Male to Female



Most reputable Medical Practitioners, Mental Health professionals and Gender Therapists who work with transsexuals follow as closely as possible the Harry Benjamin Standards of Care. Although only guidelines, they do provide specific instructions related to hormone and SRS referral letters. At times you you can find a doctor who chooses not to adhere to these guidelines, in respect of hormone regimes. If the MTF/TS are only seeking hormones. This is viewed as acceptable but if you are considering going through to the stage of SRS (Sex reassignment surgery) or similar related surgeries it is advisable to obtain a letter of recommendation to save time and problems later as most reputable gender surgeons require the letter and will normally refuse to carry out the surgery if you do not produce one.

Hormones are manufactured and controlled by the endochrine system, therefore, an endocrinologist is the best person to consult, if one is not available in your area then a good gyneacologist would suffice, as they are often more understanding and are used to prescribing testosterone, estrogens and progesterones.

In male to female sex change candidates, the principal feminising hormones are estrogens. Estrogen alone can induce most of the female characteristics that are required. The second sex steroid produced by the ovaries are progesterone. It's feminising effect is likely limited but the formation of breast tissue have been noted

Gender Reassignment programs for M to F transsexuals normally consist of reducing androgen effects with spironolactone/cyproterone and stimulating feminization of secondary sex characteristics with estrogen.

Tests for HRT include the following:

• Comprehensive metabolic panel
• Lipid profile
• Testosterone : total + free
• Urinalysis
• Electrolytes
• Creatinine and baseline
• Baseline: liver panel, renal panel, lipid profile, prolactin level, glucose
• Mammography or breast exam
• Prostate exam
• Extremity exam for varicose vein, edema and signs of DVT
• Cardiac and respiratory exams
• Neurological exam
• Estradiol level



There are high risks associated with hormone therapy in both men and women and it is, therefore, inadvisable to take any form of hormone product unless it is medically prescribed. The use of progesterone to augment breast development is controversial in physicians treating MTF transsexuals.

When deciding on a hormone regimen, it should be borne in mind that it is estrogen that causes the serious side effects, so the lowest effective dose should be used.

NOTE: The manufacturers of oestrogen and progesterone products specify them for medical use in females and do not acknowledge their use for transsexuals, there is little clinical data available.


Any natural or artificial substance that induces estrus and the development of female sex characteristics; more specifically, the estrogenic hormones produced by the ovary; the female sex hormones. Estrogens are responsible for cyclic changes in the vaginal epithelium and endometrium of the uterus. Natural estrogens include estradiol, estrone, and their metabolic product, estriol. When used therapeutically, estrogens are usually given in the form of a conjugate such as ethinyl estradiol, conjugated estrogens, or the synthetic estrogenic substance diethylstilbestrol. These preparations are effective when given by mouth. Estrogens provide a satisfactory replacement hormone for treating menopausal symptoms and for reducing the risk of osteoporosis and cardiovascular disease in postmenopausal women. It is important to observe patients closely for any malignant changes in the breast or endometrium. Estrogen should be administered intermittently and in the lowest effective dose.
"Taber's Cyclopedic Medical Dictionary," Copyright © 2005 by F. A. Davis Co., Phil., PA

It has been suggested that 'unopposed action of estrogens' by progestagens could constitute a risk of carcinoma of the breast (cancer).

In terms of its effect there are no superior estrogens. The choice relies heavily on availability, cost and preference. Initial side effects are reported to be non-existent. All oral estrogens initially pass the liver after intestinal absorption and exert an effect on liver metabolism.

Ethinyl estradiol (Lynoral) 50 orally twice daily or more is the most impotent estrogenic drug. It is very cheap and available worldwide. It is often used by male to female transsexuals as it can be obtained easily in the form of the contraceptive pill (always combined with progestagens) Metabolised estrogens from other sources (pregnant mare urine) are known as conjugated estrogens (Premarin) an active does in post menopausal women is .0625 - 1.25 mg but for cross gender purposes the active dose is 5 - 10 mg. These are said to have less side effects than other estrogens. In trials estrogens in the dose of 2.5 and 5 mg orally per day are clearly associated with an increased risk of thrombosis.

Estradiol is the most potent of the three forms of active estrogens in the human body. It is produced synthetically and can be administered orally (Progynovak, Estrofem, Zumenon 2 - 4 mg per day) Intramuscularly (Progynon Depot 20 - 200 mg per month) or transdermally. Eastradern TI'S 100 patches are replaced twice weekly. To date this latter form is very promising with a low number of induced side effects.

Ethinyl Estradiol 100 mg orally per day used to be the standard treatment for most male to female transsexuals but due to the relatively high risk of thrombosis in persons (over 40. Most persons over 40 are best treated with Estraderm TTS 100 two patches a week.

After SRS the dose is usually reduced to a minimum this produces no clinical symptoms of sex hormone deficiency and forms a protection against osteoporisis.


Annihilation of male pattern baldness is possible but only to a limited extent. It will not replace hair that is already lost but may stop further hair loss. The body hair does not disappear but becomes less course and visible. If hairlessness is desired then electrolysis is effective. the beard can also become less obtrusive after several years of estrogen treatment.

Penis length is not reduced by hormones but due to its continuous flaccid state and an increase in lower abdominal fat it may appear to be reduced. Although spontaneous erections are suppressed usually within three months during erotic arousal erections still occur in most persons. Testicular size can be reduced by as much as 25 % in the first year.

Female characteristic induction in the initial phases of hormone therapy can be quite painful and is common. The breast size evolves gradually with period of little or no growth the maximum growth is attained over a two year period. In many persons the estrogen induced breast size is deemed as unsatisfactory, the majority who are not satisfied request breast surgery

Estrogens do not affect the pitch of the voice. Speech therapy is necessary, therefore, to achieve a more feminine vocal range.

Bone structure does not change with Estrogens. However Estrogen treatment does at time result in more fat around the hips this can vary a great deal from individual to individual.

Dry skin and fragile nails can occur, avoidance of detergents and application of creams are advised.

Effects of antiandrogens alone or in combination with estrogens on the mood and the emotional functioning are also prevalent in a number of persons

Male to Female Changes

Males transitioning to females (MTF) experience the following effects of estrogen:

Temporary changes, which are reversible after HT is stopped, include the following: Risks associated with HT include the following:


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