About Hormones

 

A hormone (from Greek ὁρμή - "impetus") is a chemical released by a cell in one part of the body, that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. It is essentially a chemical messenger that transports a signal from one cell to another. All multicellular organisms produce hormones; plant hormones are also called phytohormones. Hormones in animals are often transported in the blood. Cells respond to a hormone when they express a specific receptor for that hormone. The hormone binds to the receptor protein, resulting in the activation of a signal transduction mechanism that ultimately leads to cell type-specific responses. Endocrine hormone molecules are secreted (released) directly into the bloodstream, while exocrine hormones (or ectohormones) are secreted directly into a duct, and from the duct they either flow into the bloodstream or they flow from cell to cell by diffusion in a process known as paracrine signalling.

 

Hormones are one of the body's great communication networks (the others are the nervous and immune systems). A hormone molecule, released by one of about a dozen glands, travels through the blood until it reaches a cell with a receptor that it fits. Then, like a key in a lock, the molecule attaches to the receptor and sends a signal inside the cell. The signal may tell the cell to produce a certain protein or to multiply.

 

Hormones are involved in just about every biological process: immune function, reproduction, growth, even controlling other hormones.

 

Endocrine hormones are released by the thyroid, parathyroid, adrenal and other glands, under the general direction of the pituitary gland.

 

Sex hormones are responsible for some of the most dramatic changes that occur in the body. They control puberty, egg and sperm production, pregnancy, birth and lactation (breastfeeding).

 

Puberty 

Girls- In girls, between the ages of about 10 and14, the pituitary gland produces Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) which together stimulate the production of the sex hormones by the ovaries.

The ovaries start to produce oestrogen and progesterone which begin the bodily changes that happen during puberty. The changes, known as secondary sexual characteristics, are:

The breasts develop

The hips and thighs widen

Pubic and underarm hair develop

The ovaries start to produce eggs

Menstruation starts

 

Boys- In boys, between the ages of about 12 and 15, the pituitary gland produces LH and FSH, which together stimulate the production of the sex hormones.

The testes start to produce testosterone which begins the development of secondary sexual characteristics. In boys these are:

The voice breaks

Hair grows on the face and the body

The body becomes more muscular

The genitals develop

Sperm are produced 

 

M-F feminising hormones.

 

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

 

There are many hormones produced by the body but the ones that interest us most are the sex hormones; Oestrogen, Progesterone, Prolactin, Testosterone, in the main. 

 

A gender reassignment program for male to female transsexuals normally includes the prescription of feminising hormones, oestrogen and progesterone which develop female secondary sexual characteristics. In addition this may be accompanied before surgery by anti-androgen treatment to reduce the effect of the patients own male sex hormones. There may be risks attached to hormone therapy in both men and women and therefore it is definitely inadvisable to take any form of hormone product unless it is medically prescribed. However, this risk is unproven.

 

What are these hormones?

 

Oestrogens:

Synthetics, conjugated and bio-identical.

 

Synthetic: EthinylOestradiol, such as Diane 35mcg, a combined oral contraceptive. Contains, Cyproterone acetate 2mg and Ethinylestradiol 35mcg. Cyproterone acetate ia an anti-androgen. EE is less used now because of the possible greater risk from DVT. The dosage was about 105 mcg.

Conjugated: Premarine, a hormone extracted from the urine of pregnant mares. Usual dose 5- 10 mg. Not very popular because of it's origins and the perceived cruelty.

17β-oestradiol: The oestrogen, 17β-oestradiol, is chemically and biologically identical to the endogenous human 17β-oestradiol and is therefore classified as a human oestrogen. These include Progynova (Oestrodiol Valerate), Zumenon (oestradiol hemihydrate).Normally prescribed would be 2- 4mg, more effective is 6- 8mg. Hemihydrate is marginally stronger than Valerate. The risk posed by 17β-oestradiol is thought to be very low.

Oestrodiol also comes in topical gels, patches, injectables.

 

Progesterones (progesterins)

Synthetics and bio-identical.

 

Many women who take hormone replacement supplements are also asking the “natural vs. synthetic” question. Is natural always better? What is the difference between natural micronized progesterone and the synthetic progestin, medroxyprogesterone, also commonly prescribed as Provera?

The most outstanding difference between the two is that medroxyprogesterone is an analog, a “look alike”, of progesterone, not truly a progesterone at all, but rather a progestin. The chemical structure of medroxyprogesterone closely resembles the chemical structure of progesterone as it is produced naturally in the human body. But, even a slight difference in the molecular configuration of a compound can produce a totally different response from its natural counterpart. The difference between medroxyprogesterone and natural progesterone is that the synthetic hormone can actually lower a patient’s blood level of progesterone. Some women who take medroxyprogesterone to combat PMS or oppose estrogen in menopause report headaches, mood swings and fluid retention. There are other Progestins, such as Duphaston but I will not go into them now.

Natural Progesterones include, Cyclogest and Utrogestan. Dosage would be between 100- 200mg. Cyclogest is a pessary or supository; the progesterone is suspended in fat. Utrogest is a capsule where the progesterone is suspended in peanut oil. Not suitable if you have a nut allergy.

The risk posed by natural progesterone is thought to be very low.

 

Anti- androgens:

 

Anti-androgens are used as part of a M-F feminisation programme, to purposefully prevent or counteract masculinisation in the case of transsexual women undergoing sex reassignment therapy, and to prevent the symptoms associated with reduced testosterone, such as hot flushes, following castration.

 

Anti-androgens are not an essential part of a feminising hormone regime but help makes the hormones work more effectively by lowering the testosterose levels.

 

Anti-androgens are not necessary following Re-assignment Surgery. However, it may be beneficial to continue with Finasteride (Proscar, Propecia) and dutasteride (Avodart), for a while. 

 Spironolactone (Aldactone, Spiritone), a synthetic 17-spirolactone corticosteroid, which is a renal competitive aldosterone antagonist in a class of pharmaceuticals called potassium-sparing diuretics, used primarily to treat low-renin hypertension, hypokalemia, and Conn’s syndrome.

Cyproterone acetate (Androcur, Climen, Diane 35, Ginette 35), a synthetic steroid, a potent antiandrogen that also possesses progestational properties.

Flutamide (Eulexin), nilutamide (Anandron, Nilandron) and bicalutamide (Casodex), nonsteroidal, pure antiandrogens. Flutamide is the oldest and has more unwanted side effects than the others. Bicalutamide is the newest and has the least side effects.

Ketoconazole (Nizoral), an imidazole derivative used as a broad-spectrum antifungal agent effective against a variety of fungal infections, side effects include serious liver damage and reduced levels of androgen from both the testicles and adrenal glands. Ketoconazole is a relatively weak antiandrogen.

Finasteride (Proscar, Propecia) and dutasteride (Avodart), inhibitors of the 5-α-reductase enzyme that prevent the conversion of testosterone into dihydrotestosterone (DHT). Finasteride blocks only 5-α-reductase type II, dutasteride also blocks type I. They are not general antiandrogens in that they don’t counteract the effects or production of other androgens other than DHT, however, DHT is 3-5 times more potent than testosterone or other androgens.

The above are by no means the full extent of anti-androgens but a useful guide.

Before embarking on a hormone regime, you should research and understand the effects of hormones, what is best, dosages and balance. This is important whether you are being prescribed or self medicating. You need to know that your gender therapist is doing his best for you. Most do not.

It is important to remember that feminisation closely tracks the female puberty, provided that a sufficient well balanced hormone regime is maintained for a sufficiently long period of time, a minimum of 7- 10 years. You should resist allowing your hormones to be reduced, post op. this is where the hormones really kick in and feminisation takes off.

4mg Oestrogen, pre-op. and 2mg post op. will not do it.