Estrogen and the Transgender Woman

This is just the tip of the iceberg. Hormones and the enzymes that alter them are very complicated. They are often created one from another. Estrone and estradiol are kept in balance by an enzyme. Estradiol is created by another enzyme acting on free testosterone. On and on it goes to the point that only through lab testing can we know how our individual bodies are responding to any therapy. To find a doctor that truly understands how to monitor our transformations is probably the most difficult task we have. Keep studying.

A bit more on estrogen. Men do have estrogen in our systems. It is generated by the conversion of testosterone into estradiol by the aromatase enzyme. As men grow older the amount of aromatase increases. At the same time the amount of testosterone produced is in decline. Add to this that one of the prime sites for aromatase production is in fat cells and an obese middle aged man can have an elevated estrogen level. The body's natural defense to this the the conversion of testosterone to dht which is 30 times as strong as testosterone fighting the estrogen. Dht unfortunately produces the side effects of male baldness and prostrate problems.
As far as I have found there is no way short of dangerous prescription drugs to upregulate aromatase. Some article say alcohol will increase aromatase production but it appears that this is probably from miss reading results of estradiol being elevated by the lowered metabolism of estradiol in the liver as the result of cirrhosis. Not a good idea.
So the take away is that a middle aged man can be subject to ED and gynecomastia

2016_transitioning for transgender and transsexual women: Anonymous original post: 

I recently came across this article and thought many here would like to read it. What’s been your experience or what are your concerns?

Testosterone and estrogen are the hormones associated with gender. The average male, female and everyone in between have bodies that run on and need both. Today we are going to explore estrogen and the effects of it on the transgender female. Please note before we proceed that if you are currently undergoing or thinking of undergoing hormone replacement therapy with estrogen that we strongly recommend you do so under the care of a physician. There can be many dangers and health risks if estrogen is not administered and monitored properly.

Any of a group of steroid hormones that promote the development and maintenance of female characteristics of the body. Such hormones are also produced artificially for use in oral contraceptives or to treat menopausal and menstrual disorders.

Hormone Replacement Therapy (HRT) and testosterone

Hormone Replacement Therapy with estrogen is the process of administering the hormone to “male to female” transgender patients in order to induce and maintain the development of female secondary sex characteristics. Though estrogen cannot reverse the effects of puberty, HRT with estrogen can help develop female characteristics and make a patient look more like the female gender they identify with. It causes significant social and psychological changes while affecting your mood, energy, appearance and overall health. Though not a full cure it is very effective at treating patients with gender dysphoria. Estrogen can be administered by injections, pills, patches and subdermal pellet implants.

Physical changes associated with estrogen

There are many changes that occur when taking estrogen. Some are permanent and some are reversible.

Permanent changes

Breast development

Enlarged nipples and areolae

Stretch marks (for some)

Reversible changes

Redistribution of body fat

Reduced muscle development

Decreased libido

Changes in the texture of the skin

Significantly reduced and lightened body hair

Ocular changes – the lens of the eyes changes in curvature

Reduced gonadal “gonads” size

Less prominence of veins

Possible hair growth in balding areas

Eyebrow hair becomes less “bushy” or scattered

What estrogen cannot change

Facial Hair: Though there are slight changes estrogen will not remove facial hair

Voice: The voice will not change without training

Adam’s Apple: Estrogen will not reduce the size of an Adam’s Apple

Hips: The width of the hips are not affected in individuals who are past puberty

Brow: Estrogen will not reduce the size of brow ridges

Changes to the face (over time)

Cheeks: The face can become fuller and more rounded

Other known changes

The prostate shrinks

The bladder shrinks

The line that runs down the underside of the penis and down the middle of the scrotum darkens

Minor water retention is likely.

The affects on bone structure

Both testosterone and estrogen are needed for healthy bone and to prevent osteoporosis. Estrogen is the predominant sex hormone that slows bone loss. The hips will rotate slightly forward due to changes in the tendons so hip discomfort is not uncommon. If estrogen therapy is conducted prior to the pelvis ossification that occurs around the age of 25, the pelvic outlet and inlet open slightly. This widening will also widen the femora as they are connected to the pelvis. The pelvis will still have some masculine characteristics by default but the end result will be wider hips than a normal male and closer to a cis female.

Fat redistribution

The body will now tend to accumulate new adipose tissue (fat) in a typically female pattern. This includes the hips, thighs, rear, pubis, upper arms, and breasts.

Metabolic risks associated with estrogen

Estrogen therapy causes decreased insulin sensitivity which places transgender women at increased risk of developing type II diabetes

One’s metabolism slows down and one tends to gain weight, lose energy, need more sleep, and become cold more easily. Due to androgen deprivation a loss of muscle tone, a slower metabolism, and physical weakness becomes more evident. Building muscle will take twice as much work than before. However, the addition of a progestogen may increase energy although an increase in appetite may be seen as well.

Possible mental risks associated with estrogen

Mood changes can occur – including the development of depression

Migraines can be made worse or unmasked by estrogen therapy

Estrogens can induce the development of prolactinomas, which is why prolactin levels should periodically be monitored in transgender women.

Summary

Hormone Replacement Therapy can have many great benefits for male to female patients when administered correctly. It can have a positive affect on one’s mental state and the changes that occur to the body are often positive for those who identify as female. In addition to estrogen many male to female transgender patients also take an antiandrogen to reduce the production of testosterone. Some patients also take progestogens, though there is much debate whether it’s use has any benefits. Again we highly recommend you see a medical professional such as an Endocrinologist who has experience treating transgender patients if you are taking or considering taking estrogen.