Feminising Hormone Therapy guide

Types of Hormone Regimens

Oestrogen Therapy

Oestradiol gender affirming hormone therapy involves taking oestrogen to induce feminine physical traits such as breast development, fat redistribution, and softening of skin. This therapy is often prescribed for individuals transitioning from male to female or for nonbinary individuals seeking more feminine traits.

Forms of administration:

• Transdermal Estradiol: Applied as patches or gel
  • Patch: 25–50 mcg, applied twice weekly
  • Gel: 0.5–1.5 mg daily
  • Oral Estradiol: Taken as 1 to 2mg daily.

Testosterone blockers (GNRH Analogues)

Testosterone blockers can be beneficial for many trans women and non-binary individuals assigned male at birth. These medications reduce testosterone production and sperm generation by suppressing testicular function. They can usually be stopped if the testes are removed or if treatment requirements change.

In the UK, GnRH analogues are the preferred choice and are usually given as an injection every 12 weeks. Although medications like spironolactone, finasteride, and cyproterone acetate are widely used in other countries, they are not recommended for long term use in trans individuals in the UK due to their less favourable side effect profiles. Consequently, Transcend Service does not routinely prescribe these medications.

• Injectable GNRH analogue: Leuprorelin (Prostap) or Triptorelin (Decapeptyl SR) given 12 weekly.

Progesterone Treatment in Feminising Hormone Therapy

In line with other NHS gender services in England, Transcend does not routinely prescribe or recommend progesterone as part of feminising hormone therapy. While some private gender clinics include progesterone, such as micronised progesterone (Utrogestan), in their treatments, its benefits remain largely anecdotal and are not supported by strong evidence.

Reports suggest potential improvements in breast and areolar development, mood, libido, and body shape, but these claims lack robust clinical data. Furthermore, the long-term risks of progesterone treatment are not fully understood and may outweigh any potential benefits. Known adverse effects of progestins include weight gain, depression, and changes in lipid levels.

The recently released World Professional Association for Transgender Health (WPATH) Standards of Care (Version 8) highlights the limited evidence supporting the use of progestins and cautions against their routine inclusion in feminising hormone regimens. Any continued use of micronised progesterone should be considered on an individual basis, following a thorough discussion of the possible risks and uncertainties.

Expected changes

a) Complete removal of male sexual hair requires electrolysis or laser treatment or both.
b) Familial scalp hair loss may occur if estrogens are stopped.
c) Treatment by speech pathologists for voice training is most effective.

Hembree et al. (2009). The Endocrine Society

Irreversible changes

Potential risks and side effects

• Increased risk of blood clots, especially with oral oestrogen
  • What is it? Oestradiol can increase the risk of developing blood clots, which can block blood flow in veins
  • Why does it happen? Oestrogen affects blood coagulation, making it easier for blood to clot
  • Potential complications: Blood clots can lead to deep vein thrombosis (DVT), pulmonary embolism, or stroke.
• Elevated blood pressure
  • What is it? Oestradiol can increase blood pressure, potentially leading to hypertension
  • Why does it happen? Hormonal changes can affect how blood vessels function, leading to elevated blood pressure in some individuals
  • Potential complications: Long term high blood pressure can increase your risk of heart disease, stroke, or kidney damage.
• Liver function changes
  • What is it? Oestradiol can sometimes affect liver function, causing elevated liver enzymes or liver stress
  • Why does it happen? Hormones like oestrogen are processed by the liver, and high doses may lead to liver strain
  • Potential complications: Prolonged liver dysfunction can lead to liver damage or disease.
• Lipid profile changes
  • What is it? Oestradiol can affect your lipid profile, potentially leading to increased triglycerides, decreased LDL (Low Density Lipoprotein) or “bad” cholesterol, increased HDL (High-Density Lipoprotein) or “good” cholesterol
  • Why does it happen? Oestrogen influences how fats are processed in the body, which can change cholesterol levels
  • Potential complications: While increased HDL is generally beneficial, high triglycerides may increase the risk of cardiovascular issues.
• Risk of infertility

Feminising hormone therapy can impact fertility, but the extent and potential for reversibility are not fully understood. It is important to consider options for gamete storage (sperm banking) to preserve fertility before starting feminising hormones. The UK Human Fertilisation and Embryology Authority (HFEA) offers valuable information on fertility preservation, available on their website: HFEA Fertility Preservation Information

Hormone monitoring

Blood monitoring will initially take place every three months until all blood levels are stable and no changes to medication doses. Once the clinician is happy with your results the blood tests will be moved to six monthly then annually. The following blood levels will be requested at each blood test; oestradiol, testosterone, prolactin, liver function tests and lipids. Aswell as other investigations such as blood pressure monitoring and BMI.

Blood tests for monitoring hormone therapy are ideally conducted at specific times to ensure accurate measurement of Oestradiol levels.

Patches

For individuals using patches, blood samples should be taken on the second day of patch wear (36 to 48 hours after the patch has been applied).

Gels and sprays

For those using gels or sprays, blood tests should be conducted four to six hours after application.

Tablets

For oral Oestradiol, testing should occur approximately four hours after dosing.
The dosage of oestradiol is gradually adjusted to achieve the desired level of feminisation within established target ranges.

Contact information

If you have any concerns about testosterone therapy or would like more information, please contact your healthcare provider.
Telephone: 0151 317 8581
Email: transcend.merseycare@nhs.net

Disclaimer

This leaflet provides general information and is not intended to replace medical advice. Consult your doctor for personalized guidance on hormone therapy and associated risks.

By staying informed, regularly monitoring your health, and discussing the best form of testosterone therapy for you, you can safely manage the benefits and risks of gender affirming hormone therapy.

Our patients matter

Mersey Care NHS Foundation Trust listens and responds to patients and their carers to help improve the services we deliver.

If you have any comments, compliments or concerns you can speak with a member of staff or contact our Patient Advice and Liaison Service (PALS) and Complaints Team.

Mersey Care NHS Foundation TrustV7 BuildingKings Business ParkPrescotMerseysideL34 1PJ

Phone: 0151 471 2377Freephone: 0800 328 2941Email: palsandcomplaints@merseycare.nhs.uk