Services include Hormone therapy for FTM and MTF patients. Conventional hormones and anti -androgen medications are prescribed. Bio-identical hormones in sublingual or transdermal forms can also be prescribed, but may be more costly.

Naturopathic medicine can address health risks and medication side effects that can occur with hormone therapy. For example, Testosterone can adversely affect cholesterol and lipid levels. There are effective naturopathic treatments in addition to diet and exercise counseling that can be used to reduce the cardiovascular risks associated with unhealthy lipid levels.

It is important to explore the transgendered person's goals and expectations for transitioning. The transition can be with or without hormone therapy and/or surgery. Hormone therapy must be continued for life, although doses may be reduced over time or post surgery. Hormone therapy usually precedes surgery for several reasons. Dissatisfaction with hormone effects may indicate ambivalence about proceeding to surgical interventions. On the other hand, changes due to hormones may preclude the desire for certain surgical procedures.

Click on one of these selections for more information:

Male To Female information         Female To Male information

Male to Female Hormone Therapy
Changes occur slowly and may be less than desired.
Male body/bone size and structure, facial hair growth patterns will not change. Beard hair will be less thick but will remain.
Electrolysis is helpful, but is a slow process.
Voice pitch will not change, but more typically feminine vocal patterns can be taught.
Most changes are reversible, except breast enlargement.

Feminizing Hormone Therapy
Estrogens: daily pills or by patch in high dose for at least 2 years.
Dose may be reduced after orchiectomy surgery or after maximum feminization is reached.
Doses are 4 to 8 times the HRT dose for menopausal women. Patch reduces risk for blood clots.
Must be stopped for 2 weeks prior to surgery due to risk of blood clots.
Anti-androgen: usually spironolactone (a diuretic with testosterone reducing and receptor blocking effects). May enable lower doses of estrogen to be needed.
Also, finasteride, progestins, other medications. Aspirin therapy for clot risk.

Expected Desirable Effects:
breast development- a size B cup is usually maximum, and will take at least 2 years to reach.
redistribution of body fat, increasing in hips, thighs and buttocks and less in abdomen.
softening of skin
suppression of testosterone production, decreased size of testes and possible penis, with less frequent and weaker erections
less muscle mass in upper body (and strength)
torso and extremity hair will lessen over several years, but areola, armpit and pubic hair change less.
slowed or reversed loss of scalp hair

Possible or Theoretical Desirable Effects:
decreased heart disease risks, improved lipid profile
improved mood and impulse control
decreased benign prostatic hypertrophy

Adverse Effects:
blood clots (venous thrombosis) in legs, lungs, other areas. Pulmonary embolism, heart attack and stroke may be fatal.
thrombophlebitis
hypertension, prolactinoma,diabetes, nausea/vomiting, migraine headache, decreased libido, impotence, gallbladder disease, abnormal liver function tests, mood disorder/depression, melasma (skin darkening in spots), acne, lipid abnormalities/elevated triglycerides, elevated potassium

Possible or Theoretical Adverse Effects:
increased risk of breast cancer, hepatitis, heart attack, stroke, other cancers, liver tumors, infertility (possibly permanent)
Consider sperm banking, if appropriate

Based on the risk of adverse effects, there are some corresponding precautions and contraindications for hormone therapy.

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Female to Male Hormone Therapy
Changes occur quickly, within a few months, and most are permanent.

Masculinizing hormone therapy
Testosterone: by self-injection every one to two weeks, patch
Dose may be reduced after oophorectomy, must must be maintained for osteoporosis prevention and masculinization effects.

Expected desirable effects
cessation of menses
lowered voice range (permanent)
increased hair growth on face, chest, extremities (permanent)
increased upper body muscle mass and strength
increased weight
clitoral enlargement (permanent)
redistribution of body fat from hips to abdomen
mild breast atrophy

Possible or theoretical desirable effects
decreased risk of osteoporosis
increased libido, interest and arousability
increased physical energy

Adverse effects
abdominal (apple shaped) obesity
peripheral edema
acne
erythrocytosis, abnormal liver tests
worsening of cholesterol profile, increased risk of cardiovascular disease
headache
coarsening of skin
emotional lability, increased anger and aggression
male pattern baldness (permanent)
infertility (may be permanent)
liver tumors

Possible or theoretical risks
increased risk of breast cancer
hypertension
thrombophlebitis
polycystic ovaries, ovarian cancer

Based on these risks, there are corresponding precautions and contraindications for hormone therapy.
Reproductive counseling regarding loss of fertility should be included in informed consent.

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Thanks to the Tom Waddell Health Center Transgender Team in San Francisco for their protocol information.

The best way to optimal wellness is to find a licensed naturopathic physician to work with, then you will also have access to professional quality herbal and nutritional supplements that can be the most effective. It this is not possible, there are good online natural pharmacies that offer reliable products.