Hormones for MTF's

Hormones: A guide for MTFs
While there are some health risks involved with hormone therapy, it can
have positive and important effects on trans people's quality of life.
Knowing what you can expect will help you work with your health care
providers to maximize the benefits and minimize the risks.
The purpose of this booklet is to:
• explain how hormones work
• describe the changes to expect from MTF1 hormones, and outline
risks and possible side effects
• give you information about how to maximize the benefits and
minimize the risks
Trans Care
Gender transition
Hormones:
A guide for MTFs
Already sure you want to start hormones? The booklet Getting Hormones,
available from the Transgender Health Program (see last page), explains the
process.
1 We use “MTF” as shorthand for a spectrum that includes not just transsexuals, but anyone who
was assigned male at birth and who identifies as female, feminine, or a woman some or all of
the time. Some non-transsexuals (androgynous people, drag queens, bi-gender and multigender
people, etc.) may also want hormone therapy, and may not identify or live as women.
For this reason we use the term MTF instead of “trans women.”

This booklet is written specifically for people in the MTF spectrum who
are considering taking hormones. It may also be a helpful resource for
partners, family, and friends who are wondering how hormones work and
what they do. For medical professionals who are involved in prescribing
hormones or are looking after the health of someone who is taking hormones,
there is a detailed set of guidelines for doctors and nurses available from
the Transgender Health Program (see last page).
How Hormones Work
Hormones are chemical messengers produced by one part of the body to
tell cells in another part of the body how to function, when to grow, when
to divide, and when to die. They regulate many functions, including growth,
sex drive, hunger, thirst, digestion, metabolism, fat burning and storage,
blood sugar and cholesterol levels, and reproduction.
Sex hormones regulate the development of sex characteristics – including
the sex organs that develop before we are born (genitals, ovaries/testicles,
etc.) and also the secondary sex characteristics that typically develop at
puberty (facial/body hair, bone growth, breast growth, voice changes, etc.).
The three categories of sex hormones that naturally occur in the body are:
• androgens: testosterone, dehydroepiandrosterone (DHEA),
dihydrotestosterone (DHT)
• estrogens: estradiol, estriol, estrone
• progestagens: progesterone
Generally, “males”2 tend to have higher androgen levels, and “females”2
tend to have higher levels of estrogens and progestagens.
There are various types of medication that can be taken to change the
levels of sex steroids in the body. Changing these levels will affect fat
distribution, muscle mass, hair growth, and other features that are
associated with sex and gender. For MTFs this can help make the body
2
2 The binary terms “male”,“female”,“masculine”,“feminine”,“masculinizing”, and “feminizing”don’t
accurately reflect the diversity of trans people’s bodies or identities. But in understanding how
hormones work for trans people, it is helpful to understand how testosterone works in “typical”
(non-intersex, non-trans) men’s bodies, and how estrogen and progesterone works in “typical”
women’s bodies.We keep these terms in quotes to emphasize that they are artificial and
imperfect concepts.

look and feel less “masculine” and more “feminine” – making your body
more closely match your identity.
What Medications Are Involved for MTFs?
Various kinds of medication can be used to change the levels of sex
hormones in your body. Some work on the part of your brain that
stimulates sex hormone production, some work on your testicles (which
produce testosterone), and some work directly on the cells in your body
that respond to sex hormones. Some of these medications are also
hormones, and some are another type of chemical.
Typically MTF hormone therapy involves estrogen, medication to block
testosterone, or a combination of the two. Sometimes a progestagen is
added to the mix.
1. Estrogen
Estrogen is the main hormone responsible for promoting “female”
physical traits. It works directly on tissues in your body (e.g., makes
breasts develop) and also indirectly suppresses your testosterone.
Estrogen can be taken in different ways:
• pill (oral application)
• skin patch or gel (transdermal application)
• injection (intramuscular application)
For reasons that aren’t understood, estrogen seems to cause blood clots
less when it is taken through the skin rather than by pills or injections.
For this reason, transdermal estrogen is usually recommended to anyone
who is over age 40, a smoker, or otherwise at risk for blood clots.
Transdermal estrogen also tends not to elevate triglycerides (a type of fat
in the blood) as much as estrogen taken by pill/injection, so it is
recommended if you are at risk of heart disease or stroke.
There are different chemical formulations of estrogen. Usually 17-betaestradiol
(patch = Estradot®, Estraderm®, or Oesclim®; pill form =
Estrace®) is used because it has the least health risks. Conjugated
estrogens (e.g., Premarin®) and ethinyl estradiol are not recommended
because studies of non-trans women have shown them to increase the
risk of some types of health problems.

2. Anti-androgens (also known as androgen blockers
or androgen antagonists)
Anti-androgen drugs work by blocking the effect of testosterone. This
reduces “male” physical traits and has a mildly “feminizing” effect. For
example, they will help slow “male”-pattern baldness, reduce growth of
facial hair, and stop spontaneous/morning erections. There are different
types of anti-androgens. The ones most typically prescribed to MTFs are
spironolactone (Aldactone®) and finasteride (Proscar®). Cyproterone
(Androcur®) can be used, but risks include depression and liver enzyme
elevation so spironolactone is generally preferred.
Anti-androgen drugs are often prescribed in addition to estrogen, as the
two have effects that complement each other. Taking anti-androgens
reduces the amount of estrogen you need to get the same effects, which
minimizes the health risks associated with high doses of estrogen. Antiandrogen
drugs can be prescribed alone for MTFs who want to reduce
“masculine” characteristics for a more androgynous appearance, as it’s
less “feminizing” than estrogen.
3. Progestagens
There are mixed opinions about using progestagens (e.g., Prometrium®,
Provera®) for MTFs. Most trans health programs around the world don’t
use progestagens due to the lack of clear evidence that they are important
in “feminization,” and the known side effects (which include depression,
weight gain, and changes to blood fats). Other doctors use progestagens:
• to supplement estrogen if estrogen isn’t working even at the
maximum dose, or
• as a replacement for estrogen if there are concerns about estrogen’s
side effects or health risks, or
• because they believe that progestagens help with nipple development
As with estrogen and anti-androgens, balancing possible risks and
benefits of progestagens is a decision between you and your health care
provider.

What’s a Typical Dose?
Clinical protocols for MTF therapy vary greatly. There is no one right
hormone combination, type, or dose. Deciding what to take depends on
your health (each medication has different risks and side effects), what is
available locally, and what you can afford. It also depends on how your
body reacts when you start taking hormones – everyone’s body is different
and sometimes people have a negative reaction to a specific kind of
medication.
The right dose or type of medication for you may not be the same as for
someone else. It is a good idea to discuss the advantages and disadvantages
of different treatment options with a medical professional who has trans
health training and experience with hormones. If you have any concerns
about being able to take the medications, or about the side effects, costs,
or health risks, let them know – it’s important that your needs and
concerns be taken into account when planning your hormone therapy.
The table on page 6 summarizes the forms of hormone therapy most
commonly used by MTFs in BC, and gives the range of starting doses
recommended by the Transgender Health Program. Your health provider
may start you on a lower dose if you have chronic health problems, are
at risk for specific side effects, or have had your testicles removed. If you
have been prescribed a dose that is quite a bit higher or lower than the
doses outlined in the table below, talk with your health care provider
about their reasons for suggesting the dose you have been prescribed
(and get a second opinion if you want one).

In prescribing a particular medication and dosage, your doctor should
consider your health, including any other medications you are taking.
Every person is different in terms of how their body absorbs, processes,
and responds to sex hormones. Some people have more changes than
others; changes happen more quickly for some people than others.
Taking more hormones than the dose you were prescribed is not a good
way to try to speed up changes. Taking a higher dose can actually slow
down the changes you want: extra estrogen in the body can be converted
to testosterone by an enzyme called aromatase. Taking more than your
prescribed dose also greatly increases your health risks. If you think your
dose is too low, talk with a health care professional who has trans health
training to discuss options. It may be better to try a different type of
medication or combination of medications, rather than increasing the dose.
After removal of the testicles (see the booklet Surgery: A guide for
MTFs) your body is only producing a tiny amount of testosterone, so the
dosage of estrogen is usually cut in half and anti-androgens greatly
6
Hormone therapy commonly used by MTFs in BC
Estrogen Anti-androgen
Chemical 17-beta estradiol Spironolactone and/or Finasteride
Brand name Estradot®,
Estraderm®,
Oesclim® Estrace® Aldactone® Proscar®
Taken via Skin patch Pill Pill Pill
Typical start with 0.1 mg start with 1–2 mg start with 50–100 2.5 mg every
starting patch twice per per day; gradually mg per day; other day
dose week; gradually increase up to increase by
increase up to maximum 8 mg 50–100 mg each
maximum of 0.4 per day month up to
mg patch twice maximum
per week 200–300 mg per
day
Typical cost 0.1 mg twice/ 2 mg per day: 300 mg per day: 2.5 mg every
(as of 2005) week: ~$25/ ~$15/month* ~$22/month* other day:
month* ~$30/month*
* Plus the dispensing fee set by each pharmacy and billed each time a prescription is refilled.
In BC this averaged $9.25 in 2005. Compounding pharmacies may charge significantly more.

reduced or stopped. You will need to stay on estrogen or another form of
medication for the rest of your life to preserve bone strength (see Trans
people and osteoporosis booklet). Your doctor may also suggest that you
take Calcium and Vitamin D supplements to protect your bones.
What Changes Can I Expect, and
How Soon? (Benefits)
“Feminizing” hormone therapy has important psychological benefits.
Bringing the mind and body closer together eases gender dysphoria and
can help trans people feel better about their bodies. People who have
had gender dysphoria often describe being less anxious, less depressed,
calmer, and happier when they start taking hormones. For some people
this psychological change happens as soon as they start taking hormones,
and for others it happens as physical changes happen.
The degree and rate of change depends on factors that are different for
every person, including your age, the number of hormone receptors in
your body, and how sensitive your body is to the medication. There is no
way of knowing how your body will respond before you start hormones.
1. Taking anti-androgens alone (without estrogen)
Taking an anti-androgen without estrogen has relatively mild effects.
The changes are caused by the medication blocking the effect of
testosterone in your body. Most of the changes are reversible (i.e., they
will reverse if you stop taking the medication).
Typical changes from anti-androgens (vary from person to person)
Average timeline Effect of blocking testosterone
1–3 months after • decrease in sex drive
starting anti- • fewer instances of waking up with an erection or spontaneously
androgens having an erection; some MTFs also have difficulty getting an
erection even when they are sexually aroused
• decreased ability to make sperm and ejaculatory fluid
Gradual changes • slower growth of facial and body hair
(usually at least • slowed or stopped “male”-pattern balding
2 years) • slight breast growth (reversible in some cases, not in others)
Anti-androgens affect the entire body.
It’s not possible to pick some changes and not others.

2. Estrogen
Taking estrogen has stronger physical “feminizing” effects, caused by
the estrogen’s direct influence on cells of your body that have estrogen
receptors and also by an indirect suppression of testosterone production.
Typical changes from estrogen (vary from person to person)
Average timeline Effect of estrogen
1–3 months after • softening of skin
starting estrogen • decrease in muscle mass and increase in body fat
• redistribution of body fat to a more “feminine” pattern
• decrease in sex drive
• fewer instances of waking up with an erection or spontaneously
having an erection; some MTFs also find their erections are less
firm during sex, or can’t get erect at all
• decreased ability to make sperm and ejaculatory fluid
Gradual changes • nipple and breast growth
(maximum change • slower growth of facial and body hair
after 1–2 years • slowed or stopped “male”-pattern balding
on estrogen) • decrease in testicular size
Estrogen affects the entire body.
It’s not possible to pick some changes and not others.
Breast and nipple growth starts early but is usually gradual – it can
take two years or more for breasts to reach their maximum size. As in
non-trans women, there is great variation in how large breasts grow from
estrogen. In many MTFs breasts do not grow beyond an A or B cup. If you
are not happy with the size of your breasts after 18–24 months on estrogen,
you can consider surgical augmentation (see Surgery: A guide for MTFs
booklet). The implants will look most natural if you wait to get as much
growth as you can from hormones.
Most of the effects of hormones happen in the first two years. During
this time, the doctor who prescribes your hormones will want to see you
one month after starting or changing your dose, then 3–4 times in the
next year, then every six months. At appointments in the first two years,
your doctor will likely:

• look at your facial/body hair and ask how fast your hair grows back
after you remove it
• measure your breasts, hips, and testicles, and examine your
breast/nipple development
• ask about changes to your sex drive, erections, or other sexual
changes
• order a blood test to see what your hormone levels are
• ask how you feel about the changes that have happened thus far
After two years have passed, you will likely just be asked if you notice
any further changes from the hormones.
Are These Changes Permanent?
Most of the changes brought on by “feminizing” hormone therapy are
not permanent. If you stop taking the medication, most of the changes
will reverse themselves. There are two types of changes that may be
permanent: breast growth and sterility.
If you are taking anti-androgens without estrogen because you don’t
want visible changes, you should be aware that you may have some
breast growth (although it will happen slowly, so you can stop early on
if you need to). Breast growth from anti-androgens is usually minor and
reversible, but in some cases the breast tissue has remained even after
anti-androgens were stopped.
Estrogen causes permanent nipple development and breast growth.
Even if you stop taking estrogen, breast tissue will not go away and your
nipples will not shrink.
Both anti-androgens and estrogen affect your production of sperm. The
long-term effects on fertility are not fully understood and the ability to
make sperm may or may not come back even if you stop taking the
medication. We strongly recommend that you talk about options for sperm
banking before starting hormone therapy. If you have already started
hormones, you can work with your doctor to go off them, give sperm
samples, and store them if they are viable (then go back on hormones).

What Won’t Change?
1. Hormone therapy won’t solve all body image
problems.
The point of hormone therapy is to feel more comfortable with your body
by bringing physical characteristics closer to your internal sense of self.
This relief can increase self-esteem and make you feel more confident and
attractive. However, you will find that there are also attractiveness
standards after hormone therapy, and you may not fit them.
It can be hard to separate out gender dysphoria from body image
problems. Professional and peer counselling can be helpful to sort out
your expectations about your appearance, and to work towards greater
self-acceptance.
2. Hormone therapy won’t make you into
somebody else.
Many people experience positive emotional changes with hormone
therapy. But you’ll likely find, after the excitement wears off and you’ve
incorporated the changes into your day-to-day life, that if you were shy
you’re still shy, if you didn’t like your laugh you still don’t, and you’re still
afraid of spiders. Whatever things you think of as your strengths and
weaknesses will still be there. Hopefully, you will be happier, and that is
good for anyone. Hormone therapy may help you to be more accepting of
yourself. But if you are expecting that all your problems will pass away,
and that everything is going to be easy emotionally and socially from here
on in, you’re probably going to be disappointed.
This extends to mental health concerns as well. Trans people who were
depressed because of gender dysphoria may find that taking hormones
greatly alleviates their depression. However, if you have depression
caused by biological factors, the stresses of transphobia or unresolved
personal issues, you may still be depressed after you start hormones.
Likewise, if you are having problems with drugs or alcohol, hormones
will not necessarily get rid of those problems.

3. Hormone therapy won’t provide you with a
perfect community.
For some trans people, hormone therapy is a ritual affirming that they
are who they say they are. Making physical changes is a way to bring who
you are to the rest of the world so other people can see it. This process of
self-emergence can be very liberating but it does not guarantee that you
will find acceptance or understanding.
Some MTFs hope that after they make physical changes they will be
validated as “real” women, or feel more accepted by the trans community.
But the idea that trans people aren’t “real” unless they’ve changed their
bodies is transphobic, and communities or groups that have this belief are
not likely to be fully respectful in terms of trans people’s identities and
bodies.
During the various stages of transition, it’s common to dream about
finding an ideal community of trans people. When starting hormones
there can be a particular drive to find other people who have gone through
similar experiences. There are a lot of very cool trans people to talk with
about hormones. But having taken hormones doesn’t automatically make
trans people welcoming, approachable, or sensitive to the needs of others,
and despite having some experiences in common you will likely find that
no trans person will exactly mirror your personal experiences, identity,
and beliefs. Being realistic about the likelihood that you will at times feel
lonely and alone after you start taking hormones is part of emotionally
preparing for hormone therapy.
4. Hormone therapy won’t remove all
“male”/“masculine” aspects of your body
Some physical characteristics aren’t changed by hormone therapy, or
are only slightly changed. This includes aspects of your body that develop
before birth (penis, sex chromosomes, etc.) and also physical characteristics
that developed from the increase in testosterone at puberty.
Hormone therapy may make facial and body hair grow more slowly and
be less noticeable, but hair will not go away completely. Electrolysis and/or
laser treatments are used by many MTFs for hair removal (electrolysis is
permanent; it is not yet clear how long-lasting laser hair removal is).

While “male”-pattern baldness may slow down or stop, bald areas will
not regrow hair. Some MTFs use wigs or hairpieces, while others get hair
transplants or other medical treatments.
“Feminizing” hormone therapy does not change voice pitch or speech
patterns (see Changing speech booklet). Speech therapy can help change
pitch and other aspects of speech associated with sex/gender. Some MTFs
have surgery on their vocal cords or the surrounding cartilage to try to
further raise voice pitch.
Once your bones have stopped growing after puberty, feminizing
hormone therapy won’t change the size or shape of your bones. Facial
feminizing surgery (see MTF surgery booklet) can be used to change the
shape of the skull and facial features, and to reduce a prominent Adam’s
apple. There are no treatments you can take to reduce your height or the
size of your hands/feet.
Although anti-androgens and estrogen affect sperm production and can
make you permanently sterile, there may still be a chance that you could
make someone pregnant even after starting hormone therapy. Depending
on how you have sex, you may need to consider birth control options.
Hormone therapy doesn’t decrease the risks of HIV and sexually
transmitted infections. Depending on how you have sex, you may need to
consider condoms, gloves, or other latex barriers. “Feminizing” hormones
can make erections less firm, increasing the risk of condom leakage. In
this situation your partner can use a special condom that they put inside
their anus or vagina (they’re called “female condoms” but can be used by
people of any gender).
What are the Possible Side Effects/Risks
of “Feminizing”Hormones?
The medical effects and safety of “feminizing” hormones are not fully
understood. Most of the studies on the medications used by MTFs as part
of hormone therapy involve non-trans people using different doses than
MTFs usually use. There may be long-term risks that are not yet known.
Many of the known risks of “feminizing” hormones can be reduced by
creating a hormone combination that is tailored to your specific situation.
Prevention includes periodic blood tests to keep an eye on potentially

13
risky conditions, and minimizing other health risks. Stopping smoking is
the number one thing you can do to reduce your risk of blood clots and
heart disease (and also make it possible to increase the amount of estrogen
that can safely be prescribed).
1. General risks
The medications taken in hormone therapy are processed by the liver.
There is a possibility that taking hormones over a long period of time can
put strain on the liver, possibly leading to liver disease. It is generally
recommended that MTFs taking feminizing hormone therapy get their
liver enzyme levels checked periodically to monitor liver health. This is
especially important if you have Hepatitis B or C, are a heavy drinker,
or are otherwise at risk for liver disease.
Being visibly trans in a transphobic society has social risks. While it is
possible to stay closeted if you’re taking small doses of anti-androgens (as
the changes aren’t highly visible), estrogen causes changes that can be
visible, including breast growth. Some visibly trans people experience
violence, harassment, and discrimination, while others have lost support
of loved ones. If you are worried or stressed about these possibilities, or
unsure of how to tell a loved one that you are thinking about taking or
planning to take hormones, peer and/or professional counselling can be
useful.
2. Side effects/risks of estrogen
Taking estrogen increases the risk of blood clots. Blood clots can cause
death, permanent lung damage (clot in the lungs), permanent brain damage
(stroke), heart attack, or chronic problems with the veins in your legs. The
risk of blood clots is much higher for smokers, especially those who are age
40 or higher. The danger is so high that some doctors will not prescribe
estrogen if you are a smoker; most will only prescribe you a low dose as
long as you are still smoking. The risk of blood clots may be reduced by
taking estrogen via skin patch, cream, or gel (rather than pill/injection)
and also by using a lower dose of estrogen.
Taking estrogen changes the way your body metabolizes and stores fat.
Taking estrogen can increase deposits of fat around your internal organs,
which is associated with increased risk for diabetes and heart disease.
Estrogen also increases the risk of gallstones, which can block your

gallbladder. If you have chest or abdominal pain, you should see a medical
professional right away.
Estrogen can cause increased blood pressure. This can be counteracted
by taking it with spironolactone, which tends to lower blood pressure. If
you can’t take spironolactone, there are other changes that can be tried,
including other types of medication, exercise, and changes to diet.
In some MTFs estrogen causes nausea and vomiting, similar to morning
sickness in pregnant women. Estrogen can also cause headaches or
migraines. If you are getting frequent headaches/migraines or the pain is
unusually bad, or if you are vomiting for more than a couple of days, talk
to a health professional.
With breast growth there is often an increase in milky discharge from
the nipples (galactorrhea). This is caused by the estrogen stimulating the
production of the hormone prolactin, which in turn stimulates breast
ducts to form milk. It is not known whether this increases the risk of noncancerous
tumours of the pituitary gland, which produces prolactin
(prolactinoma). Although prolactinoma is usually not life-threatening, it
can damage vision and cause headaches. For this reason, blood levels of
prolactin are usually checked for at least three years when you start
taking estrogen, and further tests may be ordered if prolactin levels are
very high or if prolactinoma is suspected.
It is not known if estrogen increases the risks of breast cancer (see
Trans people and cancer booklet). There have been cases of MTFs who
have developed breast cancer after starting hormones. Risks of breast
cancer are increased if you have a family history of breast cancer, have
been taking estrogen and/or progestagens for more than 5 years, are age
50+, or are overweight. Talk with your health care provider about
screening tests that can be done to catch early signs of breast cancer.
3. Side effects/risks of anti-androgens
Spironolactone affects the balance of water and salts in the kidneys. If
the proportion of water and blood salts gets out of balance, you can have
problems with low blood pressure or, rarely, high levels of potassium in
the blood (this can cause changes to heart rhythm that may be lifethreatening).
The doctor/nurse who prescribes you hormones should check
your potassium levels and kidney function on a regular basis if you:

• have a history of kidney problems
• are taking medication that can raise blood potassium (ask your
doctor or pharmacist)
• are taking ACE-inhibitors (e.g., Accupril®, Altace®, Capoten®,
Coversyl®, Inhibace®, Lotensin®, Mavik®, Monopril®, Prinivil®,
Vasotec®, Zestril®) – commonly prescribed for people with high blood
pressure or heart problems
Spironolactone can also cause a skin rash. If this happens, see the
doctor/nurse who prescribed the hormones.
Summary of risks and possible side effects of MTF hormone therapy
General risks • increased strain on liver Þ increased risk of liver disease
• harassment, discrimination, violence, and rejection by
people who do not support your decision to take hormones
Estrogen Risks Possible side effects
• increased risk of blood clots • increase in blood pressure
(risk of death or permanent • nausea or vomiting
damage) • increase in frequency or severity
• increased risk of diabetes and of headaches/migraines
heart disease • milky discharge from nipples
• increased risk of gallstones
• may be increased risk of noncancerous
tumour of pituitary
gland
• not known if breast cancer
risk is increased
Spironolactone Risks Possible side effects
• low blood pressure • skin rash
• changes to heart rhythm due
to high levels of blood
potassium

Health Checkups While You’re Taking
Hormones
As long as you are taking hormones (possibly the rest of your life), you
need to have regular physical exams and lab tests to monitor your overall
health. The first year after starting hormones, the prescribing doctor/
nurse will want to see you at least every 3–4 months; after that, you will
have appointments at least every 6 months. At each of these
appointments, the doctor/nurse will likely:
• ask questions about your overall health
• check your blood pressure and your weight, and listen to your lungs
• look at your arms, legs, hands, and feet to check your overall
circulation as well as any signs of swelling, fluid retention, or pain
• check for early warning signs of health problems that can be caused
by hormone therapy or made worse by hormone therapy (e.g., blood
clots, heart disease, diabetes)
• recommend blood tests to check your blood sugar, blood fats, blood
cells, and liver health
• recommend other tests (e.g., bone scan, heart stress function test) as
needed, depending on your health history, age, and any signs of
possible health problems
It is not known whether hormone therapy increases MTFs’ risks for
breast cancer. Depending on your age, family history, and other risks
for breast cancer, your health care provider may recommend a yearly
mammogram. If you are older than 50, your health care provider should
check your prostate (via a finger in your rectum) once a year.3 For more
information on cancer screening, see the Transgender Health Program’s
cancer booklet.
While the Transgender Health Program’s training for health care
providers emphasizes the need to be creative and consider stopping
hormones as a last resort (rather than a first resort), there are some
health problems that make it dangerous to take hormones. If your health
16
3 Like the testicles, the prostate (an organ that sits around the neck of the bladder) usually
shrinks from “feminizing” hormones.However, prostate cancer can still happen. PSA (prostatespecific
antigen) tests are sometimes recommended to monitor prostate health. Antiandrogens
and estrogen can artificially lower PSA levels, making PSA tests unreliable in MTFs
who are taking hormones.

care provider suspects you have one of these conditions, they will try to
control it through medical treatment and/or changes to your diet, exercise,
or other lifestyle issues. If the condition can’t be controlled, you may be
switched to another type of hormone, or your dose may be reduced or
stopped until your other health problems get under control.
Maximizing the Benefits,Minimizing
the Risks
There are a number of things that you can do to help ensure your
hormone therapy is as effective and safe as possible:
• Be informed. Understanding how hormones work, what to expect,
possible side effects/risks, and guidelines for care gives you the tools
to be in charge of your health and to make informed decisions. Do
your own research and ask questions. If you’re not sure where to
look, the Transgender Health Program (see last page) can help you
find resources.
• If you smoke, stop or cut down. Smoking greatly increases the
risks involved with hormone therapy. If you are a smoker, your
estrogen level may have to be kept low. If you need help to quit, your
health care provider can help you develop a plan and/or direct you to
further resources (or contact QuitNow, toll-free at 1-877-455-2233,
http://bc.quitnet.com). If you aren’t ready to quit, consider cutting
down: every little bit helps.
• Find a health care provider you trust and can be honest with.
To get the most from hormone therapy, you need to be able to talk
openly about what you want, concerns you have, and any problems you
are experiencing. You also need to be able to talk openly with your
health care provider about your health history, smoking, alcohol,
street drugs, dietary supplements, herbs, and any other medication
you are taking. Hormone therapy can be affected by all of these
things, and being honest about them will help create a plan that is
right for you.
• Deal with problems early on. If caught early enough, most of the
problems that can result from taking hormones can be dealt with in
a creative way that doesn’t involve stopping hormones completely.
Waiting can worsen your health to the point where you can’t take
hormones at all.

• Don’t change medication on your own. Check with your health
care provider if you want to start, stop, or change the dose of any of
your medication. Taking medication more frequently or at a higher
dose than prescribed increases health risks and can slow down the
effects you want. Going against the instructions of your health care
provider also erodes trust with them. If you want to change your
medication, talk with your health provider first.
• Take a holistic approach to your health. Health involves more
than just hormone levels, and taking hormones is only one way for
trans people to improve quality of life. Building a circle of care that
includes health professionals, friends, partners, and other people who
care about you will help support you to deal with other health problems
as they come up, and to heal from societal transphobia.
• Know where to go for help. Staff at the Transgender Health Program
can help you find information on trans health and transition issues,
and can also help you connect with trans groups and community
resources in your region. They can help with referrals if you need
assistance finding a trans-experienced medical provider, counsellor,
or another type of health professional.
18
Questions? Contact the Transgender Health Program:
Office: #301-1290 Hornby Street,Vancouver, BC V6Z 1W2
Phone/TTY/TDD: 604-734-1514 or 1-866-999-1514 (toll-free in BC)
Email: transhealth@vch.ca
Web: http://www.vch.ca/transhealth
The Transgender Health Program is an anonymous and confidential free
service for anyone in BC who has a trans health question or concern.
Services for trans people and loved ones include:
• information about trans advocacy, medical care, hormones, speech change,
and surgery
• help finding health/social services, and help navigating the trans health
system
• non-judgmental peer counselling and support
• information about trans community organizations and peer support
groups

© February 2006 Vancouver Coastal Health, Transcend Transgender Support & Education
Society and Canadian Rainbow Health Coalition
This publication may not be commercially reproduced, but copying for educational
purposes is encouraged.
This booklet was written by Olivia Ashbee and Joshua Mira Goldberg as part of the
Trans Care Project, a joint effort of Transcend Transgender Support & Education
Society and Vancouver Coastal Health’s Transgender Health Program.We thank the
Canadian Rainbow Health Coalition and Vancouver Coastal Health for funding this
project.We also thank Jacqueline Allan, Fionna Bayley,Dr.Marshall Dahl, Emily Hodge,
and Sam Larkham for their input.
For more copies, email the Transgender Health Program at trans.health@vch.ca or
call/TTY 1-866-999-1514 (toll-free in BC) and quote Catalogue No. GA.100.H7822.
TRANSCEND

for better understanding http://www.vch.ca/transhealth/resources/library/tcpdocs/consumer/hormones-MTF.pdf