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What are Hormones?

As an adult, your body needs to continually replace body cells as they are damaged and wear out. The endocrine system helps your body manage this task. Hormones are chemicals of the endocrine system, which act as messengers between various parts of your body.

Hormones are produced in the body by glands. The glands that produce most of the sex hormones in a male are called testes and in a female are called ovaries. Sex hormones are carried from the glands throughout the body via the blood stream.

They travel to different areas, for example to the breast tissue, hair follicles and fat tissue under the skin, as well as to the sexual organs where they play important roles during sexual activity, in maintaining fertility and during the process of having children.

Sex hormones remind the body as it rebuilds and grows, to follow a male pattern if they are male hormones or a female pattern if they are female hormones.

The patterns they follow are already in every cell of your body. They are the kind of patterns that result in you having a nose similar to your parents and other family traits. They are all called genes.

Everyone's genes include male and female patterns. Although sex hormones are involved in many activities they are basically the messengers that remind the body to continue to follow the same pattern.

Hormone Therapy

Medical scientists earlier this century identified hormones and have been able to extract them from natural sources (e.g. From animal stock) or reproduce them as synthetic hormones in the laboratory.

The female hormone responsible for female characteristics like breast development is called oestrogen. The male hormone responsible for most male characteristics like beard growth and voice deepening is called testosterone.

If a person takes opposite sex hormones (e.g. biological female takes male hormones), then they will block the message from their own glands (ovaries) and introduce a new message. Over time this will slowly soften some of their feminine traits and introduce male characteristics. This type of hormone therapy can be prescribed by your doctor to help you effect a change of gender role in your life.

Hormone therapy is a slow process. Changes will occur over a period of time similar to that of natural puberty.

Hormone therapy will initially involve regular blood tests to monitor your hormone levels. These tests can eventually be carried out less frequently, though at least once a year is advisable. This should be discussed with your doctor.

How Much is Enough?

The long-term development achieved from hormone therapy, for example in breast tissue or muscles, will depend on your genes. If therapy is commenced during or soon after puberty then the hormones will be more effective in achieving change.

When you begin hormone therapy, your doctor will prescribe a low dose of hormones and gradually increase the dose until it is enough to block the messages from your own glands and replace them with the new ones. This is achieved by keeping your hormones at a similar level to adults born naturally into the gender you are moving towards.

People normally have different amounts of naturally occurring hormones in their bodies. Therefore, the dose prescribed by the doctor will differ for each person.

The most important point to remember is that it will be necessary to stay on some hormone medication for the rest of your life.

If you are unhappy with the dose or the type of medication you are on, you should discuss this with your doctor and make any changes under their guidance. Repeatedly stopping and starting hormone therapy could seriously affect your long-term health.

Extra tablets or injections will not improve the long-term results. Taking more tablets or having extra injections to speed up the process will put you at greater risk of developing tumors, blood clots, heart disease or other serious illnesses. Always stay on the dose agreed to with your doctor.

Taking Hormones

There are some medicines that interfere with the effect of testosterone. Tell your doctor what other prescription and non-prescription medicines you are using. When you discuss hormone therapy it will be helpful to consider the following:

Hormone Products

There are a number of forms of testosterone that are currently available in Australia including:

• Testosterone Injections;
• Long acting Testosterone Injections;
• Implants;
• Patches;
• Capsules;
• Testosterone gel; and
• Other synthetic androgens

Patient convenience and familiarity, cost and availability will depend on the type of treatment prescribed.

Commercial testosterone preparations contain only the natural testosterone molecule. This is chemically produced from plant materials. In this regard all testosterone therapies can be considered to be natural products.

Testosterone injections (Sustanon®, Primoteston®)

Testosterone injections of 1ml are given into the muscle, usually the buttock, every two to three weeks, depending upon the dose needed and the response achieved. Injections of 250mg are standard treatment, although lower doses (100mg) may be used. Some men find the injections painful, and other delivery methods should be considered.

As the testosterone is dissolved in an oily base, it should be warmed to room temperature to make injection easier.

Long acting testosterone injections (Reandron® 1000)

Very recently a new intramuscular injectable form of testosterone that lasts up to 14 weeks was approved in Australia.

This form of testosterone is given as a deep injection into the buttock. Following the initial injection a second injection is given at 6 weeks and then approximately every 12 weeks thereafter.

The testosterone is released slowly so that you do not experience the peaks and troughs that are common with standard injections.

Remember: If you inject your own hormones or you assist friends with theirs, never share needles or syringes. Dispose of them safely after a single use.

Needles and syringes can be obtained from the Gender Centre, any needle exchange program and some chemists. Contact Alcohol & Drug Information Service (ADIS) on 9331 2111 for 24 hour information on needle exchange services.

Testosterone implants

Small "pellets" (about 1cm in length and each containing 200mg of testosterone) can be placed under the skin of either the abdomen or the buttock.

Doctors experienced in this technique must perform the implanting procedure, which is done using local anaesthetic. Most will need three or four 200mg pellets implanted each time. The implants produce normal testosterone levels in the blood over a long period once in place, implants may last several months and provide an effective continuous dose.

Unfortunately about 10 per cent of the pellets work their way to the surface of the skin and are eventually pushed out. Because of the long time of action, implants should be used with caution.

Implants are probably not a good idea when you first begin hormones, as they are not available in the large doses usually required in the initial stages of therapy. They are more appropriate for people who have had surgery (involving the removal of their ovaries or testes) or people who have been on hormones for many years.

Testosterone patches (Androderm®)

Testosterone is available in patches that are put on at night and work at all times to allow testosterone to be absorbed through the skin. The normal dose is a single 5mg patch but 2.5mg patches are also available to allow some dose adjustment.

The patches are put on to the back, arms, shoulders, abdomen or buttocks.

About one in ten young men and about one in five older men develop a skin rash when using the patches.

This can sometimes be avoided by changing the place where the patches are put on and / or by the use of a cortisone cream (Aristocort® cream, 0.02 per cent triamcinolone) under the patch.

Capsules - Oral testosterone undeconoate (Andriol®)

These 40mg capsules must be taken with fluid that contains fat (for example, milk) to help the absorption.

One or two capsules are normally taken three times per day.

The testosterone levels gained with this form of treatment usually do not fully replace the testosterone levels and are usually only chosen when a man is unable to handle other forms of treatment.

Testosterone gel (Testogel®)

Testosterone gel, which is rubbed into the skin once a day, is available in Australia and has proved very popular overseas.

When the gel is applied to the shoulders, arms or abdomen, testosterone is absorbed into the skin, which acts as a reservoir. This results in a slow, continuous delivery of testosterone into the bloodstream, at relatively constant concentrations over 24 hours.

Other synthetic androgens

An oral preparation, which is placed inside the mouth (buccal) and absorbed through the membranes lining the gums, is available overseas and is not yet available in Australia.

A testosterone cream preparation (Andromen® cream) is available only in Western Australia.

This cream preparation may not always provide sufficient and constant levels of testosterone because of uneven absorption through the skin.

Some oral preparations (medical lozenges or troches), may be produced by compounding chemists.

However, these are not Government approved and it is not clear how well they work.

Hormone products prescribed to you will be manufactured from different sources and by a variety of methods. These products have very similar effects. However, it is not uncommon for patients to experience slight differences in how some products react to their body. This can be discussed with your doctor.

The costs of individual hormonal preparations will vary. Only some will be available under the Pharmaceutical Benefits Scheme. When you start a new regime ask your doctor how much it will cost.

The Effects of Hormones

The long-term effects of sex hormones are wide ranging throughout the body. Limited research has been carried out on the long-term effects, risks and benefits relating to hormone therapy for people with gender issues.

Many health services and providers lack experience with the problems and issues involved. Despite these difficulties, experienced providers do exist and it is important if you are considering hormone therapy to obtain referrals to an endocrinologist (hormone specialist) and psychiatrist familiar with gender issues.

Treatment should be preceded by considerable thought and thorough discussion of the physical, emotional and social implications of treatment with the doctors and counselling services available. Discussions should include the medical risks associated with hormone treatment and the fact that some of the effects will be irreversible. Any other ongoing health problems also need to be considered.

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