Hormones

1. Methods of testosterone delivery
2. Effects of testosterone
- (typically) desired effects
- (typically) undesired effects
3. Health maintenance
- bloodwork
- overall wellness issues
- risk reduction (cardio, polycythemia etc.)
- cholesterol and blood pressure
- liver levels
- pelvic exams
4. Where does testosterone (injectable) come from? Is it kosher?
5. Injection how to (& needle phobia)
6. Factors that may influence dosage or ability to take hormones
7. Testosterone availability
8. Shaving and razor burn
9. Prosthetics for passing and playing

The most common method of testosterone delivery is through intramuscular (IM) injection. Testosterone is available in the following formats:

a. Injection (Intramuscular)
- Depo Testosterone - Testosterone Cypionate (in a cottonseed carrier oil)
- DELATESTRYL - Testosterone Enanthate (in a sesame seed carrier oil)

b. AndroDerm (or Testoderm TTS Patch) (transdermal patch)
http://www.androderm.com/

c. Testoderm (scrotal patch)
(not appropriate/effective for FTM surgically constructed scrotums)

d. Androgel
http://androgel.com/main.html

e. Testopel® (Bartor Pharmacal) (Pellets)
http://rain.prohosting.com/~martydr/untitled.html
http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/tes1595.shtml

A good resource for learning more about prescription medications is rxlist.com

Testosterone can cause many effects in the body of individuals who take it. There is some variability in the results (and risks) achieved based on the method of delivery. Also, different individuals rate the effects differently. For example, some people find that increased body hair is a DESIRED effect, while others may not appreciate it. Likewise, changes in body smell may be positive for some, negative for others, and neutral for others still.

The lists of effects below do contain some cross-over items (mainly some of the effects that are popularly heard of as both positive and negative by many trans+/SOFFA individuals).

a. Desired Effects (typically) (not all effects happen in all people)

- cessation of menstruation
- body shape changes (elongated breasts, narrowing hips, broadening shoulders, increased neck, finger, feet and other sizes, etc.)
- increased body hair
- deeper voice
- increased libido
- increased clitoral size
- facial hair
- mood changes (calmer, variable, teenager spikes, etc.)
- increased energy
- increased metabolism (for some)
- increased muscle mass/strength
- weight changes (some lose weight, some gain)
- changes in smell (namely urine and sweat)
- "vaginal" lubrication changes (for some, lubrication diminishes)

b. Undesired Effects (typically) (not all effects happen in all people)

- acne
- increased blood pressure
- increased cholesterol levels
- increased liver levels
- red blood cells changes/polycythemia
- balding/hair loss
- weight changes (increase or decrease)
- body shape changes (elongated breasts, narrowing hips, broadening shoulders, increased neck, finger, feet and other sizes, etc.)
- increased cardiac risk factors
- changes in smell (namely urine and sweat)
- "vaginal" lubrication changes (for some, lubrication diminishes)
- ovarian changes
- increased libido
- increased sweating
- "hot flashes" (in the first few months of use)
- edema (swelling/water retention in the hands or ankles)
- pain at injection site (when applicable)
- mood changes (calmer, variable, teenager spikes, etc.)

Each health care provider may focus on slightly different areas for healthcare maintenance. Discussing with your provider what is important to you, what your risk factors are (i.e. family history, current medical conditions, lifestyle), and what areas your provider would like to track are essential for maintaining good health and a positive working relationship with your provider. The following areas are often of concern to people using testosterone:

a. Bloodwork

Most health care providers like to track the following:

- complete blood count
- glucose levels
- cholesterol levels
- liver function
- testosterone level

In Sheila Kirk's book "Masculinizing hormonal therapy for the transgendered" (Publisher: Together Lifeworks; 1st ed. edition June 4, 1997 - ASIN: 1887796029), Dr. Kirk outlines many medical protocols and suggestions for health care providers to follow. While Dr. Kirk is conservative and may propose more rigorous testing and follow-up than many physicians/nurse practitioners would adhere to, her guide offers a fairly comprehensive outline as to what medical steps could be pursued.

b. Overall wellness issues

Overall wellness issues may include many aspects of health, including mental health. Here are some key areas that many people find important to track in order to achieve a positive wellness state:

- blood pressure
- cardiovascular health
- healthy diet
- healthy activity level
- management of other medical conditions
- management of mental health conditions
- adequate rest
- stress management

c. Risk reduction

The use of testosterone can increase the risk for some cardiovascular, liver and other conditions. Some ways to reduce some of the risks include:

- excercise
- healthy diet
- moderate (to no) alcohol consumption
- minimal (or no) smoking
- reduction in red meat consumption
- proper use of medication to control medical and mental health conditions
- adequate rest
- stress management
- changes (reduction) in the amount of testosterone (sometimes necessary if liver function levels are elevated, or if polycythemic, or for other reasons)
- giving blood (to reduce polycythemia)

d. Cholesterol and blood pressure

In our culture, many people eat fast foods, live sedentary life-styles, have high stress, have jam-packed schedules and rush-rush-rush attitudes. The rates of high cholesterol and blood pressure are increasing across a wide range of demographics.

If you have high blood cholesterol or blood pressure, please consult with your health care provider to get help in reducing your levels. Many people use medication,
exercise, changes in diet, stress reduction, meditation, yoga, relaxation techniques, and many other ways to reduce their risks and drop their levels. Some find that over the counter supplements like niacin can be useful in lowering cholesterol levels.

e. Liver levels

A serious concern when taking testosterone is an increase in liver function levels. For some individuals, this elevation cannot be avoided or changed through diet or other behavioral changes. Having a health care provider monitoring blood levels is important in assuring a healthy liver (and the rest of your body!). Some people find they can maintain a healthier liver through reducing alcohol consumption and using the supplement Milk Thistle.

f. Pelvic exams

Many people who have a uterus, ovaries or other "female bits" prefer to not have routine pelvic exams with PAP smears. While taking testosterone can and usually does stop menstruation, it does not stop the need for regular gynecologic (GYN) exams. Certainly, those who have had a complete hysterectomy with vaginectomy are exempt from such exams, but it's important for the rest who have the parts to take care of our whole bodies.

Some physicians (and others) believe there is a higher rate of polycystic ovarian syndrome (PCOS) found in female-born/bodied people who are taking testosterone. PCOS, and many other GYN conditions, can be identified (and then treated), with regular pelvic exams. For this reason, as well as for general wellness and prevention, please consult with your physician or nurse practitioner about how frequently pelvic exams are advised.

A question arose over whether or not injectable testosterone (either enanthate or cypionate) are "kosher" (i.e. does the testosterone come from pigs, bulls, animals, or is it purely synthetic). FORGE has contacted the manufacturers, but have not received a response. If anyone knows where the testosterone in injectable (or other forms) testosterone comes from, please email info@forge-forward.org!

Many physicians' offices are writing out prescriptions for injectable testosterone, but are not providing instruction to their clients. While FORGE encourages individuals to seek out appropriate medical care - which would include instruction on how to inject testosterone - we recognize that not all physicians are willing to take the time to inform their patients. FORGE cares about the health of individuals injecting testosterone and has constructed two handouts which may be useful in learning how to inject and in dealing with anxiety associated with injecting.

How to Inject
http://www.forge-forward.org/handouts/injection.pdf

Just a Prick: Dealing with Needle-Anxiety
http://www.forge-forward.org/handouts/Needle-anxiety.pdf

Both of these handouts focus on how FTM+s and SOFFAs can successfully and safely (emotionally and physically) inject testosterone. 'How to Inject" is a step-by-step description of how to safely inject at home. "Dealing with Needle Anxiety" takes a comprehensive look at this pervasive issue. It covers alternatives to injectable testosterone, alternatives to self-injection, an in-depth discussion of how to address the anxiety itself, and a descriptive list of techniques, tools and suggestions.

Every body is different and needs different levels of hormones in order to be healthy. Some individuals (and/or their physicians) may wish to start and stay on low doses of testosterone, while others may choose to ramp up or ramp down depending on any number of factors.

Some physicians aim to achieve "normal" male levels of testosterone in their FTM+ patients (which is often desired by many FTM+s, as well). However, some factors may influence the amount, type, or frequency of testosterone administered. Other medical conditions may be the primary reason testosterone dosage may need to be reduced or modified. Conditions such as cardiovascular disease, polycythemia, or liver dysfunction, may influence the safety of administering "moderate" to high levels of testosterone - which may increase the severity of those conditions.

Age may play a role in determining dosage, since some people wish to maintain testosterone levels that are similar to biological men in their age group. Since older non-trans men typically have lower levels of testosterone, some older FTMs may wish to have similar amounts in their body, as well.

Another factor that may influence a reduced dosage of testosterone is if a person has had a hysterectomy.

Many are finding that compounding pharmacies offer cheaper rates for testosterone. Given that name brand (e.g. Upjohn) injectable testosterone is frequently $80-100 per 10ml vial, and Androgel is usually quite a bit higher in price than injectable forms, the low prices of $40-60 (sometimes less) for compounding pharmacies is quite appealing. Two pharmacies that many FTM+s have purchased compounded testosterone from are:

Kronos Compounding Pharmacy
3675 S. Rainbow Blvd. #103
Las Vegas, NV 89103-1059

ApotheCure
13720 Midway Rd. #109
Dallas, TX, 75244
972-960-6601
FAX 1-800-687-5252

Razor burn is generally caused by pressing too hard as you shave, by using a dull blade, by hair that is pushed back into the follicle and becomes inflamed, or by shaving with a blade that has some bacteria on it (i.e. from acne or from not being cleaned properly).

One of the easiest things to do is to change your blade frequently (every few shaves), if you are using a blade razor (vs. electric). When preparing to shave, make sure to moisten your face with warm compresses, so that pores open and hairs are easier to access without the need to press as firmly. Using a moisturizing, thick shaving cream is also useful. When you are finished shaving, rinse your face with cool water, followed by a after shave moisturizing cream. Many companies sell after shave care products. Many have a sensual scent and help your face feel smooth and relaxed after shaving.

Good Vibrations has been working with the FTM+/SOFFA community for years. They offer several products that can be useful to FTM+s. They used to sell a "Pack 'n' Play" device that could be worn as a semi-soft pack, and could also be used for penetration. However, they found many people were unhappy with them because they were too noticable for soft packing, and were too small (for most people) for penetrative play.

Good Vibrations does sell a WIDE variety of dildos and insertable devices for playing. They also carry a "Soft Pack", which is made of realistic feeling cyberskin. The Soft Pack comes in mini, small and large - all with scrotum and penis - and comes in both peach and chocolate colors.

To keep your packy in place, they are also carrying a "Cock Sock", which is similar to a jock strap, allowing a tight to the body fit without the need for a harness or worry about your packy falling out of your briefs accidentally.

Good Vibrations can be found on the web at www.goodvibes.com or by phone at (800) 289-8423.

Another great option are prosthetics created by Camouflage Prosthetics. While the Good Vibrations products are less costly, they are limited by size, shape, and colors available, as well as their "single purpose" efficiency.

Camouflage Prosthetics are created by Joseph DArienzo, in Australia, who is a Maxillo Facial prosthetist. His designs are expensive ($450+), but he focuses on creating a realistic looking prosthetics, matching skin color, and creating just the size you desire. Aside from the flacid packing device, he also has created an "erect" model, as well as a "dual" model which allows the wearer to pack and penetrate with it.

For more information, go to: www.ftmprosthetics.com

For more information about FORGE (meetings, past meetings, basic information, resources), please contact FORGE, PO Box 1272, Milwaukee, WI 53201. Phone: 414-278-6031. Email: info@forge-forward.org.