:PROPERTIES:
:ID:       47ba16c3-6f29-4d66-8d0d-1d5dee2de36a
:ROAM_ALIASES: HRT
:END:
#+title: Feminizing hormone therapy

* How should estrogen be administered?

Options include:
- Oral/Sublingual pills
- Transdermal patches
- Injections

High-dose oral estradiol carries a higher risk of blood clots; lower-dose
transdermal patches may be a preferable option ([[id:0bb3735b-eb05-4831-8b99-f1f9de43eb43][Prior, 2019]]).

* Effects on and management of sexual function

Lowered androgen levels correlate with lowered [[id:225dc9bd-4352-40de-b3de-5554b939d47e][sexual interest]] and nocturnal
erections. They did not, however, correlate to loss of erections due to sexual
stimulation. It appears more likely that any reduction in sexual function
experienced during HRT is due to lowered interest and atrophy ([[id:26d9bcd1-93f0-446f-a85c-f5a412a9ddb8][Bettocchi et al.,
2004]]).

Relational or personal distress due to lowered [[id:225dc9bd-4352-40de-b3de-5554b939d47e][sexual interest]] meets the critera
for hypoactive sexual desire disorder (HSDD).

Maintenance of erectile function may benefit from low-dose
testosterone or erectile dysfunction medications ([[id:f94cbbe7-8a99-47ee-8a11-51e4f1295b81][Holmberg et al., 2018]]).
Alternatively, consider consulting with your doctor about reducing or halting
androgen blocking medication. While ED meds may help, it's worth noting that
erections with them may not feel the same as you're used to ([[id:6130de63-b365-4615-84a8-3dc27d974dcf][Trans Women and
Viagra – Trans Tool Shed]]).

* Is Progesterone an important addition to a feminizing HRT regimen?
:PROPERTIES:
:ID:       5408d3a2-96e6-4fcc-9711-4f7329b9b918
:END:

The addition of progesterone contributes to healthy bone density, and may yield
improved feminization and breast maturation in transgender women ([[id:0bb3735b-eb05-4831-8b99-f1f9de43eb43][Prior, 2019]]).

It is unclear whether it is more beneficial to be [[id:1339fb52-8f4a-41d5-918e-9c3278a5b296][Taking progesterone rectally]]
vs orally as commonly prescribed.
* References
- [[id:be1a1499-3346-4a27-89d1-8cc2e218ee0e][Guidelines for gender-affirming primary care with trans and non-binary
  patients]], from Sherbourne Health in Ontario, 2019.
- [[id:46d23dc3-af17-48a5-bbe9-15192ea8b928][Guidelines for the primary and gender-affirming care of transgender and gender
  nonbinary people (second edition)]], from the University of California, San
  Francisco, 2016.
- [[id:f94cbbe7-8a99-47ee-8a11-51e4f1295b81][Supporting sexuality and improving sexual function in transgender persons]],
  Nature Reviews Urology, Sweden, 2018.
- [[id:0bb3735b-eb05-4831-8b99-f1f9de43eb43][Progesterone is important for transgender women’s therapy—applying evidence
  for the benefits of progesterone in ciswomen]], Endocrine Society, 2019.

* Resources
- [[https://www.plannedparenthood.org/planned-parenthood-great-northwest-hawaiian-islands/patient/services-transgender-patients][Gender Affirming Hormone Care at Planned Parenthood]]
- [[https://www.pennmedicine.org/providers/profile/ilona-lorincz][Dr Ilona S. Lorincz, Endocrinologist at Penn Medicine]]
- [[https://www.einstein.edu/pride-program][Einstein Pride Program]]
- [[https://www.welcomeprojectpa.org/][The Welcome Project PA]]
  - Working on setting up training for doctors.
  - Hosts the [[https://www.sagahatboro.com/][SAGA (Sexuality and Gender Acceptance) Community Center]] in Hatboro
    PA.