Feminization Therapy

For feminization to occur in a genetic male, there must be an increase in estrogens and a decrease in testosterone. Most hormone therapies for the feminization of genetic men include both estrogens as well as some anti-androgenic drugs such as spironolactone, aldactone, finasteride and dutasteride.

Generally speaking, feminization is a gradual process. The process of hormonal feminization, while essential, can't be rushed or accelerated. Increasing the hormonal doses above what is prescribed may not give you a great increase in the speed of results, and will be more likely to increase any unwanted side effects. The genetic male's full response to feminizition therapy appears over a matter of years. Feminization will begin to be noticed about 1-3 months after starting on an a regime.

Although Life Pharmacy provides all of the products listed without prescription, we recommend you seek professional medical advice before taking any of these medicines. Some anti-androgens may require ongoing monitoring of you liver function to prevent perminant liver damage: By having a doctor or physician monitor your progress you can have access to many diagnostics, such as being able to monitor your hormone levels, which can allow optimisation of dosages if necessary.

Estrogens

Estrogen dosing regimens for gender transition vary widely. Estrogen should be prescribed at the lowest possible effective doses to avoid the serious complications of high-dose estrogen therapy.

Current recommendations for estrogen dosing range from starting doses of 0.625 to 2.5 mg of conjugated estrogen.

Estrogen is the most important part of any feminizing regimen.

Some typically-used estrogen dosages for pre-operatives are as follows:

• Oral estrogens:
  • Estradiol (eg. Estrofem); 6-8 mg daily; or
  • Estradiol Valerate (eg. Progynova): 6-8 mg daily; or
  • Conjugated Equine Estrogens (eg. Premarin): 5mg daily; or
• Transdermal estrogen:
  • Estradiol (eg. Climara, Estraderm): two 0.1 mg patches, applied simultaneously

Progestins

Taken cyclically in a relatively small dose, progestins may have limited potential to promote breast development in individuals.

• Oral progestins:
  • Medroxyprogesterone (eg. Provera): 5-10 mg daily; or
  • Micronized Progesterone (eg. Microgest): 100 mg twice daily; or
• Injectable (intramuscular) progestins:
  • Medroxyprogesterone (eg. Depo-Provera): 50 mg every two weeks;

Oral Anti-Androgens

The drug most commonly used for the task of diminishing one's response to androgens is spironolactone (branded as Aldactone). Like many other drugs in the category of anti-androgen, spironolactone is used other than for its primary or generally intended purpose. In the case of spironolactone, it is a diuretic and anti-hypertensive medication.

Spironolactone is a good choice for an anti-androgen. It is generally well tolerated, even when administered over a period of years. And when by happenstance, a mildly hypertensive patient enters into transgender treatment, often spironolactone can be provided as a substitute; by doing so, the medication now serves a dual purpose. While spironolactone is a potassium saving diuretic, the normal monitoring of blood chemistry during transgender treatment assures its safe administration.

Patients often report increased unpleasant side effects (such as a need for frequent urination) when doses over 300mg per day are taken. Typically doses of 200mg daily or less are well tolerated.

Another good choice for an anti-androgen is finasteride (Proscar, Propecia), and is able to be used in concert with spironolactone. The primary use of Proscar (finasteride 5 mg) was in the treatment of benign prostatic enlargement, but with its reintroduction as Propecia (finasteride 1 mg), the drug is being largely marketed to promote scalp hair growth. For transgendered women, finasteride when given in the larger dose promotes not only scalp hair growth but acts as an potent anti-androgen as it is highly effective in inhibiting the conversion of testosterone to DHT (dehydrotestosterone) responsible for male sexual characteristics. Finasteride is usually physically well tolerated over long durations.

• Spironolactone (eg. Aldactone, Spirotone): 100-300mg daily in divided doses; or
• Bicalutamide (eg. Casodex): 100-150mg daily.

Example of Pre-Operative Regimen with Patch Medications

• Estradiol: 2mg to 4mg (sublingual) daily
• Estradiol Patch : Apply 2 patches weekly to the skin.
• Finasteride: 6mg finasteride (divided, morning and evening) or 5mg finasteride in the morning
• Spironolactone : 100mg to 200mg divided dose, morning and evening
• Progestin: 5mg to 10mg daily for 10 days of the month (optional)

Possible Variations to Standard Regimens

Substituting Dutasteride for Finasteride: Dutasteride is a recently launched antiandrogen which is noticably more effective than Finasteride (Proscar) in lowering both type I and II DHT. The optimal dose for dutasteide to achieve a large redution in DHT is 2.0mg to 2.5mg per day, although 0.5 per day will give similar reuslts to 5mg of Finsateride per day.

If you have any questions please feel free to contact us.

Life Pharmacy is a member of the United Pharmacies Group. United Pharmacies offers a full range medicines.