Hormones
Also known As:
T-blockers, t, spiro, and sold under brand names, like Estrace for a form of estrogen.
What is it?
Hormone therapy, also known as hormone replacement therapy (HRT), is a medical treatment used to change an individuals level of sex hormones (testosterone, estrogen, and progesterone) through the administration of sex hormones and/or hormone blockers. It can be used to relieve symptoms of menopause and andropause, and to treat gender dysphoria in transgender and non-binary people. Drugs used for HRT can include: Estradiol (estrogen), Progesterone, Testosterone, Premarin, Spironolactone, Cyproterone Acetate, Finasteride, and Lupron (TRIP! Project, 2018).
How does it work?
Hormones are chemical substances produced by an endocrine gland that are carried by the bloodstream to tissues and organs and act to alter the structure or function of the body’s systems. These systems include those which regulate metabolism, heart rate, appetite, sexual function, growth, and more.
They can be classified as Amine Hormones, Peptide Hormones and Steroids Hormones (such as adrenal steroids and sex hormones).
For Harm Reduction purposes, the most relevant information is organized in two different sections on this website: Steroids and sex hormones. This page focuses on sex hormones.
What does it look like?
Hormones come in various forms, such as clear injectable solutions, pills, gels, or patches.
Is there a safe dose?
HRT risks are low when medically supervised, and they increase significantly when a person self-medicates. However, hormones may be difficult to access due to cost, medical gatekeeping, or both.
Here are some tentative dose range recommendations for non-medically supervised users. Please note that these ranges are NOT equivalent to medical advice, and that the appropriate dosage will vary depending on the individual and their needs. These dosages have been included in the event that a user is unable to obtain medical supervision such that the likelihood of harm is reduced. Please also see the ‘Harm Reduction Tips’ section below for more information on HRT without medical supervision (TRIP! Project, 2018).
Spironolactone
With spironolactone, it is recommended to start with 50mg a day.
If 50mg is not having any effect after 6 months, then go up to 50mg twice a day.
If 50mg twice a day is not having any effect after ANOTHER 6 months (one year total), then go up to 100mg twice a day.
It is not recommended to exceed 200mg per day (TRIP! Project, 2018).
Estrogen
For estrogen, if one is taking it in pill form, it is recommended to start with 1mg a day. If no noticeable changes occur in 6 months, one can increase to 1mg twice a day, and then to 2mg twice a day after another 6 months if there are still no noticeable changes.
It is not recommended to exceed 4mg per day (TRIP! Project, 2018).
Injectable Estradiol Valerate
With injectable estradiol valerate, it is recommended to start with a dosage of 10mg every two weeks, or 5mg once a week. If one does not notice any results after 6 months, one can move up to 20mg every two weeks or 10mg every week.
It is not recommended to exceed this dosage (TRIP! Project, 2018).
Injectable Testosterone Cypionate
With injectable testosterone cypionate, it is recommended to start with 50mg every two weeks, or 25mg per week. If one has no noticeable results after 6 months, one can move up to 100mg every two weeks or 50mg once a week.
It is not recommended to exceed 100 mg every two weeks (TRIP! Project, 2018).
Testosterone Gel
For testosterone gel, it is recommended to start with 1 pump of gel. The packaging will often contain dose instructions, as it’s designed so that each pump of gel contains a specific dose. The same applies for estradiol gel. If you use gel, beware that you don’t accidentally expose others to your hormones– it’s best to use the gel on a part of the skin where other people will not come into contact with (TRIP! Project, 2018).
Progesterone
For progesterone, it is recommended to go with 100mg per day (TRIP! Project, 2018).
Cyproterone acetate
Cyproterone acetate is recommended to be taken in a 50mg dose (TRIP! Project, 2018).
Finasteride
For finasteride, it is recommended to go with a dose below 1mg, which is lower than the 5mg dose that it is usually available in.
(TRIP! Project, 2018)
Effects
The effects of HRT vary depending on the regimen. For instance, HRT as part of a user’s transition may look like physical feminization with estrogen or physical masculinization with testosterone. Progesterone can augment breast development or stop the menstrual cycle. Spironolactone generally prevents testosterone from having an effect on the body, and lupron stops the body from producing sex hormones (TRIP! Project, 2018).
Side effects and cautions
These also vary depending on the user’s HRT regimen, but may include (Transhealth, 2014):
Thromboembolism (blood clot in a deep vein) or pulmonary embolism (blood clot in the lung)
Cardiovascular disease
Hyperprolactinemia (excessive prolactin in blood)
Liver damage
Osteoporosis
Depressive mood
Changes to hyperkalemia (excessive potassium in the blood)
Those seeking to alleviate symptoms of menopause, for instance, may experience different side effects due to this being a different HRT regimen. These possible effects include bloating, breast swelling/tenderness, changes in mood, headaches, nausea, and/or vaginal bleeding (WebMD, 2017). However, there is room for overlap between these regimens and side effects.
Don’t Forget!
It’s important to know what your hormone levels are before and during HRT, especially if they are high or fluctuating. Consequences can range from being an ineffective treatment to being potentially dangerous (TRIP! Project, 2018).
Therapeutic Uses?
As mentioned previously, HRT can be used to alleviate symptoms of menopause and andropause, as well as gender dysphoria in transgender and non binary people. It can also be used to treat hormone-sensitive cancers, such as breast and prostate cancer (TRIP! Project, 2018).
Harm Reduction Tips
IN ORDER TO REDUCE THE POSSIBLE HARMS OF SEX HORMONES, THE FOLLOWING IS SUGGESTED By Transhealth (2014) and TRIP! Project (2018);
When deciding on non-medically supervised hormone dosage, one way to assess the reliability of non-medical sources (such as web sites and forums) is to compare the dosage recommendations against those provided by reputable medical sources.
When buying your medication, try to base purchases on well-established and reputable suppliers, not price, so you can try to avoid problems with quality.
Try to use bioidentical hormones, the ones naturally produced by the human body, instead of synthetic hormones, such as the ones found in birth control pills or anabolic steroids used by bodybuilders, that are far more potent and have higher health risks.
Start with a low dose and wait before determining if an increase is needed to produce the desired effects.
Try to get your general health assessed regularly and get blood work done by asking a general practitioner, so you can monitor your hormone levels.
Always use sterile injection equipment and never share equipment to reduce infection and the spread diseases like HIV and Hepatitis C. Do not use the same equipment for hormones and other drugs, and try to switch up injection times and spots as much as possible to prevent the overuse of an area.
Get familiar with intramuscular injection best practices, such as knowing the best spots to inject (front thigh, because it contains large muscles, or the side of the butt, but not the actual butt itself) and ensuring you are using intramuscular (IM) injection equipment, not intravenous (IV).
Be aware that alcohol or other drugs can have a different effect on a person who is undergoing HRT. Smoking tobacco can increase your chances of clotting.
(Transhealth, 2014; TRIP! Project, 2018)
Legal Status: Use, Possession, & Distribution
The use and possession of sex hormones is legal in Canada, and many are available at pharmacies if you have a prescription. When you buy hormone medications illicitly, you cannot be sure about the quality and dosage of the product. Unlike medications from a pharmacy, they may be diluted or mixed with unknown substances (Trans Care BC, n.d.).
For users covered by the Ontario Drug Benefit (ODB) program, oral estrogen (Estrace, Premarin) and intramuscular (IM) testosterone are covered with the submission of an Exceptional Access Form (LGBT Health Program, 2015).
References
LGBT Health Program. (2015). Guidelines and Protocols for Hormone Therapy and Primary Health Care for Trans Clients. Toronto: Sherbourne Health Centre.
Trans Care BC. (n.d.). Hormone Readiness. Retrieved from http://www.phsa.ca/transcarebc/hormones/readiness#
Transhealth (2014, July 14). HRT Self-Medication: Information Accuracy and Risks of HRT. Retrieved from http://www.trans-health.com/2002/hrt-self-medication/
Trip! Project (2018, November 29). Self Medding Hormone Replacement Therapy (HRT). Retrieved from http://tripproject.ca/self-medding-hormone-replacement-therapy-hrt/#more-1007
WebMD (2017, December 20). Hormone Replacement Therapy for Menopause. Retrieved from https://www.webmd.com/menopause/guide/menopause-hormone-therapy#1
Image Sources:
Banner: Vial of clear liquid with syringe. (2019). iStock. Retrieved from https://www.pharmacy.biz/dhsc-warns-of-supply-issue-for-diamorphine-5-mg-injections-two-contraceptive-pills/vial-of-clear-liquid-with-syringe/
Depo-Estradiol. (2019). McGuff Medical Company. Retrieved from https://www.mcguffmedical.com/deporeg-estradiol-estradiol-cypionate-5mgml-mdv-5ml-vial