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”

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”

New study on trans women’s developmental milestones: Self-awareness precedes disclosure by several years

I’ve previously criticized Lisa Littman’s study of the alleged condition of “rapid onset gender dysphoria” – since corrected as “perceived to show signs of a rapid onset of gender dysphoria” – on the grounds that its methodology, solely relying on the reports of parents about their children’s history of gender identity expression, will by design entirely fail to capture the developmental processes that trans people experience prior to expressing their gender externally in a way that would be perceived by others. The suggestion that their transgender identity should be regarded with suspicion as a mere passing phase or transient interest rather than a genuine expression of gender dysphoria, and that any kind of affirmation of their “newly” expressed gender is therefore likely to be premature or inappropriate, may thus be unwarranted. The study’s corrected title much more accurately describes the limits of this methodology: parents may indeed perceive that their child’s transness has simply appeared rapidly. But this is just an incomplete picture – it does not account for trans people’s experiences of gender dysphoria before coming out, and this limitation does not therefore mean that these experiences never took place. It is a study of parents’ secondhand perceptions, not trans people’s firsthand realities, and asserting that there must have been an actual “rapid onset” of gender dysphoria based solely on the former is a mistake.

A recent study in Transgender Health provides further information on those unseen developmental processes of gender identity in trans people, and it does so via the appropriate method: by asking trans people themselves. Continue reading “New study on trans women’s developmental milestones: Self-awareness precedes disclosure by several years”

Trans women may face a higher risk of breast augmentation complications compared to cis women

Breast augmentation is a common gender-affirming surgery sought by transgender women and transfeminine people. Even with feminizing HRT, trans women typically do not experience the same degree of breast growth as cisgender women (Reisman, Goldstein, & Safer, 2019), and studies have indicated that 60% of trans women seek to undergo breast augmentation. Continue reading “Trans women may face a higher risk of breast augmentation complications compared to cis women”