Feminizing Drug Regimens: Pre-SRS Transsexual Medications

Hello Girls,

I don’t know if any of you are serious about really becoming girls, but if you are, my advice would be to seek medical advice in the first instance. If you do choose to self-medicate, which can be risky, below is a ‘typical’ transsexual MtoF feminizing medication regimen from: http://www.transgendercare.com/medical/resources/tmf_program/tmf_program_regimens.asp.

This is a U.S. site and some people have suggested (see comments) that the doses recommended here are far too high. It is best not to self-medicate at all if you can get hormones through a Gender Identity Clinic or from your GP. If you must self-medicate, start off with a relatively low dosage, like 2 mg of Estrofem or similar a day, and see how you go.

This is how I started, and together with the 5mg Finasteride which I was taking anyway for prostate problems (BHP), was sufficient to cause breast growth.

The following full transsexual regimen, which I have been taking more recently (minus the Spironolactone), certainly promotes full feminisation fairly rapidly:

Feminising Medication Regimen

  1.  4 mg Estradiol (Estrofem) (sublingually – under the tongue) daily – one in morning, one in evening
  2.  Two 50ug (mcg) Estradiol (Estrodot) patches applied weekly Saturday morning and Tuesday evening, or any other two days in the week, three and a half days apart – but stick to the same days each week.  Alternatively you can use transdermal gel rather than patches – see the above website.
  3.  5 mg Finsasteride in the morning (in the U.K., you can get this from your G.P. on the NHS, if you have a dodgy prostate – BHP – Benign Prostatic Hyperplasia).
  4. (Optional) 25 mg Spironolactone (Spirotone) in morning, 25 mg Spironolactone in evening – building up to 50 mg Spironolactone in morning, 50 mg Spironolactone in evening after 6 weeks, and thereafter optionally building up to as much as 200 mg per day, according to the transgender care website (http://www.transgendercare.com/medical/resources/tmf_program/tmf_program_regimens.asp)  BUT BEWARE! I don’t actually take this myself, because I had a severe allergic reaction to Spironolactone.
  5.  (Optional) Progestin : 5 mg daily for 10 days at beginning of the month.

From: http://www.transgendercare.com/medical/resources/tmf_program/tmf_program_regimens.asp

PLEASE NOTE:  I am not a doctor or medically trained.  You should NOT start taking feminizing hormones unless you are absolutely sure you want to do this. In my case it came from somewhere so deep down in my psyche and subconscious that it was inevitable that I would do it eventually.

It SHOULD be done under medical supervision.  If you don’t want your transition to be medicalised and controlled by an ‘expert’ gender identity clinic, involving psycho-sexual psychiatrists and psychologists, endocrinologists and SRS/GRS surgeons, whether private (or if you are in the U.K., at an NHS clinic such as the one at Charing Cross Hospital), you can obtain the feminising hormones from a reputable Internet supplier such as InHousePharmacy – I can recommend this company without reservation.  They deliver anywhere in the world, it’s the real proprietary medicine, and thay are prompt and reliable on delivery.  In the U.K., you may have to pay 20% V.A.T. plus £8 handling charge to the Post Office when you import the drugs, but this is quite hit and miss.  The last two deliveries from InHouse Pharmacy I had to pay it, but on the most recent one I didn’t, so it seems to depend on the efficiency (or otherwise) of the local Post Office.

It is wonderful and truly liberating that one can control one’s own feminizing drug regimen, and it has only been possible to do this since the advent of the Internet – certainly no one could do it in the 1970s, or 1980s – or I might have started a lot sooner.

BUT, and here is a very important point, you should still at least tell your G.P. what you are taking, in case there is any conflict with other medication. My G.P. (who is female), knows what I am doing, and so far she has been pretty good about it.  She hasn’t commented on the full transsexual drug regimen, as above, as she admits honestly that she is not an expert in this area.

UPDATE: I am about to start sessions with an NHS Gender Identity Clinic (October 2011), and I am guessing they probably won’t be that pleased that I have been self-medicating.  I hope they don’t tell me off too much!  Hopefully I will finally receive some advice from an expert clinician in transgender endocrinology and be able to get the hormones on NHS prescription in future.

Please be warned: it is best NOT to do what I have done.  Taking female hormones has well-known risks associated with it for women or men.  If becoming the woman you have always felt yourself to be is important enough to you, you will no doubt proceed in spite of the risks – but be aware of them.

I was surprised to realise recently, looking back on my invoices from  Inhouse Pharmacy http://www.inhousepharmacy.vu/transgender/transgender.html that I have been taking female hormones for over 5 years, so I guess it’s not surprising that I have boobs and a curvy shape – my hips have broadened, and my fat distribution is pretty female – my arms and legs look feminine, and it has also feminised my face.

I did not begin with the full pre-SRS MtoF transsexual feminising regimen as above, but started with just 2 mg of Estradiol (Estrofem or Progynova) for most of that time, building up to 4 mg per day.  That is enough to promote breast growth and body feminisation- you start to see the difference after 6-9 months.

I was lucky in that I started with a fairly un-masculine body to begin with – I am not that tall, I can wear a normal female size of shoes and clothing, and I have always had broad hips and rather narrow shoulders, and not much musculature – so my body lapped up the female hormones from the beginning.  I am also blonde, which means that body hair has not been a great problem, and it has now reduced to a female level anyway.

I have had quite a lot of laser hair removal treatments to get rid of facial hair, and can now manage with only light foundation or no foundation at all. I will probably also have to have electrolysis eventually to get rid of the remaining facial hair, as I want to look as natural a woman as possible.  I would love also to have Facial Feminisation Surgery (FFS), but I am frightened to do it.  My face is reasonably feminine anyway, and since I went full-time as a woman from July 2011, I haven’t really had any problems so far. (However, see update below about Facial Feminisation Surgery – I have decided to go for FFS.)

I am able to go shopping en femme with my wife, and I don’t get stared at.  I can go into the female changing rooms  – I guess I just look like a woman.  I can hardly believe it myself!  My wife says when we are shopping and she looks round, she just sees another woman – and doesn’t always realise it’s me!

I have my own shoulder length blonde hair, and so don’t have to wear a wig, and my boobs are big enough to give me some cleavage.  I dress sensibly, and wear what other women around my age wear.  It’s great to be able to spend as long as I want looking at lingerie and women’s clothes and shoes without feeling embarrassed!  I have debit and credit cards in my female name, so paying is no problem.  I am working hard on developing a feminine voice – so far without much success – more on this is a future blog.

UPDATE:  I AM having Facial Feminisation Surgery this November 2011 at the Facial Team Clinic in Marbella, Spain – and I am still frightened!  But I am going ahead anyway, as I think it will give me more confidence that I just look like any other woman.  I will post about this nearer the time and after the surgery.

I hope this has been some help to a few of you – please do let me know by commenting.

Hugs and kisses x x x

Amber (Kate)

12 responses to “Feminizing Drug Regimens: Pre-SRS Transsexual Medications”

  1. Thanks, Ms. Amber,

    Still out here in the male world as an ‘impostor’ but hopefully not for long.

    Cici – Oregon

  2. Hi Amber. I’m curious about how the ‘plumbing’ is working with taking the Spironolactone, given that it suppresses your sex drive (well, the Cyproterone I took certainly did ;-/ ) and that that was an important consideration in your original post? I also found the Cyproterone really dulled my senses & ‘zest for life’ – have you experienced that? Also, why such a complex regime? Thanks for the post and all 🙂

    1. Christy, i am not taking Spironlactone. It doesn’t agree with me. I had a serious allergic reaction to it – see my post:

      Cyproterone or Androcur) is a very strong drug – I have never taken that, and it is banned it the U.S. I think it is only available in Europe. You should definitely have regular drug tests and be monitored by your G.P., if you are on this.

      As regards Spironolactone, I have tried to take it several times, but the last time I ended up in the A & E Dept. at our local hospital. So I will never be taking that again.

      In response to your comment about ‘such a complex regime’ – it is not really complex, but you have to take both female hormone (Estrogen) and an Androgen-blocker, to block the effects of testosterone.

      I have found you can ‘modulate’ your sex-drive by adjusting your female hormone intake temporarily or for longer, depending on how often you want to have sex using your male naughty bits! If you take much above 2mg of Estrofem or its equivalent, you will find this will effect your ability to get a hard-on, to be frank!

      But if you reduce your Estrogen intake, your sex-drive will come back and you will be able to have an erection fairly soon. HOWEVER – you really shouldn’t mess about in this way (although I have – but I try not to now).

      This is what I take at present, as near as I can remember:

      1. 4 mg Estrofem per day in 2 divided doses of 2 mg tablets, morning and evening
      2. 50 mg Estrodot patch twice a week (which I will substitute for Estrogel transdermal gel once I have used the Estrodot up). Estrodot is fine, but because it is a patch, you get a sticky line round the patch, which you can rub off in the bath. For this reason, some Trans women and Genetic women on HRT don’t like patches – but they are convenient. To replace the Estrodot with Estrogel, I am going to have to rub the gel on my arms in the correct dose twice a day – which some women prefer to do, but I will probably find it a chore!
      3. 5 mg Finasteride. This is a powerful anti-androgen, plus it promotes hair growth on the scalp and even helps to reverse male-pattern baldness to some extent – so it is a magical elexir for Trans girls! I take it anyway, free from the NHS, because it is also a treatment for prostate problems, Benign Prostatic Hyperplasia,which many men (or in my case, ex-men) start to get in their 40s and 50s. It is happy serendipity that this also happens to be a powerful anti-androgen, if you are transgendered. The young male G.P. I saw when I had the allergic reaction to Spironolactone told me Finasteride is much more powerful than Sprinolactone in any case, so he couldn’t see why I was taking it. And I had only taken 25 mg of Spironolactone the night before, and another 25 mg the following morning, and that was enough to precipitate the violent allergic reaction in me. So I think the stuff is poisonous – at least to me! According to the Anne Lawrence website, you can take up to 200 mg of Spironolactone a day – but I would probably have died if I’d done this – so be very, very wary of it.

      If you take 1 -3 above as I am taking, you will probably chemically castrate yourself, unless you are a very young person and very randy! You will still have a sex drive, but the down-below bits won’t work. If you are happy to do cunninglingus, or use a strap-on, this may not matter. I don’t know whether you are in a relationship, or whether it is with a man or a woman. Basically, if you take a full transsexual drug regimen, you will be like a lesbian woman, if you are heterosexual as a male. If you have a genetic woman as a partner, this may or may not satisfy her, depending on what you do, and what she feels about things!

      As I move further through my transitioning, the fact that I can’t get an erection (except on some special occasions, when something miraculous seems to happen!) matters less to me. I haven’t decided about GRS, but I guess if I went for this, it wouldn’t matter to me at all, as I wouldn’t have a penis! Hopefully this would be made up for by having an interesting time with my new vagina! My understanding of GRS is that (if you are lucky), the surgeon uses some of the sensitve skin, with a lot of nerve endings from the sensitive areas of the penis to construct your new clitoris and labia, so you might even experience something akin to a femal orgasm. If there aer any post-ops out there who no more about this – please throw some light on this!

      Also, women experience orgasm in a different way to men, it is more of a ‘whole-body’ experience, and it can build in waves, so they can orgasm repeatedly. I think women get a better deal than men in this respect! Men, the poor saps. just have the one orgasm, which only lasts a few seconds, and is over with before you realise, practically, unless you can repeatedly ‘bring yourself’ to the point and then ‘back off’ repeatedly! And even then I don’t think it can compare in any way with the glories of the female orgasm! x Kate

  3. The statement “If you don’t want your transition to be medicalised and controlled by an ‘expert’ gender identity clinic, involving psycho-sexual psychiatrists and psychologists, endocrinologists and SRS/GRS surgeons, whether private (or if you are in the U.K., at an NHS clinic such as the one at Charing Cross Hospital)”, hit the nail absolutely on it’s head. TS/TG’s in Germany need a “Gutachten”, basically a medical psychosocial profile made to enable themselves to receive or made the recipient of “controlled substances”. What that does not say is that this process is humiliating and puts a persons identity into question under the synthetic pretences of what is normative, what it abnormal. What it basically means is that as a TS/TG you don’t have ANY human rights, you only have marginal “civil rights” as supposedly guaranteed by a constitution, which is in itself bollocks. That means you are criminalized or made into a medical case of gender dysphoria or maladaptive sexual identity. But it also indicates that a nation can ratify the International Charter of Human Rights, yet have medical practices that violate the mere concept of such a charter. I say that it is pointless seeking self help in a country like Germany, because it just ends up as a sick joke and a broken hearts club that is just a cheap boon for institutional psychiatry. If it was about caring and helping people, it would not even appear this way, at all…

    1. Hi Thomas,

      Thank you for your interesting comment about what happens in Germany. I am sorry to hear that things are so difficult in what I had thought was a civilised western European country, which I had previously considered to be more of the more enlightened states as regards transgenderism.

      I have only just taken the step of asking my (female) G.P. to refer me to an NHS gender clinic, and it will probably be months before I hear from them and get an appointment. but I will keep people posted (through this blog) about how I get on.

      In the meantime, I am having FFS (Facial Feminisation Surgery) done privately at the Facial Team clinic in Marbella, Spain, having met one of the surgeons, Dr. Luis Capitan, recently at the Sparkle National Transgender Festival in Manchester, England. I had quotes from several other Facial Feminisation clinics, including the one in Ghent, Belgium and two in the U.S., and concluded that the Marbella clinic was the best for several reasons.

      I feel fairly strongly that for transgendered people who are in transition and really hope to ‘pass’ as normal women without being ‘read’, FFS is far more important than GRS (Gender Reassignment Surgery), and should be a FIRST step (after taking feminisation hormones), BEFORE GRS. My understanding of the way that transgenderism is handled by the medical establishment and the NHS in the U.K. is that GRS is considered to be the most important step, and indeed one must jump through the hoops of the psychologists and counsellors, and complete the two year ‘real-life living as a woman full-time’ test before one is considered for GRS. Then they perform GRS, regardless of how easily or otherwise the ‘patient’ can ‘pass’ as a woman – so you get post-operative transsexuals who just look like ‘men in frocks’ and cannot be happy with the results. This seems very unkind to me, and is surely getting things the wrong way round. If you expect a T-girl in transition to live two years full-time as a woman before GRS, you should make it as easy as possible for her to ‘pass’ as a normal woman, by putting her on a regimen of feminising hormones, and giving her FFS and if necessary, help with developing a female voice.

      I may be wrong or out of date about attitudes to transgenderism in the NHS – I hope I am – no doubt I will find out when I eventually make it to a gender clinic in our nearest big city.

  4. The values listed on: http://www.transgendercare.com/medical/resources/tmf_program/tmf_program_regimens.asp

    Are way too high. I wonder who wrote such of the bat recommended dosages? do not follow them. Especially the sublingual. if you take 0.5mg sublingual it will have the same efefct as wearing a patch for 5 days!

    1. Not sure about this, Sasha. I do at present take 4 mg Estrofem per day, sublingually – 2mg tablet in morning, and 2mg tablet in evening, plus the patches – two per week. This might be why my body and face have feminised so much recently!

  5. Hi Amber. Thanks for you reply. Maybe ‘complex’ wasn’t quite the word I was looking for – but I am confused as to why the patches *and* tablets. I was on 2mg/day eostradiol valerate – it did the ‘business’ but without the feeling I have had in the past under different drugs – felt like guy on hormones – have switched to ethinyl estradiol 50mcg/day. I have had no adverse reaction to Spironolactone – am on 25mg/day – not much I know but a happy medium to keeping some sexual feeling/function & hormonal goals.

    I agree that FFS is probably more beneficial than GRS as a first step – I guess the medical establishment is set in their conventional attitudes – maybe it’s their way of weeding out the “wannabes”, I mean if you’re prepared to lose your crown jewels, you must be serious??? But FFS would make a much better first big step, and be of much more benefit mental health/adjustment wise?

    If you don’t mind sharing, roughly how much is your FFS costing, & why the Spanish clinic?



    1. Hi Christy,

      As regards why the Facial Team clinic in Spain, there are several reasons:

      1) I researched four clinics – the one in Ghent, two in the U.S., and the Facial Team clinic – I felt the Facial Team clinic in Marbella, Spain was the best all round on costs and care.
      2) I met Dr. Capitan from the Facial Team clinic at Sparkle 2011. I liked him and he listened to me regarding what I wanted. He quoted me for what I asked for, which was the minimum I felt I needed. He didn’t try to sell me procedures I didn’t ask about and don’t want. The other three clinics all tried to sell me extra procedures, which I think must be intended to turn folk into Barbie dolls! Perhaps this is what they want in the States – to be turned into some kind of ‘ideal’ woman clone like a Hollywood starlet! I definitely didn’t want this – I just want to look like a ‘normal’ woman for my age, as far as possible.
      3) As well as being impressed with Dr. Capitan (and Dr. Simon at the Facial Team clinic was also willing to speak to me by Skype video), I was very impressed with the high degree of care and help I received regarding booking accommodation, and all other issues I discussed with the Spanish clinic. This was thanks largely to the friendliness and proactive, positive attitude of Lilia, who works at the clinic as an administrator, and I also met her at Sparkle and have been in correspondence with her by email and on Skype since then. (Thanks, Lilia!)
      4) I was very unimpressed with some of the ‘Before’ and ‘After’ photos on the Ghent clinic’s website (I thought some of them looked better in the ‘Before’ photo!) Dr. Van de Ven also charges for consultations, which the Spanish clinic do not.
      5) Both the American clinics, the one in Boston (Dr. Spiegel) and the one in San Francisco (Dr. Ousterhout) were very expensive compared with both European clinics, with Ousterhout coming out $10,000 or so more than Spiegel, who in turn was a lot more expensive than the European clinics, and both quoted procedures which I hadn’t asked about and didn’t want.
      6) It is much more expensive to fly and stay in the States from the UK than it is to fly to Marbella, Spain on EasyJet. The Spanish clinic also sorted out my hotel for me.
      7) I didn’t fancy going to Thailand for FFS – I felt I would prefer to have it done in the EU. My face is Caucasian – I am sure the Bangkok clinics have plenty of experience with FFS surgery for Thai Ladyboys and other folk with Far Eastern facial features, but I felt I might get a better job done in Europe. However, if it doesn’t work out for me to get GRS on the NHS in the UK, I would consider going to Thailand for GRS – probably with Dr Suporn in Thailand, as I know someone who was pleased with the results and his technique does not involve penile inversion.
      8) If I have to go back for further facial or scalp surgery, it is much closer to go back to Spain than to have to fly to the States.
      9) I heard a bad report about one of the U.S. clinics, where the frontal brow bone had been shaved too thin and collapsed on one occasion. I can’t say which one, because knowing how Americans like litigation, I don’t want to get myself into trouble!
      10) I regret I am unable to tell you how much my FFS is costing – there wouldn’t be any point, as it all depends what procedures you want done. The clinics I dealt with were all upfront about their costs, so if you send them some mug shots of yourself they will give you a run-down of what they would charge. If cost is the main issue for you, go to Thailand or Eastern Europe.
      11) I couldn’t find any clinic in the UK that does this stuff privately – if there is one, they certainly don’t advertise on the Web. You can get basic rhinoplasty and that stuff done in the UK, but I am not sure about maxillo-facial surgery such as brow and orbital reduction. I’d be interested to hear from anyone who has had these procedures done in the UK.

      Hope that’s some help!

  6. Thanks Ambergoth!
    Glad to touch base yesterday also by phone. Thanks for being such a great help for others who are considering FFS. You´re a star!

  7. Good luck I wish I was as brave as you.love Karen

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