Spironolactone can be ineffective as an antiandrogen for many trans women

For trans women and transfeminine people who choose medical transition, one of the most common treatments is the use of hormonal medications to reduce testosterone levels and raise estrogen levels. By moving testosterone and estrogen levels into the normal female range, cross-sex hormone therapy diminishes masculine features and produces the development of feminine features.

However, one of the medications most commonly used to block testosterone for trans women in the United States may be one of the less effective medications for this purpose. A growing body of evidence suggests that spironolactone does not usefully lower testosterone into the female range for many trans women. Continue reading “Spironolactone can be ineffective as an antiandrogen for many trans women”

Case series of trans women suggests HIV drug efavirenz may make oral estradiol less effective

Disclaimer: I am not a medical professional and this is not medical advice.

Transgender women face a highly elevated prevalence of HIV infection, with Becasen et al. (2019) estimating that 14% of trans women in the United States are HIV-positive. Trans women of color are disproportionately affected: 44% of black trans women and 26% of Hispanic/Latina trans women have HIV, compared to only 7% of white trans women. A recent case series reported in Transgender Health highlights one way in which HIV medications may interact with cross-sex hormone therapy and require changes in the HRT regimen used. Continue reading “Case series of trans women suggests HIV drug efavirenz may make oral estradiol less effective”

Minnesota Mom is Just… Terrible. Really Awful.

By Penny Robo

Already self-sufficient for years due to parents dealing with substance abuse issues, 13 year old “EJK” came out to her parents as gay, triggering a wave of verbal and physical abuse. Her mother permitted her to live with her biological father at 15, but he was soon incarcerated and, rather than returning to her mother, lived with friends and her grandmother, all while attending school and starting to work, eventually moving into her own apartment by 16. After more than 6 months without any contact with her mother, and considering the ongoing circumstances of her life (including her demonstrated self-sufficiency) she was considered for all intents and purposes to be an adult and in charge of her own medical decisions.

One of her first decisions was to begin hormone replacement therapy. Continue reading “Minnesota Mom is Just… Terrible. Really Awful.”

New data on trans women’s estradiol/estrone ratios for different routes of administration of HRT

Disclaimer: I am not a medical professional and this is not medical advice.

I’ve previously covered anecdotal reports from HRT provider Dr. Will Powers on the role of relative levels of different kinds of estrogens in producing effective physical feminization in trans women. Estrogen is not one thing; estradiol (E2), the most common estrogen used in trans women’s HRT, is just one kind. Another form of estrogen, estrone (E1), binds to estrogen receptors but is much weaker in its effects than estradiol, and excessive levels of estrone compared to estradiol can crowd out estradiol at these receptors, inhibiting its feminizing effects. However, lab tests for trans women’s estrogen levels often only measure estrogen as a whole, rather than estradiol and estrone separately. Because of this, what appear to be adequate levels of estrogen may in reality consist mostly of less effective estrone rather than estradiol. Continue reading “New data on trans women’s estradiol/estrone ratios for different routes of administration of HRT”

How trans youth and their parents decide to start medical transition

The process by which trans adolescents seek out and access medical transition treatment, including puberty blockers and/or cross-sex hormones, is one of the most widely misunderstood subjects in the public imagination. Initiating treatment is frequently depicted as something capricious, a decision made rashly by youth who may simply be experiencing a “phase”, with little or no in-depth consideration of its significance and impact; their parents are portrayed as either going along with this under the coercion of threats of suicide, or swept up in an alleged “trend” themselves; trans-supportive clinicians are in turn maligned as reckless enablers who supposedly allow immediate access to these treatments on the basis of mere adolescent whims. This bizarre caricature is the image of adolescent transition most commonly promoted in alarmist and sensationalist media outlets today. Continue reading “How trans youth and their parents decide to start medical transition”