May 30, 2013

HRT is Not Something to be Messed With


The journal article I put out a request for last time (thanks again, August!) definitely turned out to be worth the read. It’s not a study with any new information, but instead a conformational study that collects and organizes all sorts of observational data points on prior research about how hormone replacement therapy (HRT) affects the human body. The overall picture is a daunting one for anyone considering HRT.

The article’s authors are Dr. Louis Gooren, a Dutch endocrinologist known for his work in transsexual science; and Erik J. Gitlay, a Dutch psychiatrist who has worked with Gooren’s clinic. The aim of this article was not to contribute new results; instead, they’ve gather the reported results of thirty other studies, many of them produced in part by Gooren and/or Giltay. The result is a rough but compelling picture of the overall effects of HRT on the human body and the ways in which “a large part of sex differences in biological function are not irreversibly determined early in life or at puberty but appear to depend on the prevailing hormone milieu.” In other words, changing your hormones has body-wide effects.

Here’s just a partial laundry list of things that HRT affects in the human body, according to the compiled studies:

  • Changes both subcutaneous and visceral fat [i.e. fat under the skin and fat around the organs]
  • Cholesterol levels
  • Proteins and protein resistances correlated to cardiovascular risk
  • Blood pressure
  • Insulin sensitivity and insulin-like growth factors
  • Bone “turnover” [i.e. the rate at which the body makes new bone]
  • Bone density
  • Verbal fluency
  • Spatial visualization
  • Aggression
  • Sexual arousal
  • Cortisol levels
  • Immune system function
  • Hair density and growth
  • Skin temperature and suppleness

Even allowing that this is a rough list supported, in many cases, by only a single study (the researchers use the term “grosso-moto” to describe it), that’s an impressive and daunting amount of potential impact. Messing with the immune system? Brain function? Risk for heart disease? HRT is not something to be trifled with.

For me, this article has capped a lot of reading I’ve been doing about the effects of HRT. And I have learned one thing from it all: I would never, ever try to undertake HRT by myself, the way some in the transgender community have chosen to. Asian estrogens and black-market androgens may be out there, but just because they’re available doesn’t mean they’re a smart choice. I’ll wait until I can do it under the care of a trained professional who’s aware of all these things and who knows how to monitor them.

As a side note: the clinic upon which many of the findings in the article were based uses cyproterone acetate (CA) as its antiandrogen of choice. I’d never heard of any antiandrogen being used in HRT other than spironolactone (“spiro”), but that appears to be because I am based in the United States; Wikipedia makes the claim that spiro is the most common in the U.S., while CA is the most common outside of the U.S.

Unfortunately, Wikipedia offers neither a reference nor an explanation for this fact, but it’s got me curious. I think I’ve found my next Science! article …

No Comments

    • I’m not so sure. They’re both classed as “competitive antagonists,” i.e. absorption blockers. At least, that’s the 10-cent info I’ve found so far.

      • I read the Wikipedia entry on cipro. If I read it correctly, cipro has a weak effect in blocking the formation of testosterone at the cellular level.

        Or it may just be anecdotal and for other reasons that European mtfs have better results.

        • As is often the case with these subjects, it looks like both have multiple levels of biological effect. Nothing is ever straightforward where the body is concerned. 🙂

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