Disclaimer: This page is only included for interest and
information, it does NOT constitute Medical Advice.
Beginning My Journey
In 1994 I became an "expat" and was astonished to discover that female contraceptive pills were available from local pharmacies without prescription. I began taking these like sweets as I turned age 30 but soon experienced severe nausea and a permanent metallic taste in the mouth. I then stopped for a few weeks or even a month before starting again. I was getting it all wrong as I varied my oestrogen dose from nothing to excessive.
It was not until November 1996 that I went continuously on hormones for a significant period, which lasted seven months until the end of June 1997. Within two months I could have shared a bed with Miss World and just been worried whether I had brushed my teeth! I was desperate to develop and pass physically and probably overdosed - taking 0.625mg Premarin pills three times a day.
There was then a long two year break before I went back on hormones in summer 1999, and I have remained on them ever since. While this long break was in retrospect very unfortunate, it did at least give me a chance to consider what I really wanted to do. I would certainly recommend to any transsexual woman who's not absolutely certain that gender and sex re-assignment is the right solution for her, come off female hormones after about six months and have a hard re-assessment of your choices.
In my experience, after just a few weeks on hormones I would lose all sex drive and become incapable of an erection, which may disappoint some readers who've watched far too many she-male videos starring men with generous breast implants! Also, when I stopped taking hormones in 1997 after 7 months use, my sex drive and libido never completely recovered, even after a year off hormones. When I resumed hormones in 1999, I suspect that I was effectively chemically castrated and almost infertile long before my orchiectomy three years later, in 2002.
The initial effects of female hormones on the transsexual woman has often, and perhaps with some accuracy, been described as a second puberty. While breast development is easily the most obvious result of taking hormones, there are also many other more subtle long-term physical and mental benefits.
The changes are so very slow and imperceptible, even with the breasts it's impossible to observe that your bust is 1/100 of an inch larger than it was yesterday, although you may wonder if a bra is a little tighter than the last time you wore it. However cumulatively over months the effects become substantial and noticeable - whether or not you want them to be. For me nothing really seemed to happen other than to my boobs, but I knew from my measurements, old photo's, trying on old clothes, comments, etc. that my body had changed far more than I felt it had.
Progesterone: It is commonly recommended that transsexual women take Progesterone as well as Oestrogen to help promote breast development. In addition to my intake of progesterone via the Nordial:21 pill, I have since January 2001 have been taking supplemental progesterone. I have tried both Cyclogest from Cox Pharmaceuticals (one pessary daily containing 400mg Progesterone PhEur) and Duphaston tablets from Solvay Pharmaceuticals (two tablets daily, each containing 10mg Dydrogesterone).After a few months taking Cyclogest and/or Duphaston, I could feel a greater fullness in my breasts which may well be thanks to the additional Progesterone hormones. I currently take Duphaston, preferring it over the somewhat awkward Cyclogest pessary.
I keep getting asking about hormone regimens, so summarising the info above ...
My daily regimen during 2001 was:
Another regimen I considered, which doesn't require specific antiandrogen drugs:
And an easy to obtain and quite cheap hormone regimen that I actually used for a while:
(Note: On balance, one Nordiol and two Diane-35 may have been a much better combination because of its extra antiandrogen, but this combination would then be light on progesterone.)
Please note that these hormone regimens may not suit other transsexual women. The optimal hormone regimen will vary from individual to individual and I would recommend experiment to find what works best with the minimum of contradictions (side effects) Also, many medical experts have their preferences and opinions. For example, below is a hormone regimen suggested by a Canadian clinic (I have no connection with them!):
My doctor recommended that I change to Premarin from Wyeth-Ayerst, and stop taking the Nordiol:21. The Androcur antiandrogen was also now redundant. My daily regimen became:
Prevara is more commonly taken than Duphaston by transsexual women, but as I was already taking Duphaston he told me to continue with this. I eventually reduced the dose to one tablet per day. It was later suggested that I reduce the Premarin intake to just 0.625mg/day, but I instead began to take a 1.25mg pill with my Duphaston. Thus my daily regimen became:
Metformin: In early January 2003 a visiting friend of mine (and a doctor) suggested that I should take Metformin. Although normally a drug associated with diabetes, it's also considered useful for aiding and enhancing the body fat redistribution (including limbs and face) of transsexual women taking oestrogen. However in my experience it has at least two serious downsides, one is that no alcohol should be consumed while taking Glucophage, the other is very severe nausea.
The doctors prescription was for Glucophage from Lipha Sante (initially 2 tablets daily, each containing 500mg Metformin - $7.50 per pack of 100, $4.50 per month). After a week, continuous nausea and occasional vomiting made me decide (without any professional medical advice) to reduce my dose to one tablet a day. This thankfully helped my nausea a lot, indeed the sickness had nearly gone completely after a month of use.
In early February 2004 I optimistically anticipated being wined and dined by my boyfriend for Valentine's Day. I decided that after nearly four years continuously on hormones my body fat was probably as redistributed as it was ever going to be, and that enjoying a bottle of expensive wine was preferable to continuing to take my Glucophage pill!
From research I became worried about the potential risk of taking oestrogen orally long term, for example constant the stress on my liver. I discussed this with my doctor and in 2007 my prescription was changed from Premarin tablets to a fortnightly 10 mg intravenous injection of Estradiol Valerate. A major downside of this was the cost - my pharmacy bill immediately increased to over $140 a month!
I took the second injection a little early - 10 days after the first. This created an estrogen high followed by an estrogen low for several days before my next injection. The deliberate result was that I had a 28-day hormonal cycle roughly mimicking the period of a cis-woman. I'm not conscious of the resulting mood swings and changes in my behaviour, but my husband was!
I also continued to take Duphaston. Despite the many medical reports claiming that taking progesterone has no benefits for transwomen, from experience I firmly believe that it helps to maintain my physical, mental and sexual health as a woman.
4. Long Term
My GP of many years had retired but a young replacement enthusiastically took up my case and suggested Evorel 25 skin patches instead - which release 25 micrograms of estradiol per 24 hours. He also prescribed Utrogestan - one capsule daily containing 100 mg of micronised progesterone. I was dubious about taking this as I was wedded to Duphaston, but he promised that it was a low risk and easily assimilated form of progesterone that would benefit my hormonal balance and overall health given my lack of both ovaries and testes.
I stopped taking my Estradiol injections but after a few months using just the patches I was increasingly suffering from headaches, fatigue, nausea, hot flushes, ... I wasn't a happy bunny! The doctor diagnosed that my oestrogen levels were too low and doubled the dosage by moving me from Evorel 25 to Evorel 50. Unfortunately Evoral 50 was not available from local pharmacies so I had to just use two Evorel 25 patches instead of one. I soon felt much better but was still not compleletely back to normal, so a few months later my GP moved me to Conti patches. This is a combined patch which releases both oestrogen (50mg estradiol a day) and progesterone (170 mg norethisterone a day). I no longer needed to take Utrogestan.
The Conti patch seems to have hit my hormonal sweet spot. I no longer have any menopausal like problems, and my occasional health checks record my estradiol blood levels as being between 60-100 pg/mL. That is a sweet spot - minimising medication risks whilst avoiding potential problems such as reducing bone density and even cancer. A downside is that Evorel Conti has also become unavailable from my local pharmacies, instead I have to order them on-line. The cheapest I can find (2018) for a three months supply (24 patches) is £75 (roughly €90) from a UK pharmacy, but add on shipping, taxes, customs and admin fees and it becomes about €150 - or c.$60 a month.
From my research c.2000 there seemed to be a link between taking female hormones and weight gain, and a desire to reduce my hormone intake and thus weight was a dubious driver for my having an orchiectomy. In practice there was no noticeable effect weight wise.
I have to be careful about what I eat and drink, and exercise daily (usually a long walk over Jane Fonda workout), in order to avoid moving from well-rounded to simply fat.
I have never had excessive trunk and limb hair, and years on hormones have helped ensure that it has never become a problem. However, like the vast majority of transsexual women who start hormone treatment years after puberty, facial hair and beard growth has been an issue.
When I was young (early 20's) and had only light and sparse facial hair growth, or when I was only occasionally passing as Annie for short periods, I found shaving to be an acceptable solution. Unfortunately, as I spent more time as Annie my facial hair became a serious problem. The constant need for close shaves was inconvenient and despite generous use of soaps and creams, it caused unsightly rashes and skin irritation, particularly on my neck area. Also, despite the greatest care, a shaving cut is an inevitable occasional nightmare!
In mid-2000 I began taking the contraceptive pill Diane-35 which is commonly used by women who suffer from hirsutism (excess body and facial hair) as it helps stop scalp hair loss while decreasing body and facial hair. Before any benefits from Diane-35 were noticeable, undoubtedly in part because the dosage of Cyproterone Acetate was too low, I changed to taking the drug Eulexin which I believe is more powerful in it's anti-hirsutism effect.
As usual with hormones, the results were imperceptible, but by December 2000 - when I transitioned full-time - there was definitely a slowing of the rate of growth of my beard, and my skin was in much better condition. I found that one early morning “double wet shave” plus plentiful and regularly revisited make-up was sufficient for the working day, although I would repeat the shave if I was going out in the evening.
As the year 2001 progressed I noticed further slowing of my beard growth, the hairs also becoming somewhat finer, allowing me to use less make-up. However, by late 2001 it had become obvious that the hormones and anti-androgens wouldn't completely stop my facial hair growth, and it remained a problem to my passing as a woman - and a serious embarrassment when in close company 24 hours a day. I thus began in November 2001 a course of Alexandrite laser hair removal. By May 2002 I had had six laser treatments, done at 5-6 week intervals.
In addition to the laser treatments, in early 2002 I also began using Vaniqa from the Bristol-Myers Squibb Company, a hair retardation cream which contains eflornithine hydrochloride. Unfortunately it's expensive, I paid an outrageous $119 per 30gm tube (about a 3 weeks supply in my experience) for my first batch, but I think it was worthwhile in delaying re-growth and lengthening the shave-less period between laser treatments. I purchased subsequent batches of three tubes for what worked out to be $75 a tube, but I have seen USA prices of under $40 per tube on the Internet - if you have a prescription and thus can avoid paying a so-called "consulting fee".
After my 2001/2 laser treatments I had very little hair re-growth for two months, indeed I did not have a further treatment until early September 2002. This wonderfully long period was probably due to a combination of the effects of the cumulative laser treatments, Vaniqa and my orchiectomy all kicking in simultaneously. As an economy measure I stopped applying Vaniqa in December 2002 when my supply was exhausted.
Because of gradual re-growth I was forced to have a laser session in late April 2003, a gap of nearly 9 months and definitely over due. I had another in May and then further laser treatments at roughly 6 month intervals. In 2006 my facial hair follicles seemed to give up the battle and since then I've been faced (!) with just the odd hair which can be plucked.
The elimination of my beard has significantly helped my ability to pass as a woman, and thus my confidence. But I regret that I didn't seek more treatment before my transition, with hindsight relying on just shaving was crazy.
you have any questions, or perhaps just want to know more about me,
please feel free to email me.
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Copyright (c) 2003, Annie Richards
Last updated: 10 September, 2018