How do spironolactone and cyproterone acetate compare for testosterone suppression in trans women?

Posted on August 1, 2019 by Zinnia Jones

Disclaimer: I am not a medical professional and this is not medical advice.

Zinnia JonesTrans women are often understandably curious about which HRT regimens, typically consisting of estrogen and an antiandrogen, are most effective in producing the desired levels of estrogen while suppressing testosterone. Regional differences exist in which antiandrogens are usually prescribed: the synthetic progestin cyproterone acetate (CPA) is widely used in Europe, while this medication is not approved in the United States and spironolactone is usually used instead. Although availability may differ by area, trans women and their providers still deserve quality evidence on which treatments work best for this purpose. Continue reading →

Posted in Endocrinology, Transgender medicine | Tagged , | 1 Comment

New data on trans women’s estradiol/estrone ratios for different routes of administration of HRT

Posted on July 31, 2019 by Zinnia Jones

Disclaimer: I am not a medical professional and this is not medical advice.

Zinnia JonesI’ve previously covered anecdotal reports from HRT provider Dr. Will Powers on the role of relative levels of different kinds of estrogens in producing effective physical feminization in trans women. Estrogen is not one thing; estradiol (E2), the most common estrogen used in trans women’s HRT, is just one kind. Another form of estrogen, estrone (E1), binds to estrogen receptors but is much weaker in its effects than estradiol, and excessive levels of estrone compared to estradiol can crowd out estradiol at these receptors, inhibiting its feminizing effects. However, lab tests for trans women’s estrogen levels often only measure estrogen as a whole, rather than estradiol and estrone separately. Because of this, what appear to be adequate levels of estrogen may in reality consist mostly of less effective estrone rather than estradiol. Continue reading →

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Unsolved mystery: Trans women have significantly lower semen quality than cis men – before starting HRT

Posted on July 31, 2019 by Zinnia Jones

Zinnia JonesSperm banking is the recommended method of fertility preservation for trans women prior to medical transition (Coleman et al., 2012), as cross-sex hormone therapy can impair fertility, and gonadectomy (removal of the testes during vaginoplasty or orchiectomy) results in permanent sterility. Semen cryopreservation before starting hormone therapy is a precautionary measure, as the impact of HRT on fertility can be highly variable between individuals – contrary to certain myths and misconceptions, taking hormones does not reliably produce permanent or even temporary sterility in trans women. In a literature review, Schneider et al. (2017) reported:

Whereas three publications described a marked reduction of the spermatogenic level in all patients examined, eight publications reported inconsistent results. Histological analyses showed highly variable outcomes from qualitatively normal spermatogenesis and undisturbed Leydig/Sertoli cell morphology to full testicular regression with severe cellular damage and hyalinization.

This wide variation in the effects of HRT on sperm production makes clear why trans women cannot rely on cross-sex hormones as a method of birth control; trans women engaging in sexual activity that could result in pregnancy should still use an appropriate contraceptive method. Continue reading →

Posted in Fertility and reproduction, Transgender medicine | Tagged | Leave a comment

How trans youth and their parents decide to start medical transition

Posted on July 1, 2019 by Zinnia Jones

Zinnia JonesThe process by which trans adolescents seek out and access medical transition treatment, including puberty blockers and/or cross-sex hormones, is one of the most widely misunderstood subjects in the public imagination. Initiating treatment is frequently depicted as something capricious, a decision made rashly by youth who may simply be experiencing a “phase”, with little or no in-depth consideration of its significance and impact; their parents are portrayed as either going along with this under the coercion of threats of suicide, or swept up in an alleged “trend” themselves; trans-supportive clinicians are in turn maligned as reckless enablers who supposedly allow immediate access to these treatments on the basis of mere adolescent whims. This bizarre caricature is the image of adolescent transition most commonly promoted in alarmist and sensationalist media outlets today. Continue reading →

Posted in Media, Trans youth, Transgender medicine | Tagged , | Leave a comment

What is transphobia made of? Perception of deception predicts transphobic prejudice

Posted on July 1, 2019 by Zinnia Jones

Zinnia JonesTo the frustration of trans people, allies, and other generally reasonable individuals, transphobic attitudes continue to exist and inflict harm on innocent people. We know all too well that far too many people are transphobic – but why? What motivates this hostility, and in what beliefs and attitudes is it rooted? Previous studies have identified correlations between negative attitudes toward trans people and endorsement of homophobia, benevolent sexism, religious fundamentalism, discomfort with sexuality generally, and a lack of any personal contact with trans people (Rye, Merritt, & Straatsma, 2019).

These associations between transphobia and attitudes in other areas of life are well-established. But what is it about trans people specifically that inspires disapproval? A recent study looked more closely at one manifestation of prejudice, distrust toward trans people, as well as what beliefs are linked to this mistrust and what separates this antipathy from disapproval of other sexual minorities. Continue reading →

Posted in Sociological research, Transphobia and prejudice | Tagged , | 2 Comments