases testosterone effects and increases gonadotropin activity by blocking androgenic negative feedback on the hypothalamus and anterior pituitary), inhibition of steroid (testosterone) production in the testes, progesterone receptor activation (progestognenic effect), and increased estradiol presence (by enhancing conversion of testosterone into estradiol and by inhibiting conversion of estradiol into other less active forms of estrogen). Because spironolactone is also a diuretic medication which affects the renin-angiotensin system by competitively inhibiting (blocking) aldosterone (a glucocorticoid) receptors in the distal convoluted tubule of nephrons (meaning it is given to increase fluid excretion by the kidneys), it is also prescribed as blood-pressure regulating and reducing medication (antihypertensive effects). This means that if taken as a testosterone blocker, spironolactone may cause low blood pressure, drowsiness, dizziness and fatigue. Other side effects of hormonal treatments are cardiovascular issues, thrombotic disorders (blood clots, which may cause stroke), hormonal imbalance (hyperprolactinemia), diabetes (type 2), hyperlipidemia, obesity, hyperkalemia (high potassium levels) and increased risk of breast cancer. Because erectile and ejaculatory dysfunction as well as permanent infertility can result for hormone therapy, storing sperm samples before starting treatment may be an option for those who want to preserve the ability to have genetical children in the future.
Masculinizing Hormone Therapy
In masculinizing hormone therapy (female-to-male transition), the male reproductive hormone testosterone is taken to induce phenotypically masculine body traits (such as increased muscle mass, decreased breasts and fat deposits, decreased hair growth and lower pitched voice) and support matching gender identity with physical appearance (alleviating gender dysphoria). Taking testosterone medications can also have serious risks and side effects. These include obesity, diabetes (type 2), dyslipidemia (imbalance of cholesterol and other lipids), hypertension (high blood pressure), cardiovascular issues, thrombosis (potentially leading to pulmonary embolism) , male pattern baldness (receding hairline and bald spot on top of the head), acne (skin impurities), and sleep apnea (irregular breathing during the night). Because vaginal and pelvic discomfort, as well as permanent infertility can be the result of hormonal therapy, storing egg cells before start of treatment may be an option for those who want to preserve the ability to have genetical children in the future.
