Hormones & Doses & Labs, Oh My! Reasons Behind Dose Variance Between Patients.

An often debated issue in regards to hormone therapy for transgender individuals is the dosage of the medications received. Inevitably, because we are only human, we will compare each other's medications, most especially if we are receiving the same type of therapy. Unfortunately, in situations such as hormone therapy being prescribed for transitioning purposes, this can lead to an awful lot of misunderstandings and bad feelings between patients and providers. Now, I'm not going to defend the providers who prescribe cookie cutter medicine for just about everyone. That's ridiculous. We are all different. We deserve different and unique regimens. However, I thought as a healthcare provider who actually prescribes this stuff, I could help clear a couple things up with an explanation of why dosages vary so much (or at least why they should).

Going through a hormonal transition, when talking about transgender folks, is a very hands-on and involved process. There should be frequent and open communication between a patient and their provider. In my own practice, I allow patients to text me at any time to clarify something for them. I find that this fosters a much better relationship between my patients and myself. After all, I am here to be their friend and mentor as I guide them through this wonderful stage in their lives, so they should be able to contact me as they would any of their other friends.

Getting back to the topic at hand, hormone dosages will most definitely be wide and varied depending on the patient. There are many reasons for this, but here are the top five:

1. Age. A patient’s age can determine what dosages they will need. After all, you would not expect a 70-year-old man to have a 20-year-old man’s testosterone level. The same goes for women. Post-menopausal women (most commonly those over 50-55 years) will not have the same levels of estrogen in their bodies as younger women. So depending on your age, the target hormone level can vary, which means the dose of medication changes as you age.

2. Health. A patient’s overall health also plays a part. There are many factors having to do with a patient's health that must be taken into consideration. For example, if a transfemale patient is a smoker, then the current recommendations are that they should not be kept on oral estrogen therapy for very long due to the increased risk for DVT (blood clots). The length of allowable oral estrogen therapy for smokers is often age dependent, because the older you are as a smoker, the higher your risk. It is deemed safer for a smoker to have a regimen that involves an estrogen that is injectable or transdermal (patches). Another example of health being a factor is a patient’s weight. Did you know that adipose (fat) tissue produces estrogen on its own? So a transfemale who is overweight may not end up requiring as high a dose of estrogen as someone who is thin. Also, estrogen therapy can cause weight gain, so if someone is already overweight, this is something to take into consideration as well. Conversely, if a transmale is overweight, then this may end up requiring a slightly higher dose of testosterone therapy to fight the excess estrogen being produced by his fat cells. Then there are health cases that are a little more difficult. Such as when someone has an uncontrolled mental health disorder, and they are seeking masculinizing therapy. Testosterone has the potential to exacerbate some mental health issues. So someone with uncontrolled bipolar disorder, for example, should probably not be placed on testosterone therapy until they have seen their mental health professional and have gotten their bipolar disorder under control. Then there are some conditions which generally prohibit prescribing hormone therapy. Such as if someone has had previous strokes, heart attacks, or more than one blood clot. The current consensus is that these individuals should not receive hormone therapy due to the increased risk it poses to their health, being that it could potentially end up killing them by making these conditions worse and/or reoccur.

3. Uniqueness. Everyone is different. We know this to be a fact. Just look around at how many people can eat 10 pounds of food and not gain weight, while there are other people who could just smell a donut and seem to gain 10 pounds. People also process medications differently in this fashion. Some people metabolize medications very quickly, necessitating higher doses. Others are slow metabolizers, meaning that they would need less of a dose to be effective. This is just part of your natural physiology, and is not truly alterable.

4. Goals. Not everyone has the same gender goal. For example: some transmen are looking for maximum male traits. They want muscles, thicker bones, a square jaw, facial hair, body hair, and everything else that goes with being masculine. Others however, may only be looking for a little fat redistribution with a stronger jawline and perhaps slightly broader shoulders. And since we all start off looking different from the get-go, we may not all need as much of a medical transition as others. I mean, think about it. Everyone has seen a woman who has very masculine facial features. Or a man who has a very feminine build. For people like this, they may not need so much of the male or female hormones to be able to transition effectively. It all depends on what the individual is looking for in their own transition.

5. Idiots. Sometimes you do just get an idiot for a provider. I'll just put that out there. It is a definite possibility. As I have mentioned before, we are only human. A lot of times, these providers mean well, but they are just not very educated about the entire process. Sometimes, though, they really are assholes. It is generally pretty easy to figure this out, however, because word-of-mouth travels very fast. And I guess I should also say that not all of the providers who seem to be what I am referring to above as “idiots” are actually idiots. They are usually just following outdated research. It happens all the time in medicine. New research comes out, but it doesn't get much publicity, and people tend to cling to what they know. There are healthcare providers out there who are treating people's blood pressure issues based on medical education from 15-20 years ago. It is the same with transgender hormone therapy. And perhaps even worse, since the available research and knowledge is very sparse on this topic when compared to more mainstream issues.

So there you have it. My five top reasons for differences in hormone dosages. Some of these reasons also exemplify why you should not be self-dosing with medicine obtained outside of the usual legal avenues. I understand that self education can be just as good as any education that you could receive formally in a degree program. But there are so many things out there that are dangerous in regards to black market hormone quality, so that you never know what exactly you are putting in your body. All the self learning in the world will not prevent fillers and contaminants from hiding in black market products.

In closing, I will say that what matters the most about hormone therapy are the lab values that go along with it. It doesn't matter if you are on a high dose or low dose as long as your hormone levels are within the values that are safe and effective for your age, health, and gender goals. I mean, less medicine is a good thing. All medicine is just poison with some good benefits that seem to outweigh the bad. The less of them that you have to take, the better in the long run. So see your provider, take your meds, and get your labs.

Have fun y'all!

Stacie, NP

Spectrum: The Other Clinic

Transgender Hormone Therapy

Telemedicine Clinic in Mississippi

otherclinic@gmail.com

601-466-9495 Text Me!

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