*This information is no substitute for, or pretends to be, medical advice. I am a web developer and writer, not a medical professional. Any information here is presented based on research and experience. However, we stress that you speak to your medical provider about any questions you have and before you begin treatment.

What are Hormones?

Hated science class? Well tough falsies because one- science rocks, and two- you wouldn’t work on a carburetor if you didn’t know what it did or how it worked. So tough it out and learn about your body.

Here’s the quick answer, hormones are one of the three main components of what makes up the physical facets of gender. Chromosomes and gonads are the other two. The rest of what you think is male or female is really a secondary gender marker and can honestly occur in men or women. Some women have square jaws, some men develop breasts. What can I say? Bodies are weird that way.

For men, the hormones consist of Testosterone and its derivative 5alpha-dihydrotestosterone (DHT). Strong stuff, which we will get to later. For women you are looking at Estrogen and progesterone, which are no slouch themselves. However, in HRT the effect and scope of change is very different. But we will get into that later.

So What Do Hormones Do?

Often, we see gender attributed solely to chromosomes, and don’t hear as much about hormones. However, it is these hormones that set many of the secondary gender markers like body hair, voice pitch, etc. And so for those wishing to attain certain visual characteristics, hormones are a must.

Hold up keyboard warriors, that isn’t to say that being gender non-conforming or being trans means you HAVE to undergo HRT (Hormone Replacement Therapy), or that it is a requirement of transition. For health, financial, religious, or personal reasons- there are many people who opt to be non-op or non-hrt or both. Some people identify as transgender and don’t transition. It’s all valid, of course. But somethings just won’t happen without HRT.

TransgenderCare.com offers this explanation:

Testosterone and its potent derivative 5alpha-dihydrotestosterone (DHT) induce penile growth and secondary sex characteristics as sexual hair, deepening of the voice, a muscular build and the greater average height in males in comparison to the females. In girls, estrogens in conjunction with Progestogens induce breast formation and a fat distribution predominantly around the hips; subcutaneous fat padding produces a softness of the body configuration and of the skin. The skin in women is further generally less oily than in men; the latter on the basis of activation of the sebaceous glands by androgen.

So puberty comes along, and blammo- secondary gender markers all up in the joint. Up until puberty, we generally have to go out of our way to express our gender identity. As we saw in “Stranger Things” a preteen girl with a shaved head and neutral clothing had no problem passing as male (unintentionally). And it was even harder in the past when everyone pretty much put all kids in the same clothes- mostly dresses. Aside from a primary gender marker like genitalia to discern out- there is little difference outwardly.

So What Does that Mean to Me?

Me, me, me. That’s all you talk about. Well, to answer your question, it means that we are attempting to induce secondary gender markers and traits after puberty- to varying degrees of time. Or, we are trying to hold off puberty and avoid having these hormones start doing their remodeling work in the first place so that HRT can be begun. In many cases we are looking to also minimize unwanted gender markers as well as making changes to the body.

In the case of trans women, we are looking to not only block testosterone and DHT but also introduce estrogen or progesterone into the body. We will talk a bit more about how exactly this is done a bit later. Seriously, buckle up, it’s a long article.

So if that is your goal in mind, then HRT might be your ticket. Of course, there are some things to consider when starting HRT.

Some Things to Consider When Starting HRT

I know, great literary transition. Call me Hemingway.

So, the first thing you have to know is this- there is a process to medical transition. If you want to use medical procedures to alter your body, you have to go through the proper channels. If you were curious, they also won’t do spinal surgery without going through all the steps either. They generally like to check some boxes first.

The biggest thing is a letter from a therapist. Pretty much any Endocrinologist (think “hormone doctor”) is going to look at you vacantly and play out the movie “Diner” in their head while you talk if you try to go in and talk to them about HRT without a letter from your therapist recommending you for hormones. That’s because they tend to like their job. And performing a procedure on someone that hasn’t been properly checked out amounts to malpractice. So you will have to obtain a letter before an endocrinologist will see you.

Ah, the golden letter. What many transgender people seek, it is seen as a magical ticket that opens up the doors to the rest of your life. That’s right, one letter can change your life. So, for the life of me, I don’t understand why so many people think they can just call a therapist and ask them to write a letter or go to one session and get one. This is a big step- one that can have some irreversible effects. And, frankly, I’d be leery of any professional therapist handing out letters like a vending machine. We call those “letter factories”.

Generally, the rule for both therapists and Endocrinologists is one year of therapy to begin HRT. That’s when you can usually expect to get a letter. It might not be consecutive, or with the same therapist. But you at least need to show you’ve put in some consistent effort and made a commitment to this.

The letter itself is usually pretty straightforward. It essentially says that they’ve seen you for however long and that they’ve found you to be of sound mind and rational enough to make this decision. So that everyone can see it isn’t symptomatic of another condition. Usually, it is also covered that you are not being coerced in any way into this decision and you are doing it of your free will. Also, that it is not sexually motivated.

Once you have this letter, you will get referred to an Endocrinologist. This is either done through your regular doctor, a clinic like planned parenthood or directly from your therapist (ONLY if they are a psychiatrist).

The endocrinologist will run several tests to make sure that you are healthy and suitable for HRT. This will include a medical history and a good amount of blood work. After you get the all clear, your endocrinologist will sit down and work out a plan with you for your treatment including schedule, exact medication, and dosages.

For the record- we won’t be talking about dosages here. It’s considered a no-no. You need to stick to the dosage you are given. Even if you feel it isn’t happening fast enough and your friend is on a higher dosage than you. Just know that you are on the right dosage for you, and if you aren’t then your doctor will adjust that. Taking too much, or an incorrect dosage can lead to blood clots, strokes, seizures, taking not good blood thinners and death. Did you come all this way to wind up like that? Read more at http://sideeffectsofxarelto.org/current-xarelto-lawsuits/ and think.

Do I Have to be on HRT Forever?

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Unfortunately, the answer is yes. You will be on HRT for the rest of your life. Some of the effects of hormone replacement therapy are reversible and you will wind up right back where you started if you quit. You will need to discuss this further with your endocrinologist.

What Will I Be Taking?

This is entirely dependent on what your endocrinologist prescribes for you. But here are the types of hormones you can expect to receive:

Male to Female

• Estrogens
  The most commonly prescribed estrogens in HRT for transgender women are micronized estradiol, certain estradiol esters such as estradiol valerate and estradiol cypionate (which are prodrugs of estradiol), and conjugated equine estrogens (Premarin). Estrogens may be administered orally, nasally, sublingually, by intramuscular injection, from an implant, or transdermally (via gel, spray, or patch).
• Progestogens
  Progestogens include progesterone and progestins (synthetic progestogens). Progestogens commonly prescribed for transgender women include progesterone, cyproterone acetate, and medroxyprogesterone acetate. They may be administered orally, sublingually, rectally (by suppository), transdermally (in gel form), or by intramuscular injection.
• Anti-Androgens
  Anti-androgen medications work by blocking the effects of testosterone. For example, they will help slow male-pattern baldness, reduce growth of facial hair, and stop spontaneous/morning erections. They are not needed if one has undergone a bilateral orchidectomy (removal of both testicles).Anti-androgen drugs are often prescribed in addition to oestrogen, as the two have effects that complement each other. Taking anti-androgens reduces the amount of oestrogen you need to get the same effects, which minimizes the health risks associated with high doses of oestrogen. Anti-androgen drugs can be prescribed alone for those who want to reduce ‘masculine’ characteristics for a more androgynous appearance, as it’s less ‘feminizing’ than oestrogen.
  • Steroidal
    The most commonly used antiandrogens for trans women are steroidal: spironolactone and cyproterone acetate. Spironolactone, which is relatively safe and inexpensive, is the most frequently used antiandrogen in the United States. Cyproterone acetate, which is unavailable in the United States, is more commonly used in the rest of the world.
  • 5α-Reductase inhibitors
    Certain antiandrogens do not reduce testosterone or prevent its action upon tissues, but instead prevent its metabolite, dihydrotestosterone (DHT), from forming. These medications can be used when the patient has male-pattern hair loss and/or an enlarged prostate (benign prostatic hyperplasia), both of which DHT exacerbates. Two medications are currently available to prevent the creation of DHT: finasteride and dutasteride. DHT levels can be lowered up to 60–75% with the former, and up to 93–94% with the latter. These medications have also been found to be effective in the treatment of hirsutism in women.
  • Non-Steroidal
    Non-steroidal antiandrogens used in HRT for trans women include flutamide, nilutamide, and bicalutamide, all three of which are primarily used in the treatment of prostate cancer.[45][46] Unlike steroidal antiandrogens such as spironolactone and cyproterone acetate, these drugs are pure androgen receptor antagonists. They do not lower androgen levels; rather, they act solely by preventing the binding of androgens to the androgen receptor.
  • GnRH analogues
    In both sexes, the hypothalamus produces gonadotropin-releasing hormone (GnRH) to stimulate the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This in turn cause the gonads to produce sex steroids such as androgens and estrogens. In adolescents of either sex with relevant indicators, GnRH analogues such as goserelin acetate can be used to stop undesired pubertal changes for a period without inducing any changes toward the sex with which the patient currently identifies.
  • GnRH agonists
    GnRH agonists work by initially overstimulating the pituitary gland, then rapidly desensitizing it to the effects of GnRH. After an initial surge, over a period of weeks, gonadal androgen production is greatly reduced. Conversely, GnRH antagonists act by blocking the action of GnRH in the pituitary gland.

Female to Male

• Androgens
  A natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics. This is usually just generically referred to as “T” or testosterone.
• GnRH agonists
  In all people, the hypothalamus releases GnRH (gonadotropin-releasing hormone) to stimulate the pituitary to produce LH (luteinizing hormone) and FSH (follicle-stimulating hormone) which in turn cause the gonads to produce sex steroids. In adolescents of either sex with relevant indicators, GnRH agonists, such as nafarelin can be used to suspend the advance of sex steroid induced, inappropriate pubertal changes for a period without inducing any changes in the gender-appropriate direction. GnRH agonists work by initially over stimulating the pituitary then rapidly desensitizing it to the effects of GnRH. Over a period of weeks, gonadal androgen production is greatly reduced.
• Progestin injections
  Depo-Provera (depot medroxyprogesterone acetate, or DMPA) may be injected every three months just as it is used for contraception. Generally, after the first cycle, menses are greatly reduced or eliminated. This may be useful for transgender men prior to initiation of testosterone therapy. These work to help eliminate menstruation and acts as birth control.
• Supplements
  Andro ‘Pro-hormones’: Androstenedione, 4-androstenediol, 5-androstenediol, 19-androstenediol, and 19-norandrostenediol are sold as supplements that are purported to increase serum testosterone, increase muscle mass, decrease fat, elevate mood, and increase sexual performance (i.e. many of the effects transgender men seek with androgen therapy). However, there is no good medical evidence that the pro-hormones do any of these things. However, there is evidence that ingestion of these substances can cause elevated estrogen levels, and decreases in HDL (good) cholesterol.

What Will Change?

This will vary depending on dosage, length on therapy, and whether you are a trans male or female.

Female to Male

• deepening of the voice,
• growth of facial and body hair
• male pattern baldness (in some individuals)
• an enlargement of the clitoris
• growth spurt and closure of growth plates if given before the end of puberty
• possible shrinking and/or softening of breasts, although this is due to changes in fat tissue
• increased libido
• redistribution of body fat
• cessation of ovulation and menstruation
• further muscle development (especially upper body)
• increased sweat and changes in body odor
• prominence of veins and coarser skin
• acne (especially in the first few years of therapy)
• alterations in blood lipids (cholesterol and triglycerides)
• increased red blood cell count

Male to Female

• Breast development and enlargement
• Softening and thinning of the skin
• Decreased body hair growth and density
• Redistribution of body fat in a feminine pattern
• Decreased muscle mass and strength
• Widening of the hips (if epiphyseal closure has not yet occurred; see below)
• Decreased acne, skin oiliness, scalp hair loss, and body odor
• Decreased size of the penis, scrotum, testicles, and prostate
• Suppressed or abolished spermatogenesis and fertility
• Decreased semen production/ejaculate volume
• Changes in mood, emotionality, and behavior
• Decreased sex drive and incidence of spontaneous erections

Potential Side Effects

Male to Female

• Blood Clots
• Prolactinoma
• Gallstones
• Possible Risk of Cancer
• Heart Disease
• Infertility

Special note about Spironolactone
Spironolactone is often prescribed in MTF therapy for pre-op trans women. It’s used off-label to this end, as it is usually prescribed for high blood pressure or edema. It is a diuretic that expels water and holds on to potassium. However, you can hold on to too much potassium and wind up with a life threatening situation. So you have to make sure you have your levels closely monitored.

Female to Male

• Heart disease
• Stroke
• Diabetes
• Increased red blood cells and hemoglobin
• Onset or worsening of headaches and migraines
• Cancer
• Mental Health

That’s a very broad overview to start, what questions do you have that you would like answered in part 2? We will be covering supplements, online ordering, administering medication, and more. Let us know what you want in the comments below.

Trans-health.com, ran by Sherbourne Health Centre, has a series of DVDs that they give to patients to help them with many of the aspects of transition. This video shows, step-by-step, how to give yourself injections of your hormones.

The HRT Injection Video Guide

This is so important, given that most people have never had to give themselves a shot before- unless they are diabetic. So check out this video, and hopefully it can help you too.

Taking Care of Business: A DIY Guide to Self Injecting ‘T’ is an exciting and innovative one of a kind health teaching resource made by and for the trans communities. To date it has been well received by both the trans communities and health care providers. At Sherbourne Health Centre we regularly provide copies of the video to trans folks (including some trans women) who will be self-injecting hormones for the first time. It has also been an effective resource for friends/partners/lovers who administer hormone injections to people at home.

The DVD features a chapter selection menu so that individuals can easily review specific sections as well as a PDF injection guide. Although I am able to pass around copies of the DVD free of charge to individuals who need them and stop by the health centre, I am not always able to mail out copies to individuals that request them.

Due to popular demand, or rather geographically diverse needs, I have now posted Taking Care of Business on YouTube. I unfortunately had to edit it down a bit to meet their time restrictions and for all of you who participated in the project I have also edited out most of the credits.

Thankfully, Zepharius Be put out a video to help answer at least a couple of questions about chest binders. Primarily, he covers how to put on a binder without getting yourself all twisted and position your breasts for optimum aesthetics and comfort.

Don’t worry, we will be getting into more on this subject soon- but we wanted start off with something that might help those that have already made the purchase and have struggled with it.

He also makes a couple of important comments. One being to make sure you buy a quality chest binder, and not the cheapest thing you find on eBay in order to get the best and safest results. But more importantly, in the comments Zepharius touches on a very important topic.

“Using more than one binder can be very dangerous! A proper sized binder is tight in all the right places. It works on getting your chest flat while letting your chest still expand when you inhale. Using more than one binder will constrict your chest, not allowing your lungs to expand completely and it can also cause bad damage to your ribcage.”

CHeck out his entire channel for more videos here.

We asked some trans men who have been through the process of transitioning while in a relationship for the best kind of support they would or could have been offered, and other helpful things to consider in a similar situation. (Note: Things are different for every person, situation and relationship. This is from the perspectives of four trans-identified people who offer up their own experiences as personal advice.)

Rudy is 25, Middle Eastern and identifies as a straight male. He had a girlfriend during his social transition at 22 (so no surgery or hormone usage at the time). They are no longer together but are still friends.

Evan is 27 and from Los Angeles. He realized he was trans* at 18, but didn’t start transitioning until he was 22. He is now married to a cisgender woman and identifies as queer, using male pronouns.

Leo is 26 and has been transitioning over the last eight months. He has been in a relationship with the same woman for four years, and she has been “extremely supportive.”

Simon* is 32 and began medically transitioning two years ago, although he identified as genderqueer/on the trans spectrum for the last 10 years. He identifies as a trans man. He was in a three-year, long-distance relationship at the beginning of his transition.

Q. When you came out and were beginning the transition process, what was your partner’s reaction and how did it make you feel? Was there something you would have liked for them to do better/different?

Rudy:  Well, she was very supportive—I was actually extremely transphobic before I came out. Of course, that was me internally not accepting myself.

Evan: I realized I was trans* when I was 18 while I was at college in San Francisco. My girlfriend at the time was really supportive with me becoming comfortable discovery what being trans. We broke up for a reason that had nothing to do with being trans*.

I lived in a gray area of genderqueer for four years too scared to transition mostly out of fear of the unknown. During that time I was in a on-again/off-again relationship with a girl that started off as a long distance thing but after two years she moved in with me. We broke up for many reasons one was she was very controlling and had problems with my genderqueer “stuff” i.e my deodorant or the fact that I wear boxers and men’s clothes. After we broke up I hit what I call the Trans Walls, where I needed to face the fact that was was not living and if I didn’t transition I was going to kill myself.

I met my wife about a year into my transition. When we met my wife identified as straight, I know that I am very lucky. When it comes to being with a trans person support is the most important thing. Also being realistic. With a transition all your relationship go though a transition, and sometimes lovers become friends. I understand why a lesbian  would not want to date me. I’m fabulous, but I look very, very much like a man. On the other hand I get why most straight woman would not want to date me.

Leo: Coming out to my partner wasn’t difficult at all. I kind of had one of those “thought out loud” type of moment. We were laying in bed about to go to sleep when I was thinking about how to tell her and it just came out. She turned and looked at me and told me that she was fine with it. She loved me for who I was, not my gender or what I had in between my legs.

Honestly, if I could go back and repeat that moment, I wouldn’t change a thing. In an awkward kind of way, it was perfect.

Simon: I began the transition process about six weeks before I told my girlfriend at the time. There were several reasons for this. First, I wanted to make sure that starting hormones felt “right” to me before I told a lot of people, particularly those with a much stronger vested interest in my gender/identity, like my girlfriend and my family. I had been debating about starting hormones for so long that I wanted to make it easy on myself to stop them if I didn’t like what happened, or if taking them didn’t make me feel any better. I was also a little worried about her reaction because I had a friend in college whose girlfriend broke up with him because she did not want to date “a man” and was a “lesbian.” I figured that because we were apart, dealing with that kind of reaction long-distance would be harder than if I could tell her in person.

Because my girlfriend and I lived apart, it was easy for her not to know. There aren’t many huge changes in the first few months, so there wasn’t too much physiologically for me to discuss, and anything I did want to chat about, I talked to my trans friends about. When I did tell my girlfriend, it was the first time we had seen each other in person in about four months. I told her over lunch while visiting her on the east coast. She took it well and didn’t seem too concerned at first. But she also is very much an internal processor, so even if she had been troubled, I’m not sure how much of that would have come out at first. She identified as queer as well, and had a history of dating cis men, so I think to her, the change was not threatening in any way.

I learned after we broke up that she was much more upset about my waiting to tell her than she initially let on. I was happy with her reaction, I suppose. She is not particularly outwardly-emotive, so I wasn’t expecting a lot of enthusiasm. She told me she supported me and that was what I wanted to hear. Had I known how upset she was that I had waited, I would have been able to better explain why I felt the stakes were so high and why I decided to wait.

Now that you are on hormones, everything switches. You probably already have stopped shaving your body but now you have to contend with your facial hair. Of course for trans men, like cis boys going through puberty, seeing that hair come in is exciting and a huge checkpoint in growing into manhood. That doesn’t mean you aren’t going to want to keep it looking good.

Perhaps want to keep it shaved down until it comes in less patchy. Or once it’s coming in fully, you might want to shave the neck and the edges to keep it neat looking. Of course that is IF that’s what you want. As we all know there are no real rules to transition and how you present. Shave half of it if you like. Live your life player.

While there are tricks and tips to shaving your body, there are also tricks to shaving your face and skin care for men. So here is Skin Care with Ross checking in with a great video on everything you need to know about face shaving.

He covers skin prep, technique and aftercare that you were tragically not introduced to.

Let us know in the comments about your experience shaving. What mistakes did you make?

*I want to make clear that I know it would be preferable to have a video from a trans man demonstrating shaving. However, there aren’t many very good options for that out there. Most I found were poor technique, or poor quality. And most videos were less about how to shave as they were about the experience of shaving for a trans man. If you have any suggestions on videos with trans men, I will be happy to post them. Let me know in the comments.

Checkout Ross’ YouTube channel or his blog.

Okay, don’t forget them, they are pretty awesome too. But one of the biggest physical traits men exhibit is that class “V” shape that starts with a broad top and tapers down to a fit waist. And let’s face it, the bigger your back, the smaller your waist looks.

We aren’t talking about super definition, at least not right off the bat. What we want to focus on is getting the foundation muscles laid and starting to shape your body.

The best reason to really focus on your back is the most obvious. The stronger your core is, the stronger your body is. You will never build true strength if you don’t pay proper attention to your back and core. Plus it helps prevent back injury and fatigue, and in general, it just makes you feel better and more energized.

So check out these exercises to start getting your muscles built up, and you might be surprised how quickly you see the changes in your body.

And what a handsome man he is. Dat smolder doe.

Ty is celebrating two big years on testosterone, and all of the changes that have come along with it. The physical changes have really been amazing as I’ve followed Ty’s videos for a while now. To see how his outside has grown to match who he was inside is just incredible.

And can we talk about these muscles?

So check out his video and let us know what you think.

You can check out his entire YouTube channel here. Or you can follow him on Facebook or Tumblr.