*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.

It is this thickening that makes your voice become deeper. Think of it like guitar strings- the thicker the string the lower the tone. For trans men, this means that HRT will alter your voice and give you a more traditionally masculine voice. Unfortunately, no amount of estrogen or testosterone blocking will skinny up your vocal chords. It’s one of the sad truths about HRT for transgender women- we just don’t experience as many physical changes as trans men do.

There are surgeries that you can undergo to attempt to change your voice, but these can be risky and are most certainly expensive. Luckily, however, you can train your voice to become more “feminine” by altering your pitch, tone, and speech pattern. It isn’t a quick or easy fix, but it has worked for countless trans women and it can work for you. These are the techniques that have been used long before we had the alternatives of surgery. No matter where your voice is now, no matter how deep, you can make headway. Now, you won’t go from Barry White to Mariah Carey- let’s be honest here. However, you will see a difference if you put in the work.

Here, the beautiful and prolific Stef Sanjati goes over the exercises and practices she has employed over the last year for voice training and displays the results comparing her own voice over the course of a year.

Just remember, it’s more than pitch. Talking like Mickey Mouse isn’t going to accomplish your goal. You need to keep in mind pitch, tone, and flow (speech patterns)- it is only in altering all three that you will get the results you want.

One final note, please keep in mind what Stef says in her video. It is important that you are doing this for the right reasons. Don’t do it because you feel obligated, or because you think it is expected. Do it because it is something you want and it will help you to feel more complete. As with every stage of transition, do voice training because it is what you want.

Check out Stef’s YouTube Channel for more great videos.

Transgender Services Come to Kansas City

Starting April 11th, at their Kansas City North location (Gladstone, MO), Planned Parenthood of Kansas and Mid-Missouri will be offering comprehensive services specifically for the transgender community. They join the more than 27 Planned Parenthood locations offering similar services across the country. Currently finding some of the vital transgender services needed has been difficult. However, Planned Parenthood has made it easier to find them; and most importantly, in an environment that strives for safety and inclusive.

At launch the northland clinic will be offering counseling referrals and guidance, HRT (Hormone Replacement Therapy) for both trans men and women, as well as all of the blood tests and monitoring that are so important to HRT. However, there is one service that is critical but often overlooked. Many trans men fail to get yearly exams such as pap smears, for fear of embarrassment or body dysmorphia. Planned Parenthood understands those fears and has sought making this as comfortable as possible a paramount goal.

Part of their commitment to this goal is the approach they’ve taken with their own education. They have taken great pains to make sure their staff and doctors understand the particular needs of the transgender community. They have reached out to therapists in the area for guidance, seeking to understand and embrace the “standards of care” for transgender individuals. Additionally they are bringing in transgender men and women to talk to the staff so they can share their experiences and needs.

“We want to focus on caring for both physical and emotional needs in a safe place.” said Bonyen Lee-Gilmore, Director of Communications & Marketing for Planned Parenthood of Kansas and Mid-Missouri, “We need to put health first.”

Reproductive Health for All

Part of this initiative is the growth of their PrEP (Pre Exposure Prophylaxis) services for HIV/AIDS. On March 14th, Planned Parenthood expanded those services with launches in midtown Kansas City, MO as well as Columbia, MO- with plans to expand to all six locations within six months to a year. In fact, this chapter of Planned Parenthood in particular finds itself in a state of great growth.

The reason for the expansion of these services is simple, women are the fastest growing segment of the population to contract HIV/AIDs. This includes the often overlooked menopausal and post-menopausal population.

Their treatment program is multi-faceted, covering risk factors as well as treatment. Not only do they handle the prescription of the drug Truvada, they also monitor kidney function, and over health with regular screenings and checkups.

However, most importantly, they seek to service the community with education. Bonyen Lee-Gilmore continued, “There is a great need for education about reproductive health and STI symptoms. We are seeking to change this by providing education and treatment for all regardless of gender, gender identity, or generation.”

For further information visit Planned Parenthood of Kansas and Mid-Missouri online.

For transgender specific services you can reach out to the Gladstone office at 816-453-6000 or at their clinic page.

You can also find them on Facebook, Twitter, and Instagram.

(edit- Corrected proper name for mid-America branch. Added social media. Corrected start date for transgender services.)

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.

Just keep in mind that you can’t expect miracles. There isn’t much in a way of muscles in that area, we are basically dealing with skeletal shape and bone structure.

So what muscles can we find down there? We are going to be focusing on the gluteus muscles, primarily the minimus and medius. These are abductor muscles that work to move a limb away from your body. These are not muscles that are accustomed to being worked out for size rather than support strength. That means we are going to be doing some very intense work.

As always, don’t overdo a new exercise routine. These are exercises you may not be familiar with, so take your time and make sure you have your form down before anything else. Whenever possible, try and set yourself in front of a mirror so you can check your form. And always consult your doctor before starting a new exercise routine.

1. Side Lunge (with Barbell or Dumbbells)

   You might be familiar with the side lunge, but you probably haven’t ever done it quite like this. For those who don’t know, a side lunge starts with your feet about shoulder width apart. You take a step to your side and bend your knee until you are in a lunge position. This version of the side lunge is a bit different.

   First of all, you will start with a wider base than a normal side lunge. First, grab your weights, start light because you don’t want to underestimate this exercise. Stand with your feet shoulder-width apart and then, with either foot, take one decent step out to your side. Next, bend your knee down on the first leg until you are in a lunge position with your other leg pivoting out but always remaining in place. Then use your leg you are bending, and keeping your weight on that foot, to push yourself back up into your original wide-leg stance. Repeat to the other side. You should feel it right there in your hip. If you don’t, experiment with your angle and positioning of your foot when rising out of the lunge until you feel it.With this wider stance we take stress off of the knee. That means we can do more, and use more weight. Remember that you are working out a relatively small area, so you are going to feel this tomorrow.

2. Side Lying Hip Abduction

   This is another one that is deceptive in how effective it is and how much you will feel it. Start by laying down on your side with your bottom arm supporting your head and your upper arm resting on your side. Optionally you can add a free weight, resting it on your hip.It’s pretty simple, just lift your upper leg up and slightly to the back for a gentle diagonal line. But be careful not to raise your leg too high so you don’t put undo stress on your hip. Roll over and repeat.

3. Standing Hip Abduction

   We are working the same muscle group as with the last exercise, but it can be a nice alternative, or one you can throw in on another day to keep working it. You can do both in the same workout, but we wouldn’t recommend it. Too much stress and repetitive motion. You can also add a resistance band to step it up.Simply stand and support your side you won’t be using, and perform the same motion with your leg going out and slightly back. If you are using a resistance band then be sure to keep pressure and tension on for the entire release. Seems elementary, but I’ve seen people slingshot themselves pretty impressively with bands. And you don’t want to whack your ankle on a squat rack.

4. Side Planks

   Time for our good friend, the plank. Planks are one of the most effective exercises that you can do to strengthen and tone your core. Why is this important? Your core is, well, your core. It’s the base of everything. It doesn’t matter how strong your arms or legs are if you are weak in the middle. It helps with overall strength and support as well as protecting your back.There are many variations on the plank, but for our purposes we will be sticking with the side plank. While not necessarily working the hips, it does work your side or oblique abs. Toning up this area will help with your overall figure and in conjunction with your other exercises, it will help make your hips look wider as you get trimmer looking in the middle.Lay on your side again with your upper arm resting on your leg and your lower bent out at a 90 degree angle under you. Lift yourself up on that lower arm and straighten your body with your arm fully perpendicular to you. Your arm is just a support here, we are looking at the middle. So use your core muscles to keep you straight and avoid sagging in the middle. Try going for as long as you can, and aim for three reps on each side if you can.

5. Sumo Walk

   For this one, we are going to need a resistance band. And the ability to look a little odd. Put the resistance band (doubled up if you need to) around your legs. You can put them anywhere, but we recommend nearer the ankles to reduce strain and encourage the glutes to fire up.Simply walk like a sumo wrestler, taking steps forward while keeping tension on the band. You can also think of the exaggerated gait of a gunslinger or a bulldog too. Work up the distance you can do and repeat for up to 3 sets.

We know this is a frustrating area to build up, and an area that probably already vexes you. These exercises along with HRT can help to give you a more feminine shape. Don’t get frustrated though, results don’t come overnight and it’s going to take hard work. Stick with it and keep working it!