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My Hormone Experience

 

Important Disclaimer: This page is only included for historical interest and information, it does NOT constitute Medical Advice.  Hormone treatment should always be done under the supervision of a qualified medical professional.


A sample from my medicine cabinet in 2002.

Introduction
Firstly, I'm no doctor and you should seek proper medical advice and supervision before starting hormone therapy, also it's essential to remember that some of the physical changes resulting from the long term consumption of so called "female" hormones by a genetic male are permanent - there's simply no easy going back.   However I know that the reality is that many girls (like myself for several years) do go DIY, and I want to offer you my personal experiences.
 It's also important to recognise that every transwoman is different - which is something that clinics and doctors sadly often neglect as they focus on prescribing their medically ideally ideal hormone regome.  In practice, I've found that it needs some trial and error to find the optimum hormone regime.

 

Beginning My Journey

In my teens I learnt about transsexuals such as Tula, and adopted an androgenous appearance - always hoping to be called "Miss" by strangers.  My mother was incorrectly convinced that I was "gay".  When I left university I was hoping to transition full-time, but the obstacles proved just too high. 

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 but they caused severe nausea and a metallic taste in the mouth, so after a month I would stop taking them for a few weeks before starting again.  I was getting it all wrong as I my oestrogen intake oscilated widely from nothing to far too much.

In November 1996 - now age 31 - I realised that I needed to stop the flip-flopping and become more sensible.  After some research (pre-Internet) I settled on taking 0.625mg Premarin pills three times a day.  Within a few months I could have shared a bed with Miss World and just be worried whether I had brushed my teeth! 

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.

In June 1997 I was again planning my transition and even SRS when the unexpected happened - I met a girl who I became besotted with. I ceased taking hormones fit two years, only resuming in mid-1999.  While this long break was in retrospect very unfortunate physically, it did at least give me a chance mentally 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 6-12 months and have a hard re-assessment of your life 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,  libido and penis never completely recovered.  I was probably very close to a permanent "hormonal castration" when I stopped taking Pramarin.

 

   

 
My Hormone Regime (Complicated!)

1. Before my Orchiectomy
Oestrogen: After some research and experimentation with different brands of oral contraceptive pill, I eventually settled on the Nordiol:21 from Wyeth-Pharma, which is a combination pill containing both oestrogen and progesterone hormones.  I believe it's similar to Ovran which is sometimes prescribed to transsexuals in the UK.  

From September 1999 until my orchiectomy in May 2002 I took a pill morning and night for a daily dose of 0.1mg Ethinyl Estradiol and 0.05mg Levonorgestrel.  This seems to have the desired benefits without any noticeable bad side effects at all - and the monthly cost was a very reasonable $7.  

Another contraceptive pill I took in addition for a while (see Facial Hair) was Diane-35 from Schering AG which contains 2mg Cyproterone Acetate and 0.035 mg Ethinyl Estrodiol.  

Antiandrogens:  Diane-35 is of interest to transsexual women because Cyproterone Acetate is progestogen which acts as an antiandrogen, helping (among other benefits) to slow the growth of facial and body hair.  A pack of 21 tablets cost me about $8, or $12 a month.  If I had continued to take Diane-35  then in retrospect I may have begun taking three or four pills daily, while simultaneously dropping the Nordiol:21 in favour of a progesterone-only tablets such as Duphaston in order to help minimise any potential side effects or long-term risks.

I stopped taking Diane-35 because I obtained a prescription for the antiandrogen Eulexin from Schering AG, I took two capsules three times daily, each containing 125mg of Flutamide (a nonsteroidal anti-androgen).  Eulexin proved expensive (I was paying about $150 a month, which I subsequently discovered was in fact very cheap!) and at the beginning of 2001 I switched to the much cheaper and easier to obtain antiandrogen Aldactone from Searle ( 2 tablets daily, each containing 100mg Spironolactone, and costing just $30 a month).  However the Aldactone began to apparently give me stomach upsets and at the end of 2001 I went full circle by changing to Androcur from Schering AG (1 tablet daily, containing 50mg Cyproterone Acetate, and costing about $40 a month) which has the same antiandrogen as Diane-35.

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:

Description Regimen Approx Cost
Nordiol:21
(equivalent to Ovran
2 tablets daily (i.e. one in the morning and one at night) each containing 0.05mg Ethinyl Estradiol (oestrogen) and 0.025mg Levonorgestrel (progesterone) $2.35 per pack of 21,
$6.70 per month
Androcur 2 half-tablets daily, a tablet containing 50mg Cyproterone Acetate (anti-androgen) $27.00 per pack of 20, $40.50 per month
Duphaston 2 tablets daily, each containing 10mg Dydrogesterone (progesterone) $16.50 per pack of 20, $49.70 per month
Total: $109.40 per month

Notes:

  1. The progesterone dose was probably higher than necessary, but I was reluctant at this time to switch from the Nordiol:21 combination pill, which seemed to suit me well, to a different oestrogen-only pill such as Premarin.

  2. A Cyproterone Acetate dosage level of 100mg daily is frequently recommended for pre-op transsexuals.  However recent studies have shown no significant difference in effects between 100mg and less than 2mg of Cyproterone Acetate daily in many women, so the best advice is to start low and slowly increase if necessary.

  3. I believe that Cyproterone Acetate is not approved by the US FDA and is not available in the USA.

Another regimen I considered, which doesn't require specific antiandrogen drugs:

  • Diane-35: three tablets daily, each containing 0.035 mg Ethinyl Estrodiol and 2mg Cyproterone Acetate 

  • Duphaston: two tablets daily, each containing 10mg Dydrogesterone

And an easy to obtain and quite cheap hormone regimen that I actually used for a while:

  • Nordiol:21 [equivalent to Ovran] : two tablets daily each containing 0.05mg Ethinyl Estradiol (oestrogen) and 0.025mg Levonorgestrel (progesterone)

  • Diane-35 : one tablet daily containing 0.035 mg Ethinyl Estrodiol and 2mg Cyproterone Acetate (anti-androgen)

(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 experimenting to find what works best with the minimum of contradictions (side effects).  Also, many medical experts have their preferences and opinions.  Below is an example of a hormone regimen suggested by a Canadian clinic that seems reasonable, but other clinics have their own variantions and recommendations.

For those that want to learn more about hormones, here's two important links:- FAQ: Hormone Therapy for M2F Transsexuals and Some Typical Hormone Regimens.

2. After my Orchiectomy
In May 2002 I had an orchiectomy - this removed from my body the masculinising testosterone and other androgens produced by the testes, and also reduced resistance to feminising estrogens.

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:

Description Regimen Approx Cost
Premarin  2 tablets daily, each containing 0.625mg
conjugated oestrogen
0.625mg - $9.50 per pack of 100, $5.70 per month;
Duphaston 1 tablet daily, containing 10mg Dydrogesterone (progesterone) $16.50 per pack of 20,
$24.70 per month
Total: $30.40 per month

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:

Description Regimen Approx Cost
Premarin  1 tablet daily, containing 1.25mg conjugated oestrogen $12.70 per pack of 100, $3.80 per month
Duphaston 1 tablet daily, containing 10mg Dydrogesterone (progesterone) $16.50 per pack of 20,
$24.70 per month
Total: $28.50 per month

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!

3. After my SRS
I had sex-reassignment surgery in 2004.  To my surprise, the surgeon gave me no clear advice as to how I should change my hormone regime, and was happy for me to continue taking Premarin and Duphaston. 

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
Ten years after my SRS I was in my late 40's and at an age where the menopause starts to become common in cis women, indeed this and HRT had become a frequent topic of conversation for my female family members and acquaintances.  As the relative merits of 'bioidentical' estrogen patches based on estradiol, estrone and estriol were increasingly discussed - I realised that I had become very out of date in my knowledge.  This made me wonder if the costly Estradiol Valerate injections were still my best option health-wise. 

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 two Evorel 25 patches instead.  I soon felt much better but was still not completely back to normal, so a few months later he 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 seemed to hit my hormonal sweet spot.  I no longer had any menopausal like problems, and occasional blood checks showed my estradiol levels as being between 60-100 pg/mL.  That is an ideal level - minimising medication risks whilst avoiding potential problems such as reducing bone density and even cancer.  But a problem was that in 2018 Evorel Conti became unavailable from my local pharmacies, instead I had to order them on-line.  The cheapest I could find for a three months supply (24 patches) was £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.

5. Very Long Term (Current situation)

There are two problems with long-term hormone therapy - your body evolves (ages!) and the available treatments change.

The use of HRT by menopausal women has soared in popularity in recent years, as result the demand for patches has outstripped supply and at the start of 2022 I ran out of Evorel Conti and was unable to obtain it anywhere.  The next few months were farcical as my GP resorted to prescribing me various pills (usually contraceptives) that local pharmacies might have in stock - so much for a personalised plan based upon my physiological needs.  I was almost back to where I was in the 1990's!

The most available pills were Microlite (20 micrograms of ethinylestradiol and 100 micrograms of levonorgestrel) and Microgynon 30 (30 micrograms of ethinylestradiol and 150 micrograms of levonorgestrel).  These contained the synthetic rather than the bio-identical form of oestrogen that my body had happily become used to, and side effects were soon obvious - not least nausea and very sensitive nipples.  Thankfully, by mid-2022 the local pharmacies were able to obtain the Estradot patch (releasing 50 mcg of estrodiol per day) and I changed to this.

A recent medical development is the recognition that post-GCS transwomen respond well to the use of vaginal creams and tablets that release oestrogen.  I just begun inserting Vagifem tablets (releasing 10 mcg of estrodiol over several days), the main challenge so far is keeping the tablet in place, but if it works I should be able to move back to a lower dose patch after a few months.


Breast Development
The hormone pills I began taking in 1994 initially had a dramatic effect - within 18 months I was a small B cup.  But progress thereafter limited and by 2001 it was clear that my breast development had stopped at a full B cup.  A realistic assessment was that they were too small for my size and build and I reluctantly had breast augmentation - as do at least 50% of all transwomen. 

 

Weight
Until my early '30's I was very slim and had no conscious problem staying that way but keeping my weight down has been a constant challenge since then.  Even before my transition I easily gained weight and found it very difficult to then lose even a few pounds.  This was probably due to a combination of the effects of hormones and a natural tendency to become more "rounded" as I got older. 

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 followed by an ancient Jane Fonda workout video) in order to avoid moving from well-rounded to simply fat. 

 

Hair
I have never had obvious chest, body and limb hair, and years on hormones have helped ensure that this has never become a problem.  However, like the vast majority of transsexual women who start hormone treatment 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, shaving was an acceptable solution when I occassionally ventured out as a woman.  Unfortunately by age 30 - as I again spent more time passing - as a woman 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!

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, probably because the dosage of Cyproterone Acetate was too low, I changed to taking the drug Eulexin which I believe is more powerful in its 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 an early morning “double wet shave” was sufficient for the working day, although I would repeat the shave if I was going out in the evening.  However, by late 2001 it was obvious that hormones and anti-androgens were not going to completely stop my facial hair growth, and I thus began electrolysis and laser hair removal. 

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". 

In 2006 my facial hair follicles seemed to finally give up the battle and since then I've been faced (!) with just the odd hair appearing, 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.


  


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Last updated: 10 September, 2018

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