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@@ -13,18 +13,18 @@
\captionsetup[table]{aboveskip=3pt}
\hypersetup{
colorlinks=true,
linkcolor=blue,
filecolor=magenta,
urlcolor=magenta,
}
colorlinks=true,
linkcolor=blue,
filecolor=magenta,
urlcolor=magenta,
}
% TO-DO
% add in an a5 pdf version
% decide how to showcase translations + translation notes
% add auto loc func for available loc when setting up loc
\usepackage{graphicx}
\graphicspath{ {./img/} }
\graphicspath{{./img/}}
\renewcommand{\abstractname}{DISCLAIMER}
\title{A PRACTICAL GUIDE TO FEMINIZING HRT}
\author{\href{https://katea.gay/}{Katie Tightpussy}}
@@ -39,7 +39,7 @@
\maketitle
\tableofcontents
\begin{abstract}
I am not a doctor. I do not work in medicine. I am not a medical professional in any capacity. I am a layperson offering lay opinions based on the extent of my own education and experiences. All information and assertions below should be treated accordingly as mere opinion rather than statement of fact or medical advice. This guide prioritizes community moral truth where scientific research falters. Basically, don’t get mad at me.
I am not a doctor. I do not work in medicine. I am not a medical professional in any capacity. I am a layperson offering lay opinions based on the extent of my own education and experiences. All information and assertions below should be treated accordingly as mere opinion rather than statement of fact or medical advice. This guide prioritizes community moral truth where scientific research falters. Basically, don’t get mad at me.
\end{abstract}
@@ -156,10 +156,10 @@ These are still fairly experimental so there is little to say about them, but th
\subsection{Is this chart accurate?}\label{1-12}
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{STUPID_CHART_evil_bad_bad_destroy_evil_bad.png}
\caption{This Chart Sucks}
\label{fig:scebbdeb}
\centering
\includegraphics[width=1\linewidth]{STUPID_CHART_evil_bad_bad_destroy_evil_bad.png}
\caption{This Chart Sucks}
\label{fig:scebbdeb}
\end{figure}
\textbf{No.} While this guide is not interested in playing whackamole by responding directly to every instance of misinformation on social media, the prevalence of this chart both online and in doctor-provided resources across languages paired with the sheer volume of harm it has caused denotes need for special exception beyond off-hand reference in Question \ref{11-6}.
@@ -272,9 +272,9 @@ The math is simple, I promise! Below is a small reference table comparing concen
\caption{Example Dosages for Common Concentrations by Volume}
\label{tab:concentrations}
\begin{tabular}{@{}lllll@{}}
\toprule
\multicolumn{1}{c}{} & \multicolumn{4}{c}{Concentrations (mg/ml)} \\
\cmidrule(rl){2-5}
\toprule
\multicolumn{1}{c}{} & \multicolumn{4}{c}{Concentrations (mg/ml)} \\
\cmidrule(rl){2-5}
& 5 & 10 & 20 & 40 \\
\cmidrule(rl){2-5}
Dosage (mg) & \multicolumn{4}{c}{Volume (mL)} \\
@@ -286,7 +286,7 @@ Dosage (mg) & \multicolumn{4}{c}{Volume (mL)} \\
8 & 1.6 & 0.8 & 0.4 & 0.2 \\
9 & 1.8 & 0.9 & 0.45 & 0.23 \\
10 & 2 & 1 & 0.5 & 0.25 \\
\bottomrule
\bottomrule
\end{tabular}
\end{table}
@@ -294,7 +294,7 @@ Dosage (mg) & \multicolumn{4}{c}{Volume (mL)} \\
\subsection{How do I convert dosages between esters?}
\textbf{You don’t. }Because they behave differently, there isn’t a “conversion” between dosages in that sense. If you swap from one ester to another, you should just do a typical dosage for the new ester and work from there. You can make comparisons between them, but there is no method to convert one to another.
\textbf{You don’t.} Because they behave differently, there isn’t a “conversion” between dosages in that sense. If you swap from one ester to another, you should just do a typical dosage for the new ester and work from there. You can make comparisons between them, but there is no method to convert one to another.
\subsection{How can I compare different curves and dosages between esters?}
@@ -315,12 +315,12 @@ Please note that in some regions pills are confusingly sold with the name \texti
\textit{Estradiol valerate} is the most finicky of esters. It rapidly spikes to a very high peak a few days after injection and just as quickly crashes back down. This relative instability can be unpleasant depending on your personal sensitivities, but with adjustments to frequency and dosage this can be mitigated to a degree.
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{ev.png}
\caption{Serum Estradiol (pg / ml) of Estradiol Valerate vs Time (days) }
\label{fig:ev}
\end{figure}
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{ev.png}
\caption{Serum Estradiol (pg / ml) of Estradiol Valerate vs Time (days)}
\label{fig:ev}
\end{figure}
\subsection{How do I dose \textit{estradiol cypionate}?}
@@ -330,12 +330,12 @@ Please note that in some regions pills are confusingly sold with the name \texti
\textit{Estradiol cypionate} is more forgiving than \textit{estradiol valerate}. The curve does not progress as quickly with a much lower variation between high and low, but there is still a noticeable rise and fall over a typical weekly duration.
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{ec.png}
\caption{Serum Estradiol (pg / ml) of Estradiol Cypionate vs Time (days) }
\label{fig:ec}
\end{figure}
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{ec.png}
\caption{Serum Estradiol (pg / ml) of Estradiol Cypionate vs Time (days)}
\label{fig:ec}
\end{figure}
\subsection{How do I dose \textit{estradiol enanthate}?}
@@ -345,14 +345,14 @@ Please note that in some regions pills are confusingly sold with the name \texti
\textit{Estradiol enanthate} is the gold standard for injectable estrogen. It has a curve that is extremely flat (i.e., has little variance) over the duration of a typical weekly duration. This allows for very consistent levels without any negative side effects related to variance (See Question \ref{7-3}).
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{een.png}
\caption{Serum Estradiol (pg / ml) of Estradiol Enanthate vs Time (days) }
\label{fig:een}
\end{figure}
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{een.png}
\caption{Serum Estradiol (pg / ml) of Estradiol Enanthate vs Time (days)}
\label{fig:een}
\end{figure}
\subsection{How do I dose\textit{ estradiol undecylate}?}
\subsection{How do I dose \textit{estradiol undecylate}?}
\textit{Estradiol undecylate} is capable of extending far beyond weekly into the range of monthly or quarterly. The recommended dosing for this, however, is not standardized or known. The factors that affect how the estrogen from an injection is absorbed (\textit{“pharmacokinetics”}) that are negligible for other esters are significant for \textit{estradiol undecylate}. As a result, this is still highly experimental territory that is beyond the scope of this guide. Consider consulting a witch’s almanac for the lunar calendar to inject once every full moon.
@@ -360,12 +360,12 @@ Please note that in some regions pills are confusingly sold with the name \texti
We don’t really know. The data is too sparse to paint an accurate picture of it in full, and the variables are plentiful. It is something that you can research and experiment with if you are interested, but it is new ground and you need to understand the risks involved with being a human guinea pig, so I don’t recommend it unless you know what you are doing.
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{moon.png}
\caption{The Moon}
\label{fig:moon}
\end{figure}
\begin{figure}[H]
\centering
\includegraphics[width=1\linewidth]{moon.png}
\caption{The Moon}
\label{fig:moon}
\end{figure}
@@ -396,7 +396,7 @@ While having the information is obviously preferable to not, HRT is extremely sa
\subsection{What should I test for?}
\textit{Estradiol} (E2) and \textit{total testosterone} (T) at the least because these are the main things to be concerned about. \textit{Sex hormone binding globulin} (SHBG), \textit{dihydrotestosterone} (DHT), \textit{estrone} (E1), and \textit{prolactin }(PRL) can also be useful to test if you are experiencing issues because these can be useful for troubleshooting. \textit{Follicle-stimulating hormone} (FSH) and \textit{luteinizing hormone} (LH) can tell you if your HPG axis is inactive which is the basis of monotherapy (See Question \ref{2-3}). But again: \textbf{\textit{Estradiol} and \textit{Total Testosterone} are the primary concerns. }
\textit{Estradiol} (E2) and \textit{total testosterone} (T) at the least because these are the main things to be concerned about. \textit{Sex hormone binding globulin} (SHBG), \textit{dihydrotestosterone} (DHT), \textit{estrone} (E1), and \textit{prolactin}(PRL) can also be useful to test if you are experiencing issues because these can be useful for troubleshooting. \textit{Follicle-stimulating hormone} (FSH) and \textit{luteinizing hormone} (LH) can tell you if your HPG axis is inactive which is the basis of monotherapy (See Question \ref{2-3}). But again: \textbf{\textit{Estradiol} and \textit{Total Testosterone} are the primary concerns.}
\subsection{When should I take a blood test during my hormone cycle?}
@@ -437,11 +437,11 @@ For additional clarity: \textbf{maintaining a minimum of about 100 pg/ml (350 pm
\subsection{Is there anything that can cause a blood test to be inaccurate?}
Depending on how the blood is measured (\textit{“assay”}), biotin supplements can cause \textit{estradiol} (E2) levels (among others, but \textit{estradiol }is our concern) to be unexpectedly high. It is not always possible to know the type of assay that will be used, so pausing any biotin supplements a few days before testing is recommended. It is also possible that there was an error with the equipment or the sample, although this is not likely.
Depending on how the blood is measured (\textit{“assay”}), biotin supplements can cause \textit{estradiol} (E2) levels (among others, but \textit{estradiol} is our concern) to be unexpectedly high. It is not always possible to know the type of assay that will be used, so pausing any biotin supplements a few days before testing is recommended. It is also possible that there was an error with the equipment or the sample, although this is not likely.
\subsection{Do different estrogen esters or administration routes show up differently on blood tests?}\label{4-16}
No. There is no way to tell what type of estrogen someone is taking based solely on a blood test result. The various injectable esters all convert to \textit{estradiol }like we want, and the same is true for pills, patches, gels, sprays, or whatever else. It's all estrogen at the end of the day.
No. There is no way to tell what type of estrogen someone is taking based solely on a blood test result. The various injectable esters all convert to \textit{estradiol} like we want, and the same is true for pills, patches, gels, sprays, or whatever else. It's all estrogen at the end of the day.
@@ -503,14 +503,14 @@ No. “Aspiration” refers to pulling the plunger back after puncturing the ski
\subsection{How do I minimize pain during injection?}
Aside from practicing your technique and improving your skill, the main factor for injection discomfort is the needle and syringe combination that you are using. \textbf{To minimize discomfort, the highest needle gauge that your vial’s carrier oil is capable of tolerating should be used along with an appropriately sized syringe and needle length. }You should ask “What needle gauge and length should I inject with?” To answer that, let’s talk about how needles work.
Aside from practicing your technique and improving your skill, the main factor for injection discomfort is the needle and syringe combination that you are using. \textbf{To minimize discomfort, the highest needle gauge that your vial’s carrier oil is capable of tolerating should be used along with an appropriately sized syringe and needle length.} You should ask “What needle gauge and length should I inject with?” To answer that, let’s talk about how needles work.
\subsection*{Knowing Your Needles}
\addcontentsline{toc}{subsection}{\textemdash{} Knowing Your Needles}
\subsection{What is “needle gauge”?}
\textit{Needle gauge }is a measure of needle thickness. The bigger the number, the thinner the needle. A 25G needle is thinner than a 20G needle, for instance. Higher gauge needles also tend to be shorter because longer needles become more prone to bending, so their length has a lower maximum. Unsurprisingly, thinner needles generally hurt less. It should be noted that the gauge of needle(s) used will not affect HRT in any way; it will only affect the ease and comfort of the injection itself.
\textit{Needle gauge} is a measure of needle thickness. The bigger the number, the thinner the needle. A 25G needle is thinner than a 20G needle, for instance. Higher gauge needles also tend to be shorter because longer needles become more prone to bending, so their length has a lower maximum. Unsurprisingly, thinner needles generally hurt less. It should be noted that the gauge of needle(s) used will not affect HRT in any way; it will only affect the ease and comfort of the injection itself.
\subsection{What are “Luer lock” and “insulin” syringe/needles?}\label{5-13}
@@ -530,7 +530,7 @@ If you are using Luer lock syringes, the length of the drawing needle does not m
\subsection{What needle gauge should I inject with?}\label{5-16}
This is a tricky and highly subjective question, and your answer will depend on 4 main factors: 1) the carrier oil for what you are injecting; 2) if the vial contains a cosolvent; 3) your patience to have a needle in your leg for longer; and 4) your willingness/ability to push harder on the syringe plunger. It’s a question of comfort. Thicker oils mean more time and more effort when using a higher gauge, but also higher gauges can be significantly less painful going in. \textbf{As a baseline, 25G is the minimum needle gauge that you should use to manage discomfort. }Most common carrier oils can generally do up to 27G comfortably, whereas MCT oil in particular is notable for being able to easily do 30G (See Question \ref{6-16}).
This is a tricky and highly subjective question, and your answer will depend on 4 main factors: 1) the carrier oil for what you are injecting; 2) if the vial contains a cosolvent; 3) your patience to have a needle in your leg for longer; and 4) your willingness/ability to push harder on the syringe plunger. It’s a question of comfort. Thicker oils mean more time and more effort when using a higher gauge, but also higher gauges can be significantly less painful going in. \textbf{As a baseline, 25G is the minimum needle gauge that you should use to manage discomfort.} Most common carrier oils can generally do up to 27G comfortably, whereas MCT oil in particular is notable for being able to easily do 30G (See Question \ref{6-16}).
\subsection{What needle length should I inject with?}
@@ -546,7 +546,7 @@ It depends on your local jurisdiction as some localities ban the sale of needles
\subsection{Is it okay if I reuse needles or syringes?}
\textbf{No. Never reuse needles or syringes. }Or share either. You probably already know this but I’m just reminding you because it’s really not good or safe to do!
\textbf{No. Never reuse needles or syringes.} Or share either. You probably already know this but I’m just reminding you because it’s really not good or safe to do!
\subsection{What if I want to do injections but have difficulty performing it on myself?}\label{5-21}
@@ -561,9 +561,9 @@ Aside from looking for signs of coring (see below), you should look for any sign
\subsection{What is “coring”?}\label{5-23}
\textit{Coring} is when a piece of the rubber stopper breaks away and falls into the vial. This can occur with too large of drawing gauges, repeated punctures on the exactly same spot, or too many punctures (i.e., a very small volume injection with a very large volume vial). \textbf{A cored vial should be immediately discarded. }The \href{https://www.youtube.com/watch?v=w5F0SLoMjC8}{\textit{45-90° technique}} can also be used to help minimize coring.
\textit{Coring} is when a piece of the rubber stopper breaks away and falls into the vial. This can occur with too large of drawing gauges, repeated punctures on the exactly same spot, or too many punctures (i.e., a very small volume injection with a very large volume vial). \textbf{A cored vial should be immediately discarded.} The \href{https://www.youtube.com/watch?v=w5F0SLoMjC8}{\textit{45-90° technique}} can also be used to help minimize coring.
The concern with coring is that you do not want to inject bits of rubber into you. If there are large bits of rubber, there might be smaller ones that you can't see. The purpose of the stopper is to protect the contents from the elements, so a vial with a hole in the top is more prone to oxidation and/or bacterial growth. \textbf{As a side note: Please ensure that you remove the metal or plastic cap off the top of a new vial. }This may seem obvious, but some vial designs can be confusing.
The concern with coring is that you do not want to inject bits of rubber into you. If there are large bits of rubber, there might be smaller ones that you can't see. The purpose of the stopper is to protect the contents from the elements, so a vial with a hole in the top is more prone to oxidation and/or bacterial growth. \textbf{As a side note: Please ensure that you remove the metal or plastic cap off the top of a new vial.} This may seem obvious, but some vial designs can be confusing.
\subsection{How long until a vial expires?}
@@ -708,15 +708,15 @@ Likely, yes. Commercial brewers should be held to a high standard if you are giv
\subsection{What should I look for in a vial?}
The ingredients inside of a vial can be categorized as \textit{“active”} and \textit{“excipient”}. The\textit{ active} is the estrogen ester in our case, and the \textit{excipients} are everything else. There are generally three or four ingredients: 1) the estrogen ester; 2) the carrier oil; 3) the preservative; and optionally, 4) any cosolvent(s). We have already covered the estrogen esters in Section \ref{td} “TYPES AND DOSAGES”. Pharmaceutical vials almost always have all four ingredients.
The ingredients inside of a vial can be categorized as \textit{“active”} and \textit{“excipient”}. The \textit{active} is the estrogen ester in our case, and the \textit{excipients} are everything else. There are generally three or four ingredients: 1) the estrogen ester; 2) the carrier oil; 3) the preservative; and optionally, 4) any cosolvent(s). We have already covered the estrogen esters in Section \ref{td} “TYPES AND DOSAGES”. Pharmaceutical vials almost always have all four ingredients.
\subsection{What carrier oil should I look for in a vial?}\label{6-16}
This is a question of preference, personal tolerance, and possibly allergies. \textbf{The main variable relevant to you is viscosity because that affects injection comfort and convenience.} As discussed (See Question \ref{5-16}), thinner oils are able to more conveniently use higher gauge needles without difficulty when drawing and injecting. \textbf{The most commonly used carrier oils for HRT are castor oil and MCT oil. }Castor oil is the thickest oils commonly used, but it also tends to result in the least amount of irritation so pharmaceutical vials typically use it. MCT oil is the thinnest oil commonly used, but some people find it more irritating than other oils and it’s DIY only. Cottonseed oil and grapeseed oil occasionally find use, but usually not by HRT manufacturers. Other oils like sunflower or sesame or whatever else occasionally find use but aren’t generally recommended. Depending on your circumstances, this question might not matter to you, you might not have a choice, or it may be a strict requirement.
This is a question of preference, personal tolerance, and possibly allergies. \textbf{The main variable relevant to you is viscosity because that affects injection comfort and convenience.} As discussed (See Question \ref{5-16}), thinner oils are able to more conveniently use higher gauge needles without difficulty when drawing and injecting. \textbf{The most commonly used carrier oils for HRT are castor oil and MCT oil.} Castor oil is the thickest oils commonly used, but it also tends to result in the least amount of irritation so pharmaceutical vials typically use it. MCT oil is the thinnest oil commonly used, but some people find it more irritating than other oils and it’s DIY only. Cottonseed oil and grapeseed oil occasionally find use, but usually not by HRT manufacturers. Other oils like sunflower or sesame or whatever else occasionally find use but aren’t generally recommended. Depending on your circumstances, this question might not matter to you, you might not have a choice, or it may be a strict requirement.
\subsection{What preservatives should I look for in a vial?}\label{6-17}
The most common preservative used in injectable vials is \textit{benzyl alcohol} (BA) in low concentration. This is mandatory and not up to debate. \textbf{You should never use a vial without a preservative. }For people with the rare allergy, \textit{chlorobutanol }is an alternate commonly used preservative, but almost never by DIY sources which would necessitate hunting specific pharmaceutical formulas.
The most common preservative used in injectable vials is \textit{benzyl alcohol} (BA) in low concentration. This is mandatory and not up to debate. \textbf{You should never use a vial without a preservative.} For people with the rare allergy, \textit{chlorobutanol} is an alternate commonly used preservative, but almost never by DIY sources which would necessitate hunting specific pharmaceutical formulas.
\subsection{What cosolvents should I look for in a vial?}
@@ -731,7 +731,7 @@ The main cosolvent used is \textit{benzyl benzoate} (BB) which reduces the visco
\subsection{My levels aren’t what I expected them to be. Why not?}
There are a number of possibilities. Recall first that model estimations cannot take into account any plethora of factors which may cause some deviation. Recall as well that it takes multiple injections until you reach stability, so if you just changed your dosage that may be why. Quadruple check with a friend that you are injecting as much as you think you are. That is more commonly an issue than you might think, but for DIY sources it is also possible that the concentration is lower than advertised due to inexperience or less precise equipment. In that case, injecting you may just need to inject a little more for that vial. \textbf{But remember, the most important thing is how you feel, not your levels. }Please note that even professional compounding pharmacies can produce dud vials not caught by quality control, as hopefully rare as that may be!
There are a number of possibilities. Recall first that model estimations cannot take into account any plethora of factors which may cause some deviation. Recall as well that it takes multiple injections until you reach stability, so if you just changed your dosage that may be why. Quadruple check with a friend that you are injecting as much as you think you are. That is more commonly an issue than you might think, but for DIY sources it is also possible that the concentration is lower than advertised due to inexperience or less precise equipment. In that case, injecting you may just need to inject a little more for that vial. \textbf{But remember, the most important thing is how you feel, not your levels.} Please note that even professional compounding pharmacies can produce dud vials not caught by quality control, as hopefully rare as that may be!
\subsection{Can I compare levels across different tests if I didn’t test at trough?}
@@ -770,7 +770,7 @@ No. Assuming you have otherwise followed all of the suggestions within this guid
\subsection{I am experiencing a lot of itchiness and irritation after injecting. Will I die?}
Probably not. There are a number of possible causes. Infection is the most concerning cause, but is unlikely in most cases. \textbf{Immediately go to a doctor if you are experiencing a fever, severe pain, muscle aches, pus, red streaks, or other signs of infection. }In most cases however, irritation like itchiness, redness, light swelling, warmth, etc are the result of using a vial whose estrogen and oil have separated (“crashed out of solution”). See below. It’s possible that you may be having a reaction to the carrier oil, but if you are suddenly experiencing issues after some injections without any issue, it is most likely that the vial contents are out of solution.
Probably not. There are a number of possible causes. Infection is the most concerning cause, but is unlikely in most cases. \textbf{Immediately go to a doctor if you are experiencing a fever, severe pain, muscle aches, pus, red streaks, or other signs of infection.} In most cases however, irritation like itchiness, redness, light swelling, warmth, etc are the result of using a vial whose estrogen and oil have separated (“crashed out of solution”). See below. It’s possible that you may be having a reaction to the carrier oil, but if you are suddenly experiencing issues after some injections without any issue, it is most likely that the vial contents are out of solution.
\subsection{My vial has crystals in it. Can I still use it?}
@@ -786,7 +786,7 @@ It most likely means your vial got too cold. Warm it up and gently shake to rein
\subsection{What is the difference between “progesterone” vs “progestin” / ”progestogen”?}
The class of hormones, both natural and synthetic, that activate the progesterone receptor are “proges\textbf{togens}”. The natural, bioidentical, and most important progestogen is “proges\textbf{terone}”. Synthetic progestogens are “proges\textbf{tins}”. These three terms are mistakenly used interchangeably in scientific literature and in clinical settings, likely causing much of the broader confusion regarding the role of progesterone in HRT, despite the fact that they are \textbf{not }equivalent.
The class of hormones, both natural and synthetic, that activate the progesterone receptor are “proges\textbf{togens}”. The natural, bioidentical, and most important progestogen is “proges\textbf{terone}”. Synthetic progestogens are “proges\textbf{tins}”. These three terms are mistakenly used interchangeably in scientific literature and in clinical settings, likely causing much of the broader confusion regarding the role of progesterone in HRT, despite the fact that they are \textbf{not} equivalent.
\subsection{Do I want progesterone or a progestin?}
@@ -810,7 +810,7 @@ Aside from topical applications, the main form is via a pill. It is prescribed a
\subsection{Are you serious that progesterone should be taken as a suppository?}
Progesterone metabolizes entirely differently when taken orally vs rectally due to passing through the liver when taken orally. Oral progesterone primarily converts to \textit{allopregnanolone} which can cause heavy drowsiness, whereas rectal progesterone primarily converts to progesterone itself which is what we want (although some still converts). Some people take additional oral progesterone as a sleep aid, but please note that too much \textit{allopregnanolone }can sometimes lead to negative mental health side effects.
Progesterone metabolizes entirely differently when taken orally vs rectally due to passing through the liver when taken orally. Oral progesterone primarily converts to \textit{allopregnanolone} which can cause heavy drowsiness, whereas rectal progesterone primarily converts to progesterone itself which is what we want (although some still converts). Some people take additional oral progesterone as a sleep aid, but please note that too much \textit{allopregnanolone} can sometimes lead to negative mental health side effects.
\subsection{How do I take progesterone as a suppository?}
@@ -893,13 +893,13 @@ If you are an American, you would have to get a prescription or ask any juicer a
\subsection{Are other steroids equivalent to testosterone in an HRT context?}
Anabolic-androgenic steroids, i.e., drugs that are structurally similar to testosterone, are not all equivalent. Commonly used black market steroids like \textit{trenbolone acetate} have a laundry list of undesirable side effects, but steroids like \textit{nandrolone decanoate }are occasionally used for postmenopausal cis women due to their relatively low androgenic properties which make them very favorable for transfeminine individuals. Regardless, in America it is unlikely you will be prescribed anything other than testosterone itself, if you are able to get a prescription at all.
Anabolic-androgenic steroids, i.e., drugs that are structurally similar to testosterone, are not all equivalent. Commonly used black market steroids like \textit{trenbolone acetate} have a laundry list of undesirable side effects, but steroids like \textit{nandrolone decanoate} are occasionally used for postmenopausal cis women due to their relatively low androgenic properties which make them very favorable for transfeminine individuals. Regardless, in America it is unlikely you will be prescribed anything other than testosterone itself, if you are able to get a prescription at all.
\subsection{What is the relationship between testosterone and \textit{dihydrotestosterone} (DHT)?}
\textit{Dihydrotestosterone} is primarily synthesized from testosterone via the 5$\alpha$-Reductase enzyme with around 5\% of testosterone in your body being converted. Generally speaking, if testosterone levels are suppressed (or if you have had bottom surgery) then there should not be much left to convert, but systemic levels won’t be zero because it is still locally produced. Depending on your body, this would be the main reason that you might want to consider supplementing with a 5$\alpha$-Reductase Inhibitor antiandrogen as discussed in the following section. As a reminder, \textit{dihydrotestosterone }is the hormone that is responsible for body hair and hair loss.
\textit{Dihydrotestosterone} is primarily synthesized from testosterone via the 5$\alpha$-Reductase enzyme with around 5\% of testosterone in your body being converted. Generally speaking, if testosterone levels are suppressed (or if you have had bottom surgery) then there should not be much left to convert, but systemic levels won’t be zero because it is still locally produced. Depending on your body, this would be the main reason that you might want to consider supplementing with a 5$\alpha$-Reductase Inhibitor antiandrogen as discussed in the following section. As a reminder, \textit{dihydrotestosterone} is the hormone that is responsible for body hair and hair loss.
\textbf{For any trans mascs reading this,} I will make a brief detour to note that at time of writing it is not clear what role the hormone plays with bottom growth regarding speed or total size as it relates to 5$\alpha$-Reductase inhibition. That is to say: it is known that \textit{dihydrotestosterone }plays a primary role in penile development, but it’s not clear how directly the lack thereof affects a trans masc person. Applying knowledge of micropenis treatment, we know that a topical cream is more effective than exogenous injections particularly with how \textit{dihydrotestosterone }cream is useful when a patient doesn’t respond to testosterone (particularly in the case of 5$\alpha$-Reductase deficiencies). So, food for thought. Someone get Oliver Longdick to handle the rest of this.
\textbf{For any trans mascs reading this,} I will make a brief detour to note that at time of writing it is not clear what role the hormone plays with bottom growth regarding speed or total size as it relates to 5$\alpha$-Reductase inhibition. That is to say: it is known that \textit{dihydrotestosterone} plays a primary role in penile development, but it’s not clear how directly the lack thereof affects a trans masc person. Applying knowledge of micropenis treatment, we know that a topical cream is more effective than exogenous injections particularly with how \textit{dihydrotestosterone} cream is useful when a patient doesn’t respond to testosterone (particularly in the case of 5$\alpha$-Reductase deficiencies). So, food for thought. Someone get Oliver Longdick to handle the rest of this.
@@ -907,7 +907,7 @@ Anabolic-androgenic steroids, i.e., drugs that are structurally similar to testo
\subsection{What are “antiandrogens”?}
\textit{Antiandrogens, }commonly also referred to as “T blockers” or just “blockers”, as the name(s) may suggest prevent androgens (that’s what testosterone is) from acting on your body. There are many types of antiandrogens and they are commonly prescribed as part of an HRT regimen. They are needed if someone still produces testosterone and is not doing a form of HRT conducive to monotherapy, such as injections, but they are usually not desirable. It also should be noted that (most) antiandrogens do not reduce testosterone levels in any way that matters but instead simply reduce/negate effects on the body. This is relevant when interpreting lab results and such.
\textit{Antiandrogens}, commonly also referred to as “T blockers” or just “blockers”, as the name(s) may suggest prevent androgens (that’s what testosterone is) from acting on your body. There are many types of antiandrogens and they are commonly prescribed as part of an HRT regimen. They are needed if someone still produces testosterone and is not doing a form of HRT conducive to monotherapy, such as injections, but they are usually not desirable. It also should be noted that (most) antiandrogens do not reduce testosterone levels in any way that matters but instead simply reduce/negate effects on the body. This is relevant when interpreting lab results and such.
\subsection{Why wouldn’t I want antiandrogens?}
@@ -915,7 +915,7 @@ The main issue with most antiandrogens is that they generally have very undesira
\subsection{When might I want antiandrogens?}
If you are not most cases, if you desire peace of mind, or if your insurance requires a prescription on file before they will cover a procedure, then you may want antiandrogens. The medications used as antiandrogens might have other effects that may be desirable outside of their antiandrogen properties depending on your health situation. Additionally, if you are supplementing androgens, you may want a \textit{dihydrotestosterone }(DHT) blocker to minimize side effects related to body hair and hair loss, but be aware that this may not be the case if you are not using bioidentical testosterone (e.g. \textit{nandrolone decanoate}) because not all androgens behave the same.
If you are not most cases, if you desire peace of mind, or if your insurance requires a prescription on file before they will cover a procedure, then you may want antiandrogens. The medications used as antiandrogens might have other effects that may be desirable outside of their antiandrogen properties depending on your health situation. Additionally, if you are supplementing androgens, you may want a \textit{dihydrotestosterone} (DHT) blocker to minimize side effects related to body hair and hair loss, but be aware that this may not be the case if you are not using bioidentical testosterone (e.g. \textit{nandrolone decanoate}) because not all androgens behave the same.
\textbf{It should be noted that temporarily using antiandrogens at the start of HRT when planning to perform monotherapy is unlikely to be necesssary nor is it recommended.} There is an adjustment period that you will experience regardless while your body adapts to the change in your primary hormones, so there is no need to overcomplicate what you are doing. Don't worry about it.
@@ -931,7 +931,7 @@ In case you are unfamiliar, some of the many side effects include: brain fog, le
\subsection{When might I want to take \textit{bicalutamide}?}
If you are going to take an antiandrogen, \textit{bicalutamide} is likely the one to take. It is generally well tolerated, barring 1\% cases of abnormal liver function test results and symptoms of liver dysfunction, but otherwise performs the job with relatively minimal side effects. \textbf{If you take \textit{bicalutamide}, ensure regular liver function tests to make sure that your results are in range. }The liver risks are dependent on your body rather than cumulative so any problem would likely present itself within the first year. Otherwise, there should be no issues.
If you are going to take an antiandrogen, \textit{bicalutamide} is likely the one to take. It is generally well tolerated, barring 1\% cases of abnormal liver function test results and symptoms of liver dysfunction, but otherwise performs the job with relatively minimal side effects. \textbf{If you take \textit{bicalutamide}, ensure regular liver function tests to make sure that your results are in range.} The liver risks are dependent on your body rather than cumulative so any problem would likely present itself within the first year. Otherwise, there should be no issues.
\subsection{When might I want to take \textit{cyproterone acetate}?}
@@ -947,13 +947,13 @@ It should be noted that \textit{dutasteride} can cause adverse mood effects in s
\subsection{When might I want to take \textit{finasteride}?}
If \textit{dutasteride }is not something prescribed to you or if your insurance mandates \textit{finasteride} specifically to cover a hair treatment. Otherwise, \textit{dutasteride} is preferred as it is more effective and better tolerated.
If \textit{dutasteride} is not something prescribed to you or if your insurance mandates \textit{finasteride} specifically to cover a hair treatment. Otherwise, \textit{dutasteride} is preferred as it is more effective and better tolerated.
It should be noted that \textit{finasteride} can cause adverse mood effects in some people, in which case stopping is strongly recommended. Note as well that these depressive effects may be felt for up to a month after stopping.
\subsection{Where can I get antiandrogens?}
Aside from being prescribed them by your doctor or perhaps available over-the-counter, there is also the option of grey market foreign pharmacies. These are simply pharmacies in another country, although these often take some hurdles to purchase from. \textit{Dutasteride} and \textit{finasteride }are generally the easiest to get over-the-counter because of their commonality as hair loss medication.
Aside from being prescribed them by your doctor or perhaps available over-the-counter, there is also the option of grey market foreign pharmacies. These are simply pharmacies in another country, although these often take some hurdles to purchase from. \textit{Dutasteride} and \textit{finasteride} are generally the easiest to get over-the-counter because of their commonality as hair loss medication.
@@ -1020,7 +1020,7 @@ Similar to the last question, it’s important to understand what is happening.
\subsection{Does bottom surgery cause an increase in testosterone?}
No. This is not a thing. There is not a magic mechanism that suddenly causes testosterone to increase the moment that testicles are removed. Even if magic was stored in the balls, this simply isn’t how hormone production works. “Well, your adrenals…” They don’t work like that either. The only possible rare exception would be undiagnosed adrenal hyperandrogenism conditions that were suppressed by an antiandrogen like \textit{spironolactone }prior to surgery which might show itself after antiandrogens are ceased. Please stop repeating this myth.
No. This is not a thing. There is not a magic mechanism that suddenly causes testosterone to increase the moment that testicles are removed. Even if magic was stored in the balls, this simply isn’t how hormone production works. “Well, your adrenals…” They don’t work like that either. The only possible rare exception would be undiagnosed adrenal hyperandrogenism conditions that were suppressed by an antiandrogen like \textit{spironolactone} prior to surgery which might show itself after antiandrogens are ceased. Please stop repeating this myth.
\subsection{How do I prevent/revert hair loss?}\label{11-14}
@@ -1096,7 +1096,7 @@ Only if you follow the dipshit WPATH SOC 8 guidelines that list a recommended re
\subsection{But my doctor said-?}
The average doctor has essentially no training in anything related to trans healthcare, and \href{https://www.endocrine.org/news-and-advocacy/news-room/2017/endocrinologists-want-training-in-transgender-care }{4/5 endocrinologists have never had any formal training in trans healthcare}. It is most likely that you are their first trans patient and that they are inexperienced in the practical elements of managing a trans patient. Even among doctors who care a lot, they are often limited by conservative standards of care that they are forced to follow which do not always align with the care best for you. See above.
The average doctor has essentially no training in anything related to trans healthcare, and \href{https://www.endocrine.org/news-and-advocacy/news-room/2017/endocrinologists-want-training-in-transgender-care}{4/5 endocrinologists have never had any formal training in trans healthcare}. It is most likely that you are their first trans patient and that they are inexperienced in the practical elements of managing a trans patient. Even among doctors who care a lot, they are often limited by conservative standards of care that they are forced to follow which do not always align with the care best for you. See above.
Please also be aware of “trans broken arm syndrome”, aka the tendency of doctors to blame everything on HRT. If your arm is broken, it's probably not “because of those hormones”!
@@ -1104,7 +1104,7 @@ And I should put this as a separate question but I don't want to break the forma
\subsection{My doctor won’t prescribe me injections. What do I do?}
Attempt to convince them, replace them, or seek DIY sources. Do not let a gatekeeping medical establishment prevent you from receiving the appropriate care that you deserve. \textbf{The most crucial aspect of interfacing with the medical system while trans is that you have to advocate for yourself. }This is compounded with disability, ethnicity, and other afflictions that scare doctors like womanhood.
Attempt to convince them, replace them, or seek DIY sources. Do not let a gatekeeping medical establishment prevent you from receiving the appropriate care that you deserve. \textbf{The most crucial aspect of interfacing with the medical system while trans is that you have to advocate for yourself.} This is compounded with disability, ethnicity, and other afflictions that scare doctors like womanhood.
\subsection{How does HRT for menopausal cis women relate to HRT for trans women?}\label{11-29}