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”

How soon can AFAB trans adolescents expect physical changes from testosterone?

As of this month, it’s been seven years since I started HRT, and I can still recall the excitement, anticipation, and impatience of waiting for the first physical results to appear. (It turned out to be 10 days after starting, with the first noticeable hint of breast and areolar changes.) I also remember the acute discomfort and deep sadness, ten years prior to that, of seeing my body grow more and more unsightly and uncomfortable hair every day, heading in exactly the wrong direction. It would have been fantastic if the dread of the latter could have been replaced with the joy of the former, and with the advent of puberty blockers, trans youth today increasingly have the opportunity to access that very possibility.

But even the Endocrine Society’s most recent version of its transgender treatment guidelines offers only rough estimates of the timeframes of physical changes from hormone treatments for trans adults, apparently based only on the authors’ general clinical experience, and nothing on trans youth using puberty blockers and cross-sex hormones to induce the correct puberty. A recent study helps to change that, examining just what the course of puberty looks like for adolescent trans boys. Continue reading “How soon can AFAB trans adolescents expect physical changes from testosterone?”

Study: Spironolactone with medroxyprogesterone acetate suppresses testosterone in trans women more effectively than spironolactone alone

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

While spironolactone is one of the most commonly used antiandrogens in feminizing hormone therapy, some trans women are still unable to achieve suppression of their testosterone levels into the desired female range with spironolactone. A recent clinical study examined the potentially beneficial effects on trans women’s testosterone levels from adding a medication whose use in feminizing HRT has been hotly debated: the synthetic progestin medroxyprogesterone acetate (MPA). Continue reading “Study: Spironolactone with medroxyprogesterone acetate suppresses testosterone in trans women more effectively than spironolactone alone”

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”

Should elderly trans women continue taking HRT?

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

One question frequently asked by trans women pertains to whether they will continue to take cross-sex hormones throughout their lifetime, or whether this will be tapered off or discontinued once they reach an age at which most cis women experience menopause. For many trans women, this won’t become relevant to them for several decades, but for others, this is a more immediate question: Gooren & T’Sjoen (2018) note that hundreds of trans women at the VU University gender clinic in Amsterdam are now age 60 or older. Additionally, some trans women may first seek treatment at an age beyond that at which cis women typically experience menopause. The circumstances of aging trans women, who do not possess ovaries and may or may not still possess testes, are clearly different from those of postmenopausal cis women in regards to sex hormones and development. So what approach to HRT is recommended for this group? Continue reading “Should elderly trans women continue taking HRT?”