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class="vector-toc-text"> 4.1 Mental changes </div> </a> <ul id="toc-Mental_changes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Fat_distribution" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fat_distribution"> <div class="vector-toc-text"> 4.2 Fat distribution </div> </a> <ul id="toc-Fat_distribution-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Breast_development" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Breast_development"> <div class="vector-toc-text"> 4.3 Breast development </div> </a> <ul id="toc-Breast_development-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Fertility" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Fertility"> <div class="vector-toc-text"> 4.4 Fertility </div> </a> <ul id="toc-Fertility-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Skin" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Skin"> <div class="vector-toc-text"> 4.5 Skin </div> </a> <ul id="toc-Skin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Skeleton" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Skeleton"> <div class="vector-toc-text"> 4.6 Skeleton </div> </a> <ul id="toc-Skeleton-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Hair" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Hair"> <div class="vector-toc-text"> 4.7 Hair </div> </a> <ul id="toc-Hair-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Eye_morphology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Eye_morphology"> <div class="vector-toc-text"> 4.8 Eye morphology </div> </a> <ul id="toc-Eye_morphology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cardiovascular_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cardiovascular_effects"> <div class="vector-toc-text"> 4.9 Cardiovascular effects </div> </a> <ul id="toc-Cardiovascular_effects-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Gastrointestinal" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Gastrointestinal"> <div class="vector-toc-text"> 4.10 Gastrointestinal </div> </a> <ul id="toc-Gastrointestinal-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cancer_risk" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cancer_risk"> <div class="vector-toc-text"> 4.11 Cancer risk </div> </a> <ul id="toc-Cancer_risk-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Unaffected_characteristics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Unaffected_characteristics"> <div class="vector-toc-text"> 4.12 Unaffected characteristics </div> </a> <ul id="toc-Unaffected_characteristics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Monitoring" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Monitoring"> <div class="vector-toc-text"> 5 Monitoring </div> </a> <ul id="toc-Monitoring-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 6 History </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> 7 See also </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 8 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> 9 Further reading </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 10 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Feminizing hormone therapy</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 13 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-13" aria-hidden="true" > 13 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A7%D9%84%D8%AA%D8%A3%D9%86%D9%8A%D8%AB_%D8%A8%D8%A7%D9%84%D8%B9%D9%84%D8%A7%D8%AC_%D8%A7%D9%84%D9%87%D8%B1%D9%85%D9%88%D9%86%D9%8A" title="التأنيث بالعلاج الهرموني – Arabic" lang="ar" hreflang="ar" data-title="التأنيث بالعلاج الهرموني" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Terapia_de_sustituci%C3%B3n_hormonal_(hombre_a_mujer)" title="Terapia de sustitución hormonal (hombre a mujer) – Spanish" lang="es" hreflang="es" data-title="Terapia de sustitución hormonal (hombre a mujer)" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Hormona_anstata%C5%ADiga_terapio_(vir-al-ina)" title="Hormona anstataŭiga terapio (vir-al-ina) – Esperanto" lang="eo" hreflang="eo" data-title="Hormona anstataŭiga terapio (vir-al-ina)" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D9%87%D9%88%D8%B1%D9%85%D9%88%D9%86%E2%80%8C%D8%AF%D8%B1%D9%85%D8%A7%D9%86%DB%8C_%D8%B2%D9%86%D8%A7%D9%86%D9%87%E2%80%8C%D8%B3%D8%A7%D8%B2%DB%8C" title="هورمون‌درمانی زنانه‌سازی – Persian" lang="fa" hreflang="fa" data-title="هورمون‌درمانی زنانه‌سازی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%8A%B8%EB%9E%9C%EC%8A%A4%EC%A0%A0%EB%8D%94_%ED%98%B8%EB%A5%B4%EB%AA%AC_%EC%B9%98%EB%A3%8C_(MTF)" title="트랜스젠더 호르몬 치료 (MTF) – Korean" lang="ko" hreflang="ko" data-title="트랜스젠더 호르몬 치료 (MTF)" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Terapi_hormon_feminin" title="Terapi hormon feminin – Indonesian" lang="id" hreflang="id" data-title="Terapi hormon feminin" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-ne mw-list-item"><a href="https://ne.wikipedia.org/wiki/%E0%A4%AA%E0%A4%BE%E0%A4%B0%E0%A4%B2%E0%A5%88%E0%A4%99%E0%A5%8D%E0%A4%97%E0%A4%BF%E0%A4%95_%E0%A4%B9%E0%A4%B0%E0%A5%8D%E0%A4%AE%E0%A5%8B%E0%A4%A8_%E0%A4%A5%E0%A5%87%E0%A4%B0%E0%A4%BE%E0%A4%AA%E0%A4%BF_(%E0%A4%AA%E0%A5%81%E0%A4%B2%E0%A4%BF%E0%A4%99%E0%A5%8D%E0%A4%97%E0%A5%80%E0%A4%AC%E0%A4%BE%E0%A4%9F_%E0%A4%B8%E0%A5%8D%E0%A4%A4%E0%A5%8D%E0%A4%B0%E0%A5%80%E0%A4%B2%E0%A4%BF%E0%A4%99%E0%A5%8D%E0%A4%97%E0%A5%80)" title="पारलैङ्गिक हर्मोन थेरापि (पुलिङ्गीबाट स्त्रीलिङ्गी) – Nepali" lang="ne" hreflang="ne" data-title="पारलैङ्गिक हर्मोन थेरापि (पुलिङ्गीबाट स्त्रीलिङ्गी)" data-language-autonym="नेपाली" data-language-local-name="Nepali" class="interlanguage-link-target">नेपाली</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Feminiserende_kj%C3%B8nnsbekreftende_behandling" title="Feminiserende kjønnsbekreftende behandling – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Feminiserende kjønnsbekreftende behandling" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Terapia_hormonal_feminizante" title="Terapia hormonal feminizante – Portuguese" lang="pt" hreflang="pt" data-title="Terapia hormonal feminizante" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A4%D0%B5%D0%BC%D0%B8%D0%BD%D0%B8%D0%B7%D0%B8%D1%80%D1%83%D1%8E%D1%89%D0%B0%D1%8F_%D0%B3%D0%BE%D1%80%D0%BC%D0%BE%D0%BD%D0%B0%D0%BB%D1%8C%D0%BD%D0%B0%D1%8F_%D1%82%D0%B5%D1%80%D0%B0%D0%BF%D0%B8%D1%8F" title="Феминизирующая гормональная терапия – Russian" lang="ru" hreflang="ru" data-title="Феминизирующая гормональная терапия" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%DA%86%D8%A7%D8%B1%DB%95%D8%B3%DB%95%D8%B1%DB%8C_%DA%BE%DB%86%D8%B1%D9%85%DB%86%D9%86%DB%8C%DB%8C_%D8%AA%D8%B1%D8%A7%D9%86%D8%B3%D8%AC%DB%8E%D9%86%D8%AF%DB%95%D8%B1_(%D9%86%DB%8E%D8%B1_%D8%A8%DB%86_%D9%85%DB%8E)" title="چارەسەری ھۆرمۆنیی ترانسجێندەر (نێر بۆ مێ) – Central Kurdish" lang="ckb" hreflang="ckb" data-title="چارەسەری ھۆرمۆنیی ترانسجێندەر (نێر بۆ مێ)" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target">کوردی</a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%DB%81%D8%A7%D8%B1%D9%85%D9%88%D9%86%D9%88%DA%BA_%DA%A9%D8%A7_%D9%85%D8%B9%D8%A7%D9%84%D8%AC%D8%A7%D8%AA%DB%8C_%D9%86%D8%B3%D9%88%D8%A7%D9%86%DB%8C%D8%A7%D9%86%D8%A7" title="ہارمونوں کا معالجاتی نسوانیانا – Urdu" lang="ur" hreflang="ur" data-title="ہارمونوں کا معالجاتی نسوانیانا" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target">اردو</a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E5%A5%B3%E6%80%A7%E5%8C%96%E6%BF%80%E7%B4%A0%E7%96%97%E6%B3%95" title="女性化激素疗法 – Chinese" lang="zh" hreflang="zh" data-title="女性化激素疗法" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target">中文</a></li> </ul> <div class="after-portlet after-portlet-lang"><a 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class="sidebar sidebar-collapse nomobile nowraplinks"><tbody><tr><td class="sidebar-pretitle">Part of <a href="/wiki/Outline_of_transgender_topics" title="Outline of transgender topics">a series</a> on</td></tr><tr><th class="sidebar-title-with-pretitle"><a href="/wiki/Transgender" title="Transgender">Transgender topics</a></th></tr><tr><td class="sidebar-image">     </td></tr><tr><td class="sidebar-above"> <div class="hlist"><ul><li><a href="/wiki/Outline_of_transgender_topics" title="Outline of transgender topics">Outline</a></li><li><a href="/wiki/Transgender_history" title="Transgender history">History</a></li><li><a href="/wiki/Timeline_of_transgender_history" title="Timeline of transgender history">Timeline</a></li></ul></div></td></tr><tr><td class="sidebar-content" style="padding-top: 0.35em;"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)"><a 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title="Koekchuch">Koekchuch</a></li> <li><a href="/wiki/Third_gender" title="Third gender">Third gender</a> <ul><li><a href="/wiki/Bakla" title="Bakla">Bakla</a></li> <li><a href="/wiki/Fa%CA%BBafafine" title="Faʻafafine">Faʻafafine</a></li> <li><a href="/wiki/Femminiello" title="Femminiello">Femminiello</a></li> <li><a href="/wiki/Khanith" title="Khanith">Khanith</a></li> <li><a href="/wiki/M%C4%81h%C5%AB" title="Māhū">Māhū</a></li> <li><a href="/wiki/Mudoko_dako" title="Mudoko dako">Mudoko dako</a></li> <li><a href="/wiki/Mukhannath" title="Mukhannath">Mukhannath</a></li> <li><a href="/wiki/Muxe" title="Muxe">Muxe</a></li> <li><a href="/wiki/Travesti_(gender_identity)" title="Travesti (gender identity)">Travesti</a></li> <li><a href="/wiki/Two-spirit" title="Two-spirit">Two-spirit</a></li> <li><a href="/wiki/Winkte" title="Winkte">Winkte</a></li> <li><a href="/wiki/X-gender" title="X-gender">X-gender</a></li></ul></li> <li><a href="/wiki/Trans_man" title="Trans man">Trans man</a></li> <li><a href="/wiki/Trans_woman" title="Trans woman">Trans woman</a> <ul><li><a href="/wiki/Fakaleit%C4%AB" title="Fakaleitī">Fakaleitī</a></li> <li><a href="/wiki/Mak_nyah" title="Mak nyah">Mak nyah</a></li> <li><a href="/wiki/Rae-rae" title="Rae-rae">Rae-rae</a></li></ul></li> <li><a href="/wiki/Transgender" title="Transgender">Transgender</a> <ul><li><a href="/wiki/Transgender_youth" title="Transgender youth">Youth</a></li> <li><a href="/wiki/Akava%27ine" title="Akava'ine">Akava'ine</a></li></ul></li> <li><a href="/wiki/Transsexual" title="Transsexual">Transsexual</a></li></ul> </div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)"><a href="/wiki/Transgender_health_care" title="Transgender health care">Health care</a> practices</div><div class="sidebar-list-content mw-collapsible-content hlist" style="padding-top: 0.2em; padding-bottom: 0.7em;"> <ul><li><a href="/wiki/Gender_identity_clinic" title="Gender identity clinic">Gender clinic</a></li> <li><a href="/wiki/Gender_dysphoria" title="Gender dysphoria">Gender dysphoria</a> <ul><li><a href="/wiki/Gender_dysphoria_in_children" title="Gender dysphoria in children">in children</a></li> <li><a href="/wiki/Causes_of_gender_incongruence" title="Causes of gender incongruence">Causes</a></li></ul></li> <li><a href="/wiki/Sex_assignment" title="Sex assignment">Sex assignment</a></li></ul> <hr /> <ul><li><a href="/wiki/Gender-affirming_hormone_therapy" title="Gender-affirming hormone therapy">Hormone therapy</a> <ul><li><a class="mw-selflink selflink">feminizing</a></li> <li><a href="/wiki/Masculinizing_hormone_therapy" title="Masculinizing hormone therapy">masculinizing</a></li> <li><a href="/wiki/DIY_transgender_hormone_therapy" title="DIY transgender hormone therapy">DIY</a></li></ul></li> <li><a href="/wiki/Puberty_blocker" title="Puberty blocker">Puberty-suppressing hormone therapy</a></li></ul> <hr /> <ul><li><a href="/wiki/Gender-affirming_surgery" title="Gender-affirming surgery">Gender-affirming surgery</a> <ul><li><a href="/wiki/Masculinizing_surgery" title="Masculinizing surgery">masculinizing</a></li> <li><a href="/wiki/Feminizing_surgery" title="Feminizing surgery">feminizing</a></li></ul></li> <li><a href="/wiki/Facial_feminization_surgery" title="Facial feminization surgery">Facial feminization surgery</a></li> <li><a href="/wiki/Facial_masculinization_surgery" title="Facial masculinization surgery">Facial masculinization surgery</a></li></ul> <hr /> <ul><li><a href="/wiki/Hair_removal" title="Hair removal">Hair removal</a></li> <li><a href="/wiki/Transgender_pregnancy" title="Transgender pregnancy">Pregnancy</a></li> <li><a href="/wiki/Use_of_assisted_reproductive_technology_by_LGBTQ_people" title="Use of assisted reproductive technology by LGBTQ people">Assisted reproductive technology</a></li> <li><a href="/wiki/Transgender_voice_therapy" title="Transgender voice therapy">Voice therapy</a></li> <li><a href="/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">WPATH</a> <ul><li><a href="/wiki/Standards_of_Care_for_the_Health_of_Transgender_and_Gender_Diverse_People" title="Standards of Care for the Health of Transgender and Gender Diverse People">Standards of Care</a></li></ul></li></ul> <hr /> <ul><li><a href="/wiki/Transgender_health_care_misinformation" title="Transgender health care misinformation">Transgender health care misinformation</a></li></ul> </div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)">Rights and <a href="/wiki/Legal_status_of_transgender_people" title="Legal status of transgender people">legal status</a></div><div class="sidebar-list-content mw-collapsible-content hlist" style="padding-top: 0.2em; padding-bottom: 0.7em;"> <ul><li><a href="/wiki/Gender_self-identification" title="Gender self-identification">Gender self-identification</a></li> <li><a href="/wiki/Legal_gender" title="Legal gender">Legal gender</a></li> <li><a href="/wiki/Legal_recognition_of_non-binary_gender" title="Legal recognition of non-binary gender">Non-binary gender</a></li></ul> <hr /> <ul><li><a href="/wiki/Transgender_rights_movement" title="Transgender rights movement">Rights movement</a></li> <li><a href="/wiki/List_of_transgender-rights_organizations" title="List of transgender-rights organizations">Organizations</a></li> <li><a href="/wiki/List_of_transgender_political_office-holders" title="List of transgender political office-holders">Political office-holders</a> <ul><li><a href="/wiki/List_of_transgender_public_officeholders_in_the_United_States" title="List of transgender public officeholders in the United States">United States</a></li></ul></li></ul> <hr /> <ul><li><a href="/wiki/Transgender_asylum_seekers" title="Transgender asylum seekers">Asylum</a></li> <li><a href="/wiki/Legal_status_of_gender-affirming_healthcare" title="Legal status of gender-affirming healthcare">Healthcare</a></li> <li><a href="/wiki/Transgender_people_and_military_service" title="Transgender people and military service">Military service</a> <ul><li><a href="/wiki/Transgender_personnel_in_the_South_Korean_military" title="Transgender personnel in the South Korean military">South Korea</a></li> <li><a href="/wiki/Transgender_personnel_in_the_United_States_military" title="Transgender personnel in the United States military">United States</a></li></ul></li> <li><a href="/wiki/LGBTQ_people_in_prison#Transgender_issues" title="LGBTQ people in prison">Prisons</a></li> <li>Toilets <ul><li><a href="/wiki/Bathroom_bill" title="Bathroom bill">Bathroom bills</a></li> <li><a href="/wiki/Unisex_public_toilet" title="Unisex public toilet">Unisex</a></li></ul></li></ul> <hr /> <ul><li><a href="/wiki/Anti-gender_movement" title="Anti-gender movement">Anti-gender movement</a> <ul><li><a href="/wiki/21st-century_anti-trans_movement_in_the_United_Kingdom" class="mw-redirect" title="21st-century anti-trans movement in the United Kingdom">Anti-trans movement in the UK</a></li> <li><a href="/wiki/Gender-critical_feminism" title="Gender-critical feminism">Gender-critical or trans-exclusionary radical feminism</a></li></ul></li> <li><a href="/wiki/Transphobia" title="Transphobia">Discrimination</a> <ul><li><a href="/wiki/Discrimination_against_non-binary_people" title="Discrimination against non-binary people">Non-binary</a></li> <li><a href="/wiki/Parental_rights_movement" title="Parental rights movement">Parental rights movement</a></li> <li><a href="/wiki/Discrimination_against_transgender_men" title="Discrimination against transgender men">Transgender men</a></li> <li><a href="/wiki/Transmisogyny" title="Transmisogyny">Transmisogyny</a></li></ul></li> <li><a href="/wiki/Transgender_genocide" title="Transgender genocide">Genocide</a></li> <li><a href="/wiki/Transgender_inequality" title="Transgender inequality">Inequality</a></li> <li><a href="/wiki/Violence_against_transgender_people" title="Violence against transgender people">Violence</a> <ul><li><a href="/wiki/List_of_people_killed_for_being_transgender" title="List of people killed for being transgender">Murders</a></li> <li><a href="/wiki/Trans_panic_defense" class="mw-redirect" title="Trans panic defense">Trans panic defense</a></li></ul></li> <li><a href="/wiki/Yogyakarta_Principles" title="Yogyakarta Principles">Yogyakarta Principles</a></li></ul> </div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)">Society and culture</div><div class="sidebar-list-content mw-collapsible-content hlist" style="padding-top: 0.2em; padding-bottom: 0.7em;"> <div style="font-weight: bold;line-height:normal;">Events and awareness</div> <ul><li><a href="/wiki/Transgender_Awareness_Week" title="Transgender Awareness Week">Awareness Week</a></li> <li><a href="/wiki/Category:Transgender_beauty_pageants" title="Category:Transgender beauty pageants">Beauty pageants</a></li> <li><a href="/wiki/Transgender_Day_of_Remembrance" title="Transgender Day of Remembrance">Day of Remembrance</a></li> <li><a href="/wiki/International_Transgender_Day_of_Visibility" title="International Transgender Day of Visibility">Day of Visibility</a></li> <li><a href="/wiki/Transgender_flag" title="Transgender flag">Flag</a></li> <li><a href="/wiki/Trans_march" title="Trans march">March</a></li> <li><a href="/wiki/Category:Transgender_events" title="Category:Transgender events">more</a></li></ul> <hr /> <div style="font-weight: bold;line-height:normal;">Culture</div> <ul><li><a href="/wiki/Terminology_of_transgender_anatomy" title="Terminology of transgender anatomy">Anatomical terminology</a></li> <li><a href="/wiki/List_of_fictional_trans_characters" title="List of fictional trans characters">Fictional characters</a></li> <li><a href="/wiki/List_of_feature_films_with_transgender_characters" title="List of feature films with transgender characters">Film</a></li> <li><a href="/wiki/Transgender_literature" title="Transgender literature">Literature</a></li> <li><a href="/wiki/Transgender_culture_of_New_York_City" title="Transgender culture of New York City">Transgender culture of New York City</a></li> <li><a href="/wiki/Media_portrayals_of_transgender_people" title="Media portrayals of transgender people">Media portrayals</a></li> <li><a href="/wiki/List_of_transgender_people" title="List of transgender people">People</a> <ul><li><a href="/wiki/List_of_non-binary_people" title="List of non-binary people">non-binary</a></li></ul></li> <li><a href="/wiki/List_of_transgender_publications" title="List of transgender publications">Publications</a></li> <li><a href="/wiki/Transgender_people_and_religion" title="Transgender people and religion">Religion</a></li> <li><a href="/wiki/Transgender_people_in_sports" title="Transgender people in sports">Sports</a></li> <li><a href="/wiki/List_of_transgender_characters_in_television" title="List of transgender characters in television">Television</a></li></ul> </div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)">Theory and concepts</div><div class="sidebar-list-content mw-collapsible-content hlist" style="padding-top: 0.2em; padding-bottom: 0.7em;"> <ul><li><a href="/wiki/Androphilia_and_gynephilia" title="Androphilia and gynephilia">Androphilia and gynephilia</a></li> <li><a href="/wiki/Blanchard%27s_transsexualism_typology" title="Blanchard's transsexualism typology">Blanchard's typology</a></li> <li><a href="/wiki/Childhood_gender_nonconformity" title="Childhood gender nonconformity">Childhood gender nonconformity</a></li> <li><a href="/wiki/Cisgender" title="Cisgender">Cisgender / cissexual</a></li> <li><a href="/wiki/Cisnormativity" title="Cisnormativity">Cisnormativity</a></li> <li><a href="/wiki/Cross-dressing" title="Cross-dressing">Cross-dressing</a></li> <li><a href="/wiki/Deadnaming" title="Deadnaming">Deadnaming</a></li> <li><a href="/wiki/Gender_binary" title="Gender binary">Gender binary</a></li> <li><a href="/wiki/Detransition" title="Detransition">Gender detransitioning</a></li> <li><a href="/wiki/Gender_expression" title="Gender expression">Gender expression</a></li> <li><a href="/wiki/Gender_transition" title="Gender transition">Gender transitioning</a></li> <li><a href="/wiki/Gender_identity" title="Gender identity">Gender identity</a></li> <li><a href="/wiki/Gender_nonconformity" title="Gender nonconformity">Gender nonconformity</a></li> <li><a href="/wiki/Questioning_(sexuality_and_gender)" title="Questioning (sexuality and gender)">Gender-sexuality questioning</a></li> <li><a href="/wiki/Postgenderism" title="Postgenderism">Postgenderism</a></li> <li><a href="/wiki/Rapid-onset_gender_dysphoria_controversy" title="Rapid-onset gender dysphoria controversy">Rapid-onset dysphoria</a></li> <li><a href="/wiki/Transgender_studies" title="Transgender studies">Studies</a></li> <li><a href="/wiki/Transfeminism" title="Transfeminism">Transfeminism</a> <ul><li><a href="/wiki/Feminist_views_on_transgender_topics" title="Feminist views on transgender topics">views</a></li></ul></li> <li><a href="/wiki/Transmedicalism" title="Transmedicalism">Transmedicalism</a></li> <li><a href="/wiki/Transmisogyny" title="Transmisogyny">Transmisogyny</a></li></ul> </div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)"><a href="/wiki/Category:Transgender_topics_by_continent" title="Category:Transgender topics by continent">By country</a></div><div class="sidebar-list-content mw-collapsible-content hlist" style="padding-top: 0.2em; padding-bottom: 0.7em;"> <div style="font-weight: bold;line-height:normal;">Rights</div> <ul><li><a href="/wiki/Transgender_rights_in_Argentina" title="Transgender rights in Argentina">Argentina</a> <ul><li><a href="/wiki/Gender_Identity_Law_(Argentina)" title="Gender Identity Law (Argentina)">2012 law</a></li> <li><a href="/wiki/Diana_Sacay%C3%A1n%E2%80%93Lohana_Berkins_Law" title="Diana Sacayán–Lohana Berkins Law">2021 law</a></li></ul></li> <li><a href="/wiki/Transgender_rights_in_Australia" title="Transgender rights in Australia">Australia</a></li> <li><a href="/wiki/Transgender_rights_in_Brazil" title="Transgender rights in Brazil">Brazil</a></li> <li><a href="/wiki/Transgender_rights_in_Canada" title="Transgender rights in Canada">Canada</a> <ul><li><a href="/wiki/An_Act_to_amend_the_Canadian_Human_Rights_Act_and_the_Criminal_Code" title="An Act to amend the Canadian Human Rights Act and the Criminal Code">2016 bill</a></li></ul></li> <li><a href="/wiki/Transgender_people_in_China" title="Transgender people in China">China</a></li> <li><a href="/wiki/Transgender_history_in_Finland" title="Transgender history in Finland">Finland</a></li> <li><a href="/w/index.php?title=Transgender_people_in_France&action=edit&redlink=1" class="new" title="Transgender people in France (page does not exist)">France</a> [<a href="https://fr.wikipedia.org/wiki/Transidentit%C3%A9_en_France" class="extiw" title="fr:Transidentité en France">fr</a>]</li> <li><a href="/wiki/Transgender_rights_in_Germany" title="Transgender rights in Germany">Germany</a> <ul><li><a href="/wiki/Transsexuals_Act_(Germany)" title="Transsexuals Act (Germany)">1980 law</a></li> <li><a href="/wiki/Third_gender_law_(Germany)" title="Third gender law (Germany)">2018 law</a></li> <li><a href="/wiki/Self-Determination_Act_(Germany)" title="Self-Determination Act (Germany)">2024 law</a></li></ul></li> <li>India <ul><li><a href="/wiki/Rights_of_Transgender_Persons_Bill,_2014" title="Rights of Transgender Persons Bill, 2014">2014 bill</a></li> <li><a href="/wiki/Transgender_Persons_(Protection_of_Rights)_Act,_2019" title="Transgender Persons (Protection of Rights) Act, 2019">2019 act</a></li> <li><a href="/wiki/LGBTQ_rights_in_Tamil_Nadu" title="LGBTQ rights in Tamil Nadu">Tamil Nadu</a></li></ul></li> <li><a href="/wiki/Transgender_rights_in_Iran" title="Transgender rights in Iran">Iran</a></li> <li><a href="/wiki/Transgender_rights_in_Ireland" class="mw-redirect" title="Transgender rights in Ireland">Ireland</a></li> <li>Pakistan <ul><li><a href="/wiki/Transgender_Persons_(Protection_of_Rights)_Bill,_2017" title="Transgender Persons (Protection of Rights) Bill, 2017">2017 bill</a></li> <li><a href="/wiki/Transgender_Persons_(Protection_of_Rights)_Act,_2018" title="Transgender Persons (Protection of Rights) Act, 2018">2018 act</a></li></ul></li> <li><a href="/wiki/Transgender_rights_in_New_Zealand" title="Transgender rights in New Zealand">New Zealand</a></li> <li>Norway <ul><li><a href="/wiki/Gender_Recognition_Act_(Norway)" title="Gender Recognition Act (Norway)">2016 act</a></li></ul></li> <li><a href="/wiki/Transgender_people_in_Singapore" title="Transgender people in Singapore">Singapore</a></li> <li>South Africa <ul><li><a href="/wiki/Alteration_of_Sex_Description_and_Sex_Status_Act,_2003" title="Alteration of Sex Description and Sex Status Act, 2003">2003 act</a></li></ul></li> <li><a href="/wiki/Transgender_people_in_South_Korea" title="Transgender people in South Korea">South Korea</a></li> <li>Spain <ul><li><a href="/wiki/Ley_Trans" title="Ley Trans">2022 law</a></li></ul></li> <li><a href="/wiki/Transgender_rights_in_the_United_Kingdom" title="Transgender rights in the United Kingdom">United Kingdom</a> <ul><li><a href="/wiki/21st-century_anti-trans_movement_in_the_United_Kingdom" class="mw-redirect" title="21st-century anti-trans movement in the United Kingdom">Anti-trans movement</a></li> <li><a href="/wiki/Gender_Recognition_Act_2004" title="Gender Recognition Act 2004">2004 act</a></li> <li><a href="/wiki/Gender_Recognition_Reform_(Scotland)_Bill" title="Gender Recognition Reform (Scotland) Bill">2022 bill</a></li></ul></li> <li><a href="/wiki/Transgender_rights_in_the_United_States" title="Transgender rights in the United States">United States</a> <ul><li><a href="/wiki/Transgender_disenfranchisement_in_the_United_States" title="Transgender disenfranchisement in the United States">Disenfranchisement</a></li> <li><a href="/wiki/Gender_identity_under_Title_IX" title="Gender identity under Title IX">Title IX</a></li> <li><a href="/wiki/Transphobia_in_the_United_States" title="Transphobia in the United States">Transphobia</a></li></ul></li></ul> <hr /> <div style="font-weight: bold;line-height:normal;"><a href="/wiki/Transgender_history" title="Transgender history">History</a></div> <ul><li><a href="/wiki/Transgender_history_in_Argentina" class="mw-redirect" title="Transgender history in Argentina">Argentina</a> [<a href="https://es.wikipedia.org/wiki/Historia_transg%C3%A9nero_en_Argentina" class="extiw" title="es:Historia transgénero en Argentina">es</a>]</li> <li><a href="/wiki/Transgender_history_in_Australia" class="mw-redirect" title="Transgender history in Australia">Australia</a> <ul><li><a href="/wiki/Re_Kevin" title="Re Kevin">Re Kevin</a></li></ul></li> <li><a href="/wiki/Transgender_history_in_Brazil" title="Transgender history in Brazil">Brazil</a></li> <li><a href="/wiki/Transgender_history_in_China" class="mw-redirect" title="Transgender history in China">China</a></li> <li><a href="/wiki/Transgender_history_in_Finland" title="Transgender history in Finland">Finland</a></li> <li><a href="/wiki/Transgender_people_in_Nazi_Germany" title="Transgender people in Nazi Germany">Nazi Germany</a></li> <li><a href="/wiki/Transgender_history_in_Singapore" class="mw-redirect" title="Transgender history in Singapore">Singapore</a></li> <li><a href="/wiki/Transgender_history_in_the_United_Kingdom" title="Transgender history in the United Kingdom">United Kingdom</a></li> <li><a href="/wiki/Transgender_history_in_the_United_States" title="Transgender history in the United States">United States</a> <ul><li><a href="/wiki/Transgender_legal_history_in_the_United_States" title="Transgender legal history in the United States">Legality</a></li> <li><a href="/wiki/List_of_transgender_public_officeholders_in_the_United_States" title="List of transgender public officeholders in the United States">elected officials</a></li> <li><a href="/wiki/Compton%27s_Cafeteria_riot" title="Compton's Cafeteria riot">Cafeteria riot</a></li> <li><a href="/wiki/Stonewall_riots" title="Stonewall riots">Stonewall</a></li></ul></li></ul> </div></div></td> </tr><tr><td class="sidebar-content"> <div class="sidebar-list mw-collapsible mw-collapsed"><div class="sidebar-list-title" style="background: lavender; padding-left: 3px;;color: var(--color-base)">See also</div><div class="sidebar-list-content mw-collapsible-content hlist" style="padding-top: 0.2em; padding-bottom: 0.7em;"> <ul><li><a href="/wiki/Anti-LGBTQ_rhetoric" title="Anti-LGBTQ rhetoric">Anti-LGBTQ rhetoric</a></li> <li><a href="/wiki/Gender" title="Gender">Gender</a></li> <li><a href="/wiki/Gender_studies" title="Gender studies">Gender studies</a></li> <li><a href="/wiki/Intersex" title="Intersex">Intersex</a></li> <li><a href="/wiki/Queer_heterosexuality" title="Queer heterosexuality">Queer heterosexuality</a></li> <li><a href="/wiki/LGBTQ" title="LGBTQ">LGBTQ</a></li> <li><a href="/wiki/Sex" title="Sex">Sex</a></li> <li><a href="/wiki/Sex%E2%80%93gender_distinction" title="Sex–gender distinction">Sex–gender distinction</a></li> <li><a href="/wiki/Sexual_orientation" title="Sexual orientation">Sexual orientation</a></li> <li><a href="/wiki/Social_construction_of_gender" title="Social construction of gender">Social construction of gender</a></li></ul> </div></div></td> </tr><tr><td class="sidebar-below" style="border-top:1px solid #aaa; padding: 0.15em 0.3em 0.3em; border-bottom: 1px solid #aaa;"> <div class="hlist"><ul><li><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Nuvola_LGBT_flag.svg/16px-Nuvola_LGBT_flag.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Nuvola_LGBT_flag.svg/24px-Nuvola_LGBT_flag.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0e/Nuvola_LGBT_flag.svg/32px-Nuvola_LGBT_flag.svg.png 2x" data-file-width="512" data-file-height="512" /> <a href="/wiki/Portal:LGBTQ" title="Portal:LGBTQ">LGBTQ portal</a></li><li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /> <a href="/wiki/Category:Transgender_topics" title="Category:Transgender topics">Category</a></li></ul></div></td></tr><tr><td class="sidebar-navbar"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Transgender_sidebar" title="Template:Transgender sidebar"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Transgender_sidebar" class="mw-redirect" title="Template talk:Transgender sidebar"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Transgender_sidebar" title="Special:EditPage/Template:Transgender sidebar"><abbr title="Edit this template">e</abbr></a></li></ul></div></td></tr></tbody></table> Feminizing hormone therapy, also known as transfeminine hormone therapy, is a form of <a href="/wiki/Transgender_health_care#Gender-affirming_care" title="Transgender health care"> gender-affirming care</a> and a <a href="/wiki/Gender-affirming_hormone_therapy" title="Gender-affirming hormone therapy"> gender-affirming</a> <a href="/wiki/Hormone_therapy" title="Hormone therapy">hormone therapy</a> to change the <a href="/wiki/Secondary_sex_characteristic" title="Secondary sex characteristic">secondary sex characteristics</a> of <a href="/wiki/Transgender" title="Transgender">transgender</a> people from <a href="/wiki/Masculine" class="mw-redirect" title="Masculine">masculine</a> to <a href="/wiki/Feminine" class="mw-redirect" title="Feminine">feminine</a>.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-Deutsch2016-3">[3]</a><a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a><a href="#cite_note-Bourns2018-6">[6]</a>[<a href="/wiki/Wikipedia:Citing_sources#Bundling_citations" title="Wikipedia:Citing sources">excessive citations</a>] It is a common type of <a href="/wiki/Transgender_hormone_therapy" class="mw-redirect" title="Transgender hormone therapy">transgender hormone therapy</a> (another being <a href="/wiki/Masculinizing_hormone_therapy" title="Masculinizing hormone therapy">masculinizing hormone therapy</a>) and is used to treat <a href="/wiki/Transgender_women" class="mw-redirect" title="Transgender women">transgender women</a> and <a href="/wiki/Non-binary_gender" title="Non-binary gender">non-binary</a> <a href="/wiki/Transfeminine" class="mw-redirect" title="Transfeminine">transfeminine</a> individuals. Some, in particular <a href="/wiki/Intersex" title="Intersex">intersex</a> people, but also some non-transgender people, take this form of therapy according to their personal needs and preferences. The purpose of the therapy is to cause the development of the secondary sex characteristics of the desired <a href="/wiki/Sex" title="Sex">sex</a>, such as <a href="/wiki/Breasts" class="mw-redirect" title="Breasts">breasts</a> and a feminine pattern of <a href="/wiki/Body_hair" title="Body hair">hair</a>, <a href="/wiki/Fat_distribution" class="mw-redirect" title="Fat distribution">fat</a>, and <a href="/wiki/Skeletal_muscle" title="Skeletal muscle">muscle</a> distribution. It cannot undo many of the changes produced by naturally occurring <a href="/wiki/Puberty" title="Puberty">puberty</a>, which may necessitate <a href="/wiki/Surgery" title="Surgery">surgery</a> and other treatments to reverse (see <a href="#Unaffected_characteristics">below</a>). The medications used for feminizing hormone therapy include <a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">estrogens</a>, <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogens</a>, <a href="/wiki/Progestogen" title="Progestogen">progestogens</a>, and <a href="/wiki/Gonadotropin-releasing_hormone_modulator" title="Gonadotropin-releasing hormone modulator">gonadotropin-releasing hormone modulators</a> (GnRH modulators). Feminizing hormone therapy has been empirically shown to reduce the distress and discomfort associated with <a href="/wiki/Gender_dysphoria" title="Gender dysphoria">gender dysphoria</a> in transfeminine individuals.<a href="#cite_note-7">[7]</a><a href="#cite_note-8">[8]</a><a href="#cite_note-9">[9]</a> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Requirements">Requirements</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=1" title="Edit section: Requirements">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Main articles: <a href="/wiki/Transgender_hormone_therapy#Requirements" class="mw-redirect" title="Transgender hormone therapy">Transgender hormone therapy § Requirements</a>, and <a href="/wiki/Transgender_hormone_therapy#Accessibility" class="mw-redirect" title="Transgender hormone therapy">Transgender hormone therapy § Accessibility</a></div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/DIY_transgender_hormone_therapy" title="DIY transgender hormone therapy">DIY transgender hormone therapy</a></div> Many physicians operate by the <a href="/wiki/World_Professional_Association_of_Transgender_Health" class="mw-redirect" title="World Professional Association of Transgender Health">World Professional Association of Transgender Health</a> (WPATH) <a href="/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People" class="mw-redirect" title="Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People">Standards of Care</a> (SoC) model and require <a href="/wiki/Psychotherapy" title="Psychotherapy">psychotherapy</a> and a <a href="/wiki/Letter_of_recommendation" title="Letter of recommendation">letter of recommendation</a> from a <a href="/wiki/Psychotherapist" class="mw-redirect" title="Psychotherapist">psychotherapist</a> in order for a transgender person to obtain hormone therapy.<a href="#cite_note-ColemanBockting2012-2">[2]</a> Other physicians operate by an <a href="/wiki/Informed_consent" title="Informed consent">informed consent</a> model and have no requirements for transgender hormone therapy aside from consent.<a href="#cite_note-ColemanBockting2012-2">[2]</a> Medications used in transgender hormone therapy are also sold without a prescription on the <a href="/wiki/Internet" title="Internet">Internet</a> by unregulated <a href="/wiki/Online_pharmacy" title="Online pharmacy">online pharmacies</a>, and some transgender women purchase these medications and treat themselves using a <a href="/wiki/Do-it-yourself" class="mw-redirect" title="Do-it-yourself">do-it-yourself</a> (DIY) or <a href="/wiki/Self-medication" title="Self-medication">self-medication</a> approach.<a href="#cite_note-Branstetter2016-10">[10]</a><a href="#cite_note-Newman2016-11">[11]</a> One reason that many transgender people turn to DIY hormone therapy is due to long waiting lists of up to years for standard physician-based hormone therapy in some parts of the world such as the <a href="/wiki/United_Kingdom" title="United Kingdom">United Kingdom</a>, as well as due to the often high costs of seeing a physician and the restrictive criteria that make some ineligible for treatment.<a href="#cite_note-Branstetter2016-10">[10]</a><a href="#cite_note-Newman2016-11">[11]</a> The accessibility of transgender hormone therapy differs throughout the world and throughout individual countries.<a href="#cite_note-ColemanBockting2012-2">[2]</a> <div class="mw-heading mw-heading2"><h2 id="Medications">Medications</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=2" title="Edit section: Medications">edit</a>]</div> A variety of different <a href="/wiki/Sex-hormonal_medication" class="mw-redirect" title="Sex-hormonal medication">sex-hormonal medications</a> are used in feminizing hormone therapy for <a href="/wiki/Trans_woman" title="Trans woman">transgender women</a>.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-Deutsch2016-3">[3]</a><a href="#cite_note-pmid28159148y-4">[4]</a> These include <a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">estrogens</a> to induce <a href="/wiki/Feminization_(biology)" title="Feminization (biology)">feminization</a> and suppress <a href="/wiki/Testosterone" title="Testosterone">testosterone</a> levels; <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogens</a> such as <a href="/wiki/Androgen_receptor_antagonist" class="mw-redirect" title="Androgen receptor antagonist">androgen receptor antagonists</a>, <a href="/wiki/Antigonadotropin" title="Antigonadotropin">antigonadotropins</a>, <a href="/wiki/GnRH_modulator" class="mw-redirect" title="GnRH modulator">GnRH modulators</a>, and <a href="/wiki/5%CE%B1-reductase_inhibitor" class="mw-redirect" title="5α-reductase inhibitor">5α-reductase inhibitors</a> to further oppose the effects of androgens like testosterone; and <a href="/wiki/Progestogen" title="Progestogen">progestogens</a> for various possible though uncertain benefits.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-Deutsch2016-3">[3]</a><a href="#cite_note-pmid28159148y-4">[4]</a> An estrogen in combination with an antiandrogen is the mainstay of feminizing hormone therapy for transgender women.<a href="#cite_note-Shore2014-12">[12]</a><a href="#cite_note-AlexanderJohnson-Mallard2017-13">[13]</a> <div class="mw-heading mw-heading3"><h3 id="Estrogens">Estrogens</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=3" title="Edit section: Estrogens">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Estrogen_(medication)#Transgender_women" title="Estrogen (medication)">Estrogen (medication) § Transgender women</a>, and <a href="/wiki/Estradiol_(medication)#Transgender_women" title="Estradiol (medication)">Estradiol (medication) § Transgender women</a></div> <a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">Estrogens</a> are the major sex hormones in women, and are responsible for the development and maintenance of feminine secondary sexual characteristics, such as breasts, wide hips, and a feminine pattern of fat distribution.<a href="#cite_note-pmid28159148y-4">[4]</a> Estrogens act by binding to and activating the <a href="/wiki/Estrogen_receptor" title="Estrogen receptor">estrogen receptor</a> (ER), their <a href="/wiki/Biological_target" title="Biological target">biological target</a> in the body.<a href="#cite_note-pmid16112947-14">[14]</a> A variety of different forms of estrogens are available and used medically.<a href="#cite_note-pmid16112947-14">[14]</a> The most common estrogens used in transgender women include <a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">estradiol</a>, which is the predominant natural estrogen in women, and <a href="/wiki/Estradiol_ester" class="mw-redirect" title="Estradiol ester">estradiol esters</a> such as <a href="/wiki/Estradiol_valerate" title="Estradiol valerate">estradiol valerate</a> and <a href="/wiki/Estradiol_cypionate" title="Estradiol cypionate">estradiol cypionate</a>, which are <a href="/wiki/Prodrug" title="Prodrug">prodrugs</a> of estradiol.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-pmid16112947-14">[14]</a> <a href="/wiki/Conjugated_estrogen" class="mw-redirect" title="Conjugated estrogen">Conjugated estrogens</a> (Premarin), which are used in <a href="/wiki/Menopausal_hormone_therapy" class="mw-redirect" title="Menopausal hormone therapy">menopausal hormone therapy</a>, and <a href="/wiki/Ethinylestradiol" title="Ethinylestradiol">ethinylestradiol</a>, which is used in <a href="/wiki/Birth_control_pill" class="mw-redirect" title="Birth control pill">birth control pills</a>, have been used in transgender women in the past, but are no longer recommended and are rarely used today due to their higher risks of <a href="/wiki/Blood_clot" class="mw-redirect" title="Blood clot">blood clots</a> and <a href="/wiki/Cardiovascular" class="mw-redirect" title="Cardiovascular">cardiovascular</a> problems.<a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a> Estrogens may be administered <a href="/wiki/Oral_administration" title="Oral administration">orally</a>, <a href="/wiki/Sublingual_administration" title="Sublingual administration">sublingually</a>, <a href="/wiki/Transdermal" title="Transdermal">transdermally</a>/<a href="/wiki/Topical_administration" class="mw-redirect" title="Topical administration">topically</a> (via <a href="/wiki/Transdermal_patch" title="Transdermal patch">patch</a> or <a href="/wiki/Gel_(medication)" class="mw-redirect" title="Gel (medication)">gel</a>), <a href="/wiki/Rectal_administration" title="Rectal administration">rectally</a>, by <a href="/wiki/Intramuscular_injection" title="Intramuscular injection">intramuscular</a> or <a href="/wiki/Subcutaneous_injection" class="mw-redirect" title="Subcutaneous injection">subcutaneous injection</a>, or by an <a href="/wiki/Implant_(medicine)" title="Implant (medicine)">implant</a>.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid28078219h-15">[15]</a><a href="#cite_note-16">[16]</a><a href="#cite_note-pmid2215269-17">[17]</a> <a href="/wiki/Parenteral" class="mw-redirect" title="Parenteral">Parenteral</a> (non-oral) routes are practically preferred, owing to a minimal or negligible risk of blood clots and cardiovascular issues.<a href="#cite_note-DahlFeldman-2015-5">[5]</a><a href="#cite_note-pmid30073551-18">[18]</a><a href="#cite_note-pmid29987313-19">[19]</a><a href="#cite_note-pmid17019433-20">[20]</a><a href="#cite_note-pmid17239273-21">[21]</a> The <a href="/wiki/Pharmacokinetics_of_estradiol" title="Pharmacokinetics of estradiol">pharmacokinetics of estradiol</a>'s routes of administration vary greatly. <a href="/wiki/Pharmacokinetics_of_estradiol#Sublingual_administration" title="Pharmacokinetics of estradiol">Sublingual</a> and rectal administration result in peak concentrations up to ten times higher than oral administration, and higher <a href="/wiki/Trough_level" title="Trough level">trough concentrations</a>. This makes frequent, small sublingual or rectal doses, a very efficient way to create a stable and constant increase in trough levels. A large amount of estradiol consumed sublingually, and especially <a href="/wiki/Pharmacokinetics_of_estradiol#Oral_administration" title="Pharmacokinetics of estradiol">orally</a> is <a href="/wiki/Estradiol#Metabolism" title="Estradiol">converted by the GI tract</a> into estrone and other compounds, causing a higher estrone:estradiol (E1:E2) ratio.<a href="#cite_note-22">[22]</a> This means oral doses are more subject to individual variances in enzymes and physiological chemistry. The extent of the estrone ratio's effects are unclear but, as a weaker estrogen agonist than estradiol, a high estrone level can reduce feminization by <a href="/wiki/Competitive_antagonist" class="mw-redirect" title="Competitive antagonist">competitive antagonism</a>. A high estrone ratio is linked to reduced skeletal growth in pubertal boys and insulin resistance in <a href="/wiki/Polycystic_ovary_syndrome" title="Polycystic ovary syndrome">PCOS</a>.<a href="#cite_note-23">[23]</a><a href="#cite_note-24">[24]</a><a href="#cite_note-25">[25]</a> The ratio is also known to be higher in early female puberty (~1:3), and lower in the later stages (~1-5). An average dose <a href="/wiki/Pharmacokinetics_of_estradiol#Intramuscular_injection" title="Pharmacokinetics of estradiol">intramuscular injection</a> can vary from far above to far below the average female range over the course of a week, depending on an individual's body.<a href="#cite_note-pmid1231448-26">[26]</a><a href="#cite_note-pmid7402086-27">[27]</a> <figure class="mw-halign-left" typeof="mw:File/Thumb"><a href="/wiki/File:Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4f/Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png/388px-Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png" decoding="async" width="388" height="432" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4f/Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png/581px-Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4f/Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png/775px-Estradiol_levels_with_rectal_administration_of_estradiol_in_women.png 2x" data-file-width="971" data-file-height="1082" /></a><figcaption>Estradiol blood levels with <a href="/wiki/Pharmacokinetics_of_estradiol#Rectal_administration" title="Pharmacokinetics of estradiol">rectal administration.</a></figcaption></figure> <figure class="mw-halign-center" typeof="mw:File/Thumb"><a href="/wiki/File:Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png/417px-Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png" decoding="async" width="417" height="381" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png/626px-Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png/834px-Estradiol_levels_with_oral_versus_sublingual_estradiol_in_postmenopausal_women.png 2x" data-file-width="1196" data-file-height="1093" /></a><figcaption>Estradiol levels with oral versus sublingual <a href="/wiki/Pharmacokinetics_of_estradiol" title="Pharmacokinetics of estradiol">routes of administration of estradiol</a> in postmenopausal women.</figcaption></figure> In addition to producing feminization, estrogens have <a href="/wiki/Antigonadotropic" class="mw-redirect" title="Antigonadotropic">antigonadotropic</a> effects, suppressing testosterone and other <a href="/wiki/Gonad" title="Gonad">gonadal</a> <a href="/wiki/Sex_hormone" title="Sex hormone">sex hormones</a>.<a href="#cite_note-pmid28078219h-15">[15]</a><a href="#cite_note-pmid29756046-28">[28]</a><a href="#cite_note-pmid27916515k-29">[29]</a> Levels of estradiol of 200 pg/mL and above suppress testosterone levels by about 90%, while estradiol levels of 500 pg/mL and above suppress testosterone levels by about 95%, or to an equivalent extent as <a href="/wiki/Orchiectomy" title="Orchiectomy">surgical castration</a> and GnRH modulators.<a href="#cite_note-pmid3242384-30">[30]</a><a href="#cite_note-pmid12686820-31">[31]</a> Lower levels of estradiol can also considerably but incompletely suppress testosterone production.<a href="#cite_note-pmid29756046-28">[28]</a> When testosterone levels are insufficiently suppressed by estradiol alone, <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogens</a> can be used to suppress or block the effects of residual testosterone.<a href="#cite_note-pmid28078219h-15">[15]</a> Oral estradiol often has difficulty adequately suppressing testosterone levels, due to the relatively low estradiol levels achieved with it.<a href="#cite_note-pmid29756046-28">[28]</a><a href="#cite_note-Leinung2014-32">[32]</a><a href="#cite_note-pmid29144822-33">[33]</a> <table class="wikitable sortable plainrowheaders floatright" style="margin: 1em auto; width:45%;"> <caption class="nowrap"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Medications_and_dosages_used_in_hormone_therapy_for_transgender_women" title="Template:Medications and dosages used in hormone therapy for transgender women"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Medications_and_dosages_used_in_hormone_therapy_for_transgender_women" title="Template talk:Medications and dosages used in hormone therapy for transgender women"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Medications_and_dosages_used_in_hormone_therapy_for_transgender_women" title="Special:EditPage/Template:Medications and dosages used in hormone therapy for transgender women"><abbr title="Edit this template">e</abbr></a></li></ul></div> Medications and dosages used in transgender women<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-Deutsch2016-3">[3]</a><a href="#cite_note-DahlFeldman2015-34">[34]</a><a href="#cite_note-Bourns2018-6">[6]</a><a href="#cite_note-WylieBarrett2014-35">[35]</a><a href="#cite_note-67">[a]</a> </caption> <tbody><tr> <th scope="col" style="width:100px;">Medication </th> <th scope="col" style="width:75px;">Brand name </th> <th scope="col" style="width:75px;">Type </th> <th scope="col" style="width:50px;">Route </th> <th scope="col" style="width:125px;">Dosage<a href="#cite_note-e2-youth-68">[b]</a> </th></tr> <tr> <th scope="row" style="background:#f8f9fa;" rowspan="5"><a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">Estradiol</a> </th> <td>Various</td> <td>Estrogen</td> <td>Oral</td> <td>2–10 mg/day </td></tr> <tr> <td>Various</td> <td>Estrogen</td> <td>Sublingual</td> <td>1–8 mg/day </td></tr> <tr> <td>Climara<a href="#cite_note-others-69">[c]</a></td> <td>Estrogen</td> <td><abbr title="transdermal">TD</abbr> patch</td> <td>25–400 μg/day </td></tr> <tr> <td>Divigel<a href="#cite_note-others-69">[c]</a></td> <td>Estrogen</td> <td>TD gel</td> <td>0.5–5 mg/day </td></tr> <tr> <td>Various</td> <td>Estrogen</td> <td><abbr title="subcutaneous">SC</abbr> implant</td> <td>50–200 mg every 6–24 mos </td></tr> <tr> <th scope="row" style="background:#f8f9fa;" rowspan="3"><a href="/wiki/Estradiol_valerate" title="Estradiol valerate">Estradiol valerate</a> </th> <td>Progynova</td> <td>Estrogen</td> <td>Oral</td> <td>2–10 mg/day </td></tr> <tr> <td>Progynova</td> <td>Estrogen</td> <td>Sublingual</td> <td>1–8 mg/day </td></tr> <tr> <td>Delestrogen<a href="#cite_note-others-69">[c]</a></td> <td>Estrogen</td> <td><abbr title="intramuscular injection">IM</abbr>, <abbr title="subcutaneous injection">SC</abbr></td> <td>2–10 mg/<abbr title="week(s)">wk</abbr> or 5–20 mg every 2 wks </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Estradiol_cypionate" title="Estradiol cypionate">Estradiol cypionate</a> </th> <td>Depo-Estradiol</td> <td>Estrogen</td> <td>IM, SC</td> <td>2–10 mg/wk or 5–20 mg every 2 wks </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Estradiol_dipropionate" title="Estradiol dipropionate">Estradiol dipropionate</a> </th> <td>Agofollin</td> <td>Estrogen</td> <td>IM, SC</td> <td>2–10 mg/wk or 5–20 mg every 2 wks </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Estradiol_benzoate" title="Estradiol benzoate">Estradiol benzoate</a> </th> <td>Progynon-B</td> <td>Estrogen</td> <td>IM, SC</td> <td>0.5–1.5 mg every 2–3 days </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Estriol_(medication)" title="Estriol (medication)">Estriol</a> </th> <td>Ovestin<a href="#cite_note-others-69">[c]</a></td> <td>Estrogen</td> <td>Oral</td> <td>4–6 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Spironolactone" title="Spironolactone">Spironolactone</a> </th> <td>Aldactone</td> <td>Antiandrogen</td> <td>Oral</td> <td>100–400 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;" rowspan="2"><a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">Cyproterone acetate</a> </th> <td>Androcur</td> <td rowspan="2">Antiandrogen; Progestogen</td> <td>Oral</td> <td>5–100 mg/day </td></tr> <tr> <td>Androcur Depot</td> <td>IM</td> <td>300 mg/month </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Bicalutamide" title="Bicalutamide">Bicalutamide</a> </th> <td>Casodex</td> <td>Antiandrogen</td> <td>Oral</td> <td>25–50 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Enzalutamide" title="Enzalutamide">Enzalutamide</a> </th> <td>Xtandi</td> <td>Antiandrogen</td> <td>Oral</td> <td>160 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/GnRH_analogue" class="mw-redirect" title="GnRH analogue">GnRH analogue</a> </th> <td>Various</td> <td>GnRH modulator</td> <td>Various</td> <td>Variable </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Elagolix" title="Elagolix">Elagolix</a> </th> <td>Orilissa</td> <td>GnRH antagonist</td> <td>Oral</td> <td>150 mg/day or 200 mg twice daily </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Finasteride" title="Finasteride">Finasteride</a> </th> <td>Propecia</td> <td><a href="/wiki/5%CE%B1-Reductase_inhibitor" title="5α-Reductase inhibitor"><abbr title="5α-reductase">5αR</abbr> inhibitor</a></td> <td>Oral</td> <td>1–5 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Dutasteride" title="Dutasteride">Dutasteride</a> </th> <td>Avodart</td> <td>5αR inhibitor</td> <td>Oral</td> <td>0.25–0.5 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Progesterone_(medication)" title="Progesterone (medication)">Progesterone</a> </th> <td>Prometrium<a href="#cite_note-others-69">[c]</a></td> <td>Progestogen</td> <td>Oral</td> <td>100–400 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;" rowspan="3"><a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">Medroxyprogesterone acetate</a> </th> <td>Provera</td> <td>Progestogen</td> <td>Oral</td> <td>2.5–40 mg/day </td></tr> <tr> <td>Depo-Provera</td> <td>Progestogen</td> <td>IM</td> <td>150 mg every 3 <abbr title="months">mos</abbr> </td></tr> <tr> <td>Depo-SubQ Provera 104</td> <td>Progestogen</td> <td>SC</td> <td>104 mg every 3 mos </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">Hydroxyprogesterone caproate</a> </th> <td>Proluton</td> <td>Progestogen</td> <td>IM</td> <td>250 mg/wk </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Dydrogesterone" title="Dydrogesterone">Dydrogesterone</a> </th> <td>Duphaston</td> <td>Progestogen</td> <td>Oral</td> <td>20 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Drospirenone" title="Drospirenone">Drospirenone</a> </th> <td>Slynd</td> <td>Progestogen</td> <td>Oral</td> <td>3 mg/day </td></tr> <tr> <th scope="row" style="background:#f8f9fa;"><a href="/wiki/Domperidone" title="Domperidone">Domperidone</a><a href="#cite_note-lactation-70">[d]</a> </th> <td>Motilium</td> <td>Prolactin releaser</td> <td>Oral</td> <td>30–80 mg/day<a href="#cite_note-div-71">[e]</a> </td></tr> <tr class="sortbottom"> <td colspan="5" style="width: 1px; background-color:#eaecf0; text-align: center;"><style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-lower-alpha"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-67"><a href="#cite_ref-67">^</a> Additional sources:<a href="#cite_note-pmid28159148-36">[36]</a><a href="#cite_note-pmid28078219-37">[37]</a><a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-pmid30861686-39">[39]</a><a href="#cite_note-FishmanPaliou2019-40">[40]</a><a href="#cite_note-Winkler-CrepazMüller2017_-41">[41]</a><a href="#cite_note-Urdl2009_-42">[42]</a><a href="#cite_note-pmid21449788-43">[43]</a><a href="#cite_note-Barrett2017-44">[44]</a><a href="#cite_note-TrombettaLiguori2015_-45">[45]</a><a href="#cite_note-pmid25403429-46">[46]</a><a href="#cite_note-EckstrandEhrenfeld2016-47">[47]</a><a href="#cite_note-pmid27916515-48">[48]</a><a href="#cite_note-CoxonSeal2018-49">[49]</a><a href="#cite_note-pmid17986639-50">[50]</a><a href="#cite_note-Athanasoulia-KasparStalla2019-51">[51]</a><a href="#cite_note-pmid25692882-52">[52]</a><a href="#cite_note-pmid24830596-53">[53]</a><a href="#cite_note-pmid12915619-54">[54]</a><a href="#cite_note-pmid25140398-55">[55]</a><a href="#cite_note-Arver2015-56">[56]</a><a href="#cite_note-pmid26830952-57">[57]</a><a href="#cite_note-AsschemanGooren1993-58">[58]</a><a href="#cite_note-pmid14510900-59">[59]</a><a href="#cite_note-Mirone2015_-60">[60]</a><a href="#cite_note-pmid30671393-61">[61]</a><a href="#cite_note-Israel2001_-62">[62]</a><a href="#cite_note-MajumderChatterjee2020-63">[63]</a><a href="#cite_note-pmid29372185-64">[64]</a><a href="#cite_note-pmid12674062-65">[65]</a><a href="#cite_note-OrilissaLabel-66">[66]</a> </li> <li id="cite_note-e2-youth-68"><a href="#cite_ref-e2-youth_68-0">^</a> Lower starting doses may be used in adolescents if being used in combination with a GnRH agonist or antagonist. </li> <li id="cite_note-others-69">^ <a href="#cite_ref-others_69-0">a</a> <a href="#cite_ref-others_69-1">b</a> <a href="#cite_ref-others_69-2">c</a> <a href="#cite_ref-others_69-3">d</a> <a href="#cite_ref-others_69-4">e</a> Also available under other brand names. </li> <li id="cite_note-lactation-70"><a href="#cite_ref-lactation_70-0">^</a> For <a href="/wiki/Induction_of_lactation" class="mw-redirect" title="Induction of lactation">induction of lactation</a> to allow for <a href="/wiki/Breastfeeding" title="Breastfeeding">breastfeeding</a> specifically. </li> <li id="cite_note-div-71"><a href="#cite_ref-div_71-0">^</a> Administered in divided doses. </li> </ol></div></div> </td></tr></tbody></table>Prior to <a href="/wiki/Orchiectomy" title="Orchiectomy">orchiectomy</a> (surgical removal of the gonads) or <a href="/wiki/Sex_reassignment_surgery_(male-to-female)" class="mw-redirect" title="Sex reassignment surgery (male-to-female)">sex reassignment surgery</a>, the doses of estrogens used in transgender women are often higher than replacement doses used in cisgender women.<a href="#cite_note-72">[67]</a><a href="#cite_note-WylieFung2009-73">[68]</a><a href="#cite_note-TrombettaLiguori2015-74">[69]</a> This is to help suppress testosterone levels.<a href="#cite_note-WylieFung2009-73">[68]</a> The <a href="/wiki/Endocrine_Society" title="Endocrine Society">Endocrine Society</a> (2017) recommends maintaining estradiol levels roughly within the normal average range for premenopausal women of about 100 to 200 pg/mL.<a href="#cite_note-pmid28945902-1">[1]</a> However, it notes that these physiological levels of estradiol are usually unable to suppress testosterone levels into the female range.<a href="#cite_note-pmid28945902-1">[1]</a> A 2018 <a href="/wiki/Cochrane_(organisation)" title="Cochrane (organisation)">Cochrane</a> review proposal questioned the notion of keeping estradiol levels lower in transgender women, which results in incomplete suppression of testosterone levels and necessitates the addition of antiandrogens.<a href="#cite_note-HauptHenke2018-75">[70]</a> The review proposal noted that high-dose parenteral estradiol is known to be safe.<a href="#cite_note-HauptHenke2018-75">[70]</a> The Endocrine Society itself recommends dosages of injected estradiol esters that result in estradiol levels markedly in excess of the normal female range, for instance 10 mg per week estradiol valerate by intramuscular injection.<a href="#cite_note-pmid28945902-1">[1]</a> A single such injection results in estradiol levels of about 1,250 pg/mL at peak and levels of around 200 pg/mL after 7 days.<a href="#cite_note-pmid1231448-26">[26]</a><a href="#cite_note-pmid7402086-27">[27]</a> Dosages of estrogens can be reduced after an orchiectomy or sex reassignment surgery, when gonadal testosterone suppression is no longer needed.<a href="#cite_note-DahlFeldman-2015-5">[5]</a> <figure typeof="mw:File/Thumb"><a href="/wiki/File:Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/31/Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png/350px-Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png" decoding="async" width="350" height="284" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/31/Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png/525px-Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/31/Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png/700px-Testosterone_levels_as_a_function_of_estradiol_levels_during_oral_estradiol_therapy_in_transgender_women.png 2x" data-file-width="1565" data-file-height="1271" /></a><figcaption>Testosterone levels in relation to estradiol levels (and corresponding estradiol dosages) during therapy with oral estradiol alone or in combination with an antiandrogen in transgender women.<a href="#cite_note-pmid29756046-28">[28]</a> The dashed purple line is the upper limit for the female/castrate range (~50 ng/dL) and the dashed grey line is the testosterone level in a comparison group of post-operative transgender women (21.7 ng/dL).<a href="#cite_note-pmid29756046-28">[28]</a></figcaption></figure> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png/350px-Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png" decoding="async" width="350" height="219" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png/525px-Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/7d/Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png/700px-Estradiol_and_testosterone_levels_with_a_single_intramuscular_injection_of_320_mg_polyestradiol_phosphate_in_men.png 2x" data-file-width="1767" data-file-height="1108" /></a><figcaption>Estradiol and testosterone levels over 12 weeks after a single intramuscular injection of 320 mg <a href="/wiki/Polyestradiol_phosphate" title="Polyestradiol phosphate">polyestradiol phosphate</a>, a <a href="/wiki/Polymer" title="Polymer">polymeric</a> estradiol ester and prodrug, in men with prostate cancer.<a href="#cite_note-pmid8610057-76">[71]</a> Demonstrates the suppression of testosterone levels by parenteral estradiol.</figcaption></figure> <div class="mw-heading mw-heading3"><h3 id="Antiandrogens">Antiandrogens</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=4" title="Edit section: Antiandrogens">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Antiandrogen#Transgender_hormone_therapy" title="Antiandrogen">Antiandrogen § Transgender hormone therapy</a></div> <a href="/wiki/Antiandrogen" title="Antiandrogen">Antiandrogens</a> are medications that prevent the effects of <a href="/wiki/Androgen" title="Androgen">androgens</a> in the body.<a href="#cite_note-GavaSeracchioli2017-77">[72]</a><a href="#cite_note-pmid11502457-78">[73]</a> Androgens, such as <a href="/wiki/Testosterone" title="Testosterone">testosterone</a> and <a href="/wiki/Dihydrotestosterone" title="Dihydrotestosterone">dihydrotestosterone</a> (DHT), are the major sex hormones in individuals with <a href="/wiki/Testicle" title="Testicle">testes</a>, and are responsible for the development and maintenance of masculine <a href="/wiki/Secondary_sex_characteristic" title="Secondary sex characteristic">secondary sex characteristics</a>, such as a <a href="/wiki/Deep_voice" class="mw-redirect" title="Deep voice">deep voice</a>, <a href="/wiki/Broad_shoulder" class="mw-redirect" title="Broad shoulder">broad shoulders</a>, and a masculine pattern of <a href="/wiki/Hair" title="Hair">hair</a>, <a href="/wiki/Muscle" title="Muscle">muscle</a>, and <a href="/wiki/Fat_distribution" class="mw-redirect" title="Fat distribution">fat distribution</a>.<a href="#cite_note-MelmedPolonsky2015-79">[74]</a><a href="#cite_note-Boslaugh2018-80">[75]</a> In addition, androgens stimulate <a href="/wiki/Sex_drive" class="mw-redirect" title="Sex drive">sex drive</a> and the frequency of <a href="/wiki/Spontaneous_erection" class="mw-redirect" title="Spontaneous erection">spontaneous erections</a> and are responsible for <a href="/wiki/Acne" title="Acne">acne</a>, <a href="/wiki/Body_odor" title="Body odor">body odor</a>, and <a href="/wiki/Pattern_hair_loss" title="Pattern hair loss">androgen-dependent scalp hair loss</a>.<a href="#cite_note-MelmedPolonsky2015-79">[74]</a><a href="#cite_note-Boslaugh2018-80">[75]</a> Androgens also have functional <a href="/wiki/Antiestrogen" title="Antiestrogen">antiestrogenic</a> effects in the breasts and oppose estrogen-mediated <a href="/wiki/Breast_development" title="Breast development">breast development</a>, even at low levels.<a href="#cite_note-81">[76]</a> Androgens act by binding to and activating the <a href="/wiki/Androgen_receptor" title="Androgen receptor">androgen receptor</a>, their <a href="/wiki/Biological_target" title="Biological target">biological target</a> in the body.<a href="#cite_note-pmid29481861-82">[77]</a> Antiandrogens work by blocking androgens from binding to the androgen receptor and/or by inhibiting or suppressing the <a href="/wiki/Biosynthesis" title="Biosynthesis">production</a> of androgens.<a href="#cite_note-GavaSeracchioli2017-77">[72]</a> Antiandrogens that directly block the androgen receptor are known as <a href="/wiki/Androgen_receptor_antagonist" class="mw-redirect" title="Androgen receptor antagonist">androgen receptor antagonists</a> or blockers, while antiandrogens that <a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">inhibit</a> the <a href="/wiki/Enzyme" title="Enzyme">enzymatic</a> <a href="/wiki/Biosynthesis" title="Biosynthesis">biosynthesis</a> of androgens are known as <a href="/wiki/Androgen_synthesis_inhibitor" title="Androgen synthesis inhibitor">androgen synthesis inhibitors</a> and antiandrogens that suppress androgen production in the <a href="/wiki/Gonad" title="Gonad">gonads</a> are known as <a href="/wiki/Antigonadotropin" title="Antigonadotropin">antigonadotropins</a>.<a href="#cite_note-pmid11502457-78">[73]</a> <a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">Estrogens</a> and <a href="/wiki/Progestin" class="mw-redirect" title="Progestin">progestogens</a> are antigonadotropins and hence are functional antiandrogens.<a href="#cite_note-pmid28078219h-15">[15]</a><a href="#cite_note-Brueggemeier2006-83">[78]</a><a href="#cite_note-pmid10997774-84">[79]</a><a href="#cite_note-pmid368741-85">[80]</a> The purpose of the use of antiandrogens in transgender women is to block or suppress residual testosterone that is not suppressed by estrogens alone.<a href="#cite_note-pmid28078219h-15">[15]</a><a href="#cite_note-GavaSeracchioli2017-77">[72]</a><a href="#cite_note-pmid27916515k-29">[29]</a> Additional antiandrogen therapy is not necessarily required if testosterone levels are in the normal female range or if the person has undergone <a href="/wiki/Orchiectomy" title="Orchiectomy">orchiectomy</a>.<a href="#cite_note-pmid28078219h-15">[15]</a><a href="#cite_note-GavaSeracchioli2017-77">[72]</a><a href="#cite_note-pmid27916515k-29">[29]</a> However, individuals with testosterone levels in the normal female range and with persisting androgen-dependent skin and/or hair symptoms, such as acne, <a href="/wiki/Seborrhea" class="mw-redirect" title="Seborrhea">seborrhea</a>, <a href="/wiki/Oily_skin" class="mw-redirect" title="Oily skin">oily skin</a>, or scalp hair loss, can potentially still benefit from the addition of an antiandrogen, as antiandrogens can reduce or eliminate such symptoms.<a href="#cite_note-LottiMaggi2015-86">[81]</a><a href="#cite_note-pmid26138647-87">[82]</a><a href="#cite_note-ClapauchWeiss2017-88">[83]</a> <div class="mw-heading mw-heading4"><h4 id="Steroidal_antiandrogens">Steroidal antiandrogens</h4>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=5" title="Edit section: Steroidal antiandrogens">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Spironolactone#Transgender_hormone_therapy" title="Spironolactone">Spironolactone § Transgender hormone therapy</a>, and <a href="/wiki/Cyproterone_acetate#Transgender_hormone_therapy" title="Cyproterone acetate">Cyproterone acetate § Transgender hormone therapy</a></div> <a href="/wiki/Steroidal_antiandrogen" title="Steroidal antiandrogen">Steroidal antiandrogens</a> are antiandrogens that resemble <a href="/wiki/Steroid_hormone" title="Steroid hormone">steroid hormones</a> like testosterone and <a href="/wiki/Progesterone" title="Progesterone">progesterone</a> in <a href="/wiki/Chemical_structure" title="Chemical structure">chemical structure</a>.<a href="#cite_note-pmid10637363-89">[84]</a> They are the most commonly used antiandrogens in transgender women.<a href="#cite_note-ColemanBockting2012-2">[2]</a> <a href="/wiki/Spironolactone" title="Spironolactone">Spironolactone</a> (Aldactone), which is relatively safe and inexpensive, is the most frequently used antiandrogen in the <a href="/wiki/United_States" title="United States">United States</a>.<a href="#cite_note-Schechter2016-90">[85]</a><a href="#cite_note-CarrollMizock2017-91">[86]</a> <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">Cyproterone acetate</a> (Androcur), which is unavailable in the United States, is widely used in <a href="/wiki/Europe" title="Europe">Europe</a>, <a href="/wiki/Canada" title="Canada">Canada</a>, and the rest of the world.<a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-GavaSeracchioli2017-77">[72]</a><a href="#cite_note-Schechter2016-90">[85]</a><a href="#cite_note-Erickson-Schroth2014-92">[87]</a> <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">Medroxyprogesterone acetate</a> (Provera, Depo-Provera), a similar medication, is sometimes used in place of cyproterone acetate in the United States.<a href="#cite_note-JamesonGroot2010-93">[88]</a><a href="#cite_note-EttnerMonstrey2016-94">[89]</a> <figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Testosterone_levels_with_estradiol_alone,_estradiol_plus_spironolactone,_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/17/Testosterone_levels_with_estradiol_alone%2C_estradiol_plus_spironolactone%2C_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png/350px-Testosterone_levels_with_estradiol_alone%2C_estradiol_plus_spironolactone%2C_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png" decoding="async" width="350" height="270" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/17/Testosterone_levels_with_estradiol_alone%2C_estradiol_plus_spironolactone%2C_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png/525px-Testosterone_levels_with_estradiol_alone%2C_estradiol_plus_spironolactone%2C_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/17/Testosterone_levels_with_estradiol_alone%2C_estradiol_plus_spironolactone%2C_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png/700px-Testosterone_levels_with_estradiol_alone%2C_estradiol_plus_spironolactone%2C_and_estradiol_plus_cyproterone_acetate_in_transfeminine_people.png 2x" data-file-width="1844" data-file-height="1422" /></a><figcaption><a href="/wiki/Testosterone" title="Testosterone">Testosterone</a> levels with <a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">estradiol</a> (E2) alone or in combination with an <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogen</a> (AA) in the form of <a href="/wiki/Spironolactone" title="Spironolactone">spironolactone</a> (SPL) or <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a> (CPA) in transfeminine people.<a href="#cite_note-pmid31234145-95">[90]</a> Estradiol was used in the form of oral <a href="/wiki/Estradiol_valerate" title="Estradiol valerate">estradiol valerate</a> (EV) in almost all cases.<a href="#cite_note-pmid31234145-95">[90]</a> The dashed horizontal line is the upper limit of the female/castrate range (~50 ng/dL).</figcaption></figure> Spironolactone is an <a href="/wiki/Antimineralocorticoid" class="mw-redirect" title="Antimineralocorticoid">antimineralocorticoid</a> (antagonist of the <a href="/wiki/Mineralocorticoid_receptor" title="Mineralocorticoid receptor">mineralocorticoid receptor</a>) and <a href="/wiki/Potassium-sparing_diuretic" title="Potassium-sparing diuretic">potassium-sparing diuretic</a>, which is mainly used to treat <a href="/wiki/High_blood_pressure" class="mw-redirect" title="High blood pressure">high blood pressure</a>, <a href="/wiki/Edema" title="Edema">edema</a>, <a href="/wiki/Hyperaldosteronism" title="Hyperaldosteronism">high aldosterone levels</a>, and <a href="/wiki/Hypokalemia" title="Hypokalemia">low potassium levels</a> caused by other <a href="/wiki/Diuretic" title="Diuretic">diuretics</a>, among other uses.<a href="#cite_note-pmid28634268-96">[91]</a> Spironolactone is an antiandrogen as a secondary and originally unintended action.<a href="#cite_note-pmid28634268-96">[91]</a> It works as an antiandrogen mainly by acting as an androgen receptor antagonist.<a href="#cite_note-pmid8144871-97">[92]</a> The medication is also a weak <a href="/wiki/Steroidogenesis_inhibitor" title="Steroidogenesis inhibitor">steroidogenesis inhibitor</a>, and inhibits the <a href="/wiki/Enzyme" title="Enzyme">enzymatic</a> <a href="/wiki/Biosynthesis" title="Biosynthesis">synthesis</a> of androgens.<a href="#cite_note-pmid984618-98">[93]</a><a href="#cite_note-pmid8144871-97">[92]</a><a href="#cite_note-pmid8094898-99">[94]</a> However, this action is of low <a href="/wiki/Potency_(pharmacology)" title="Potency (pharmacology)">potency</a>, and spironolactone has mixed and inconsistent effects on hormone levels.<a href="#cite_note-pmid984618-98">[93]</a><a href="#cite_note-pmid8144871-97">[92]</a><a href="#cite_note-pmid8094898-99">[94]</a><a href="#cite_note-pmid1826112-100">[95]</a><a href="#cite_note-pmid28155090-101">[96]</a> In any case, testosterone levels are usually unchanged by spironolactone.<a href="#cite_note-pmid984618-98">[93]</a><a href="#cite_note-pmid8144871-97">[92]</a><a href="#cite_note-pmid8094898-99">[94]</a><a href="#cite_note-pmid1826112-100">[95]</a><a href="#cite_note-pmid28155090-101">[96]</a> Studies in transgender women have found testosterone levels to be unaltered with spironolactone<a href="#cite_note-pmid29756046-28">[28]</a> or to be decreased.<a href="#cite_note-pmid31234145-95">[90]</a> Spironolactone is described as a relatively weak antiandrogen.<a href="#cite_note-pmid11322868-102">[97]</a><a href="#cite_note-Wu2012-103">[98]</a><a href="#cite_note-BenniVemer1990-104">[99]</a> It is widely used in the treatment of <a href="/wiki/Acne" title="Acne">acne</a>, <a href="/wiki/Hirsutism" title="Hirsutism">excessive hair growth</a>, and <a href="/wiki/Hyperandrogenism" title="Hyperandrogenism">hyperandrogenism</a> in women, who have much lower testosterone levels than men.<a href="#cite_note-pmid1826112-100">[95]</a><a href="#cite_note-pmid28155090-101">[96]</a> Because of its antimineralocorticoid activity, spironolactone has antimineralocorticoid side effects<a href="#cite_note-pmid2942707-105">[100]</a> and can cause <a href="/wiki/Hyperkalemia" title="Hyperkalemia">high potassium levels</a>.<a href="#cite_note-Aronson2009-106">[101]</a><a href="#cite_note-pmid26404748-107">[102]</a> Hospitalization and/or death can potentially result from high potassium levels due to spironolactone,<a href="#cite_note-Aronson2009-106">[101]</a><a href="#cite_note-pmid26404748-107">[102]</a><a href="#cite_note-pmid15295047-108">[103]</a> but the risk of high potassium levels in people taking spironolactone appears to be minimal in those without risk factors for it.<a href="#cite_note-pmid28155090-101">[96]</a><a href="#cite_note-pmid26897386-109">[104]</a><a href="#cite_note-pmid25796182-110">[105]</a> As such, monitoring of potassium levels may not be necessary in most cases.<a href="#cite_note-pmid28155090-101">[96]</a><a href="#cite_note-pmid26897386-109">[104]</a><a href="#cite_note-pmid25796182-110">[105]</a> Spironolactone has been found to decrease the <a href="/wiki/Bioavailability" title="Bioavailability">bioavailability</a> of high doses of oral estradiol.<a href="#cite_note-pmid29756046-28">[28]</a> Although widely employed, the use of spironolactone as an antiandrogen in transgender women has recently been questioned due to the various shortcomings of the medication for such purposes.<a href="#cite_note-pmid29756046-28">[28]</a> <a href="/wiki/Cyproterone" title="Cyproterone">Cyproterone</a> acetate is an antiandrogen and progestin which is used in the treatment of numerous <a href="/wiki/Androgen-dependent_condition" title="Androgen-dependent condition">androgen-dependent conditions</a> and is also used as a progestogen in <a href="/wiki/Birth_control_pill" class="mw-redirect" title="Birth control pill">birth control pills</a>.<a href="#cite_note-pmid8005205-111">[106]</a><a href="#cite_note-pmid12600226-112">[107]</a> It works primarily as an antigonadotropin, secondarily to its potent progestogenic activity, and strongly suppresses gonadal androgen production.<a href="#cite_note-pmid8005205-111">[106]</a><a href="#cite_note-pmid27916515k-29">[29]</a> Cyproterone acetate at a dosage of 5 to 10 mg/day has been found to lower testosterone levels in men by about 50 to 70%,<a href="#cite_note-pmid949890-113">[108]</a><a href="#cite_note-MoltzRömmler1978-114">[109]</a><a href="#cite_note-pmid6771091-115">[110]</a><a href="#cite_note-pmid6771095-116">[111]</a> while a dosage of 100 mg/day has been found to lower testosterone levels in men by about 75%.<a href="#cite_note-pmid6237116-117">[112]</a><a href="#cite_note-pmid7000222-118">[113]</a> The combination of 25 mg/day cyproterone acetate and a moderate dosage of <a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">estradiol</a> has been found to suppress testosterone levels in transgender women by about 95%.<a href="#cite_note-FungHellstern-Layefsky2017-119">[114]</a> In combination with estrogen, 10, 25, and 50 mg/day cyproterone acetate have all shown the same degree of testosterone suppression.<a href="#cite_note-pmid31751300-120">[115]</a> In addition to its actions as an antigonadotropin, cyproterone acetate is an androgen receptor antagonist.<a href="#cite_note-pmid8005205-111">[106]</a><a href="#cite_note-GavaSeracchioli2017-77">[72]</a> However, this action is relatively insignificant at low dosages, and is more important at the high doses of cyproterone acetate that are used in the treatment of prostate cancer (100–300 mg/day).<a href="#cite_note-pmid9476091-121">[116]</a><a href="#cite_note-Springer2012-122">[117]</a> Cyproterone acetate can cause <a href="/wiki/Elevated_liver_enzymes" class="mw-redirect" title="Elevated liver enzymes">elevated liver enzymes</a> and <a href="/wiki/Hepatotoxicity" title="Hepatotoxicity">liver damage</a>, including <a href="/wiki/Liver_failure" title="Liver failure">liver failure</a>.<a href="#cite_note-GavaSeracchioli2017-77">[72]</a><a href="#cite_note-pmid15604569-123">[118]</a> However, this occurs mostly in prostate cancer patients who take very high doses of cyproterone acetate; liver toxicity has not been reported in transgender women.<a href="#cite_note-GavaSeracchioli2017-77">[72]</a> Cyproterone acetate also has a variety of other <a href="/wiki/Adverse_effect" title="Adverse effect">adverse effects</a>, such as <a href="/wiki/Fatigue" title="Fatigue">fatigue</a> and <a href="/wiki/Weight_gain" title="Weight gain">weight gain</a>, and risks, such as <a href="/wiki/Blood_clot" class="mw-redirect" title="Blood clot">blood clots</a> and <a href="/wiki/Benign_tumor" title="Benign tumor">benign</a> <a href="/wiki/Brain_tumor" title="Brain tumor">brain tumors</a>, among others.<a href="#cite_note-pmid27916515k-29">[29]</a><a href="#cite_note-GavaSeracchioli2017-77">[72]</a><a href="#cite_note-Hammerstein1990-124">[119]</a> High dosages of cyproterone-based medication have been linked with <a href="/wiki/Meningioma" title="Meningioma">meningioma</a>.<a href="#cite_note-125">[120]</a> Periodic monitoring of liver enzymes and <a href="/wiki/Prolactin" title="Prolactin">prolactin</a> levels may be advisable during cyproterone acetate therapy. <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">Medroxyprogesterone acetate</a> is a progestin that is related to cyproterone acetate and is sometimes used as an alternative to it.<a href="#cite_note-JamesonGroot2010-93">[88]</a><a href="#cite_note-EttnerMonstrey2016-94">[89]</a> It is specifically used as an alternative to cyproterone acetate in the United States, where cyproterone acetate is not approved for medical use and is unavailable.<a href="#cite_note-JamesonGroot2010-93">[88]</a><a href="#cite_note-EttnerMonstrey2016-94">[89]</a> Medroxyprogesterone acetate suppresses testosterone levels in transgender women similarly to cyproterone acetate.<a href="#cite_note-EttnerMonstrey2016-94">[89]</a><a href="#cite_note-pmid29756046-28">[28]</a> Oral medroxyprogesterone acetate has been found to suppress testosterone levels in men by about 30 to 75% across a dosage range of 20 to 100 mg/day.<a href="#cite_note-126">[121]</a> In contrast to cyproterone acetate however, medroxyprogesterone acetate is not also an androgen receptor antagonist.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid10077001-127">[122]</a> Medroxyprogesterone acetate has similar side effects and risks as cyproterone acetate, but is not associated with liver problems.<a href="#cite_note-pmid12954518-128">[123]</a><a href="#cite_note-pmid2942707-105">[100]</a> Numerous other progestogens and by extension antigonadotropins have been used to suppress testosterone levels in men and are likely useful for such purposes in transgender women as well.<a href="#cite_note-129">[124]</a> Progestogens alone are in general able to suppress testosterone levels in men by a maximum of about 70 to 80%, or to just above female/<a href="/wiki/Castration" title="Castration">castrate</a> levels when used at sufficiently high doses.<a href="#cite_note-WeinKavoussi2011-130">[125]</a><a href="#cite_note-HughesHasan2013-131">[126]</a><a href="#cite_note-WenderothJacobi1983-132">[127]</a> The combination of a sufficient dosage of a progestogen with very small doses of an estrogen (e.g., as little as 0.5–1.5 mg/day oral estradiol) is synergistic in terms of antigonadotropic effect and is able to fully suppress gonadal testosterone production, reducing testosterone levels to the female/castrate range.<a href="#cite_note-SchröderRadlmaier2009-133">[128]</a><a href="#cite_note-pmid3552544-134">[129]</a> <div class="mw-heading mw-heading4"><h4 id="Nonsteroidal_antiandrogens">Nonsteroidal antiandrogens</h4>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=6" title="Edit section: Nonsteroidal antiandrogens">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Bicalutamide_medical_uses#Transgender_hormone_therapy" class="mw-redirect" title="Bicalutamide medical uses">Bicalutamide medical uses § Transgender hormone therapy</a>, <a href="/wiki/Nilutamide#Transgender_hormone_therapy" title="Nilutamide">Nilutamide § Transgender hormone therapy</a>, and <a href="/wiki/Flutamide#Transgender_hormone_therapy" title="Flutamide">Flutamide § Transgender hormone therapy</a></div> <a href="/wiki/Nonsteroidal_antiandrogen" title="Nonsteroidal antiandrogen">Nonsteroidal antiandrogens</a> are antiandrogens which are <a href="/wiki/Nonsteroidal" title="Nonsteroidal">nonsteroidal</a> and hence unrelated to steroid hormones in terms of <a href="/wiki/Chemical_structure" title="Chemical structure">chemical structure</a>.<a href="#cite_note-pmid10637363-89">[84]</a><a href="#cite_note-LemkeWilliams2008-135">[130]</a> These medications are primarily used in the treatment of prostate cancer,<a href="#cite_note-LemkeWilliams2008-135">[130]</a> but are also used for other purposes such as the treatment of <a href="/wiki/Acne" title="Acne">acne</a>, <a href="/wiki/Hirsutism" title="Hirsutism">excessive facial/body hair growth</a>, and <a href="/wiki/Hyperandrogenism" title="Hyperandrogenism">high androgen levels</a> in women.<a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-pmid28379593-136">[131]</a><a href="#cite_note-pmid24455796-137">[132]</a><a href="#cite_note-pmid29211888-138">[133]</a> Unlike steroidal antiandrogens, nonsteroidal antiandrogens are highly <a href="/wiki/Binding_selectivity" title="Binding selectivity">selective</a> for the androgen receptor and act as pure androgen receptor antagonists.<a href="#cite_note-LemkeWilliams2008-135">[130]</a><a href="#cite_note-FiggChau2010-139">[134]</a> Similarly to spironolactone however, they do not lower androgen levels, and instead work exclusively by preventing androgens from activating the androgen receptor.<a href="#cite_note-LemkeWilliams2008-135">[130]</a><a href="#cite_note-FiggChau2010-139">[134]</a> Nonsteroidal antiandrogens are more <a href="/wiki/Efficacy" title="Efficacy">efficacious</a> androgen receptor antagonists than are steroidal antiandrogens,<a href="#cite_note-pmid10637363-89">[84]</a><a href="#cite_note-pmid9000189-140">[135]</a> and for this reason, in conjunction with GnRH modulators, have largely replaced steroidal antiandrogens in the treatment of prostate cancer.<a href="#cite_note-LemkeWilliams2008-135">[130]</a><a href="#cite_note-ChabnerLongo2010-141">[136]</a> The nonsteroidal antiandrogens that have been used in transgender women include the first-generation medications <a href="/wiki/Flutamide" title="Flutamide">flutamide</a> (Eulexin), <a href="/wiki/Nilutamide" title="Nilutamide">nilutamide</a> (Anandron, Nilandron), and <a href="/wiki/Bicalutamide" title="Bicalutamide">bicalutamide</a> (Casodex).<a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-142">[137]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a><a href="#cite_note-Deutsch2016-3">[3]</a>Newer and even more efficacious second-generation nonsteroidal antiandrogens like <a href="/wiki/Enzalutamide" title="Enzalutamide">enzalutamide</a> (Xtandi), <a href="/wiki/Apalutamide" title="Apalutamide">apalutamide</a> (Erleada), and <a href="/wiki/Darolutamide" title="Darolutamide">darolutamide</a> (Nubeqa) also exist, but are very expensive due to <a href="/wiki/Generic_drug" title="Generic drug">generics</a> being unavailable and have not been used in transgender women.<a href="#cite_note-pmid29730201-143">[138]</a><a href="#cite_note-pmid29497605-144">[139]</a> Flutamide and nilutamide have relatively high <a href="/wiki/Toxicity" title="Toxicity">toxicity</a>, including considerable risks of <a href="/wiki/Hepatotoxicity" title="Hepatotoxicity">liver damage</a> and <a href="/wiki/Lung_disease" class="mw-redirect" title="Lung disease">lung disease</a>.<a href="#cite_note-pmid25270521-145">[140]</a><a href="#cite_note-pmid28379593-136">[131]</a> Due to its risks, the use of flutamide in cisgender and transgender women is now limited and discouraged.<a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-pmid28379593-136">[131]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a> Flutamide and nilutamide have largely been superseded by bicalutamide in clinical practice,<a href="#cite_note-Moser2008-146">[141]</a><a href="#cite_note-Demos2011-147">[142]</a> with bicalutamide accounting for almost 90% of nonsteroidal antiandrogen prescriptions in the <a href="/wiki/United_States" title="United States">United States</a> by the mid-2000s.<a href="#cite_note-HHS2010-148">[143]</a><a href="#cite_note-FiggChau2010-139">[134]</a> Bicalutamide is said to have excellent <a href="/wiki/Drug_tolerability" class="mw-redirect" title="Drug tolerability">tolerability</a> and <a href="/wiki/Drug_safety" class="mw-redirect" title="Drug safety">safety</a> relative to flutamide and nilutamide, as well as in comparison to cyproterone acetate.<a href="#cite_note-pmid8560681-149">[144]</a><a href="#cite_note-pmid23013078-150">[145]</a><a href="#cite_note-RamonDenis2007-151">[146]</a> It has few to no side effects in women.<a href="#cite_note-pmid24455796-137">[132]</a><a href="#cite_note-pmid29211888-138">[133]</a> Despite its greatly improved tolerability and safety profile however, bicalutamide does still have a small risk of elevated liver enzymes and association with rare cases of serious liver damage and lung disease.<a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-pmid25270521-145">[140]</a><a href="#cite_note-GretarsdottirBjornsdottir2018-152">[147]</a> Nonsteroidal antiandrogens like bicalutamide may be a particularly favorable option for transgender women who wish to preserve <a href="/wiki/Sex_drive" class="mw-redirect" title="Sex drive">sex drive</a>, <a href="/wiki/Sexual_function" title="Sexual function">sexual function</a>, and/or <a href="/wiki/Fertility" title="Fertility">fertility</a>, relative to antiandrogens that suppress testosterone levels and can greatly disrupt these functions such as cyproterone acetate and GnRH modulators.<a href="#cite_note-pmid29352423-153">[148]</a><a href="#cite_note-IversenMelezinek2001-154">[149]</a><a href="#cite_note-MorganteGradini2001-155">[150]</a> However, estrogens suppress testosterone levels and at high doses can markedly disrupt sex drive and function and fertility on their own.<a href="#cite_note-156">[151]</a><a href="#cite_note-Salam2003-157">[152]</a><a href="#cite_note-pmid7500443-158">[153]</a> Moreover, disruption of gonadal function and fertility by estrogens may be permanent after extended exposure.<a href="#cite_note-Salam2003-157">[152]</a><a href="#cite_note-pmid7500443-158">[153]</a> <div class="mw-heading mw-heading4"><h4 id="GnRH_modulators">GnRH modulators</h4>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=7" title="Edit section: GnRH modulators">edit</a>]</div> <a href="/wiki/GnRH_modulator" class="mw-redirect" title="GnRH modulator">GnRH modulators</a> are antigonadotropins and hence functional antiandrogens.<a href="#cite_note-pmid17237842-159">[154]</a> In both males and females, <a href="/wiki/Gonadotropin-releasing_hormone" title="Gonadotropin-releasing hormone">gonadotropin-releasing hormone</a> (GnRH) is produced in the <a href="/wiki/Hypothalamus" title="Hypothalamus">hypothalamus</a> and induces the <a href="/wiki/Secretion" title="Secretion">secretion</a> of the <a href="/wiki/Gonadotropin" title="Gonadotropin">gonadotropins</a> <a href="/wiki/Luteinizing_hormone" title="Luteinizing hormone">luteinizing hormone</a> (LH) and <a href="/wiki/Follicle-stimulating_hormone" title="Follicle-stimulating hormone">follicle-stimulating hormone</a> (FSH) from the <a href="/wiki/Pituitary_gland" title="Pituitary gland">pituitary gland</a>.<a href="#cite_note-pmid17237842-159">[154]</a> The gonadotropins signal the <a href="/wiki/Gonad" title="Gonad">gonads</a> to make <a href="/wiki/Sex_hormone" title="Sex hormone">sex hormones</a> such as testosterone and estradiol.<a href="#cite_note-pmid17237842-159">[154]</a> GnRH modulators bind to and inhibit the <a href="/wiki/GnRH_receptor" class="mw-redirect" title="GnRH receptor">GnRH receptor</a>, thereby preventing gonadotropin release.<a href="#cite_note-pmid17237842-159">[154]</a> As a result of this, GnRH modulators are able to completely shut-down gonadal sex hormone production, and can decrease testosterone levels in men and transgender women by about 95%, or to an equivalent extent as <a href="/wiki/Orchiectomy" title="Orchiectomy">surgical castration</a>.<a href="#cite_note-pmid17237842-159">[154]</a><a href="#cite_note-Melmed2016-160">[155]</a><a href="#cite_note-RatliffCatalona2012-161">[156]</a> GnRH modulators are also commonly known as <a href="/wiki/GnRH_analogue" class="mw-redirect" title="GnRH analogue">GnRH analogues</a>.<a href="#cite_note-pmid17237842-159">[154]</a> However, not all clinically used GnRH modulators are <a href="/wiki/Structural_analog" title="Structural analog">analogues</a> of GnRH.<a href="#cite_note-pmid25581052-162">[157]</a> There are two types of GnRH modulators: <a href="/wiki/GnRH_agonist" class="mw-redirect" title="GnRH agonist">GnRH agonists</a> and <a href="/wiki/GnRH_antagonist" class="mw-redirect" title="GnRH antagonist">GnRH antagonists</a>.<a href="#cite_note-pmid17237842-159">[154]</a> These medications have the opposite action on the GnRH receptor but paradoxically have the same therapeutic effects.<a href="#cite_note-pmid17237842-159">[154]</a> GnRH agonists, such as <a href="/wiki/Leuprorelin" title="Leuprorelin">leuprorelin</a> (Lupron), <a href="/wiki/Goserelin" title="Goserelin">goserelin</a> (Zoladex), and <a href="/wiki/Buserelin" title="Buserelin">buserelin</a> (Suprefact), are GnRH receptor <a href="/wiki/Superagonist" title="Superagonist">superagonists</a>, and work by producing profound <a href="/wiki/Downregulation_and_upregulation" title="Downregulation and upregulation">desensitization</a> of the GnRH receptor such that the receptor becomes non-functional.<a href="#cite_note-pmid17237842-159">[154]</a><a href="#cite_note-Melmed2016-160">[155]</a> This occurs because GnRH is normally released in pulses, but GnRH agonists are continuously present, and this results in excessive <a href="/wiki/Downregulation_and_upregulation" title="Downregulation and upregulation">downregulation</a> of the receptor and ultimately a complete loss of function.<a href="#cite_note-pmid1984190-163">[158]</a><a href="#cite_note-StraussIII2013-164">[159]</a><a href="#cite_note-pmid17237842-159">[154]</a> At the initiation of treatment, GnRH agonists are associated with a "flare" effect on hormone levels due to acute overstimulation of the GnRH receptor.<a href="#cite_note-pmid17237842-159">[154]</a><a href="#cite_note-pmid28753828-165">[160]</a> In men, LH levels increase by up to 800%, while testosterone levels increase to about 140 to 200% of baseline.<a href="#cite_note-pmid16986003-166">[161]</a><a href="#cite_note-pmid28753828-165">[160]</a> Gradually however, the GnRH receptor desensitizes; testosterone levels peak after about 2 to 4 days, return to baseline after about 7 to 8 days, and are reduced to castrate levels within 2 to 4 weeks.<a href="#cite_note-pmid28753828-165">[160]</a> Antigonadotropins such as estrogens and cyproterone acetate as well as nonsteroidal antiandrogens such as flutamide and bicalutamide can be used beforehand and concomitantly to reduce or prevent the effects of the testosterone flare caused by GnRH agonists.<a href="#cite_note-167">[162]</a><a href="#cite_note-pmid16986003-166">[161]</a><a href="#cite_note-JamesonGroot2015-168">[163]</a><a href="#cite_note-pmid28078219h-15">[15]</a> In contrast to GnRH agonists, GnRH antagonists, such as <a href="/wiki/Degarelix" title="Degarelix">degarelix</a> (Firmagon) and <a href="/wiki/Elagolix" title="Elagolix">elagolix</a> (Orilissa), work by binding to the GnRH receptor without activating it, thereby displacing GnRH from the receptor and preventing its activation.<a href="#cite_note-pmid17237842-159">[154]</a> Unlike with GnRH agonists, there is no initial surge effect with GnRH antagonists; the therapeutic effects are immediate, with sex hormone levels being reduced to castrate levels within a few days.<a href="#cite_note-pmid17237842-159">[154]</a><a href="#cite_note-Melmed2016-160">[155]</a> GnRH modulators are highly effective for testosterone suppression in transgender women and have few or no side effects when <a href="/wiki/Sex_hormone_deficiency" class="mw-redirect" title="Sex hormone deficiency">sex hormone deficiency</a> is avoided with concomitant estrogen therapy.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-pmid16320157-169">[164]</a> However, GnRH modulators tend to be very expensive (typically US$10,000 to US$15,000 per year in the <a href="/wiki/United_States" title="United States">United States</a>), and are often denied by <a href="/wiki/Medical_insurance" class="mw-redirect" title="Medical insurance">medical insurance</a>.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-SchechterSafa2018-170">[165]</a><a href="#cite_note-171">[166]</a> GnRH modulator therapy is much less economical than surgical castration, and is less convenient than surgical castration in the long-term as well.<a href="#cite_note-VokesGolomb2011-172">[167]</a> Because of their costs, many transgender women cannot afford GnRH modulators and must use other, often less effective options for testosterone suppression.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-SchechterSafa2018-170">[165]</a> GnRH agonists are prescribed as standard practice for transgender women in the <a href="/wiki/United_Kingdom" title="United Kingdom">United Kingdom</a> however, where the <a href="/wiki/National_Health_Service" title="National Health Service">National Health Service</a> (NHS) covers them.<a href="#cite_note-SchechterSafa2018-170">[165]</a><a href="#cite_note-T'SjoenArcelus2018-173">[168]</a> This is in contrast to the rest of <a href="/wiki/Europe" title="Europe">Europe</a> and to the United States.<a href="#cite_note-T'SjoenArcelus2018-173">[168]</a> Another drawback of GnRH modulators is that most of them are <a href="/wiki/Peptide" title="Peptide">peptides</a> and are not <a href="/wiki/Oral_administration" title="Oral administration">orally active</a>, requiring administration by <a href="/wiki/Injection_(medicine)" title="Injection (medicine)">injection</a>, <a href="/wiki/Subcutaneous_implant" title="Subcutaneous implant">implant</a>, or <a href="/wiki/Nasal_spray" title="Nasal spray">nasal spray</a>.<a href="#cite_note-JamesonGroot2015-168">[163]</a> However, non-peptide and orally active GnRH antagonists, <a href="/wiki/Elagolix" title="Elagolix">elagolix</a> (Orilissa) and <a href="/wiki/Relugolix" title="Relugolix">relugolix</a> (Relumina), were introduced for medical use in 2018 and 2019, respectively. But they are under <a href="/wiki/Patent_protection" class="mw-redirect" title="Patent protection">patent protection</a> and, as with other GnRH modulators, are very expensive at present.<a href="#cite_note-UPI2018-174">[169]</a> In adolescents of either sex, GnRH modulators can be used to <a href="/wiki/Puberty_blocker" title="Puberty blocker">suppress puberty</a>. The eighth edition of the <a href="/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">World Professional Association for Transgender Health</a>'s Standards of Care permit its use from Tanner stage 2 and recommends GnRH agonists as the preferred method of puberty blocking.<a href="#cite_note-WPATH-SOC8-175">[170]</a> <div class="mw-heading mw-heading4"><h4 id="5α-Reductase_inhibitors">5α-Reductase inhibitors</h4>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=8" title="Edit section: 5α-Reductase inhibitors">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Finasteride#Transgender_hormone_therapy" title="Finasteride">Finasteride § Transgender hormone therapy</a>, and <a href="/wiki/Dutasteride#Transgender_hormone_therapy" title="Dutasteride">Dutasteride § Transgender hormone therapy</a></div> <a href="/wiki/5%CE%B1-Reductase_inhibitor" title="5α-Reductase inhibitor">5α-Reductase inhibitors</a> are <a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">inhibitors</a> of the <a href="/wiki/Enzyme" title="Enzyme">enzyme</a> <a href="/wiki/5%CE%B1-reductase" class="mw-redirect" title="5α-reductase">5α-reductase</a>, and are a type of specific <a href="/wiki/Androgen_synthesis_inhibitor" title="Androgen synthesis inhibitor">androgen synthesis inhibitor</a>.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a> 5α-Reductase is an enzyme that is responsible for the conversion of <a href="/wiki/Testosterone" title="Testosterone">testosterone</a> into the more <a href="/wiki/Potency_(pharmacology)" title="Potency (pharmacology)">potent</a> androgen <a href="/wiki/Dihydrotestosterone" title="Dihydrotestosterone">dihydrotestosterone</a> (DHT).<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a> There are three different <a href="/wiki/Isoform" class="mw-redirect" title="Isoform">isoforms</a> of 5α-reductase, types <a href="/wiki/SRD5A1" title="SRD5A1">1</a>, <a href="/wiki/SRD5A2" title="SRD5A2">2</a>, and <a href="/wiki/SRD5A3" title="SRD5A3">3</a>, and these three isoforms show different patterns of <a href="/wiki/Gene_expression" title="Gene expression">expression</a> in the body.<a href="#cite_note-pmid28472278-176">[171]</a> Relative to testosterone, DHT is about 2.5- to 10-fold more potent as an agonist of the androgen receptor.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a><a href="#cite_note-MozayaniRaymon2011-178">[173]</a> As such, 5α-reductase serves to considerably potentiate the effects of testosterone.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a> However, 5α-reductase is expressed only in specific <a href="/wiki/Tissue_(biology)" title="Tissue (biology)">tissues</a>, such as <a href="/wiki/Skin" title="Skin">skin</a>, <a href="/wiki/Hair_follicle" title="Hair follicle">hair follicles</a>, and the <a href="/wiki/Prostate_gland" class="mw-redirect" title="Prostate gland">prostate gland</a>, and for this reason, conversion of testosterone into DHT happens only in certain parts of the body.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a><a href="#cite_note-pmid16985920-179">[174]</a> Furthermore, circulating levels of total and free DHT in men are very low at about one-tenth and one-twentieth those of testosterone, respectively,<a href="#cite_note-pmid23431485-177">[172]</a><a href="#cite_note-Bhasin1996-180">[175]</a><a href="#cite_note-pmid28472278-176">[171]</a> and DHT is efficiently inactivated into weak androgens in various tissues such as <a href="/wiki/Muscle" title="Muscle">muscle</a>, <a href="/wiki/Fat" title="Fat">fat</a>, and <a href="/wiki/Liver" title="Liver">liver</a>.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-Melmed2016-160">[155]</a><a href="#cite_note-pmid11469812-181">[176]</a> As such, it is thought that DHT plays little role as a systemic androgen hormone and serves more as a means of locally potentiating the androgenic effects of testosterone in a <a href="/wiki/Tissue_selectivity" title="Tissue selectivity">tissue-specific</a> manner.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid1551803-182">[177]</a><a href="#cite_note-pmid8630237-183">[178]</a> Conversion of testosterone into DHT by 5α-reductase plays an important role in <a href="/wiki/Male_reproductive_system" title="Male reproductive system">male reproductive system</a> development and maintenance (specifically of the <a href="/wiki/Penis" title="Penis">penis</a>, <a href="/wiki/Scrotum" title="Scrotum">scrotum</a>, <a href="/wiki/Prostate_gland" class="mw-redirect" title="Prostate gland">prostate gland</a>, and <a href="/wiki/Seminal_vesicle" class="mw-redirect" title="Seminal vesicle">seminal vesicles</a>), <a href="/wiki/Male-pattern_facial/body_hair_growth" class="mw-redirect" title="Male-pattern facial/body hair growth">male-pattern facial/body hair growth</a>, and <a href="/wiki/Scalp_hair_loss" class="mw-redirect" title="Scalp hair loss">scalp hair loss</a>, but has little role in other aspects of <a href="/wiki/Virilization" title="Virilization">masculinization</a>.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a><a href="#cite_note-pmid16985920-179">[174]</a><a href="#cite_note-pmid25321150-184">[179]</a><a href="#cite_note-pmid12573814-185">[180]</a> Besides the involvement of 5α-reductase in androgen signaling, it is also required for the conversion of <a href="/wiki/Steroid_hormone" title="Steroid hormone">steroid hormones</a> such as <a href="/wiki/Progesterone" title="Progesterone">progesterone</a> and testosterone into <a href="/wiki/Neurosteroid" title="Neurosteroid">neurosteroids</a> like <a href="/wiki/Allopregnanolone" title="Allopregnanolone">allopregnanolone</a> and <a href="/wiki/3%CE%B1-androstanediol" class="mw-redirect" title="3α-androstanediol">3α-androstanediol</a>, respectively.<a href="#cite_note-LiangRasmusson2018-186">[181]</a><a href="#cite_note-pmid24955220-187">[182]</a> 5α-Reductase inhibitors include <a href="/wiki/Finasteride" title="Finasteride">finasteride</a> and <a href="/wiki/Dutasteride" title="Dutasteride">dutasteride</a>.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid23431485-177">[172]</a> Finasteride is a <a href="/wiki/Binding_selectivity" title="Binding selectivity">selective</a> inhibitor of 5α-reductase types 2 and 3, while dutasteride is an inhibitor of all three isoforms of 5α-reductase.<a href="#cite_note-pmid28472278-176">[171]</a><a href="#cite_note-pmid10765065-188">[183]</a><a href="#cite_note-pmid25961201-189">[184]</a> Finasteride can decrease circulating DHT levels by up to 70%, whereas dutasteride can decrease circulating DHT levels by up to 99%.<a href="#cite_note-pmid10765065-188">[183]</a><a href="#cite_note-pmid25961201-189">[184]</a> Conversely, 5α-reductase inhibitors do not decrease testosterone levels, and may actually increase them slightly.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-pmid29756046-28">[28]</a><a href="#cite_note-pmid27916515k-29">[29]</a><a href="#cite_note-pmid30098986-190">[185]</a> 5α-Reductase inhibitors are used primarily in the treatment of <a href="/wiki/Benign_prostatic_hyperplasia" title="Benign prostatic hyperplasia">benign prostatic hyperplasia</a>, a condition in which the <a href="/wiki/Prostate_gland" class="mw-redirect" title="Prostate gland">prostate gland</a> becomes excessively large due to stimulation by DHT and causes unpleasant <a href="/wiki/Urogenital_symptoms" class="mw-redirect" title="Urogenital symptoms">urogenital symptoms</a>.<a href="#cite_note-pmid10765065-188">[183]</a><a href="#cite_note-pmid22333687-191">[186]</a> They are also used in the treatment of androgen-dependent scalp hair loss in men and women.<a href="#cite_note-pmid25268732-192">[187]</a><a href="#cite_note-pmid28294070-193">[188]</a><a href="#cite_note-pmid20442354-194">[189]</a> The medications are able to prevent further scalp hair loss in men and can restore some scalp hair density.<a href="#cite_note-pmid25268732-192">[187]</a><a href="#cite_note-pmid28294070-193">[188]</a><a href="#cite_note-pmid24848508-195">[190]</a> Conversely, the effectiveness of 5α-reductase inhibitors in the treatment of scalp hair loss in women is less clear.<a href="#cite_note-pmid20442354-194">[189]</a><a href="#cite_note-pmid23431485-177">[172]</a> This may be because androgen levels are much lower in women, in whom they may not play as important of a role in scalp hair loss.<a href="#cite_note-pmid20442354-194">[189]</a><a href="#cite_note-pmid23431485-177">[172]</a> 5α-Reductase inhibitors are also used to treat <a href="/wiki/Hirsutism" title="Hirsutism">hirsutism</a> (excessive body/facial hair growth) in women, and are very effective for this indication.<a href="#cite_note-Blume-PeytaviWhiting2008-196">[191]</a> Dutasteride has been found to be significantly more effective than finasteride in the treatment of scalp hair loss in men, which has been attributed to its more complete inhibition of 5α-reductase and by extension decrease in DHT production.<a href="#cite_note-ShapiroOtberg2015-197">[192]</a><a href="#cite_note-TrüebLee2014-198">[193]</a><a href="#cite_note-LemkeWilliams2008-135">[130]</a> In addition to their antiandrogenic uses, 5α-reductase inhibitors have been found to reduce adverse affective symptoms in <a href="/wiki/Premenstrual_dysphoric_disorder" title="Premenstrual dysphoric disorder">premenstrual dysphoric disorder</a> in women.<a href="#cite_note-pmid27156439-199">[194]</a><a href="#cite_note-pmid26272051-200">[195]</a> This is thought to be due to prevention by 5α-reductase inhibitors of the conversion of progesterone into allopregnanolone during the <a href="/wiki/Luteal_phase" title="Luteal phase">luteal phase</a> of the <a href="/wiki/Menstrual_cycle" title="Menstrual cycle">menstrual cycle</a>.<a href="#cite_note-pmid27156439-199">[194]</a><a href="#cite_note-pmid26272051-200">[195]</a> 5α-Reductase inhibitors are sometimes used as a component of feminizing hormone therapy for transgender women in combination with estrogens and/or other antiandrogens.<a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-pmid22392828-201">[196]</a><a href="#cite_note-TrombettaLiguori2015-74">[69]</a> They may have beneficial effects limited to improvement of scalp hair loss, body hair growth, and possibly skin symptoms such as acne.<a href="#cite_note-pmid25403429c-202">[197]</a><a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-pmid14510900u-203">[198]</a><a href="#cite_note-TrombettaLiguori2015-74">[69]</a> However, little clinical research on 5α-reductase inhibitors in transgender women has been conducted, and evidence of their efficacy and safety in this group is limited.<a href="#cite_note-pmid22392828-201">[196]</a><a href="#cite_note-pmid25692882a-204">[199]</a> Moreover, 5α-reductase inhibitors have only mild and specific antiandrogenic activity, and are not recommended as general antiandrogens.<a href="#cite_note-pmid25692882a-204">[199]</a> 5α-Reductase inhibitors have minimal side effects and are well tolerated in both men and women.<a href="#cite_note-pmid27672412-205">[200]</a><a href="#cite_note-pmid27784557-206">[201]</a> In men, the most common side effect is <a href="/wiki/Sexual_dysfunction" title="Sexual dysfunction">sexual dysfunction</a> (0.9–15.8% incidence), which may include <a href="/wiki/Decreased_libido" class="mw-redirect" title="Decreased libido">decreased libido</a>, <a href="/wiki/Erectile_dysfunction" title="Erectile dysfunction">erectile dysfunction</a>, and <a href="/wiki/Reduced_ejaculate" class="mw-redirect" title="Reduced ejaculate">reduced ejaculate</a>.<a href="#cite_note-pmid27672412-205">[200]</a><a href="#cite_note-pmid27784557-206">[201]</a><a href="#cite_note-pmid27475241-207">[202]</a><a href="#cite_note-pmid29528971-208">[203]</a><a href="#cite_note-pmid21176115-209">[204]</a> Another side effect in men is <a href="/wiki/Breast_changes" class="mw-redirect" title="Breast changes">breast changes</a>, such as <a href="/wiki/Breast_tenderness" class="mw-redirect" title="Breast tenderness">breast tenderness</a> and <a href="/wiki/Gynecomastia" title="Gynecomastia">gynecomastia</a> (2.8% incidence).<a href="#cite_note-pmid27784557-206">[201]</a> Due to decreased levels of androgens and/or neurosteroids, 5α-reductase inhibitors may slightly increase the risk of <a href="/wiki/Depression_(mood)" title="Depression (mood)">depression</a> (~2.0% incidence).<a href="#cite_note-pmid29528971-208">[203]</a><a href="#cite_note-Traish2018-210">[205]</a><a href="#cite_note-pmid29449167-211">[206]</a><a href="#cite_note-pmid27672412-205">[200]</a><a href="#cite_note-pmid24955220-187">[182]</a> There are reports that a small percentage of men may experience persistent sexual dysfunction and adverse <a href="/wiki/Mood_changes" class="mw-redirect" title="Mood changes">mood changes</a> even after discontinuation of 5α-reductase inhibitors.<a href="#cite_note-pmid21176115-209">[204]</a><a href="#cite_note-212">[207]</a><a href="#cite_note-Traish2018-210">[205]</a><a href="#cite_note-pmid29528971-208">[203]</a><a href="#cite_note-pmid27475241-207">[202]</a><a href="#cite_note-pmid24955220-187">[182]</a> Some of the possible side effects of 5α-reductase inhibitors in men, such as gynecomastia and sexual dysfunction, are actually welcome changes for many transgender women.<a href="#cite_note-pmid30256230-38">[38]</a> In any case, caution may be warranted in using 5α-reductase inhibitors in transgender women, as this group is already at a high risk for depression and <a href="/wiki/Suicidality" class="mw-redirect" title="Suicidality">suicidality</a>.<a href="#cite_note-pmid27489125-213">[208]</a><a href="#cite_note-pmid27916515k-29">[29]</a> <div class="mw-heading mw-heading3"><h3 id="Progestogens">Progestogens</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=9" title="Edit section: Progestogens">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Progesterone_(medication)#Transgender_women" title="Progesterone (medication)">Progesterone (medication) § Transgender women</a></div> <a href="/wiki/Progesterone_(medication)" title="Progesterone (medication)">Progesterone</a>, a <a href="/wiki/Progestogen" title="Progestogen">progestogen</a>, is the other of the two major sex hormones in women.<a href="#cite_note-JamesonGroot2015-168">[163]</a> It is mainly involved in the regulation of the <a href="/wiki/Female_reproductive_system" title="Female reproductive system">female reproductive system</a>, the <a href="/wiki/Menstrual_cycle" title="Menstrual cycle">menstrual cycle</a>, <a href="/wiki/Pregnancy" title="Pregnancy">pregnancy</a>, and <a href="/wiki/Lactation" title="Lactation">lactation</a>.<a href="#cite_note-JamesonGroot2015-168">[163]</a> The non-reproductive effects of progesterone are fairly insignificant.<a href="#cite_note-LemkeWilliams2012-214">[209]</a> Unlike estrogens, progesterone is not known to be involved in the development of female <a href="/wiki/Secondary_sexual_characteristic" class="mw-redirect" title="Secondary sexual characteristic">secondary sexual characteristics</a>, and hence is not believed to contribute to <a href="/wiki/Feminization_(biology)" title="Feminization (biology)">feminization</a> in women.<a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-EttnerMonstrey2016-94">[89]</a> One area of particular interest in terms of the effects of progesterone in women is breast development.<a href="#cite_note-pmid22844349-215">[210]</a><a href="#cite_note-SunBostanci2018-216">[211]</a><a href="#cite_note-pmid24618412-217">[212]</a> Estrogens are responsible for the development of the <a href="/wiki/Lactiferous_duct" title="Lactiferous duct">ductal</a> and <a href="/wiki/Connective_tissue" title="Connective tissue">connective tissues</a> of the breasts and the deposition of <a href="/wiki/Adipose_tissue" title="Adipose tissue">fat</a> into the breasts during <a href="/wiki/Puberty" title="Puberty">puberty</a> in girls.<a href="#cite_note-pmid22844349-215">[210]</a><a href="#cite_note-SunBostanci2018-216">[211]</a> Conversely, high levels of progesterone, in conjunction with other hormones such as <a href="/wiki/Prolactin" title="Prolactin">prolactin</a>, are responsible for the <a href="/wiki/Lobuloalveolar_maturation" class="mw-redirect" title="Lobuloalveolar maturation">lobuloalveolar maturation</a> of the <a href="/wiki/Mammary_gland" title="Mammary gland">mammary glands</a> during pregnancy.<a href="#cite_note-pmid22844349-215">[210]</a><a href="#cite_note-SunBostanci2018-216">[211]</a> This allows for lactation and <a href="/wiki/Breastfeeding" title="Breastfeeding">breastfeeding</a> after <a href="/wiki/Childbirth" title="Childbirth">childbirth</a>.<a href="#cite_note-pmid22844349-215">[210]</a><a href="#cite_note-SunBostanci2018-216">[211]</a> Although progesterone causes the breasts to change during pregnancy, the breasts undergo <a href="/wiki/Involution_(medicine)" title="Involution (medicine)">involution</a> and revert to their pre-pregnancy composition and size after the cessation of breastfeeding.<a href="#cite_note-pmid22844349-215">[210]</a><a href="#cite_note-pmid10226182-218">[213]</a><a href="#cite_note-SunBostanci2018-216">[211]</a> Every pregnancy, lobuloalveolar maturation occurs again anew.<a href="#cite_note-pmid22844349-215">[210]</a><a href="#cite_note-SunBostanci2018-216">[211]</a> There are two types of progestogens: progesterone, which is the <a href="/wiki/Natural_product" title="Natural product">natural</a> and <a href="/wiki/Bioidentical" class="mw-redirect" title="Bioidentical">bioidentical</a> hormone in the body; and <a href="/wiki/Progestin" class="mw-redirect" title="Progestin">progestins</a>, which are <a href="/wiki/Synthetic_compound" class="mw-redirect" title="Synthetic compound">synthetic</a> progestogens.<a href="#cite_note-pmid16112947-14">[14]</a> There are dozens of clinically used progestins.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid15358281-219">[214]</a><a href="#cite_note-BruckerKing2015-220">[215]</a> Certain progestins, namely <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a> and <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">medroxyprogesterone acetate</a> and as described previously, are used at high doses as functional <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogens</a> due to their <a href="/wiki/Antigonadotropic" class="mw-redirect" title="Antigonadotropic">antigonadotropic</a> effects to help suppress testosterone levels in transgender women.<a href="#cite_note-JamesonGroot2010-93">[88]</a><a href="#cite_note-EttnerMonstrey2016-94">[89]</a> Aside from the specific use of testosterone suppression however, there are no other indications of progestogens in transgender women at present.<a href="#cite_note-ColemanBockting2012-2">[2]</a> In relation to this, the use of progestogens in transgender women is controversial, and they are not otherwise routinely prescribed or recommended.<a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a><a href="#cite_note-Bourns2018-6">[6]</a><a href="#cite_note-pmid25403429c-202">[197]</a><a href="#cite_note-pmid25692882a-204">[199]</a><a href="#cite_note-MeyerNorthridge2007-221">[216]</a> Besides progesterone, cyproterone acetate, and medroxyprogesterone acetate, other progestogens that have been reported to have been used in transgender women include <a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">hydroxyprogesterone caproate</a>, <a href="/wiki/Dydrogesterone" title="Dydrogesterone">dydrogesterone</a>, <a href="/wiki/Norethisterone_acetate" title="Norethisterone acetate">norethisterone acetate</a>, and <a href="/wiki/Drospirenone" title="Drospirenone">drospirenone</a>.<a href="#cite_note-222">[217]</a><a href="#cite_note-pmid25692882a-204">[199]</a><a href="#cite_note-pmid19497984-223">[218]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a> Progestins in general largely have the same progestogenic effects however, and in theory, any progestin could be used in transgender women.<a href="#cite_note-pmid16112947-14">[14]</a> Clinical research on the use of progestogens in transgender women is very limited.<a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-pmid24618412-217">[212]</a> Some patients and clinicians believe, on the basis of anecdotal and subjective claims, that progestogens may provide benefits such as improved breast and/or nipple development, mood, and libido in transgender women.<a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-Deutsch2016-3">[3]</a><a href="#cite_note-pmid24618412-217">[212]</a> There are no clinical studies to support such reports at present.<a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-pmid24618412-217">[212]</a> No clinical study has assessed the use of progesterone in transgender women, and only a couple of studies have compared the use of progestins (specifically cyproterone acetate and medroxyprogesterone acetate) versus the use of no progestogen in transgender women.<a href="#cite_note-pmid24618412-217">[212]</a><a href="#cite_note-pmid3013122-224">[219]</a><a href="#cite_note-pmid16320157-169">[164]</a> These studies, albeit limited in the quality of their findings, reported no benefit of progestogens on breast development in transgender women.<a href="#cite_note-pmid24618412-217">[212]</a><a href="#cite_note-pmid16320157-169">[164]</a><a href="#cite_note-pmid25403429c-202">[197]</a> This has also been the case in limited clinical experience.<a href="#cite_note-MishellDavajan1979-225">[220]</a> Progestogens have some <a href="/wiki/Antiestrogen" title="Antiestrogen">antiestrogenic</a> effects in the breasts, for instance decreasing <a href="/wiki/Gene_expression" title="Gene expression">expression</a> of the <a href="/wiki/Estrogen_receptor" title="Estrogen receptor">estrogen receptor</a> and increasing expression of estrogen-<a href="/wiki/Metabolism" title="Metabolism">metabolizing</a> <a href="/wiki/Enzyme" title="Enzyme">enzymes</a>,<a href="#cite_note-226">[221]</a> and for this reason, have been used to treat <a href="/wiki/Breast_pain" title="Breast pain">breast pain</a> and <a href="/wiki/Benign_breast_disorder" class="mw-redirect" title="Benign breast disorder">benign breast disorders</a>.<a href="#cite_note-pmid20383772-227">[222]</a><a href="#cite_note-pmid12227885-228">[223]</a><a href="#cite_note-pmid25113944-229">[224]</a><a href="#cite_note-BińkowskaWoroń2015-230">[225]</a> Progesterone levels during female puberty do not normally increase importantly until near the end of puberty in cisgender girls, a point by which most breast development has already been completed.<a href="#cite_note-Becker2001-231">[226]</a> In addition, concern has been expressed that premature exposure to progestogens during the process of breast development is unphysiological and might compromise final breast growth outcome, although this notion presently remains theoretical.<a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-pmid24618412-217">[212]</a><a href="#cite_note-RajagopalanMukherjee2005-232">[227]</a> Though the role of progestogens in pubertal breast development is uncertain, progesterone is essential for lobuloalveolar maturation of the mammary glands during pregnancy.<a href="#cite_note-pmid22844349-215">[210]</a> Hence, progestogens are required for any transgender woman who wishes to lactate or breastfeed.<a href="#cite_note-pmid29372185-64">[64]</a><a href="#cite_note-pmid13573669-233">[228]</a><a href="#cite_note-pmid24618412-217">[212]</a> A study found full lobuloalveolar maturation of the mammary glands on histological examination in transgender women treated with an estrogen and high-dose cyproterone acetate.<a href="#cite_note-pmid10632490-234">[229]</a><a href="#cite_note-Lawrence2007-235">[230]</a><a href="#cite_note-Rosen2009-236">[231]</a> However, lobuloalveolar development reversed with discontinuation of cyproterone acetate, indicating that continued progestogen exposure is necessary to maintain the tissue.<a href="#cite_note-pmid10632490-234">[229]</a> In terms of the effects of progestogens on sex drive, one study assessed the use of dydrogesterone to improve sexual desire in transgender women and found no benefit.<a href="#cite_note-pmid19497984-223">[218]</a> Another study likewise found that oral progesterone did not improve sexual function in cisgender women.<a href="#cite_note-pmid26944460-237">[232]</a> Progestogens can have <a href="/wiki/Adverse_effect" title="Adverse effect">adverse effects</a>.<a href="#cite_note-pmid25403429c-202">[197]</a><a href="#cite_note-pmid25692882a-204">[199]</a><a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid15358281-219">[214]</a><a href="#cite_note-pmid11057840-238">[233]</a><a href="#cite_note-pmid2215269-17">[17]</a> Oral progesterone has <a href="/wiki/Central_nervous_system_depressant" class="mw-redirect" title="Central nervous system depressant">inhibitory</a> <a href="/wiki/Neurosteroid" title="Neurosteroid">neurosteroid</a> effects and can produce side effects such as <a href="/wiki/Sedation" title="Sedation">sedation</a>, <a href="/wiki/Mood_changes" class="mw-redirect" title="Mood changes">mood changes</a>, and <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>-like effects.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid17924777-239">[234]</a><a href="#cite_note-pmid23978486-240">[235]</a> Many progestins have <a href="/wiki/Off-target_activity" title="Off-target activity">off-target activity</a>, such as <a href="/wiki/Androgen" title="Androgen">androgenic</a>, <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogenic</a>, <a href="/wiki/Glucocorticoid" title="Glucocorticoid">glucocorticoid</a>, and <a href="/wiki/Antimineralocorticoid" class="mw-redirect" title="Antimineralocorticoid">antimineralocorticoid</a> activity, and these activities likewise can contribute unwanted side effects.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid15358281-219">[214]</a> Furthermore, the addition of a progestin to estrogen therapy has been found to increase the risk of <a href="/wiki/Blood_clot" class="mw-redirect" title="Blood clot">blood clots</a>, <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a> (e.g., <a href="/wiki/Coronary_heart_disease" class="mw-redirect" title="Coronary heart disease">coronary heart disease</a> and <a href="/wiki/Stroke" title="Stroke">stroke</a>), and <a href="/wiki/Breast_cancer" title="Breast cancer">breast cancer</a> compared to estrogen therapy alone in <a href="/wiki/Menopause" title="Menopause">postmenopausal</a> women.<a href="#cite_note-MooreWisniewski2003-241">[236]</a><a href="#cite_note-pmid25692882a-204">[199]</a><a href="#cite_note-pmid25403429c-202">[197]</a><a href="#cite_note-pmid29526116-242">[237]</a> Although it is unknown if these health risks of progestins occur in transgender women similarly, it cannot be ruled out that they do.<a href="#cite_note-MooreWisniewski2003-241">[236]</a><a href="#cite_note-pmid25692882a-204">[199]</a><a href="#cite_note-pmid25403429c-202">[197]</a> High-dose progestogens increase the risk of <a href="/wiki/Benign_tumor" title="Benign tumor">benign</a> <a href="/wiki/Brain_tumor" title="Brain tumor">brain tumors</a> including <a href="/wiki/Prolactinoma" title="Prolactinoma">prolactinomas</a> and <a href="/wiki/Meningioma" title="Meningioma">meningiomas</a> as well.<a href="#cite_note-pmid29930875-243">[238]</a><a href="#cite_note-NotaWiepjes2018-244">[239]</a> Because of their potential detrimental effects and lack of supported benefits, some researchers have argued that, aside from the purpose of testosterone suppression, progestogens should not generally be used or advocated in transgender women or should only be used for a limited duration (e.g., 2–3 years).<a href="#cite_note-MooreWisniewski2003-241">[236]</a><a href="#cite_note-pmid25403429c-202">[197]</a><a href="#cite_note-DahlFeldman-2015-5">[5]</a><a href="#cite_note-Bourns2018-6">[6]</a><a href="#cite_note-MeyerNorthridge2007-221">[216]</a> Conversely, other researchers have argued that the risks of progestogens in transgender women are likely minimal, and that in light of potential albeit hypothetical benefits, should be used if desired.<a href="#cite_note-Deutsch2016-3">[3]</a> In general, some transgender women respond favorably to the effects of progestogens, while others respond negatively.<a href="#cite_note-Deutsch2016-3">[3]</a> Progesterone is most commonly taken orally.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid29526116-242">[237]</a> However, oral progesterone has very low <a href="/wiki/Bioavailability" title="Bioavailability">bioavailability</a>, and produces relatively weak progestogenic effects even at high doses.<a href="#cite_note-Kuhl2011-245">[240]</a><a href="#cite_note-pmid23336704-246">[241]</a><a href="#cite_note-pmid29526116-242">[237]</a><a href="#cite_note-pmid11108875-247">[242]</a><a href="#cite_note-pmid15901742-248">[243]</a> In accordance, and in contrast to progestins, oral progesterone has no antigonadotropic effects in men even at high doses.<a href="#cite_note-pmid17924777-239">[234]</a><a href="#cite_note-pmid8300009-249">[244]</a> Progesterone can also be taken by various parenteral (non-oral) routes, including sublingually, rectally, and by intramuscular or subcutaneous injection.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid25113944-229">[224]</a><a href="#cite_note-UnferdiRenzo2006-250">[245]</a> These routes do not have the bioavailability and efficacy issues of oral progesterone, and accordingly, can produce considerable antigonadotropic and other progestogenic effects.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid11108875-247">[242]</a><a href="#cite_note-pmid12641635-251">[246]</a> Transdermal progesterone is poorly effective, owing to absorption issues.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-pmid25113944-229">[224]</a><a href="#cite_note-pmid15901742-248">[243]</a> Progestins are usually taken orally.<a href="#cite_note-pmid16112947-14">[14]</a> In contrast to progesterone, most progestins have high oral bioavailability, and can produce full progestogenic effects with oral administration.<a href="#cite_note-pmid16112947-14">[14]</a> Some progestins, such as medroxyprogesterone acetate and hydroxyprogesterone caproate, are or can be used by intramuscular or subcutaneous injection instead.<a href="#cite_note-Meikle1999-252">[247]</a><a href="#cite_note-pmid25113944-229">[224]</a> Almost all progestins, with the exception of dydrogesterone, have antigonadotropic effects.<a href="#cite_note-pmid16112947-14">[14]</a> <div class="mw-heading mw-heading3"><h3 id="Miscellaneous">Miscellaneous</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=10" title="Edit section: Miscellaneous">edit</a>]</div> <a href="/wiki/Galactogogue" class="mw-redirect" title="Galactogogue">Galactogogues</a> such as the <a href="/wiki/Peripherally_selective" class="mw-redirect" title="Peripherally selective">peripherally selective</a> <a href="/wiki/D2_receptor" class="mw-redirect" title="D2 receptor">D2 receptor antagonist</a> and <a href="/wiki/Prolactin_releaser" class="mw-redirect" title="Prolactin releaser">prolactin releaser</a> <a href="/wiki/Domperidone" title="Domperidone">domperidone</a> can be used to induce <a href="/wiki/Lactation" title="Lactation">lactation</a> in transgender women who wish to <a href="/wiki/Breastfeed" class="mw-redirect" title="Breastfeed">breastfeed</a>.<a href="#cite_note-pmid30840524-253">[248]</a><a href="#cite_note-TelisBaum2019-254">[249]</a><a href="#cite_note-pmid29372185-64">[64]</a> An extended period of combined estrogen and progestogen therapy is necessary to mature the <a href="/wiki/Lobuloalveolar_tissue" class="mw-redirect" title="Lobuloalveolar tissue">lobuloalveolar tissue</a> of the <a href="/wiki/Breast" title="Breast">breasts</a> before this can be successful.<a href="#cite_note-pmid13573669-233">[228]</a><a href="#cite_note-pmid29372185-64">[64]</a><a href="#cite_note-pmid4039061-255">[250]</a><a href="#cite_note-pmid10632490-234">[229]</a> There are several published reports of lactation and/or breastfeeding in transgender women.<a href="#cite_note-256">[251]</a><a href="#cite_note-pmid13573669-233">[228]</a><a href="#cite_note-pmid4039061-255">[250]</a><a href="#cite_note-pmid29372185-64">[64]</a><a href="#cite_note-FlückigerPozo1982-257">[252]</a> The <a href="/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">World Professional Association for Transgender Health</a> (WPATH) <a href="/wiki/Standards_of_Care_for_the_Health_of_Transgender_and_Gender_Diverse_People" title="Standards of Care for the Health of Transgender and Gender Diverse People">Standards of Care for the Health of Transgender and Gender Diverse People</a> Version 8 (SOC8), released in September 2022, recommends against therapeutic strategies including <a href="https://en.wiktionary.org/wiki/supraphysiological" class="extiw" title="wikt:supraphysiological">supraphysiological</a> estradiol levels (>200 pg/mL), use of <a href="/wiki/Progesterone_(medication)" title="Progesterone (medication)">progesterone</a> (including <a href="/wiki/Rectal_progesterone" class="mw-redirect" title="Rectal progesterone">rectal progesterone</a>), use of <a href="/wiki/Bicalutamide" title="Bicalutamide">bicalutamide</a>, and monitoring of the ratio of <a href="/wiki/Estrone" title="Estrone">estrone</a> to <a href="/wiki/Estradiol" title="Estradiol">estradiol</a>.<a href="#cite_note-WPATH-SOC8-175">[170]</a> This is due to lack of data to support these approaches in transfeminine people as well as potential risks.<a href="#cite_note-WPATH-SOC8-175">[170]</a> The WPATH SOC8 also recommends against the use of <a href="/wiki/5%CE%B1-reductase_inhibitors" class="mw-redirect" title="5α-reductase inhibitors">5α-reductase inhibitors</a> such as <a href="/wiki/Finasteride" title="Finasteride">finasteride</a> in transfeminine people.<a href="#cite_note-WPATH-SOC8-175">[170]</a> <div class="mw-heading mw-heading2"><h2 id="Interactions">Interactions</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=11" title="Edit section: Interactions">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/CYP3A4#CYP3A4_ligands" title="CYP3A4">CYP3A4 § CYP3A4 ligands</a></div> Many of the medications used in feminizing hormone therapy, such as <a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">estradiol</a>, <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a>, and <a href="/wiki/Bicalutamide" title="Bicalutamide">bicalutamide</a>, are <a href="/wiki/Substrate_(biochemistry)" class="mw-redirect" title="Substrate (biochemistry)">substrates</a> of <a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a> and other <a href="/wiki/Cytochrome_P450" title="Cytochrome P450">cytochrome P450</a> <a href="/wiki/Enzyme" title="Enzyme">enzymes</a>. As a result, <a href="/wiki/Enzyme_inducer" title="Enzyme inducer">inducers</a> of CYP3A4 and other cytochrome P450 enzymes, such as <a href="/wiki/Carbamazepine" title="Carbamazepine">carbamazepine</a>, <a href="/wiki/Phenobarbital" title="Phenobarbital">phenobarbital</a>, <a href="/wiki/Phenytoin" title="Phenytoin">phenytoin</a>, <a href="/wiki/Rifampin" class="mw-redirect" title="Rifampin">rifampin</a>, <a href="/wiki/Rifampicin" title="Rifampicin">rifampicin</a>, and <a href="/wiki/St._John%27s_wort" class="mw-redirect" title="St. John's wort">St. John's wort</a>, among others, may decrease circulating levels of these medications and thereby decrease their effects. Conversely, <a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">inhibitors</a> of CYP3A4 and other cytochrome P450 enzymes, such as <a href="/wiki/Cimetidine" title="Cimetidine">cimetidine</a>, <a href="/wiki/Clotrimazole" title="Clotrimazole">clotrimazole</a>, <a href="/wiki/Grapefruit_juice" title="Grapefruit juice">grapefruit juice</a>, <a href="/wiki/Itraconazole" title="Itraconazole">itraconazole</a>, <a href="/wiki/Ketoconazole" title="Ketoconazole">ketoconazole</a>, and <a href="/wiki/Ritonavir" title="Ritonavir">ritonavir</a>, among others, may increase circulating levels of these medications and thereby increase their effects.<a href="#cite_note-258">[253]</a> The concomitant use of a cytochrome P450 inducer or inhibitor with feminizing hormone therapy may necessitate medication dosage adjustments. <div class="mw-heading mw-heading2"><h2 id="Effects">Effects</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=12" title="Edit section: Effects">edit</a>]</div> The spectrum of effects of hormone therapy in transfeminine people depend on the specific medications and dosages used. In any case, the main effects of hormone therapy in transfeminine people are <a href="/wiki/Feminization_(biology)" title="Feminization (biology)">feminization</a> and <a href="/wiki/Demasculinization" class="mw-redirect" title="Demasculinization">demasculinization</a>, and are as follows: <table class="wikitable sortable"> <caption>Effects of feminizing hormone therapy in transfeminine people </caption> <tbody><tr> <th>Effect</th> <th>Time to expected onset of effect<a href="#cite_note-estimates-259">[a]</a></th> <th>Time to expected maximum effect<a href="#cite_note-estimates-259">[a]</a><a href="#cite_note-maximum-260">[b]</a> </th> <th>Permanency if hormone therapy is stopped </th></tr> <tr> <td><a href="/wiki/Breast_development" title="Breast development">Breast development</a> and <a href="/wiki/Nipple" title="Nipple">nipple</a>/<a href="/wiki/Areola" title="Areola">areolar</a> enlargement</td> <td>2–6 months</td> <td>1–5 years</td> <td><a href="/wiki/Breast_reduction" title="Breast reduction">Surgically reversible</a> </td></tr> <tr> <td>Thinning/slowed <a href="/wiki/Hair_growth" class="mw-redirect" title="Hair growth">growth</a> of <a href="/wiki/Facial_hair" title="Facial hair">facial</a>/<a href="/wiki/Body_hair" title="Body hair">body hair</a></td> <td>4–12 months</td> <td>>3 years<a href="#cite_note-hair-removal-261">[c]</a></td> <td>Reversible </td></tr> <tr> <td>Cessation/reversal of <a href="/wiki/Male-pattern_scalp_hair_loss" class="mw-redirect" title="Male-pattern scalp hair loss">male-pattern scalp hair loss</a></td> <td>1–3 months</td> <td>1–2 years<a href="#cite_note-hair-loss-262">[d]</a></td> <td>Reversible </td></tr> <tr> <td>Softening of <a href="/wiki/Human_skin" title="Human skin">skin</a>/decreased <a href="/wiki/Oily_skin" class="mw-redirect" title="Oily skin">oiliness</a> and <a href="/wiki/Acne" title="Acne">acne</a></td> <td>3–6 months</td> <td>Unknown</td> <td>Reversible </td></tr> <tr> <td><a href="/wiki/Gynoid_fat_distribution" title="Gynoid fat distribution">Redistribution of body fat in a feminine pattern</a></td> <td>3–6 months</td> <td>2–5 years</td> <td>Reversible </td></tr> <tr> <td><a href="/wiki/Muscle_atrophy" title="Muscle atrophy">Decreased muscle mass/strength</a></td> <td>3–6 months</td> <td>1–2 years<a href="#cite_note-exercise-263">[e]</a></td> <td>Reversible </td></tr> <tr> <td><a href="/wiki/Widening_of_the_hips" class="mw-redirect" title="Widening of the hips">Widening and rounding of the pelvis</a><a href="#cite_note-epiphyseal-closure-264">[f]</a></td> <td>Unspecified</td> <td>Unspecified</td> <td>Permanent </td></tr> <tr> <td>Changes in <a href="/wiki/Mood_(psychology)" title="Mood (psychology)">mood</a>, <a href="/wiki/Emotionality" title="Emotionality">emotionality</a>, and <a href="/wiki/Human_behavior" title="Human behavior">behavior</a></td> <td>Unspecified</td> <td>Unspecified</td> <td>Reversible </td></tr> <tr> <td>Decreased <a href="/wiki/Sex_drive" class="mw-redirect" title="Sex drive">sex drive</a></td> <td>1–3 months</td> <td>Temporary<a href="#cite_note-pmid32008926-265">[254]</a></td> <td>Reversible </td></tr> <tr> <td>Decreased <a href="/wiki/Spontaneous_erection" class="mw-redirect" title="Spontaneous erection">spontaneous</a>/<a href="/wiki/Morning_erection" class="mw-redirect" title="Morning erection">morning erections</a></td> <td>1–3 months</td> <td>3–6 months</td> <td>Reversible </td></tr> <tr> <td><a href="/wiki/Erectile_dysfunction" title="Erectile dysfunction">Erectile dysfunction</a> and <a href="/wiki/Decreased_ejaculate_volume" class="mw-redirect" title="Decreased ejaculate volume">decreased ejaculate volume</a></td> <td>1–3 months</td> <td>Variable</td> <td>Reversible </td></tr> <tr> <td>Decreased <a href="/wiki/Spermatogenesis" title="Spermatogenesis">sperm production</a>/<a href="/wiki/Male_fertility" class="mw-redirect" title="Male fertility">fertility</a></td> <td>Unknown</td> <td>>3 years</td> <td>Reversible or permanent<a href="#cite_note-fertility-266">[g]</a> </td></tr> <tr> <td><a href="/wiki/Testicular_atrophy" title="Testicular atrophy">Decreased testicle size</a></td> <td>3–6 months</td> <td>2–3 years</td> <td>Unknown </td></tr> <tr> <td>Decreased <a href="/wiki/Penis" title="Penis">penis</a> size</td> <td>Conflicting reports, with none reported observed in transgender women but significant albeit minor reduction of penis size reported in men with <a href="/wiki/Prostate_cancer" title="Prostate cancer">prostate cancer</a> on <a href="/wiki/Androgen_deprivation_therapy" title="Androgen deprivation therapy">androgen deprivation therapy</a>.<a href="#cite_note-pmid20626600-267">[255]</a><a href="#cite_note-pmid12667885-268">[256]</a><a href="#cite_note-pmid23008326-269">[257]</a><a href="#cite_note-NieschlagBehre2013-270">[258]</a></td> <td>Not applicable</td> <td>Not applicable </td></tr> <tr> <td>Decreased <a href="/wiki/Prostate_gland" class="mw-redirect" title="Prostate gland">prostate gland</a> size</td> <td>Unspecified</td> <td>Unspecified</td> <td>Unspecified </td></tr> <tr> <td><a href="/wiki/Human_voice" title="Human voice">Voice</a> changes</td> <td>None<a href="#cite_note-voice-271">[h]</a></td> <td>Not applicable</td> <td>Not applicable </td></tr> <tr class="sortbottom"> <td colspan="4" style="width: 1px; background-color:#eaecf0; text-align: center;"><style data-mw-deduplicate="TemplateStyles:r1214851843">.mw-parser-output .hidden-begin{box-sizing:border-box;width:100%;padding:5px;border:none;font-size:95%}.mw-parser-output .hidden-title{font-weight:bold;line-height:1.6;text-align:left}.mw-parser-output .hidden-content{text-align:left}@media all and (max-width:500px){.mw-parser-output .hidden-begin{width:auto!important;clear:none!important;float:none!important}}</style><div class="hidden-begin mw-collapsible" style=""><div class="hidden-title skin-nightmode-reset-color" style="text-align:center;">Footnotes and sources</div><div class="hidden-content mw-collapsible-content" style=""> Footnotes: <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist reflist-lower-alpha"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-estimates-259">^ <a href="#cite_ref-estimates_259-0">a</a> <a href="#cite_ref-estimates_259-1">b</a> Estimates represent published and unpublished clinical observations. </li> <li id="cite_note-maximum-260"><a href="#cite_ref-maximum_260-0">^</a> Time at which further changes are unlikely at maximum maintained dose. Maximum effects vary widely depending on <a href="/wiki/Genetics" title="Genetics">genetics</a>, <a href="/wiki/Body_habitus" class="mw-redirect" title="Body habitus">body habitus</a>, <a href="/wiki/Ageing" title="Ageing">age</a>, and status of <a href="/wiki/Gonadectomy" title="Gonadectomy">gonad removal</a>. Generally, older individuals with intact <a href="/wiki/Gonad" title="Gonad">gonads</a> may have less <a href="/wiki/Feminization_(biology)" title="Feminization (biology)">feminization</a> overall. </li> <li id="cite_note-hair-removal-261"><a href="#cite_ref-hair-removal_261-0">^</a> Complete removal of male facial and body hair requires <a href="/wiki/Electrolysis" title="Electrolysis">electrolysis</a>, <a href="/wiki/Laser_hair_removal" title="Laser hair removal">laser hair removal</a>, or both. Temporary <a href="/wiki/Hair_removal" title="Hair removal">hair removal</a> can be achieved with <a href="/wiki/Shaving" title="Shaving">shaving</a>, <a href="/wiki/Epilator" title="Epilator">epilating</a>, <a href="/wiki/Waxing" title="Waxing">waxing</a>, and other methods. </li> <li id="cite_note-hair-loss-262"><a href="#cite_ref-hair-loss_262-0">^</a> <a href="/wiki/Familial_scalp_hair_loss" class="mw-redirect" title="Familial scalp hair loss">Familial scalp hair loss</a> may occur if estrogens are stopped. </li> <li id="cite_note-exercise-263"><a href="#cite_ref-exercise_263-0">^</a> Varies significantly depending on the amount of <a href="/wiki/Physical_exercise" class="mw-redirect" title="Physical exercise">physical exercise</a>. </li> <li id="cite_note-epiphyseal-closure-264"><a href="#cite_ref-epiphyseal-closure_264-0">^</a> Occurs only in individuals of <a href="/wiki/Puberty" title="Puberty">pubertal</a> age who have not yet completed <a href="/wiki/Epiphyseal_closure" class="mw-redirect" title="Epiphyseal closure">epiphyseal closure</a>. </li> <li id="cite_note-fertility-266"><a href="#cite_ref-fertility_266-0">^</a> Additional research is needed to determine permanency, but a permanent impact of estrogen therapy on <a href="/wiki/Sperm_quality" class="mw-redirect" title="Sperm quality">sperm quality</a> is likely and <a href="/wiki/Semen_cryopreservation" title="Semen cryopreservation">sperm preservation</a> options should be counseled on and considered before initiation of therapy. </li> <li id="cite_note-voice-271"><a href="#cite_ref-voice_271-0">^</a> Treatment by <a href="/wiki/Speech_pathologist" class="mw-redirect" title="Speech pathologist">speech pathologists</a> for <a href="/wiki/Voice_therapy_(transgender)" class="mw-redirect" title="Voice therapy (transgender)">voice training</a> is effective. </li> </ol></div></div> Sources: Guidelines:<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-ColemanBockting2012-2">[2]</a><a href="#cite_note-Bourns2018-6">[6]</a> Reviews/book chapters: <a href="#cite_note-pmid28159148y-4">[4]</a><a href="#cite_note-FisherMaggi2015-272">[259]</a><a href="#cite_note-pmid25403429c-202">[197]</a><a href="#cite_note-Radix2016-273">[260]</a><a href="#cite_note-pmid27916515k-29">[29]</a><a href="#cite_note-MooreWisniewski2003-241">[236]</a><a href="#cite_note-AsschemanGooren1993.2-274">[261]</a><a href="#cite_note-pmid14510900u-203">[198]</a> Studies:<a href="#cite_note-deKlaver2016-275">[262]</a><a href="#cite_note-pmid29165635-276">[263]</a></div></div> </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Mental_changes">Mental changes</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=13" title="Edit section: Mental changes">edit</a>]</div> The psychological effects of feminizing hormone therapy are harder to define than physical changes. Because hormone therapy is usually the first physical step taken to transition, the act of beginning it has a significant psychological effect, which is difficult to distinguish from hormonally induced changes. Changes in mood and well-being occur with hormone therapy in transgender women.<a href="#cite_note-NguyenChavez2018-277">[264]</a> Side effects of hormone therapy have the ability to significantly impact sexual functioning, either directly or indirectly through the various side effects, such as cerebrovascular disorders, obesity, and mood fluctuations.<a href="#cite_note-klein-278">[265]</a> Some transgender women report a significant reduction in <a href="/wiki/Libido" title="Libido">libido</a>, depending on the dosage of antiandrogens.<a href="#cite_note-279">[266]</a> The effects of long-term hormonal regimens have not been conclusively studied and are difficult to estimate because research on the long-term use of hormonal therapy has not been noted.<a href="#cite_note-MooreWisniewski2003-241">[236]</a> One study found that sex drive returned to baseline after three years of hormone therapy.<a href="#cite_note-pmid32008926-265">[254]</a> It is possible to approximate outcomes of these therapies on transgender people based on their observed effect in <a href="/wiki/Cisgender" title="Cisgender">cisgender</a> men and women.<a href="#cite_note-klein-278">[265]</a> Firstly, if one is to decrease testosterone in feminizing gender transition, it is likely that sexual desire and arousal would be inhibited; alternatively, if high doses of estrogen negatively impact sexual desire, which has been found in some research with <a href="/wiki/Cisgender" title="Cisgender">cisgender</a> women, it is hypothesized that combining androgens with high levels of estrogen would intensify this outcome.<a href="#cite_note-klein-278">[265]</a> To date there have not been any randomized clinical trials looking at the relationship between type and dose of transgender hormone therapy, so the relationship between them remains unclear.<a href="#cite_note-klein-278">[265]</a> Typically, the estrogens given for feminizing gender transition are 2 to 3 times higher than the recommended dose for HRT in postmenopausal women.<a href="#cite_note-MooreWisniewski2003-241">[236]</a> Pharmacokinetic studies indicate taking these increased doses may lead to a higher boost in plasma estradiol levels; however, the long-term side effects have not been studied and the safety of this route is unclear.<a href="#cite_note-MooreWisniewski2003-241">[236]</a> Several studies have found that hormone therapy in transgender women causes the structure of the <a href="/wiki/Brain" title="Brain">brain</a> to change in the direction of female proportions.<a href="#cite_note-SmithJunger2015-280">[267]</a><a href="#cite_note-281">[268]</a> In addition, studies have found that hormone therapy in transgender women causes performance in cognitive tasks, including visuospatial, verbal memory, and verbal fluency, to shift in a more female direction.<a href="#cite_note-SmithJunger2015-280">[267]</a><a href="#cite_note-NguyenChavez2018-277">[264]</a> <div class="mw-heading mw-heading3"><h3 id="Fat_distribution">Fat distribution</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=14" title="Edit section: Fat distribution">edit</a>]</div> In hormone therapy, trans women often experience slight weight gain as men generally carry higher levels of <a href="/wiki/Abdominal_obesity" title="Abdominal obesity">visceral fat</a> compared to <a href="/wiki/Adipose_tissue#Subcutaneous_fat" title="Adipose tissue">subcutaneous fat</a>, and less fat overall compared to women. Over months and years, HRT causes the body to accumulate new fat in a feminine pattern (<a href="/wiki/Gynoid_fat" class="mw-redirect" title="Gynoid fat">gynoid fat</a>). Unlike abdominal fat, gynoid fat has little <a href="/wiki/Gynoid_fat_distribution#Health_issues" title="Gynoid fat distribution">effect on overall health</a> except in the case of severe excess or postural changes. Gynoid fat will accumulate in the hips, lower belly, thighs, buttocks, pubis, upper arms, and breasts while the body burns fat in the ribcage, upper waist, shoulders, and back.<a href="#cite_note-Gooren1992-282">[269]</a> However, fat will not simply move from one spot to another. There must be sufficient caloric intake to deposit gynoid fat, and sufficient activity to burn <a href="/wiki/Android_fat_distribution" title="Android fat distribution">android fat</a>. <div class="mw-heading mw-heading3"><h3 id="Breast_development">Breast development</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=15" title="Edit section: Breast development">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1273380762/mw-parser-output/.tmulti">.mw-parser-output .tmulti .multiimageinner{display:flex;flex-direction:column}.mw-parser-output .tmulti .trow{display:flex;flex-direction:row;clear:left;flex-wrap:wrap;width:100%;box-sizing:border-box}.mw-parser-output .tmulti .tsingle{margin:1px;float:left}.mw-parser-output .tmulti .theader{clear:both;font-weight:bold;text-align:center;align-self:center;background-color:transparent;width:100%}.mw-parser-output .tmulti .thumbcaption{background-color:transparent}.mw-parser-output .tmulti .text-align-left{text-align:left}.mw-parser-output .tmulti .text-align-right{text-align:right}.mw-parser-output .tmulti .text-align-center{text-align:center}@media all and (max-width:720px){.mw-parser-output .tmulti .thumbinner{width:100%!important;box-sizing:border-box;max-width:none!important;align-items:center}.mw-parser-output .tmulti .trow{justify-content:center}.mw-parser-output .tmulti .tsingle{float:none!important;max-width:100%!important;box-sizing:border-box;text-align:center}.mw-parser-output .tmulti .tsingle .thumbcaption{text-align:left}.mw-parser-output .tmulti .trow>.thumbcaption{text-align:center}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .tmulti .multiimageinner span:not(.skin-invert-image):not(.skin-invert):not(.bg-transparent) img{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .tmulti .multiimageinner span:not(.skin-invert-image):not(.skin-invert):not(.bg-transparent) img{background-color:white}}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Breast_development#Biochemistry" title="Breast development">Breast development § Biochemistry</a></div><figure class="mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Transgender_woman_breast.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/b/b3/Transgender_woman_breast.png/230px-Transgender_woman_breast.png" decoding="async" width="230" height="152" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/b3/Transgender_woman_breast.png/345px-Transgender_woman_breast.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/b3/Transgender_woman_breast.png/460px-Transgender_woman_breast.png 2x" data-file-width="719" data-file-height="475" /></a><figcaption>Well-developed breasts of transgender woman induced by hormone therapy.</figcaption></figure> Significant breast development in transgender women begins within two to three months of the start of hormone therapy and continues for up to two years.<a href="#cite_note-vanKesteren2002-284">[271]</a><a href="#cite_note-pmid14510900u-203">[198]</a> Breast development seems to be better in transgender women who have a higher <a href="/wiki/Body_mass_index" title="Body mass index">body mass index</a>.<a href="#cite_note-vanKesteren2002-284">[271]</a><a href="#cite_note-pmid14510900u-203">[198]</a> This indicates that weight gain in the early phases of hormone therapy may be beneficial not only for fat distribution, but for breast development.<a href="#cite_note-vanKesteren2002-284">[271]</a><a href="#cite_note-pmid14510900u-203">[198]</a> Different estrogens, such as <a href="/wiki/Estradiol_valerate" title="Estradiol valerate">estradiol valerate</a>, <a href="/wiki/Conjugated_estrogens" title="Conjugated estrogens">conjugated estrogens</a>, and <a href="/wiki/Ethinylestradiol" title="Ethinylestradiol">ethinylestradiol</a>, appear to produce equivalent results in terms of breast sizes in transgender women.<a href="#cite_note-vanKesteren2002-284">[271]</a><a href="#cite_note-pmid3013122-224">[219]</a><a href="#cite_note-pmid16320157-169">[164]</a> The sudden discontinuation of estrogen therapy has been associated with onset of <a href="/wiki/Galactorrhea" title="Galactorrhea">galactorrhea</a> (<a href="/wiki/Lactation" title="Lactation">lactation</a>).<a href="#cite_note-vanKesteren2002-284">[271]</a><a href="#cite_note-pmid14510900u-203">[198]</a> <a href="/wiki/Breast" title="Breast">Breast</a>, <a href="/wiki/Nipple" title="Nipple">nipple</a>, and <a href="/wiki/Areola" title="Areola">areolar</a> development varies considerably depending on genetics, nutrition, age of HRT initiation, and many other factors. Development can take a couple years to nearly a decade for some. However, many transgender women report there is often a "stall" in <a href="/wiki/Tanner_scale#Breasts_(female)" title="Tanner scale">breast growth</a> during transition, or significant <a href="/wiki/Breast#Asymmetry" title="Breast">breast asymmetry</a>. Transgender women on HRT often experience less breast development than cisgender women (especially if started after young adulthood). For this reason, many seek <a href="/wiki/Breast_augmentation" title="Breast augmentation">breast augmentation</a>. Transgender patients opting for <a href="/wiki/Breast_reduction" title="Breast reduction">breast reduction</a> are rare. Shoulder width and the size of the rib cage also play a role in the perceivable size of the breasts; both are usually larger in transgender women, causing the breasts to appear proportionally smaller. Thus, when a transgender woman opts to have breast augmentation, the <a href="/wiki/Breast_implant" title="Breast implant">implants</a> used tend to be larger than those used by cisgender women.<a href="#cite_note-Gooren1992-282">[269]</a> <div class="mw-heading mw-heading3"><h3 id="Fertility">Fertility</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=16" title="Edit section: Fertility">edit</a>]</div> The effect of feminizing hormone therapy on fertility is not clear, but it is known that testosterone suppression can prevent sperm production.<a href="#cite_note-285">[272]</a> The age of starting and stopping hormone therapy seems to be a significant factor, but no direct causation has been found between length of treatment and ability to reproduce.<a href="#cite_note-286">[273]</a><a href="#cite_note-287">[274]</a> There is some research showing effective restoration of fertility by alternative means than HRT cessation alone. Dr. Will Powers has demonstrated the effectiveness of clomifene in restoring <a href="/wiki/Spermatogenesis" title="Spermatogenesis">spermatogenesis</a> in trans women.<a href="#cite_note-:1-288">[275]</a> His study also includes an in-depth description of other methods for fertility restoration.<a href="#cite_note-:1-288">[275]</a> <div class="mw-heading mw-heading3"><h3 id="Skin">Skin</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=17" title="Edit section: Skin">edit</a>]</div> Estrogens cause the accumulation of <a href="/wiki/Subcutaneous_fat" class="mw-redirect" title="Subcutaneous fat">subcutaneous fat</a> and an increased epidermal thickness, softening the skin.<a href="#cite_note-Gooren1992-282">[269]</a><a href="#cite_note-Kirk1999-289">[276]</a> Some skin conditions, including <a href="/wiki/Melasma" title="Melasma">melasma</a>, are found in trans women at the same rate at cisgender women.<a href="#cite_note-:0-290">[277]</a> <a href="/wiki/Sebaceous_gland" title="Sebaceous gland">Sebaceous gland</a> activity lessens, reducing oil production on the skin and <a href="/wiki/Scalp" title="Scalp">scalp</a>. Consequently, the skin becomes less prone to acne. It also becomes drier, and lotions or oils may be necessary.<a href="#cite_note-Gooren1992-282">[269]</a><a href="#cite_note-Gooren2000-291">[278]</a> <div class="mw-heading mw-heading3"><h3 id="Skeleton">Skeleton</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=18" title="Edit section: Skeleton">edit</a>]</div> Sex hormones play an important role in bone growth and maintenance. The effects of hormone therapy on bone health are not fully understood, and may depend on whether hormone therapy is started before or after puberty.<a href="#cite_note-Ciancia2022-292">[279]</a> Bone density continue to grow and change over time. Significant changes to bone structure have been observed,<a href="#cite_note-293">[280]</a><a href="#cite_note-294">[281]</a><a href="#cite_note-295">[282]</a> and transgender women have statistically poorer bone health even before beginning the transition process, possibly due to a lack of physical exercise<a href="#cite_note-296">[283]</a> or other risk factors such as low vitamin D, eating disorders, and substance abuse.<a href="#cite_note-Giacomelli2022-297">[284]</a> Approximately 14% of transgender women suffer from <a href="/wiki/Osteoporosis" title="Osteoporosis">osteoporosis</a>.<a href="#cite_note-Giacomelli2022-297">[284]</a> Transgender women below the age of 50 show increased fracture risk compared to age-matched cisgender women, equal to the risk to cisgender men of equivalent age. Transgender women above the age of 50 have a similar fracture risk to post-menopausal women — higher than that of age-matched cis men. In both cases, trans women's fracture patterns follow that of cis women, suffering long-term stress fractures concentrated in the hip, spine, and arms, typical of chronic low bone mineral density, rather than the fracture patterns typical of external injury suffered by cis men.<a href="#cite_note-298">[285]</a> Current clinical guidelines are for bone health to be monitored regularly throughout the transition process, particularly if risk factors are present.<a href="#cite_note-Ciancia2022-292">[279]</a> Transgender individuals are encouraged to ingest at least 1g of Calcium and 1000 IU of Vitamin D daily, engage regularly in weight-bearing physical activity, and reduce alcohol and smoking consumption.<a href="#cite_note-299">[286]</a> The effects of hormone therapy on bone health are reversible should treatment be interrupted. However, withdrawing hormone therapy after <a href="/wiki/Gonadectomy" title="Gonadectomy">gonadectomy</a> can lead to bone loss,<a href="#cite_note-300">[287]</a> and poor compliance with prescribed hormone therapy after gonadectomy may account in part for the observed fracture risk.<a href="#cite_note-301">[288]</a> <div class="mw-heading mw-heading3"><h3 id="Hair">Hair</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=19" title="Edit section: Hair">edit</a>]</div> Antiandrogens affect existing <a href="/wiki/Facial_hair" title="Facial hair">facial hair</a> only slightly; patients may see slower growth and some reduction in density and coverage. This reduction of density is due to the decreasing hair diameter and slower terminal growth rate. Effects on hair size and density were noticeable in the first four months following the start of hormone therapy, but later subsided, with measurements staying constant.<a href="#cite_note-:0-290">[277]</a> In patients in their teens or early twenties, antiandrogens prevent new facial hair from developing if testosterone levels are within the normal female range.<a href="#cite_note-Gooren1992-282">[269]</a><a href="#cite_note-Gooren2000-291">[278]</a> <a href="/wiki/Body_hair" title="Body hair">Body hair</a> (on the chest, shoulders, back, abdomen, buttocks, thighs, tops of hands, and tops of feet) turns, over time, from <a href="/wiki/Terminal_hair" title="Terminal hair">terminal</a> ("normal") hairs to tiny, blonde <a href="/wiki/Vellus" class="mw-redirect" title="Vellus">vellus</a> hairs. Arm, perianal, and <a href="/wiki/Perineum" title="Perineum">perineal</a> hair is reduced but may not turn to vellus hair on the latter two regions (some cisgender women also have hair in these areas). Underarm hair changes slightly in texture and length, and <a href="/wiki/Pubic_hair" title="Pubic hair">pubic hair</a> becomes more typically female in pattern. Lower leg hair becomes less dense. All of these changes depend to some degree on genetics.<a href="#cite_note-Gooren1992-282">[269]</a><a href="#cite_note-Gooren2000-291">[278]</a> <a href="/wiki/Eyebrow" title="Eyebrow">Eyebrows</a> do not change because they are not androgenic hair.<a href="#cite_note-pmid11595812-302">[289]</a> Occasionally, hormones can have effects on scalp hair texture, depending on various genetic factors. <div class="mw-heading mw-heading3"><h3 id="Eye_morphology">Eye morphology</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=20" title="Edit section: Eye morphology">edit</a>]</div> The <a href="/wiki/Lens_(anatomy)" class="mw-redirect" title="Lens (anatomy)">lens</a> of the <a href="/wiki/Eye" title="Eye">eye</a> changes in curvature.<a href="#cite_note-303">[290]</a><a href="#cite_note-Kirk1999-289">[276]</a> Because of decreased androgen levels, the <a href="/wiki/Meibomian_gland" title="Meibomian gland">meibomian glands</a> (the sebaceous glands on the upper and lower eyelids that open up at the edges) produce less oil. Because oil prevents the <a href="/wiki/Tears" title="Tears">tear film</a> from evaporating, this change may cause dry eyes.<a href="#cite_note-304">[291]</a> <div class="mw-heading mw-heading3"><h3 id="Cardiovascular_effects">Cardiovascular effects</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=21" title="Edit section: Cardiovascular effects">edit</a>]</div> The most significant cardiovascular risk for transgender women is the prothrombotic effect (increased <a href="/wiki/Coagulation" title="Coagulation">blood clotting</a>) of estrogens. This manifests most significantly as an increased risk for <a href="/wiki/Venous_thromboembolism" class="mw-redirect" title="Venous thromboembolism">venous thromboembolism</a> (VTE): <a href="/wiki/Deep_vein_thrombosis" title="Deep vein thrombosis">deep vein thrombosis</a> (DVT) and <a href="/wiki/Pulmonary_embolism" title="Pulmonary embolism">pulmonary embolism</a> (PE), which occurs when blood clots from DVT break off and migrate to the <a href="/wiki/Lung" title="Lung">lungs</a>. Symptoms of DVT include pain or swelling of one leg, especially the <a href="/wiki/Calf_(leg)" title="Calf (leg)">calf</a>. Symptoms of PE include <a href="/wiki/Chest_pain" title="Chest pain">chest pain</a>, <a href="/wiki/Dyspnea" class="mw-redirect" title="Dyspnea">shortness of breath</a>, <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">fainting</a>, and <a href="/wiki/Palpitations" title="Palpitations">heart palpitations</a>, sometimes without leg pain or swelling. VTE occurs more frequently in the first year of treatment with estrogens. The risk of VTE is higher with oral non-bioidentical estrogens such as ethinylestradiol and conjugated estrogens than with parenteral formulations of estradiol such as injectable, transdermal, implantable, and intranasal.<a href="#cite_note-VteRiskForms-305">[292]</a><a href="#cite_note-pmid7500443-158">[153]</a><a href="#cite_note-pmid17019433-20">[20]</a> Increased risk of VTE with estrogens is thought to be due to their influence on <a href="/wiki/Liver_protein_synthesis" class="mw-redirect" title="Liver protein synthesis">liver protein synthesis</a>, specifically on the production of <a href="/wiki/Coagulation_factor" class="mw-redirect" title="Coagulation factor">coagulation factors</a>.<a href="#cite_note-pmid16112947-14">[14]</a> Non-bioidentical estrogens such as conjugated estrogens and especially ethinylestradiol have markedly disproportionate effects on liver protein synthesis relative to estradiol.<a href="#cite_note-pmid16112947-14">[14]</a> In addition, oral estradiol has a 4- to 5-fold increased impact on liver protein synthesis than does transdermal estradiol and other parenteral estradiol routes.<a href="#cite_note-pmid16112947-14">[14]</a><a href="#cite_note-FritzSperoff2012-306">[293]</a> Because the risks of <a href="/wiki/Warfarin" title="Warfarin">warfarin</a> – which is used to treat blood clots – in a relatively young and otherwise healthy population are low, while the risk of adverse physical and psychological outcomes for untreated transgender patients is high, prothrombotic mutations (such as <a href="/wiki/Factor_V_Leiden" title="Factor V Leiden">factor V Leiden</a>, <a href="/wiki/Antithrombin" title="Antithrombin">antithrombin III</a>, and <a href="/wiki/Protein_C_deficiency" title="Protein C deficiency">protein C</a> or <a href="/wiki/Protein_S_deficiency" title="Protein S deficiency">S deficiency</a>) are not absolute contraindications for hormonal therapy.<a href="#cite_note-pmid14510900u-203">[198]</a> A 2018 cohort study of 2842 transfeminine individuals in the <a href="/wiki/United_States" title="United States">United States</a> treated with a mean follow-up of 4.0 years observed an increased risk of VTE, <a href="/wiki/Stroke" title="Stroke">stroke</a>, and <a href="/wiki/Heart_attack" class="mw-redirect" title="Heart attack">heart attack</a> relative to a cisgender reference population.<a href="#cite_note-pmid30178031-307">[294]</a><a href="#cite_note-pmid30334572-308">[295]</a><a href="#cite_note-pmid30256230-38">[38]</a><a href="#cite_note-pmid29987313-19">[19]</a> The estrogens used included oral estradiol (1 to 10 mg/day) and other estrogen formulations.<a href="#cite_note-pmid29987313-19">[19]</a> Other medications such as antiandrogens like spironolactone were also used.<a href="#cite_note-pmid29987313-19">[19]</a> A 2019 <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> and <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> found an incidence rate of VTE of 2.3 per 1000 person-years with feminizing hormone therapy in transgender women.<a href="#cite_note-pmid30602475-309">[296]</a> For comparison, the rate in the general population has been found to be 1.0–1.8 per 1000 person-years, and the rate in premenopausal women taking <a href="/wiki/Birth_control_pill" class="mw-redirect" title="Birth control pill">birth control pills</a> has been found to be 3.5 per 1000 patient-years.<a href="#cite_note-pmid30602475-309">[296]</a><a href="#cite_note-pmid26076949-310">[297]</a> There was significant <a href="/wiki/Heterogeneity" class="mw-redirect" title="Heterogeneity">heterogeneity</a> in the rates of VTE across the included studied, and the meta-analysis was unable to perform subgroup analyses between estrogen type, estrogen route, estrogen dosage, concomitant antiandrogen or progestogen use, or patient characteristics (e.g., sex, age, smoking status, weight) corresponding to known risk factors for VTE.<a href="#cite_note-pmid30602475-309">[296]</a> Due to the inclusion of some studies using ethinylestradiol, which is more thrombotic and is no longer used in transgender women, the researchers noted that the VTE risk found in their study may be an overestimate.<a href="#cite_note-pmid30602475-309">[296]</a> In a 2016 study that specifically assessed oral estradiol, the incidence of VTE in 676 transgender women who were treated for an average of 1.9 years each was only one individual, or 0.15% of the group, with an incidence of 7.8 events per 10,000 person-years.<a href="#cite_note-Houlberg2019-311">[298]</a><a href="#cite_note-pmid27671969-312">[299]</a> The dosage of oral estradiol used was 2 to 8 mg/day.<a href="#cite_note-pmid27671969-312">[299]</a> Almost all of the transgender women were also taking spironolactone (94%), a subset were also taking finasteride (17%), and fewer than 5% were also taking a progestogen (usually oral progesterone).<a href="#cite_note-pmid27671969-312">[299]</a> The findings of this study suggest that the incidence of VTE is low in transgender women taking oral estradiol.<a href="#cite_note-Houlberg2019-311">[298]</a><a href="#cite_note-pmid27671969-312">[299]</a> Cardiovascular health in transgender women has been reviewed in recent publications.<a href="#cite_note-pmid28738421-313">[300]</a><a href="#cite_note-pmid30073551-18">[18]</a> <div class="mw-heading mw-heading3"><h3 id="Gastrointestinal">Gastrointestinal</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=22" title="Edit section: Gastrointestinal">edit</a>]</div> Estrogens may increase the risk of <a href="/wiki/Gallbladder_disease" title="Gallbladder disease">gallbladder disease</a>, especially in older and obese people.<a href="#cite_note-Kirk1999-289">[276]</a> <div class="mw-heading mw-heading3"><h3 id="Cancer_risk">Cancer risk</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=23" title="Edit section: Cancer risk">edit</a>]</div> Studies are mixed on whether the risk of breast cancer is increased with hormone therapy in transgender women.<a href="#cite_note-pmid30527351-314">[301]</a><a href="#cite_note-pmid24010586-315">[302]</a><a href="#cite_note-pmid25428790-316">[303]</a><a href="#cite_note-de_BlokWiepjes2019-317">[304]</a> Two cohort studies found no increase in risk relative to cisgender men,<a href="#cite_note-pmid24010586-315">[302]</a><a href="#cite_note-pmid25428790-316">[303]</a> whereas another cohort study found an almost 50-fold increase in risk such that the incidence of breast cancer was between that of cisgender men and cisgender women.<a href="#cite_note-de_BlokWiepjes2019-317">[304]</a><a href="#cite_note-pmid30527351-314">[301]</a> There is no evidence that breast cancer risk in transgender women is greater than in cisgender women.<a href="#cite_note-IwamotoDefreyne2019-318">[305]</a> Twenty cases of breast cancer in transgender women have been reported as of 2019.<a href="#cite_note-pmid30527351-314">[301]</a><a href="#cite_note-pmid30087072-319">[306]</a> Cisgender men with <a href="/wiki/Gynecomastia" title="Gynecomastia">gynecomastia</a> have not been found to have an increased risk of breast cancer.<a href="#cite_note-pmid24741509-320">[307]</a> It has been suggested that a 46,XY <a href="/wiki/Karyotype" title="Karyotype">karyotype</a> (one <a href="/wiki/X_chromosome" title="X chromosome">X chromosome</a> and one <a href="/wiki/Y_chromosome" title="Y chromosome">Y chromosome</a>) may be protective against breast cancer compared to having a 46,XX karyotype (two X chromosomes).<a href="#cite_note-pmid24741509-320">[307]</a> Men with <a href="/wiki/Klinefelter%27s_syndrome" class="mw-redirect" title="Klinefelter's syndrome">Klinefelter's syndrome</a> (47,XXY karyotype), which causes <a href="/wiki/Hypoandrogenism" class="mw-redirect" title="Hypoandrogenism">hypoandrogenism</a>, <a href="/wiki/Hyperestrogenism" title="Hyperestrogenism">hyperestrogenism</a>, and a very high incidence of gynecomastia (80%), have a dramatically (20- to 58-fold) increased risk of breast cancer compared to karyotypical men (46,XY), closer to the rate of karyotypical women (46,XX).<a href="#cite_note-pmid24741509-320">[307]</a><a href="#cite_note-pmid18369226-321">[308]</a><a href="#cite_note-Li2009-322">[309]</a> The incidences of breast cancer in karyotypical men, men with Klinefelter's syndrome, and karyotypical women are approximately 0.1%,<a href="#cite_note-PelengarisKhan2013-323">[310]</a> 3%,<a href="#cite_note-pmid18369226-321">[308]</a> and 12.5%,<a href="#cite_note-Cardenosa2004-324">[311]</a> respectively. Women with <a href="/wiki/Complete_androgen_insensitivity_syndrome" title="Complete androgen insensitivity syndrome">complete androgen insensitivity syndrome</a> (46,XY karyotype) never develop male sex characteristics and have normal and complete female <a href="/wiki/Morphology_(biology)" title="Morphology (biology)">morphology</a>, including breast development,<a href="#cite_note-IIIBarbieri2013-325">[312]</a> yet have not been reported to develop breast cancer.<a href="#cite_note-MelmedPolonsky2015-79">[74]</a><a href="#cite_note-pmid23044881-326">[313]</a> The risk of breast cancer in women with <a href="/wiki/Turner_syndrome" title="Turner syndrome">Turner syndrome</a> (45,XO karyotype) also appears to be significantly decreased, though this could be related to <a href="/wiki/Ovarian_failure" class="mw-redirect" title="Ovarian failure">ovarian failure</a> and <a href="/wiki/Hypogonadism" title="Hypogonadism">hypogonadism</a> rather than to genetics.<a href="#cite_note-pmid18282803-327">[314]</a> <a href="/wiki/Prostate_cancer" title="Prostate cancer">Prostate cancer</a> is extremely rare in <a href="/wiki/Gonadectomy" title="Gonadectomy">gonadectomized</a> transgender women who have been treated with estrogens for a prolonged period of time.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-pmid24329588-328">[315]</a><a href="#cite_note-pmid24032068-329">[316]</a> Whereas as many as 70% of men show prostate cancer by their 80s,<a href="#cite_note-Demos2011-147">[142]</a> only a handful of cases of prostate cancer in transgender women have been reported in the literature.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-pmid24329588-328">[315]</a><a href="#cite_note-pmid24032068-329">[316]</a> As such, and in accordance with the fact that androgens are responsible for the development of prostate cancer, HRT appears to be highly protective against prostate cancer in transgender women.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-pmid24329588-328">[315]</a><a href="#cite_note-pmid24032068-329">[316]</a> The risks of certain types of <a href="/wiki/Benign_brain_tumor" class="mw-redirect" title="Benign brain tumor">benign brain tumors</a> including <a href="/wiki/Meningioma" title="Meningioma">meningioma</a> and <a href="/wiki/Prolactinoma" title="Prolactinoma">prolactinoma</a> are increased with hormone therapy in transgender women.<a href="#cite_note-McFarlaneZajac2018-330">[317]</a> These risks have mostly been associated with the use of <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a>.<a href="#cite_note-McFarlaneZajac2018-330">[317]</a> Estrogens and progestogens can cause <a href="/wiki/Prolactinoma" title="Prolactinoma">prolactinomas</a>, which are benign, <a href="/wiki/Prolactin" title="Prolactin">prolactin</a>-secreting <a href="/wiki/Tumor" class="mw-redirect" title="Tumor">tumors</a> of the <a href="/wiki/Pituitary_gland" title="Pituitary gland">pituitary gland</a>.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Milk discharge from the nipples can be a sign of <a href="/wiki/Hyperprolactinemia" class="mw-redirect" title="Hyperprolactinemia">elevated prolactin levels</a>. If a prolactinoma becomes large enough, it can cause visual changes (especially decreased <a href="/wiki/Peripheral_vision" title="Peripheral vision">peripheral vision</a>), <a href="/wiki/Headache" title="Headache">headaches</a>, depression or other mood changes, <a href="/wiki/Dizziness" title="Dizziness">dizziness</a>, <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Vomiting" title="Vomiting">vomiting</a>, and symptoms of <a href="/wiki/Hypopituitarism" title="Hypopituitarism">pituitary failure</a>, like <a href="/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a>. <div class="mw-heading mw-heading3"><h3 id="Unaffected_characteristics">Unaffected characteristics</h3>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=24" title="Edit section: Unaffected characteristics">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1251242444"><table class="box-Expand_section plainlinks metadata ambox mbox-small-left ambox-content" role="presentation"><tbody><tr><td class="mbox-image"><a href="/wiki/File:Wiki_letter_w_cropped.svg" class="mw-file-description"><img alt="[icon]" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/20px-Wiki_letter_w_cropped.svg.png" decoding="async" width="20" height="14" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/30px-Wiki_letter_w_cropped.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/40px-Wiki_letter_w_cropped.svg.png 2x" data-file-width="44" data-file-height="31" /></a></td><td class="mbox-text"><div class="mbox-text-span">This section needs expansion. You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=">adding to it</a>. (December 2022)</div></td></tr></tbody></table> Established changes to the bone structure of the face are also unaffected by HRT. A significant majority of craniofacial changes occur during <a href="/wiki/Adolescence" title="Adolescence">adolescence</a>. Post-adolescent growth is considerably slower and minimal by comparison.<a href="#cite_note-PMPH2012-331">[318]</a> Facial hair develops during puberty and is only slightly affected by HRT.<a href="#cite_note-Gooren2000-291">[278]</a> A person's voice is unaffected by feminizing hormone therapy. Transgender individuals who have undergone male puberty often opt for <a href="/wiki/Vocal_training" class="mw-redirect" title="Vocal training">vocal training</a>, though this may take many years of practice to achieve the desired results. Some may also opt for vocal surgery, though this is to be done in addition to vocal training, not instead of.<a href="#cite_note-332">[319]</a><a href="#cite_note-333">[320]</a><a href="#cite_note-334">[321]</a> <div class="mw-heading mw-heading2"><h2 id="Monitoring">Monitoring</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=25" title="Edit section: Monitoring">edit</a>]</div> Especially in the early stages of feminizing hormone therapy, <a href="/wiki/Blood_test" title="Blood test">blood work</a> is done frequently to assess hormone levels and liver function. The Endocrine Society recommends that patients have blood tests every three months in the first year of HRT for estradiol and testosterone, and that spironolactone, if used, be monitored every two to three months in the first year.<a href="#cite_note-pmid28945902-1">[1]</a> Recommended ranges for total estradiol and total testosterone levels include but are not limited to the following: <table class="wikitable"> <caption><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Target_ranges_for_hormone_levels_in_hormone_therapy_for_transgender_women" title="Template:Target ranges for hormone levels in hormone therapy for transgender women"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Target_ranges_for_hormone_levels_in_hormone_therapy_for_transgender_women" title="Template talk:Target ranges for hormone levels in hormone therapy for transgender women"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Target_ranges_for_hormone_levels_in_hormone_therapy_for_transgender_women" title="Special:EditPage/Template:Target ranges for hormone levels in hormone therapy for transgender women"><abbr title="Edit this template">e</abbr></a></li></ul></div> Target ranges for hormone levels in hormone therapy for transgender women </caption> <tbody><tr> <th>Source</th> <th>Place</th> <th>Estradiol, total</th> <th>Testosterone, total </th></tr> <tr> <td><a href="/wiki/Endocrine_Society" title="Endocrine Society">Endocrine Society</a></td> <td>United States</td> <td>100–200 pg/mL</td> <td><50 ng/dL </td></tr> <tr> <td><a href="/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">World Professional Association for Transgender Health</a> (WPATH)</td> <td>United States</td> <td colspan="2" width="325px">"[T]estosterone levels [...] below the upper limit of the normal female range and estradiol levels within a premenopausal female range but well below supraphysiologic levels." "[M]aintain levels within physiologic ranges for a patient's desired gender expression (based on goals of full feminization/masculinization)." </td></tr> <tr> <td><a href="/wiki/University_of_California,_San_Francisco" title="University of California, San Francisco">Center of Excellence for Transgender Health</a> (<a href="/wiki/University_of_California,_San_Francisco" title="University of California, San Francisco"><abbr title="University of California, San Francisco">UCSF</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip University of California, San Francisco)</td> <td>United States</td> <td colspan="2" width="325px">"The interpretation of hormone levels for transgender individuals is not yet evidence based; physiologic hormone levels in non-transgender people are used as reference ranges." "Providers are encouraged to consult with their local lab(s) to obtain hormone level reference ranges for both 'male' and 'female' norms, [which can vary,] and then apply the correct range when interpreting results based on the current hormonal sex, rather than the sex of registration." </td></tr> <tr> <td><a href="/wiki/Fenway_Health" title="Fenway Health">Fenway Health</a></td> <td>United States</td> <td>100–200 pg/mL</td> <td><55 ng/dL </td></tr> <tr> <td><a href="/wiki/Callen-Lorde_Community_Health_Center" title="Callen-Lorde Community Health Center">Callen-Lorde</a></td> <td>United States</td> <td colspan="2" width="325px">"Some guidelines recommend checking estradiol and testosterone levels at baseline and throughout the monitoring of estrogen therapy. We have not found a clinical use for routine hormone levels that justifies the expense. However, we recognize that individual providers may adjust their prescribing and monitoring practices as needed to comply with guidelines or when guided by patient need." </td></tr> <tr> <td><a href="/wiki/International_Planned_Parenthood_Federation" title="International Planned Parenthood Federation">International Planned Parenthood Federation</a> (IPPF)</td> <td>United Kingdom</td> <td><200 pg/mL</td> <td>30–100 ng/dL </td></tr> <tr> <td><a href="/wiki/National_Health_Service" title="National Health Service">National Health Service</a> (NHS) <a href="/wiki/NHS_Foundation_Trust" class="mw-redirect" title="NHS Foundation Trust">Foundation Trusts</a></td> <td>United Kingdom</td> <td>55–160 pg/mL</td> <td>30–85 ng/dL </td></tr> <tr> <td><a href="/wiki/Royal_College_of_Psychiatry" class="mw-redirect" title="Royal College of Psychiatry">Royal College of Psychiatry</a> (RCP)</td> <td>United Kingdom</td> <td>80–140 pg/mL</td> <td>"Well below normal male range" </td></tr> <tr> <td><a href="/wiki/Vancouver_Coastal_Health" title="Vancouver Coastal Health">Vancouver Coastal Health</a> (VCH)</td> <td>Canada</td> <td><abbr title="No data">ND</abbr></td> <td><1.5 nmol/L </td></tr> <tr class="sortbottom"> <td colspan="5" style="width: 1px; background-color:#eaecf0; text-align: center;">Sources: See template. </td></tr></tbody></table> The optimal ranges for estrogen apply only to individuals taking estradiol (or an ester of estradiol), and not to those taking synthetic or other non-bioidentical preparations (e.g., conjugated estrogens or ethinylestradiol).<a href="#cite_note-pmid28945902-1">[1]</a> Physicians also recommend broader medical monitoring, including <a href="/wiki/Complete_blood_count" title="Complete blood count">complete blood counts</a>; tests of renal function, liver function, and lipid and glucose metabolism; and monitoring of prolactin levels, body weight, and blood pressure.<a href="#cite_note-pmid28945902-1">[1]</a><a href="#cite_note-Callen-Lorde2018-335">[322]</a> If prolactin levels are greater than 100 ng/mL, estrogen therapy should be stopped and prolactin levels should be rechecked after 6 to 8 weeks.<a href="#cite_note-Callen-Lorde2018-335">[322]</a> If prolactin levels remain high, an MRI scan of the <a href="/wiki/Pituitary_gland" title="Pituitary gland">pituitary gland</a> to check for the presence of a <a href="/wiki/Prolactinoma" title="Prolactinoma">prolactinoma</a> should be ordered.<a href="#cite_note-Callen-Lorde2018-335">[322]</a> Otherwise, estrogen therapy may be restarted at a lower dosage.<a href="#cite_note-Callen-Lorde2018-335">[322]</a> Cyproterone acetate is particularly associated with elevated prolactin levels, and discontinuation of cyproterone acetate lowers prolactin levels.<a href="#cite_note-McFarlaneZajac2018-330">[317]</a><a href="#cite_note-NotaWiepjes2018-244">[239]</a><a href="#cite_note-MahfoudaMoore2019-336">[323]</a> In contrast to cyproterone acetate, estrogen and spironolactone therapy is not associated with increased prolactin levels.<a href="#cite_note-MahfoudaMoore2019-336">[323]</a><a href="#cite_note-BissonChan2018-337">[324]</a> <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=26" title="Edit section: History">edit</a>]</div> Effective pharmaceutical female sex-hormonal medications, including androgens, estrogens, and progestogens, first became available in the 1920s and 1930s.<a href="#cite_note-Watkins2007-338">[325]</a> One of the earliest reports of hormone therapy in transgender women was published by <a href="/wiki/Denmark" title="Denmark">Danish</a> <a href="/wiki/Endocrinologist" class="mw-redirect" title="Endocrinologist">endocrinologist</a> <a href="/wiki/Christian_Hamburger" title="Christian Hamburger">Christian Hamburger</a> in 1953.<a href="#cite_note-pmid13044539-339">[326]</a> One of his patients was <a href="/wiki/Christine_Jorgensen" title="Christine Jorgensen">Christine Jorgensen</a>, who he had treated starting in 1950.<a href="#cite_note-MedicinePopulations2011-340">[327]</a><a href="#cite_note-pmid1103789-341">[328]</a><a href="#cite_note-Denny2013-342">[329]</a><a href="#cite_note-StrykerStryker2006-343">[330]</a> Additional reports of hormone therapy in transgender women were published by Hamburger, the <a href="/wiki/German-American" class="mw-redirect" title="German-American">German-American</a> endocrinologist <a href="/wiki/Harry_Benjamin" title="Harry Benjamin">Harry Benjamin</a>, and other researchers in the mid-to-late 1960s.<a href="#cite_note-GoorenAsscheman2014-344">[331]</a><a href="#cite_note-KreukelsSteensma2013-345">[332]</a><a href="#cite_note-pmid14173773-346">[333]</a><a href="#cite_note-Benjamin1966-347">[334]</a><a href="#cite_note-Benjamin1967-348">[335]</a><a href="#cite_note-HamburgerBenjamin1969-349">[336]</a> However, Benjamin had several hundred transgender patients under his care by the late 1950s,<a href="#cite_note-EttnerMonstrey2016-94">[89]</a> and had treated transgender women with hormone therapy as early as the late 1940s or early 1950s.<a href="#cite_note-pmid7733806-350">[337]</a><a href="#cite_note-Goldberg2016-351">[338]</a><a href="#cite_note-StrykerWhittle2013-352">[339]</a><a href="#cite_note-MedicinePopulations2011-340">[327]</a> In any case, Hamburger is said to be the first to treat transgender women with hormone therapy.<a href="#cite_note-pmid4902840-353">[340]</a> One of the first transgender health clinics was opened in the mid-1960s at the <a href="/wiki/Johns_Hopkins_School_of_Medicine" title="Johns Hopkins School of Medicine">Johns Hopkins School of Medicine</a>.<a href="#cite_note-Ekins2016-354">[341]</a><a href="#cite_note-EttnerMonstrey2016-94">[89]</a> By 1981, there were almost 40 such centers.<a href="#cite_note-MeyerWalker1981-355">[342]</a> A review of the hormonal regimens of 20 of the centers was published that year.<a href="#cite_note-GoorenAsscheman2014-344">[331]</a><a href="#cite_note-MeyerWalker1981-355">[342]</a> The first International Symposium on Gender Identity, chaired by <a href="/wiki/Christopher_John_Dewhurst" title="Christopher John Dewhurst">Christopher John Dewhurst</a>, was held in London in 1969,<a href="#cite_note-WPATH-Symposia-356">[343]</a> and the first medical textbook on transgenderism, titled <a href="/wiki/Transsexualism_and_Sex_Reassignment" title="Transsexualism and Sex Reassignment">Transsexualism and Sex Reassignment</a> and edited by <a href="/wiki/Richard_Green_(sexologist)" title="Richard Green (sexologist)">Richard Green</a> and <a href="/wiki/John_Money" title="John Money">John Money</a>, was published by <a href="/wiki/Johns_Hopkins_University_Press" title="Johns Hopkins University Press">Johns Hopkins University Press</a> in 1969.<a href="#cite_note-GreenMoney1969-357">[344]</a><a href="#cite_note-BenjaminIhlenfeld1970-358">[345]</a> This textbook included a chapter on hormone therapy written by Christian Hamburger and Harry Benjamin.<a href="#cite_note-HamburgerBenjamin1969-349">[336]</a> The <a href="/wiki/Harry_Benjamin_International_Gender_Dysphoria_Association" class="mw-redirect" title="Harry Benjamin International Gender Dysphoria Association">Harry Benjamin International Gender Dysphoria Association</a> (HBIGDA), now known as the <a href="/wiki/World_Professional_Association_for_Transgender_Health" title="World Professional Association for Transgender Health">World Professional Association for Transgender Health</a> (WPATH), was formed in 1979, with the first version of the <a href="/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People" class="mw-redirect" title="Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People">Standards of Care</a> published the same year.<a href="#cite_note-MedicinePopulations2011-340">[327]</a> The <a href="/wiki/Endocrine_Society" title="Endocrine Society">Endocrine Society</a> published guidelines for the hormonal care of transgender people in 2009, with a revised version in 2017.<a href="#cite_note-GoorenAsscheman2014-344">[331]</a><a href="#cite_note-pmid19509099-359">[346]</a><a href="#cite_note-pmid28945902-1">[1]</a> Hormone therapy for transgender women was initially done using <a href="/wiki/High-dose_estrogen" class="mw-redirect" title="High-dose estrogen">high-dose estrogen</a> therapy with <a href="/wiki/Oral_administration" title="Oral administration">oral</a> estrogens such as <a href="/wiki/Conjugated_estrogens" title="Conjugated estrogens">conjugated estrogens</a>, <a href="/wiki/Ethinylestradiol" title="Ethinylestradiol">ethinylestradiol</a>, and <a href="/wiki/Diethylstilbestrol" title="Diethylstilbestrol">diethylstilbestrol</a> and with <a href="/wiki/Parenteral" class="mw-redirect" title="Parenteral">parenteral</a> <a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">estrogens</a> such as <a href="/wiki/Estradiol_benzoate" title="Estradiol benzoate">estradiol benzoate</a>, <a href="/wiki/Estradiol_valerate" title="Estradiol valerate">estradiol valerate</a>, <a href="/wiki/Estradiol_cypionate" title="Estradiol cypionate">estradiol cypionate</a>, and <a href="/wiki/Estradiol_undecylate" title="Estradiol undecylate">estradiol undecylate</a>.<a href="#cite_note-Benjamin1966-347">[334]</a><a href="#cite_note-Benjamin1967-348">[335]</a><a href="#cite_note-HamburgerBenjamin1969-349">[336]</a><a href="#cite_note-MeyerWalker1981-355">[342]</a><a href="#cite_note-pmid2540730-360">[347]</a> <a href="/wiki/Progestogen_(medication)" title="Progestogen (medication)">Progestogens</a>, such as <a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">hydroxyprogesterone caproate</a>, <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">medroxyprogesterone acetate</a>, and other <a href="/wiki/Progestin" class="mw-redirect" title="Progestin">progestins</a>, were also sometimes included.<a href="#cite_note-pmid13044539-339">[326]</a><a href="#cite_note-Benjamin1966-347">[334]</a><a href="#cite_note-Benjamin1967-348">[335]</a><a href="#cite_note-MeyerWalker1981-355">[342]</a><a href="#cite_note-PriorVigna1986-361">[348]</a><a href="#cite_note-AsschemanGooren1993.2-274">[261]</a><a href="#cite_note-MooreWisniewski2003-241">[236]</a> The <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogen</a> and progestogen <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a> was first used in transgender women by 1977.<a href="#cite_note-Steinbeck1977-362">[349]</a><a href="#cite_note-ZinggKönig1980-363">[350]</a><a href="#cite_note-pmid2530920-364">[351]</a> Its use was standard at the <a href="/wiki/Center_of_Expertise_on_Gender_Dysphoria" title="Center of Expertise on Gender Dysphoria">Center of Expertise on Gender Dysphoria</a> (CEGD; Kennis- en Zorgcentrum Genderdysforie, or KZcG) in <a href="/wiki/Amsterdam,_the_Netherlands" class="mw-redirect" title="Amsterdam, the Netherlands">Amsterdam, the Netherlands</a> by 1985.<a href="#cite_note-pmid3900616-365">[352]</a><a href="#cite_note-pmid2540730-360">[347]</a> <a href="/wiki/Spironolactone" title="Spironolactone">Spironolactone</a>, another antiandrogen, was first used in transgender women by 1986.<a href="#cite_note-DahlFeldman2006-366">[353]</a><a href="#cite_note-PriorVigna1986-361">[348]</a><a href="#cite_note-pmid2540730-360">[347]</a><a href="#cite_note-FisherMaggi2015-272">[259]</a><a href="#cite_note-pmid6433746-367">[354]</a> These agents were described as allowing the use of much lower doses of estrogen than previously required, and this was considered advantageous due to risks of high doses of estrogens such as cardiovascular complications.<a href="#cite_note-PriorVigna1986-361">[348]</a><a href="#cite_note-pmid2540730-360">[347]</a><a href="#cite_note-pmid2530920-364">[351]</a> Antiandrogens were well-established in hormone therapy for transgender women by the early 1990s.<a href="#cite_note-AsschemanGooren1993.2-274">[261]</a><a href="#cite_note-MooreWisniewski2003-241">[236]</a><a href="#cite_note-SchaeferWheelerFutterweit1995-368">[355]</a> Estrogen doses in transgender women were reduced following the introduction of antiandrogens.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Ethinylestradiol, conjugated estrogens, and other non-bioidentical estrogens largely stopped being used in transgender women in favor of estradiol starting around 2000 due to their greater risks of <a href="/wiki/Blood_clot" class="mw-redirect" title="Blood clot">blood clots</a> and <a href="/wiki/Cardiovascular" class="mw-redirect" title="Cardiovascular">cardiovascular</a> issues.<a href="#cite_note-Radix2016-273">[260]</a><a href="#cite_note-pmid28738421-313">[300]</a><a href="#cite_note-pmid30602475-309">[296]</a> In modern times, hormone therapy in transgender women is usually done with the combination of an estrogen and an antiandrogen.<a href="#cite_note-RoseHughtoDunbar2021-369">[356]</a> In some places however, such as <a href="/wiki/Japan" title="Japan">Japan</a>, use of antiandrogens is uncommon, and estrogen monotherapy, for instance with high-dose injectable estradiol esters, is still frequently used.<a href="#cite_note-pmid22487218-370">[357]</a> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=27" title="Edit section: See also">edit</a>]</div> <ul><li><a href="/wiki/Menopausal_hormone_therapy" class="mw-redirect" title="Menopausal hormone therapy">Menopausal hormone therapy</a></li> <li><a href="/wiki/Androgen_replacement_therapy" title="Androgen replacement therapy">Androgen replacement therapy</a></li> <li><a href="/wiki/Masculinizing_hormone_therapy" title="Masculinizing hormone therapy">Masculinizing hormone therapy</a></li> <li><a href="/wiki/DIY_transgender_hormone_therapy" title="DIY transgender hormone therapy">DIY transgender hormone therapy</a></li> <li><a href="/wiki/Hormone_replacement_therapy" title="Hormone replacement therapy">Hormone replacement therapy</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=28" title="Edit section: References">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-pmid28945902-1">^ <a href="#cite_ref-pmid28945902_1-0">a</a> <a href="#cite_ref-pmid28945902_1-1">b</a> <a href="#cite_ref-pmid28945902_1-2">c</a> <a href="#cite_ref-pmid28945902_1-3">d</a> <a 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Urology. 58 (2 Suppl 1): 83–90. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fs0090-4295%2801%2901247-x">10.1016/s0090-4295(01)01247-x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11502457">11502457</a>. <q>There are several classes of antiandrogens including (1) antigonadotropins (eg, LHRH agonists/antagonists, synthetic estrogens [diethylstilbestrol]); (2) nonsteroidal androgen-receptor antagonists (eg, flutamide, bicalutamide, nilutamide); (3) steroidal agents with mixed actions (eg, cyproterone acetate); (4) adrenal androgen inhibitors (eg, ketoconazole, hydrocortisone); (5) steroidal agents that inhibit androgen biosynthesis (eg, 5α-reductase inhibitors (type II) and dual-acting 5α-reductase inhibitors); [...]</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Urology&rft.atitle=Androgen+deprivation+therapy+for+prostate+cancer+chemoprevention%3A+current+status+and+future+directions+for+agent+development&rft.volume=58&rft.issue=2+Suppl+1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E83-%3C%2Fspan%3E90&rft.date=2001-08&rft_id=info%3Adoi%2F10.1016%2Fs0090-4295%2801%2901247-x&rft_id=info%3Apmid%2F11502457&rft.aulast=Lieberman&rft.aufirst=R&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-MelmedPolonsky2015-79">^ <a href="#cite_ref-MelmedPolonsky2015_79-0">a</a> <a href="#cite_ref-MelmedPolonsky2015_79-1">b</a> <a href="#cite_ref-MelmedPolonsky2015_79-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMelmedPolonskyLarsenKronenberg2015" class="citation book cs1">Melmed S, Polonsky KS, Larsen PR, Kronenberg HM (11 November 2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=iPIACwAAQBAJ&pg=PA714">Williams Textbook of Endocrinology</a>. Elsevier Health Sciences. pp. 714, 934. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-323-34157-8" title="Special:BookSources/978-0-323-34157-8"><bdi>978-0-323-34157-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Williams+Textbook+of+Endocrinology&rft.pages=714%2C+934&rft.pub=Elsevier+Health+Sciences&rft.date=2015-11-11&rft.isbn=978-0-323-34157-8&rft.aulast=Melmed&rft.aufirst=S&rft.au=Polonsky%2C+KS&rft.au=Larsen%2C+PR&rft.au=Kronenberg%2C+HM&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DiPIACwAAQBAJ%26pg%3DPA714&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-Boslaugh2018-80">^ <a href="#cite_ref-Boslaugh2018_80-0">a</a> <a href="#cite_ref-Boslaugh2018_80-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBoslaugh2018" class="citation book cs1">Boslaugh S (3 August 2018). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=agVnDwAAQBAJ&pg=PA37">Transgender Health Issues</a>. <a href="/wiki/ABC-CLIO" class="mw-redirect" title="ABC-CLIO">ABC-CLIO</a>. pp. 37–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4408-5888-8" title="Special:BookSources/978-1-4408-5888-8"><bdi>978-1-4408-5888-8</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Transgender+Health+Issues&rft.pages=37-&rft.pub=ABC-CLIO&rft.date=2018-08-03&rft.isbn=978-1-4408-5888-8&rft.aulast=Boslaugh&rft.aufirst=S&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DagVnDwAAQBAJ%26pg%3DPA37&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-81"><a href="#cite_ref-81">^</a> <div><ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFStraussBarbieriGargiulo2017" class="citation book cs1">Strauss JF, Barbieri RL, Gargiulo AR (23 December 2017). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=67ZEDwAAQBAJ&pg=PA250">Yen & Jaffe's Reproductive Endocrinology E-Book: Physiology, Pathophysiology, and Clinical Management</a>. 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[Rennie et al.] found that the combination of CPA with an extremely low dose (0.1 mg/d) of DES led to a very effective withdrawal of androgens in terms of plasma testosterone and tissue dihydrotestosterone. [...] this regimen combines the testosterone-reducing effects of two compounds, therefore, only small amounts of estrogen are required to bring down plasma testosterone to approximately castrate levels.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Steroidal+Antiandrogens&rft.btitle=Hormone+Therapy+in+Breast+and+Prostate+Cancer&rft.pages=325-346&rft.pub=Humana+Press&rft.date=2009&rft_id=info%3Adoi%2F10.1007%2F978-1-59259-152-7_15&rft.isbn=978-1-60761-471-5&rft.aulast=Schr%C3%B6der&rft.aufirst=FH&rft.au=Radlmaier%2C+A&rft_id=https%3A%2F%2Farchive.org%2Fdetails%2Fhormonetherapybr00crai&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid3552544-134"><a href="#cite_ref-pmid3552544_134-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMelamed1987" class="citation journal cs1">Melamed AJ (March 1987). 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"Understanding and Addressing Hair Disorders in Transgender Individuals". American Journal of Clinical Dermatology. 19 (4): 517–527. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs40257-018-0343-z">10.1007/s40257-018-0343-z</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29352423">29352423</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:6467968">6467968</a>. <q>Non-steroidal antiandrogens include flutamide, nilutamide, and bicalutamide, which do not lower androgen levels and may be favorable for individuals who want to preserve sex drive and fertility [9].</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Clinical+Dermatology&rft.atitle=Understanding+and+Addressing+Hair+Disorders+in+Transgender+Individuals&rft.volume=19&rft.issue=4&rft.pages=%3Cspan+class%3D%22nowrap%22%3E517-%3C%2Fspan%3E527&rft.date=2018-08&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A6467968%23id-name%3DS2CID&rft_id=info%3Apmid%2F29352423&rft_id=info%3Adoi%2F10.1007%2Fs40257-018-0343-z&rft.aulast=Gao&rft.aufirst=Y&rft.au=Maurer%2C+T&rft.au=Mirmirani%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-IversenMelezinek2001-154"><a href="#cite_ref-IversenMelezinek2001_154-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFIversenMelezinekSchmidt2001" class="citation journal cs1">Iversen P, Melezinek I, Schmidt A (January 2001). <a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1464-410x.2001.00988.x">"Nonsteroidal antiandrogens: a therapeutic option for patients with advanced prostate cancer who wish to retain sexual interest and function"</a>. BJU International. 87 (1): 47–56. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1464-410x.2001.00988.x">10.1046/j.1464-410x.2001.00988.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11121992">11121992</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:28215804">28215804</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=BJU+International&rft.atitle=Nonsteroidal+antiandrogens%3A+a+therapeutic+option+for+patients+with+advanced+prostate+cancer+who+wish+to+retain+sexual+interest+and+function&rft.volume=87&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E47-%3C%2Fspan%3E56&rft.date=2001-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A28215804%23id-name%3DS2CID&rft_id=info%3Apmid%2F11121992&rft_id=info%3Adoi%2F10.1046%2Fj.1464-410x.2001.00988.x&rft.aulast=Iversen&rft.aufirst=P&rft.au=Melezinek%2C+I&rft.au=Schmidt%2C+A&rft_id=https%3A%2F%2Fdoi.org%2F10.1046%252Fj.1464-410x.2001.00988.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-MorganteGradini2001-155"><a href="#cite_ref-MorganteGradini2001_155-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMorganteGradiniRealacciSale2001" class="citation journal cs1">Morgante E, Gradini R, Realacci M, Sale P, D'Eramo G, Perrone GA, et al. 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Histopathology. 38 (3): 195–201. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1365-2559.2001.01077.x">10.1046/j.1365-2559.2001.01077.x</a>. <a href="/wiki/Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<a rel="nofollow" class="external text" href="https://hdl.handle.net/11573%2F387981">11573/387981</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/11260298">11260298</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:36892099">36892099</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Histopathology&rft.atitle=Effects+of+long-term+treatment+with+the+anti-androgen+bicalutamide+on+human+testis%3A+an+ultrastructural+and+morphometric+study&rft.volume=38&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E195-%3C%2Fspan%3E201&rft.date=2001-03&rft_id=info%3Ahdl%2F11573%2F387981&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A36892099%23id-name%3DS2CID&rft_id=info%3Apmid%2F11260298&rft_id=info%3Adoi%2F10.1046%2Fj.1365-2559.2001.01077.x&rft.aulast=Morgante&rft.aufirst=E&rft.au=Gradini%2C+R&rft.au=Realacci%2C+M&rft.au=Sale%2C+P&rft.au=D%27Eramo%2C+G&rft.au=Perrone%2C+GA&rft.au=Cardillo%2C+MR&rft.au=Petrangeli%2C+E&rft.au=Russo%2C+M&rft.au=Di+Silverio%2C+F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-156"><a href="#cite_ref-156">^</a> <div><ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFJonesReiterGreenblatt2016" class="citation journal cs1">Jones CA, Reiter L, Greenblatt E (2016). 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However, this decline in fertility due to estrogen therapy is controversial due to limited studies.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=International+Journal+of+Transgenderism&rft.atitle=Fertility+preservation+in+transgender+patients&rft.volume=17&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E76-%3C%2Fspan%3E82&rft.date=2016&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A58849546%23id-name%3DS2CID&rft.issn=1553-2739&rft_id=info%3Adoi%2F10.1080%2F15532739.2016.1153992&rft.aulast=Jones&rft.aufirst=CA&rft.au=Reiter%2C+L&rft.au=Greenblatt%2C+E&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPayneHardy2007" class="citation book cs1">Payne AH, Hardy MP (28 October 2007). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=x4ttqKIAOg0C&pg=PA422">The Leydig Cell in Health and Disease</a>. Springer Science & Business Media. pp. 422–431. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-59745-453-7" title="Special:BookSources/978-1-59745-453-7"><bdi>978-1-59745-453-7</bdi></a>. <q>Estrogens are highly efficient inhibitors of the hypothalamic-hypophyseal-testicular axis (212–214). Aside from their negative feedback action at the level of the hypothalamus and pituitary, direct inhibitory effects on the testis are likely (215,216). [...] The histology of the testes [with estrogen treatment] showed disorganization of the seminiferous tubules, vacuolization and absence of lumen, and compartmentalization of spermatogenesis.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Leydig+Cell+in+Health+and+Disease&rft.pages=%3Cspan+class%3D%22nowrap%22%3E422-%3C%2Fspan%3E431&rft.pub=Springer+Science+%26+Business+Media&rft.date=2007-10-28&rft.isbn=978-1-59745-453-7&rft.aulast=Payne&rft.aufirst=AH&rft.au=Hardy%2C+MP&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dx4ttqKIAOg0C%26pg%3DPA422&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li></ul></div> </li> <li id="cite_note-Salam2003-157">^ <a href="#cite_ref-Salam2003_157-0">a</a> <a href="#cite_ref-Salam2003_157-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSalam2003" class="citation book cs1">Salam MA (2003). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=y50kTcCCfEcC&pg=PA684">Principles & Practice of Urology: A Comprehensive Text</a>. 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This prolonged suppression is thought to result from a direct effect of estrogens on the Leydig cells.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+%26+Practice+of+Urology%3A+A+Comprehensive+Text&rft.pages=684-&rft.pub=Universal-Publishers&rft.date=2003&rft.isbn=978-1-58112-412-5&rft.aulast=Salam&rft.aufirst=MA&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dy50kTcCCfEcC%26pg%3DPA684&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid7500443-158">^ <a href="#cite_ref-pmid7500443_158-0">a</a> <a href="#cite_ref-pmid7500443_158-1">b</a> <a href="#cite_ref-pmid7500443_158-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFCoxCrawford1995" class="citation journal cs1">Cox RL, Crawford ED (December 1995). "Estrogens in the treatment of prostate cancer". 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Experimental Dermatology. 26 (6): 527–528. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fexd.13155">10.1111/exd.13155</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/27489125">27489125</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:36236057">36236057</a>. <q>[...] caution is recommended while prescribing oral finasteride to male-to-female transsexuals, as the drug has been associated with inducing depression, anxiety and suicidal ideation, symptoms that are particularly common in patients with gender dysphoria, who are already at a high risk.[9]</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Experimental+Dermatology&rft.atitle=Discriminating+in+favour+of+or+against+men+with+increased+risk+of+finasteride-related+side+effects%3F&rft.volume=26&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E527-%3C%2Fspan%3E528&rft.date=2017-06&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A36236057%23id-name%3DS2CID&rft_id=info%3Apmid%2F27489125&rft_id=info%3Adoi%2F10.1111%2Fexd.13155&rft.aulast=Tr%C3%BCeb&rft.aufirst=RM&rft_id=https%3A%2F%2Fdoi.org%2F10.1111%252Fexd.13155&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-LemkeWilliams2012-214"><a href="#cite_ref-LemkeWilliams2012_214-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLemkeWilliams2012" class="citation book cs1">Lemke TL, Williams DA (24 January 2012). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=Sd6ot9ul-bUC&pg=PA1397">Foye's Principles of Medicinal Chemistry</a>. 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Trends in Endocrinology and Metabolism. 15 (6): 277–285. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.tem.2004.06.006">10.1016/j.tem.2004.06.006</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15358281">15358281</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:35891204">35891204</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Trends+in+Endocrinology+and+Metabolism&rft.atitle=Progestogen+therapies%3A+differences+in+clinical+effects%3F&rft.volume=15&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E277-%3C%2Fspan%3E285&rft.date=2004-08&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A35891204%23id-name%3DS2CID&rft_id=info%3Apmid%2F15358281&rft_id=info%3Adoi%2F10.1016%2Fj.tem.2004.06.006&rft.aulast=Wiegratz&rft.aufirst=I&rft.au=Kuhl%2C+H&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-BruckerKing2015-220"><a href="#cite_ref-BruckerKing2015_220-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBruckerKing2015" class="citation book cs1">Brucker MC, King TL (8 September 2015). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=AniUCgAAQBAJ&pg=PA368">Pharmacology for Women's Health</a>. Jones & Bartlett Publishers. pp. 368–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-284-05748-5" title="Special:BookSources/978-1-284-05748-5"><bdi>978-1-284-05748-5</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pharmacology+for+Women%27s+Health&rft.pages=368-&rft.pub=Jones+%26+Bartlett+Publishers&rft.date=2015-09-08&rft.isbn=978-1-284-05748-5&rft.aulast=Brucker&rft.aufirst=MC&rft.au=King%2C+TL&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DAniUCgAAQBAJ%26pg%3DPA368&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-MeyerNorthridge2007-221">^ <a href="#cite_ref-MeyerNorthridge2007_221-0">a</a> <a href="#cite_ref-MeyerNorthridge2007_221-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMeyerNorthridge2007" class="citation book cs1">Meyer IH, <a href="/wiki/Mary_Northridge" title="Mary Northridge">Northridge ME</a> (12 March 2007). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=QF3jiMlMUIcC&pg=PA476">The Health of Sexual Minorities: Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations</a>. Springer. pp. 476–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-387-31334-4" title="Special:BookSources/978-0-387-31334-4"><bdi>978-0-387-31334-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Health+of+Sexual+Minorities%3A+Public+Health+Perspectives+on+Lesbian%2C+Gay%2C+Bisexual+and+Transgender+Populations&rft.pages=476-&rft.pub=Springer&rft.date=2007-03-12&rft.isbn=978-0-387-31334-4&rft.aulast=Meyer&rft.aufirst=IH&rft.au=Northridge%2C+ME&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DQF3jiMlMUIcC%26pg%3DPA476&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-222"><a href="#cite_ref-222">^</a> <div><ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFIsraelTarverShaffer2001" class="citation book cs1">Israel GE, Tarver DE, Shaffer JD (1 March 2001). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=IlPX6E5glDEC&pg=PA58">Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts</a>. <a href="/wiki/Temple_University_Press" title="Temple University Press">Temple University Press</a>. pp. 58–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-56639-852-7" title="Special:BookSources/978-1-56639-852-7"><bdi>978-1-56639-852-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Transgender+Care%3A+Recommended+Guidelines%2C+Practical+Information%2C+and+Personal+Accounts&rft.pages=58-&rft.pub=Temple+University+Press&rft.date=2001-03-01&rft.isbn=978-1-56639-852-7&rft.aulast=Israel&rft.aufirst=GE&rft.au=Tarver%2C+DE&rft.au=Shaffer%2C+JD&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DIlPX6E5glDEC%26pg%3DPA58&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFEkinsKing2006" class="citation book cs1">Ekins R, King D (23 October 2006). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=2TlvmbN9X7wC&pg=PA48">The Transgender Phenomenon</a>. <a href="/wiki/SAGE_Publications" class="mw-redirect" title="SAGE Publications">SAGE Publications</a>. pp. 48–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-84787-726-0" title="Special:BookSources/978-1-84787-726-0"><bdi>978-1-84787-726-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=The+Transgender+Phenomenon&rft.pages=48-&rft.pub=SAGE+Publications&rft.date=2006-10-23&rft.isbn=978-1-84787-726-0&rft.aulast=Ekins&rft.aufirst=R&rft.au=King%2C+D&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D2TlvmbN9X7wC%26pg%3DPA48&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMajumderSanyal2017" class="citation journal cs1">Majumder A, Sanyal D (2017). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240066">"Outcome and preferences in male-to-female subjects with gender dysphoria: Experience from Eastern India"</a>. Indian Journal of Endocrinology and Metabolism. 21 (1): 21–25. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.4103%2F2230-8210.196000">10.4103/2230-8210.196000</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240066">5240066</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28217493">28217493</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Indian+Journal+of+Endocrinology+and+Metabolism&rft.atitle=Outcome+and+preferences+in+male-to-female+subjects+with+gender+dysphoria%3A+Experience+from+Eastern+India&rft.volume=21&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E21-%3C%2Fspan%3E25&rft.date=2017&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5240066%23id-name%3DPMC&rft_id=info%3Apmid%2F28217493&rft_id=info%3Adoi%2F10.4103%2F2230-8210.196000&rft.aulast=Majumder&rft.aufirst=A&rft.au=Sanyal%2C+D&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5240066&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li></ul></div> </li> <li id="cite_note-pmid19497984-223">^ <a href="#cite_ref-pmid19497984_223-0">a</a> <a href="#cite_ref-pmid19497984_223-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKronawitterGoorenZollverOppelt2009" class="citation journal cs1">Kronawitter D, Gooren LJ, Zollver H, Oppelt PG, Beckmann MW, Dittrich R, et al. 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European Journal of Endocrinology. 161 (2): 363–368. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1530%2FEJE-09-0265">10.1530/EJE-09-0265</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/19497984">19497984</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:207122869">207122869</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Journal+of+Endocrinology&rft.atitle=Effects+of+transdermal+testosterone+or+oral+dydrogesterone+on+hypoactive+sexual+desire+disorder+in+transsexual+women%3A+results+of+a+pilot+study&rft.volume=161&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E363-%3C%2Fspan%3E368&rft.date=2009-08&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A207122869%23id-name%3DS2CID&rft_id=info%3Apmid%2F19497984&rft_id=info%3Adoi%2F10.1530%2FEJE-09-0265&rft.aulast=Kronawitter&rft.aufirst=D&rft.au=Gooren%2C+LJ&rft.au=Zollver%2C+H&rft.au=Oppelt%2C+PG&rft.au=Beckmann%2C+MW&rft.au=Dittrich%2C+R&rft.au=Mueller%2C+A&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid3013122-224">^ <a href="#cite_ref-pmid3013122_224-0">a</a> <a href="#cite_ref-pmid3013122_224-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMeyerWebbStuartFinkelstein1986" class="citation journal cs1">Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA (April 1986). "Physical and hormonal evaluation of transsexual patients: a longitudinal study". Archives of Sexual Behavior. 15 (2): 121–138. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fbf01542220">10.1007/bf01542220</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/3013122">3013122</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:42786642">42786642</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Archives+of+Sexual+Behavior&rft.atitle=Physical+and+hormonal+evaluation+of+transsexual+patients%3A+a+longitudinal+study&rft.volume=15&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E121-%3C%2Fspan%3E138&rft.date=1986-04&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A42786642%23id-name%3DS2CID&rft_id=info%3Apmid%2F3013122&rft_id=info%3Adoi%2F10.1007%2Fbf01542220&rft.aulast=Meyer&rft.aufirst=WJ&rft.au=Webb%2C+A&rft.au=Stuart%2C+CA&rft.au=Finkelstein%2C+JW&rft.au=Lawrence%2C+B&rft.au=Walker%2C+PA&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-MishellDavajan1979-225"><a href="#cite_ref-MishellDavajan1979_225-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMishellDavajan1979" class="citation book cs1">Mishell DR, Davajan V (1979). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=KCovj8R2BBEC">Reproductive endocrinology, infertility, and contraception</a>. F. A. Davis Co. p. 224. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-8036-6235-3" title="Special:BookSources/978-0-8036-6235-3"><bdi>978-0-8036-6235-3</bdi></a>. <q>It has been suggested that progestins be added during the last week of each cycle of estrogen therapy in order to develop more rounded breasts rather than the conical breasts many of these patients develop, but we have been unable to detect any difference in breast contour with or without progestins.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Reproductive+endocrinology%2C+infertility%2C+and+contraception&rft.pages=224&rft.pub=F.+A.+Davis+Co.&rft.date=1979&rft.isbn=978-0-8036-6235-3&rft.aulast=Mishell&rft.aufirst=DR&rft.au=Davajan%2C+V&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DKCovj8R2BBEC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-226"><a href="#cite_ref-226">^</a> <div><ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGompel2012" class="citation journal cs1">Gompel A (April 2012). 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Gynecological Endocrinology. 15 (Suppl 6): 37–43. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1080%2Fgye.15.s6.37.43">10.1080/gye.15.s6.37.43</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12227885">12227885</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:27589741">27589741</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gynecological+Endocrinology&rft.atitle=Cyclic+progestin+therapy+for+the+management+of+mastopathy+and+mastodynia&rft.volume=15&rft.issue=Suppl+6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E37-%3C%2Fspan%3E43&rft.date=2001-12&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A27589741%23id-name%3DS2CID&rft_id=info%3Apmid%2F12227885&rft_id=info%3Adoi%2F10.1080%2Fgye.15.s6.37.43&rft.aulast=Winkler&rft.aufirst=UH&rft.au=Schindler%2C+AE&rft.au=Brinkmann%2C+US&rft.au=Ebert%2C+C&rft.au=Oberhoff%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid25113944-229">^ <a href="#cite_ref-pmid25113944_229-0">a</a> <a href="#cite_ref-pmid25113944_229-1">b</a> <a href="#cite_ref-pmid25113944_229-2">c</a> <a href="#cite_ref-pmid25113944_229-3">d</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRuanMueck2014" class="citation journal cs1">Ruan X, Mueck AO (November 2014). "Systemic progesterone therapy--oral, vaginal, injections and even transdermal?". Maturitas. 79 (3): 248–255. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.maturitas.2014.07.009">10.1016/j.maturitas.2014.07.009</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25113944">25113944</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Maturitas&rft.atitle=Systemic+progesterone+therapy--oral%2C+vaginal%2C+injections+and+even+transdermal%3F&rft.volume=79&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E248-%3C%2Fspan%3E255&rft.date=2014-11&rft_id=info%3Adoi%2F10.1016%2Fj.maturitas.2014.07.009&rft_id=info%3Apmid%2F25113944&rft.aulast=Ruan&rft.aufirst=X&rft.au=Mueck%2C+AO&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-BińkowskaWoroń2015-230"><a href="#cite_ref-BińkowskaWoroń2015_230-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBińkowskaWoroń2015" class="citation journal cs1">Bińkowska M, Woroń J (June 2015). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498031">"Progestogens in menopausal hormone therapy"</a>. Przeglad Menopauzalny = Menopause Review. 14 (2): 134–143. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.5114%2Fpm.2015.52154">10.5114/pm.2015.52154</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498031">4498031</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26327902">26327902</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Przeglad+Menopauzalny+%3D+Menopause+Review&rft.atitle=Progestogens+in+menopausal+hormone+therapy&rft.volume=14&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E134-%3C%2Fspan%3E143&rft.date=2015-06&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4498031%23id-name%3DPMC&rft_id=info%3Apmid%2F26327902&rft_id=info%3Adoi%2F10.5114%2Fpm.2015.52154&rft.aulast=Bi%C5%84kowska&rft.aufirst=M&rft.au=Woro%C5%84%2C+J&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4498031&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-Becker2001-231"><a href="#cite_ref-Becker2001_231-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBecker2001" class="citation book cs1">Becker KL (2001). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=FVfzRvaucq8C&pg=PA889">Principles and Practice of Endocrinology and Metabolism</a>. Lippincott Williams & Wilkins. pp. 889–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7817-1750-2" title="Special:BookSources/978-0-7817-1750-2"><bdi>978-0-7817-1750-2</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Principles+and+Practice+of+Endocrinology+and+Metabolism&rft.pages=889-&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2001&rft.isbn=978-0-7817-1750-2&rft.aulast=Becker&rft.aufirst=KL&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DFVfzRvaucq8C%26pg%3DPA889&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-RajagopalanMukherjee2005-232"><a href="#cite_ref-RajagopalanMukherjee2005_232-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRajagopalanMukherjeeMohler2005" class="citation book cs1">Rajagopalan S, Mukherjee D, Mohler ER (2005). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=OWb8DrkyaD0C&pg=RA1-PA199">Manual of Vascular Diseases</a>. Lippincott Williams & Wilkins. pp. 1–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-7817-4499-7" title="Special:BookSources/978-0-7817-4499-7"><bdi>978-0-7817-4499-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Manual+of+Vascular+Diseases&rft.pages=1-&rft.pub=Lippincott+Williams+%26+Wilkins&rft.date=2005&rft.isbn=978-0-7817-4499-7&rft.aulast=Rajagopalan&rft.aufirst=S&rft.au=Mukherjee%2C+D&rft.au=Mohler%2C+ER&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DOWb8DrkyaD0C%26pg%3DRA1-PA199&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid13573669-233">^ <a href="#cite_ref-pmid13573669_233-0">a</a> <a href="#cite_ref-pmid13573669_233-1">b</a> <a href="#cite_ref-pmid13573669_233-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFoss1958" class="citation journal cs1">Foss GL (March 1958). 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Clinical Obstetrics and Gynecology. 1 (1): 245–254. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00003081-195803000-00021">10.1097/00003081-195803000-00021</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/13573669">13573669</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:42825519">42825519</a>. <q>Experimentally I have been able to induce lactogenesis in a male transvestite whose testes had been removed some years before and whose breasts had been well developed over a long period with stilbestrol and ethisterone.9 In July, 1955, 600 mg. of estradiol was implanted subcutaneously and weekly injections of 50 mg. of progesterone were given for four months. For the next month daily injections of 10 mg. estradiol dipropionate and 50 mg. progesterone were given. These injections were continued for another month, increasing progesterone to 100 mg. daily. Both hormones were then withdrawn, and daily injections of increasing doses of prolactin and somatotropin were given for four days; at the same time, the patient used a breast bump four times daily for 5 minutes on both sides. During this time the mammary veins were visibly enlarged and on the sixth and seventh days 1 to 2 cc. of milky fluid was collected.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Obstetrics+and+Gynecology&rft.atitle=Disturbances+of+lactation&rft.volume=1&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E245-%3C%2Fspan%3E254&rft.date=1958-03&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A42825519%23id-name%3DS2CID&rft_id=info%3Apmid%2F13573669&rft_id=info%3Adoi%2F10.1097%2F00003081-195803000-00021&rft.aulast=Foss&rft.aufirst=GL&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid10632490-234">^ <a href="#cite_ref-pmid10632490_234-0">a</a> <a href="#cite_ref-pmid10632490_234-1">b</a> <a href="#cite_ref-pmid10632490_234-2">c</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKanhaiHagevan_DiestBloemena2000" class="citation journal cs1">Kanhai RC, Hage JJ, van Diest PJ, Bloemena E, Mulder JW (January 2000). <a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000478-200001000-00009">"Short-term and long-term histologic effects of castration and estrogen treatment on breast tissue of 14 male-to-female transsexuals in comparison with two chemically castrated men"</a>. The American Journal of Surgical Pathology. 24 (1): 74–80. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2F00000478-200001000-00009">10.1097/00000478-200001000-00009</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/10632490">10632490</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:37752666">37752666</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Journal+of+Surgical+Pathology&rft.atitle=Short-term+and+long-term+histologic+effects+of+castration+and+estrogen+treatment+on+breast+tissue+of+14+male-to-female+transsexuals+in+comparison+with+two+chemically+castrated+men&rft.volume=24&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E74-%3C%2Fspan%3E80&rft.date=2000-01&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A37752666%23id-name%3DS2CID&rft_id=info%3Apmid%2F10632490&rft_id=info%3Adoi%2F10.1097%2F00000478-200001000-00009&rft.aulast=Kanhai&rft.aufirst=RC&rft.au=Hage%2C+JJ&rft.au=van+Diest%2C+PJ&rft.au=Bloemena%2C+E&rft.au=Mulder%2C+JW&rft_id=https%3A%2F%2Fdoi.org%2F10.1097%252F00000478-200001000-00009&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-Lawrence2007-235"><a href="#cite_ref-Lawrence2007_235-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLawrence2007" class="citation book cs1">Lawrence LA (2007). 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Journal of Clinical Pharmacology. 45 (6): 614–619. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F0091270005276621">10.1177/0091270005276621</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15901742">15901742</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:28399314">28399314</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Pharmacology&rft.atitle=Over-the-counter+progesterone+cream+produces+significant+drug+exposure+compared+to+a+food+and+drug+administration-approved+oral+progesterone+product&rft.volume=45&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E614-%3C%2Fspan%3E619&rft.date=2005-06&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A28399314%23id-name%3DS2CID&rft_id=info%3Apmid%2F15901742&rft_id=info%3Adoi%2F10.1177%2F0091270005276621&rft.aulast=Hermann&rft.aufirst=AC&rft.au=Nafziger%2C+AN&rft.au=Victory%2C+J&rft.au=Kulawy%2C+R&rft.au=Rocci%2C+ML&rft.au=Bertino%2C+JS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid8300009-249"><a href="#cite_ref-pmid8300009_249-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTollanOianKjeldsenEide1993" class="citation journal cs1">Tollan A, Oian P, Kjeldsen SE, Eide I, Maltau JM (1993). "Progesterone reduces sympathetic tone without changing blood pressure or fluid balance in men". Gynecologic and Obstetric Investigation. 36 (4): 234–238. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1159%2F000292636">10.1159/000292636</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/8300009">8300009</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Gynecologic+and+Obstetric+Investigation&rft.atitle=Progesterone+reduces+sympathetic+tone+without+changing+blood+pressure+or+fluid+balance+in+men&rft.volume=36&rft.issue=4&rft.pages=%3Cspan+class%3D%22nowrap%22%3E234-%3C%2Fspan%3E238&rft.date=1993&rft_id=info%3Adoi%2F10.1159%2F000292636&rft_id=info%3Apmid%2F8300009&rft.aulast=Tollan&rft.aufirst=A&rft.au=Oian%2C+P&rft.au=Kjeldsen%2C+SE&rft.au=Eide%2C+I&rft.au=Maltau%2C+JM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-UnferdiRenzo2006-250"><a href="#cite_ref-UnferdiRenzo2006_250-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFUnferdi_RenzoGerliCasini2006" class="citation journal cs1">Unfer V, di Renzo GC, Gerli S, Casini ML (2006). "The Use of Progesterone in Clinical Practice: Evaluation of its Efficacy in Diverse Indications Using Different Routes of Administration". Current Drug Therapy. 1 (2): 211–219. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.2174%2F157488506776930923">10.2174/157488506776930923</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1574-8855">1574-8855</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Current+Drug+Therapy&rft.atitle=The+Use+of+Progesterone+in+Clinical+Practice%3A+Evaluation+of+its+Efficacy+in+Diverse+Indications+Using+Different+Routes+of+Administration&rft.volume=1&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E211-%3C%2Fspan%3E219&rft.date=2006&rft_id=info%3Adoi%2F10.2174%2F157488506776930923&rft.issn=1574-8855&rft.aulast=Unfer&rft.aufirst=V&rft.au=di+Renzo%2C+GC&rft.au=Gerli%2C+S&rft.au=Casini%2C+ML&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid12641635-251"><a href="#cite_ref-pmid12641635_251-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBradyAndersonKinniburghBaird2003" class="citation journal cs1">Brady BM, Anderson RA, Kinniburgh D, Baird DT (April 2003). <a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1365-2265.2003.01751.x">"Demonstration of progesterone receptor-mediated gonadotrophin suppression in the human male"</a>. Clinical Endocrinology. 58 (4): 506–512. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1046%2Fj.1365-2265.2003.01751.x">10.1046/j.1365-2265.2003.01751.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12641635">12641635</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:12567639">12567639</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Clinical+Endocrinology&rft.atitle=Demonstration+of+progesterone+receptor-mediated+gonadotrophin+suppression+in+the+human+male&rft.volume=58&rft.issue=4&rft.pages=%3Cspan+class%3D%22nowrap%22%3E506-%3C%2Fspan%3E512&rft.date=2003-04&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A12567639%23id-name%3DS2CID&rft_id=info%3Apmid%2F12641635&rft_id=info%3Adoi%2F10.1046%2Fj.1365-2265.2003.01751.x&rft.aulast=Brady&rft.aufirst=BM&rft.au=Anderson%2C+RA&rft.au=Kinniburgh%2C+D&rft.au=Baird%2C+DT&rft_id=https%3A%2F%2Fdoi.org%2F10.1046%252Fj.1365-2265.2003.01751.x&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-Meikle1999-252"><a href="#cite_ref-Meikle1999_252-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMeikle1999" class="citation book cs1">Meikle AW (1 June 1999). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=ja2nBgAAQBAJ&pg=PA383">Hormone Replacement Therapy</a>. Springer Science & Business Media. pp. 383, 389. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-59259-700-0" title="Special:BookSources/978-1-59259-700-0"><bdi>978-1-59259-700-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Hormone+Replacement+Therapy&rft.pages=383%2C+389&rft.pub=Springer+Science+%26+Business+Media&rft.date=1999-06-01&rft.isbn=978-1-59259-700-0&rft.aulast=Meikle&rft.aufirst=AW&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3Dja2nBgAAQBAJ%26pg%3DPA383&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid30840524-253"><a href="#cite_ref-pmid30840524_253-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPaynter2019" class="citation journal cs1">Paynter MJ (May 2019). "Medication and Facilitation of Transgender Women's Lactation". Journal of Human Lactation. 35 (2): 239–243. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1177%2F0890334419829729">10.1177/0890334419829729</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30840524">30840524</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:73466659">73466659</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Human+Lactation&rft.atitle=Medication+and+Facilitation+of+Transgender+Women%27s+Lactation&rft.volume=35&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E239-%3C%2Fspan%3E243&rft.date=2019-05&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A73466659%23id-name%3DS2CID&rft_id=info%3Apmid%2F30840524&rft_id=info%3Adoi%2F10.1177%2F0890334419829729&rft.aulast=Paynter&rft.aufirst=MJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-TelisBaum2019-254"><a href="#cite_ref-TelisBaum2019_254-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTelisBaumSingerBerookhim2019" class="citation book cs1">Telis L, Baum S, Singer T, Berookhim BM (2019). "Fertility Issues in Transgender Care". Transgender Medicine. Contemporary Endocrinology. Cham.: Humana Press. pp. 197–212. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2F978-3-030-05683-4_11">10.1007/978-3-030-05683-4_11</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-3-030-05682-7" title="Special:BookSources/978-3-030-05682-7"><bdi>978-3-030-05682-7</bdi></a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/2523-3785">2523-3785</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:151135327">151135327</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Fertility+Issues+in+Transgender+Care&rft.btitle=Transgender+Medicine&rft.place=Cham.&rft.series=Contemporary+Endocrinology&rft.pages=%3Cspan+class%3D%22nowrap%22%3E197-%3C%2Fspan%3E212&rft.pub=Humana+Press&rft.date=2019&rft_id=info%3Adoi%2F10.1007%2F978-3-030-05683-4_11&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A151135327%23id-name%3DS2CID&rft.issn=2523-3785&rft.isbn=978-3-030-05682-7&rft.aulast=Telis&rft.aufirst=L&rft.au=Baum%2C+S&rft.au=Singer%2C+T&rft.au=Berookhim%2C+BM&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid4039061-255">^ <a href="#cite_ref-pmid4039061_255-0">a</a> <a href="#cite_ref-pmid4039061_255-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKozlovMel'nichenkoGolubeva1985" class="citation journal cs1 cs1-prop-foreign-lang-source">Kozlov GI, Mel'nichenko GA, Golubeva IV (1985). <a rel="nofollow" class="external text" href="https://elibrary.ru/item.asp?id=18910904">"[Case of galactorrhea in a transsexual male patient]"</a> [Case of galactorrhea in a transsexual male patient]. Problemy Endokrinologii (in Russian). 31 (1): 37–38. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/4039061">4039061</a>. <q>[...] castration and feminizing plastic surgery of the external genitalia was performed [...] Some time after the operation, the patient developed a renewed interest in life. After the surgical and hormonal correction, the patient irresistibly developed maternal instincts. Unmarried, the patient obtained permission for the adoption of a child, simulated pregnancy, and was discharged from the maternity hospital with a son. From the first days after the "birth", galactorrhea sharply increased, and spontaneous outflow of milk appeared, with galactorrhea (+++). The baby was breastfed up to 6 months of age. [...] Our message is the second in the world literature describing galactorrhea in a male patient with transsexualism. The first description of this kind was made in 1983 by R. [Flückiger] et al. (6). This observation demonstrates the independence of the mechanism of lactation development from one's genetic sex and is alarming with regard to the possibility of drug-induced galactorrhea development in men.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Problemy+Endokrinologii&rft.atitle=%5BCase+of+galactorrhea+in+a+transsexual+male+patient%5D&rft.volume=31&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E37-%3C%2Fspan%3E38&rft.date=1985&rft_id=info%3Apmid%2F4039061&rft.aulast=Kozlov&rft.aufirst=GI&rft.au=Mel%27nichenko%2C+GA&rft.au=Golubeva%2C+IV&rft_id=https%3A%2F%2Felibrary.ru%2Fitem.asp%3Fid%3D18910904&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-256"><a href="#cite_ref-256">^</a> <div><ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFoss1956" class="citation journal cs1">Foss GL (January 1956). <a rel="nofollow" class="external text" href="https://scholar.google.com/scholar?cluster=14484943388570116838">"Abnormalities of form and function of the human breast"</a>. Journal of Endocrinology. 14 (1): R6 – R9. <q>Based on the theories of lactogenesis and stimulated by the success of Lyons, Li, Johnson & Cole [1955], who succeeded in producing lactation in male rats, an attempt was made to initiate lactogenesis in a male transvestist. Six years ago this patient had been given oestrogens. Both testes and penis were then removed and an artificial vagina was constructed by plastic surgery. The patient was implanted with 500 mg oestradiol in September 1954, and 600 mg in July 1955. The breasts were then developed more intensively with daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately following withdrawal of this treatment, prolactin 22·9 mg was injected daily for 3 days without effect. After a second month on oestradiol and progesterone daily, combined injections of prolactin and somatotrophin were given for 4 days and suction was applied by a breast pump-four times daily. On the 4th and 5th days a few drops of colostrum were expressed from the right nipple.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Endocrinology&rft.atitle=Abnormalities+of+form+and+function+of+the+human+breast&rft.volume=14&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3ER6+-%3C%2Fspan%3E+%3Cspan+class%3D%22nowrap%22%3ER9%3C%2Fspan%3E&rft.date=1956-01&rft.aulast=Foss&rft.aufirst=GL&rft_id=https%3A%2F%2Fscholar.google.com%2Fscholar%3Fcluster%3D14484943388570116838&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGardiner-Hill1958" class="citation book cs1">Gardiner-Hill H (1958). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=bDNBAAAAYAAJ&q=%22Foss%20(1956)%22+%22Lactation%22">Modern Trends in Endocrinology</a>. Butterworth. p. 192. <q>Recently, an attempt has been made by Foss (1956) to initiate lactation in a castrated male transvestist. He was given an implant of 500 milligrams of oestradiol, and 10 months later, a further 600 milligrams of oestradiol, followed by daily injections of oestradiol dipropionate and progesterone for 6 weeks. Immediately after withdrawal of this treatment, 22·9 milligrams of prolactin were injected daily for 3 days but without effect. After a second month of treatment with oestradiol and progesterone daily, he was given combined injections of prolactin and somatotrophin for 4 days, suction with a breast-pump being employed 4 times daily. On the fourth and fifth days a few drops of colostrum were expressed from the right nipple. There is a possible application here of modern hormone knowledge to man, and further trials would be of interest.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Modern+Trends+in+Endocrinology&rft.pages=192&rft.pub=Butterworth&rft.date=1958&rft.aulast=Gardiner-Hill&rft.aufirst=H&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DbDNBAAAAYAAJ%26q%3D%2522Foss%2520%281956%29%2522%2B%2522Lactation%2522&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFPfeffer2017" class="citation book cs1">Pfeffer CA (2017). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=1xs1DQAAQBAJ&pg=PR19">Queering Families: The Postmodern Partnerships of Cisgender Women and Transgender Men</a>. <a href="/wiki/Oxford_University_Press" title="Oxford University Press">Oxford University Press</a>. pp. 19–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-19-990805-9" title="Special:BookSources/978-0-19-990805-9"><bdi>978-0-19-990805-9</bdi></a>. <q>Just 2 years later, Winfrey would feature another interview that elicited many of the same audience reactions. In this 2010 episode, lesbian partners Dr. Christine McGinn and Lisa Bortz beamed with joy as they held their infant twins. Again, audience members' jaws dropped when it was revealed that beautiful Christine was a male-to-female transsexual who used to be a handsome military officer Chris, and that Lisa had given birth to the couple's biological children using sperm Chris banked prior to gender confirmation surgeries.10 And it was Winfrey's chin that nearly hit the floor as she watched video of Christine breastfeeding the couples' children (the episode is referred to online as "The Mom Who Fathered Her Own Children"). [...]</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Queering+Families%3A+The+Postmodern+Partnerships+of+Cisgender+Women+and+Transgender+Men&rft.pages=19-&rft.pub=Oxford+University+Press&rft.date=2017&rft.isbn=978-0-19-990805-9&rft.aulast=Pfeffer&rft.aufirst=CA&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D1xs1DQAAQBAJ%26pg%3DPR19&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li></ul></div> </li> <li id="cite_note-FlückigerPozo1982-257"><a href="#cite_ref-FlückigerPozo1982_257-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFlückigerDel_Pozovon_Werder1982" class="citation book cs1">Flückiger E, Del Pozo E, von Werder K (1982). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=DgpsAAAAMAAJ&q=transsexual+lactation">Prolactin: Physiology, Pharmacology, and Clinical Findings</a>. Springer-Verlag. p. 13. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-3-540-11071-2" title="Special:BookSources/978-3-540-11071-2"><bdi>978-3-540-11071-2</bdi></a>. <q>[...] An observation (Wyss and Del Pozo unpublished) in a male transsexual showed that induction of lactation can be similarly achieved in the human male. [...]</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Prolactin%3A+Physiology%2C+Pharmacology%2C+and+Clinical+Findings&rft.pages=13&rft.pub=Springer-Verlag&rft.date=1982&rft.isbn=978-3-540-11071-2&rft.aulast=Fl%C3%BCckiger&rft.aufirst=E&rft.au=Del+Pozo%2C+E&rft.au=von+Werder%2C+K&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DDgpsAAAAMAAJ%26q%3Dtranssexual%2Blactation&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-258"><a href="#cite_ref-258">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFKimGoetzGrieveKeuroghlian2023" class="citation journal cs1">Kim HH, Goetz TG, Grieve V, Keuroghlian AS (2023). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10348476">"Psychopharmacological Considerations for Gender-Affirming Hormone Therapy"</a>. Harvard Review of Psychiatry. 31 (4): 183–194. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1097%2FHRP.0000000000000373">10.1097/HRP.0000000000000373</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1067-3229">1067-3229</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10348476">10348476</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/37437250">37437250</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Harvard+Review+of+Psychiatry&rft.atitle=Psychopharmacological+Considerations+for+Gender-Affirming+Hormone+Therapy&rft.volume=31&rft.issue=4&rft.pages=%3Cspan+class%3D%22nowrap%22%3E183-%3C%2Fspan%3E194&rft.date=2023&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC10348476%23id-name%3DPMC&rft.issn=1067-3229&rft_id=info%3Apmid%2F37437250&rft_id=info%3Adoi%2F10.1097%2FHRP.0000000000000373&rft.aulast=Kim&rft.aufirst=Hyun-Hee&rft.au=Goetz%2C+Teddy+G&rft.au=Grieve%2C+Victoria&rft.au=Keuroghlian%2C+Alex+S.&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC10348476&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid32008926-265">^ <a href="#cite_ref-pmid32008926_265-0">a</a> <a href="#cite_ref-pmid32008926_265-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDefreyneElautKreukelsDaphne_Fisher2020" class="citation journal cs1">Defreyne J, Elaut E, Kreukels B, Daphne Fisher A, Castellini G, Staphorsius A, et al. (April 2020). <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/32008926/">"Sexual Desire Changes in Transgender Individuals Upon Initiation of Hormone Treatment: Results From the Longitudinal European Network for the Investigation of Gender Incongruence"</a>. The Journal of Sexual Medicine. 17 (4): 812–825. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jsxm.2019.12.020">10.1016/j.jsxm.2019.12.020</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/32008926">32008926</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:211014269">211014269</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Sexual+Medicine&rft.atitle=Sexual+Desire+Changes+in+Transgender+Individuals+Upon+Initiation+of+Hormone+Treatment%3A+Results+From+the+Longitudinal+European+Network+for+the+Investigation+of+Gender+Incongruence&rft.volume=17&rft.issue=4&rft.pages=%3Cspan+class%3D%22nowrap%22%3E812-%3C%2Fspan%3E825&rft.date=2020-04&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A211014269%23id-name%3DS2CID&rft_id=info%3Apmid%2F32008926&rft_id=info%3Adoi%2F10.1016%2Fj.jsxm.2019.12.020&rft.aulast=Defreyne&rft.aufirst=J&rft.au=Elaut%2C+E&rft.au=Kreukels%2C+B&rft.au=Daphne+Fisher%2C+A&rft.au=Castellini%2C+G&rft.au=Staphorsius%2C+A&rft.au=Den+Heijer%2C+M&rft.au=Heylens%2C+G&rft.au=T%27Sjoen%2C+G&rft_id=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F32008926%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid20626600-267"><a href="#cite_ref-pmid20626600_267-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFElliottLatiniWalkerWassersug2010" class="citation journal cs1">Elliott S, Latini DM, Walker LM, Wassersug R, Robinson JW (September 2010). "Androgen deprivation therapy for prostate cancer: recommendations to improve patient and partner quality of life". The Journal of Sexual Medicine. 7 (9): 2996–3010. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1743-6109.2010.01902.x">10.1111/j.1743-6109.2010.01902.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/20626600">20626600</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Sexual+Medicine&rft.atitle=Androgen+deprivation+therapy+for+prostate+cancer%3A+recommendations+to+improve+patient+and+partner+quality+of+life&rft.volume=7&rft.issue=9&rft.pages=%3Cspan+class%3D%22nowrap%22%3E2996-%3C%2Fspan%3E3010&rft.date=2010-09&rft_id=info%3Adoi%2F10.1111%2Fj.1743-6109.2010.01902.x&rft_id=info%3Apmid%2F20626600&rft.aulast=Elliott&rft.aufirst=S&rft.au=Latini%2C+DM&rft.au=Walker%2C+LM&rft.au=Wassersug%2C+R&rft.au=Robinson%2C+JW&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid12667885-268"><a href="#cite_ref-pmid12667885_268-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHigano2003" class="citation journal cs1">Higano CS (February 2003). "Side effects of androgen deprivation therapy: monitoring and minimizing toxicity". Urology. 61 (2 Suppl 1): 32–38. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2FS0090-4295%2802%2902397-X">10.1016/S0090-4295(02)02397-X</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12667885">12667885</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Urology&rft.atitle=Side+effects+of+androgen+deprivation+therapy%3A+monitoring+and+minimizing+toxicity&rft.volume=61&rft.issue=2+Suppl+1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E32-%3C%2Fspan%3E38&rft.date=2003-02&rft_id=info%3Adoi%2F10.1016%2FS0090-4295%2802%2902397-X&rft_id=info%3Apmid%2F12667885&rft.aulast=Higano&rft.aufirst=CS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid23008326-269"><a href="#cite_ref-pmid23008326_269-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFHigano2012" class="citation journal cs1">Higano CS (October 2012). "Sexuality and intimacy after definitive treatment and subsequent androgen deprivation therapy for prostate cancer". Journal of Clinical Oncology. 30 (30): 3720–3725. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1200%2FJCO.2012.41.8509">10.1200/JCO.2012.41.8509</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/23008326">23008326</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Clinical+Oncology&rft.atitle=Sexuality+and+intimacy+after+definitive+treatment+and+subsequent+androgen+deprivation+therapy+for+prostate+cancer&rft.volume=30&rft.issue=30&rft.pages=%3Cspan+class%3D%22nowrap%22%3E3720-%3C%2Fspan%3E3725&rft.date=2012-10&rft_id=info%3Adoi%2F10.1200%2FJCO.2012.41.8509&rft_id=info%3Apmid%2F23008326&rft.aulast=Higano&rft.aufirst=CS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-NieschlagBehre2013-270"><a href="#cite_ref-NieschlagBehre2013_270-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNieschlagBehre2013" class="citation book cs1">Nieschlag E, Behre H (29 June 2013). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=05fsCAAAQBAJ&pg=PA54">Andrology: Male Reproductive Health and Dysfunction</a>. Springer Science & Business Media. pp. 54–. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-3-662-04491-9" title="Special:BookSources/978-3-662-04491-9"><bdi>978-3-662-04491-9</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Andrology%3A+Male+Reproductive+Health+and+Dysfunction&rft.pages=54-&rft.pub=Springer+Science+%26+Business+Media&rft.date=2013-06-29&rft.isbn=978-3-662-04491-9&rft.aulast=Nieschlag&rft.aufirst=E&rft.au=Behre%2C+H&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D05fsCAAAQBAJ%26pg%3DPA54&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-FisherMaggi2015-272">^ <a href="#cite_ref-FisherMaggi2015_272-0">a</a> <a href="#cite_ref-FisherMaggi2015_272-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFisherMaggi2015" class="citation book cs1">Fisher A, Maggi MD (2015). "Endocrine Treatment of Transsexual Male-to-Female Persons". Management of Gender Dysphoria. Springer. pp. 83–91. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2F978-88-470-5696-1_10">10.1007/978-88-470-5696-1_10</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-88-470-5695-4" title="Special:BookSources/978-88-470-5695-4"><bdi>978-88-470-5695-4</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Endocrine+Treatment+of+Transsexual+Male-to-Female+Persons&rft.btitle=Management+of+Gender+Dysphoria&rft.pages=%3Cspan+class%3D%22nowrap%22%3E83-%3C%2Fspan%3E91&rft.pub=Springer&rft.date=2015&rft_id=info%3Adoi%2F10.1007%2F978-88-470-5696-1_10&rft.isbn=978-88-470-5695-4&rft.aulast=Fisher&rft.aufirst=A&rft.au=Maggi%2C+MD&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-Radix2016-273">^ <a href="#cite_ref-Radix2016_273-0">a</a> <a href="#cite_ref-Radix2016_273-1">b</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRadix2016" class="citation book cs1">Radix AE (2016). 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Transgender Health. 8 (2): 188–194. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1089%2Ftrgh.2021.0041">10.1089/trgh.2021.0041</a>. <a href="/wiki/EISSN_(identifier)" class="mw-redirect" title="EISSN (identifier)">eISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/2380-193X">2380-193X</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/2688-4887">2688-4887</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10066771">10066771</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/37013092">37013092</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:244813679">244813679</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Transgender+Health&rft.atitle=Trends+in+Feminizing+Hormone+Therapy+for+Transgender+Patients%2C+2006%E2%80%932017&rft.volume=8&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E188-%3C%2Fspan%3E194&rft.date=2021-11-30&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC10066771%23id-name%3DPMC&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A244813679%23id-name%3DS2CID&rft.eissn=2380-193X&rft_id=info%3Adoi%2F10.1089%2Ftrgh.2021.0041&rft.issn=2688-4887&rft_id=info%3Apmid%2F37013092&rft.aulast=Rose&rft.aufirst=AJ&rft.au=Hughto%2C+JM&rft.au=Dunbar%2C+MS&rft.au=Quinn%2C+EK&rft.au=Deutsch%2C+M&rft.au=Feldman%2C+J&rft.au=Radix%2C+A&rft.au=Safer%2C+JD&rft.au=Shipherd%2C+JC&rft.au=Thompson%2C+J&rft.au=Jasuja%2C+GK&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC10066771&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> <li id="cite_note-pmid22487218-370"><a href="#cite_ref-pmid22487218_370-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFChekirEmiAraiKikuchi2012" class="citation journal cs1">Chekir C, Emi Y, Arai F, Kikuchi Y, Sasaki A, Matsuda M, et al. (June 2012). <a rel="nofollow" class="external text" href="http://ousar.lib.okayama-u.ac.jp/48439">"Altered arterial stiffness in male-to-female transsexuals undergoing hormonal treatment"</a>. The Journal of Obstetrics and Gynaecology Research. 38 (6): 932–940. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fj.1447-0756.2011.01815.x">10.1111/j.1447-0756.2011.01815.x</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/22487218">22487218</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:39877004">39877004</a>. <q>Estrogen is given to MTF transsexuals orally as conjugated estrogens, or 17b-estradiol, as transdermal estrogen, or as parenteral estrogen esters to feminize the body.5 There is no evidence that progestin has beneficial effects on treatment with estrogen in MTF transsexuals; however, progestins were administered to some of MTF transsexuals. Because administration of antiandrogen to MTF transsexuals is not common in Japan, we could exclude the modification with antiandrogen in the present study.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Obstetrics+and+Gynaecology+Research&rft.atitle=Altered+arterial+stiffness+in+male-to-female+transsexuals+undergoing+hormonal+treatment&rft.volume=38&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E932-%3C%2Fspan%3E940&rft.date=2012-06&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A39877004%23id-name%3DS2CID&rft_id=info%3Apmid%2F22487218&rft_id=info%3Adoi%2F10.1111%2Fj.1447-0756.2011.01815.x&rft.aulast=Chekir&rft.aufirst=C&rft.au=Emi%2C+Y&rft.au=Arai%2C+F&rft.au=Kikuchi%2C+Y&rft.au=Sasaki%2C+A&rft.au=Matsuda%2C+M&rft.au=Shimizu%2C+K&rft.au=Tabuchi%2C+K&rft.au=Kamada%2C+Y&rft.au=Hiramatsu%2C+Y&rft.au=Nakatsuka%2C+M&rft_id=http%3A%2F%2Fousar.lib.okayama-u.ac.jp%2F48439&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=29" title="Edit section: Further reading">edit</a>]</div> <style data-mw-deduplicate="TemplateStyles:r1239549316">.mw-parser-output .refbegin{margin-bottom:0.5em}.mw-parser-output .refbegin-hanging-indents>ul{margin-left:0}.mw-parser-output .refbegin-hanging-indents>ul>li{margin-left:0;padding-left:3.2em;text-indent:-3.2em}.mw-parser-output .refbegin-hanging-indents ul,.mw-parser-output .refbegin-hanging-indents ul li{list-style:none}@media(max-width:720px){.mw-parser-output .refbegin-hanging-indents>ul>li{padding-left:1.6em;text-indent:-1.6em}}.mw-parser-output .refbegin-columns{margin-top:0.3em}.mw-parser-output .refbegin-columns ul{margin-top:0}.mw-parser-output .refbegin-columns li{page-break-inside:avoid;break-inside:avoid-column}@media screen{.mw-parser-output .refbegin{font-size:90%}}</style><div class="refbegin" style=""> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFabrisBernardiTrombetta2015" class="citation journal cs1">Fabris B, Bernardi S, Trombetta C (March 2015). "Cross-sex hormone therapy for gender dysphoria". Journal of Endocrinological Investigation. 38 (3): 269–282. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs40618-014-0186-2">10.1007/s40618-014-0186-2</a>. <a href="/wiki/Hdl_(identifier)" class="mw-redirect" title="Hdl (identifier)">hdl</a>:<a rel="nofollow" class="external text" href="https://hdl.handle.net/11368%2F2831597">11368/2831597</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25403429">25403429</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:207503049">207503049</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Journal+of+Endocrinological+Investigation&rft.atitle=Cross-sex+hormone+therapy+for+gender+dysphoria&rft.volume=38&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E269-%3C%2Fspan%3E282&rft.date=2015-03&rft_id=info%3Ahdl%2F11368%2F2831597&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A207503049%23id-name%3DS2CID&rft_id=info%3Apmid%2F25403429&rft_id=info%3Adoi%2F10.1007%2Fs40618-014-0186-2&rft.aulast=Fabris&rft.aufirst=B&rft.au=Bernardi%2C+S&rft.au=Trombetta%2C+C&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFGooren2011" class="citation journal cs1">Gooren LJ (March 2011). 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The Journal of Clinical Endocrinology and Metabolism. 93 (1): 19–25. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1210%2Fjc.2007-1809">10.1210/jc.2007-1809</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17986639">17986639</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Clinical+Endocrinology+and+Metabolism&rft.atitle=Long-term+treatment+of+transsexuals+with+cross-sex+hormones%3A+extensive+personal+experience&rft.volume=93&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E19-%3C%2Fspan%3E25&rft.date=2008-01&rft_id=info%3Adoi%2F10.1210%2Fjc.2007-1809&rft_id=info%3Apmid%2F17986639&rft.aulast=Gooren&rft.aufirst=LJ&rft.au=Giltay%2C+EJ&rft.au=Bunck%2C+MC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFTangprichaden_Heijer2017" class="citation journal cs1">Tangpricha V, den Heijer M (April 2017). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5366074">"Oestrogen and anti-androgen therapy for transgender women"</a>. 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Translational Andrology and Urology. 5 (6): 877–884. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.21037%2Ftau.2016.09.04">10.21037/tau.2016.09.04</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227">5182227</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28078219">28078219</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Translational+Andrology+and+Urology&rft.atitle=Hormone+therapy+for+transgender+patients&rft.volume=5&rft.issue=6&rft.pages=%3Cspan+class%3D%22nowrap%22%3E877-%3C%2Fspan%3E884&rft.date=2016-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5182227%23id-name%3DPMC&rft_id=info%3Apmid%2F28078219&rft_id=info%3Adoi%2F10.21037%2Ftau.2016.09.04&rft.aulast=Unger&rft.aufirst=CA&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC5182227&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWespDeutsch2017" class="citation journal cs1">Wesp LM, Deutsch MB (March 2017). "Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons". The Psychiatric Clinics of North America. 40 (1): 99–111. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.psc.2016.10.006">10.1016/j.psc.2016.10.006</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/28159148">28159148</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Psychiatric+Clinics+of+North+America&rft.atitle=Hormonal+and+Surgical+Treatment+Options+for+Transgender+Women+and+Transfeminine+Spectrum+Persons&rft.volume=40&rft.issue=1&rft.pages=%3Cspan+class%3D%22nowrap%22%3E99-%3C%2Fspan%3E111&rft.date=2017-03&rft_id=info%3Adoi%2F10.1016%2Fj.psc.2016.10.006&rft_id=info%3Apmid%2F28159148&rft.aulast=Wesp&rft.aufirst=LM&rft.au=Deutsch%2C+MB&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFWierckxGoorenT'Sjoen2014" class="citation journal cs1">Wierckx K, Gooren L, T'Sjoen G (May 2014). "Clinical review: Breast development in trans women receiving cross-sex hormones". The Journal of Sexual Medicine. 11 (5): 1240–1247. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fjsm.12487">10.1111/jsm.12487</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24618412">24618412</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Journal+of+Sexual+Medicine&rft.atitle=Clinical+review%3A+Breast+development+in+trans+women+receiving+cross-sex+hormones&rft.volume=11&rft.issue=5&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1240-%3C%2Fspan%3E1247&rft.date=2014-05&rft_id=info%3Adoi%2F10.1111%2Fjsm.12487&rft_id=info%3Apmid%2F24618412&rft.aulast=Wierckx&rft.aufirst=K&rft.au=Gooren%2C+L&rft.au=T%27Sjoen%2C+G&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Feminizing_hormone_therapy&action=edit&section=30" title="Edit section: External links">edit</a>]</div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFDeutsch2016" class="citation web cs1">Deutsch M (17 June 2016). <a rel="nofollow" class="external text" href="https://transcare.ucsf.edu/guidelines">"Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People"</a> (2nd ed.). University of California, San Francisco: Center of Excellence for Transgender Health. p. 28.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidelines+for+the+Primary+and+Gender-Affirming+Care+of+Transgender+and+Gender+Nonbinary+People&rft.place=University+of+California%2C+San+Francisco&rft.pages=28&rft.edition=2nd&rft.pub=Center+of+Excellence+for+Transgender+Health&rft.date=2016-06-17&rft.aulast=Deutsch&rft.aufirst=M&rft_id=https%3A%2F%2Ftranscare.ucsf.edu%2Fguidelines&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li> <li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBourns2015" class="citation web cs1">Bourns A (2015). <a rel="nofollow" class="external text" href="http://sherbourne.on.ca/wp-content/uploads/2014/02/Guidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf">"Guidelines and Protocols for Comprehensive Primary Care for Trans Clients"</a> (PDF). Sherbourne Health Centre. Retrieved 15 August 2018.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Guidelines+and+Protocols+for+Comprehensive+Primary+Care+for+Trans+Clients&rft.pub=Sherbourne+Health+Centre&rft.date=2015&rft.aulast=Bourns&rft.aufirst=A&rft_id=http%3A%2F%2Fsherbourne.on.ca%2Fwp-content%2Fuploads%2F2014%2F02%2FGuidelines-and-Protocols-for-Comprehensive-Primary-Care-for-Trans-Clients-2015.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFeminizing+hormone+therapy" class="Z3988"></li> <li><a rel="nofollow" class="external text" href="https://www.transhrtresearch.com/">Transgender HRT Research Repository</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20220914084452/https://www.transhrtresearch.com/">Archived</a> 2022-09-14 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" 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title="Estrogen">Estrogen (as a hormone)</a></li> <li><a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">Estrogen (as a medication)</a></li> <li><a href="/wiki/Hormone_replacement_therapy" title="Hormone replacement therapy">Menopausal hormone therapy</a></li> <li><a class="mw-selflink selflink">Feminizing hormone therapy</a></li> <li><a href="/wiki/Estradiol-containing_birth_control_pill" title="Estradiol-containing birth control pill">Estradiol-containing birth control pill</a></li> <li><a href="/wiki/Combined_injectable_birth_control" title="Combined injectable birth control">Combined injectable birth control</a></li> <li><a href="/wiki/High-dose_estrogen" class="mw-redirect" title="High-dose estrogen">High-dose estrogen</a></li> <li><a href="/wiki/Hydroxylation_of_estradiol" title="Hydroxylation of estradiol">Hydroxylation of estradiol</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Estrogen_ester" title="Estrogen ester">Esters</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Estradiol_acetate" title="Estradiol acetate">Estradiol acetate</a></li> <li><a href="/wiki/Estradiol_acetylsalicylate" title="Estradiol acetylsalicylate">Estradiol acetylsalicylate</a></li> <li><a href="/wiki/Estradiol_anthranilate" title="Estradiol anthranilate">Estradiol anthranilate</a></li> <li><a href="/wiki/Estradiol_benzoate_butyrate" title="Estradiol benzoate butyrate">Estradiol benzoate butyrate</a></li> <li><a href="/wiki/Estradiol_benzoate_cyclooctenyl_ether" title="Estradiol benzoate cyclooctenyl ether">Estradiol benzoate cyclooctenyl ether</a></li> <li><a href="/wiki/Estradiol_benzoate" title="Estradiol benzoate">Estradiol benzoate</a></li> <li><a href="/wiki/Estradiol_butyrylacetate" title="Estradiol butyrylacetate">Estradiol butyrylacetate</a></li> <li><a href="/wiki/Estradiol_cyclooctyl_acetate" title="Estradiol cyclooctyl acetate">Estradiol cyclooctyl acetate</a></li> <li><a href="/wiki/Estradiol_cypionate" title="Estradiol cypionate">Estradiol cypionate</a></li> <li><a href="/wiki/Estradiol_decanoate" title="Estradiol decanoate">Estradiol decanoate</a></li> <li><a href="/wiki/Estradiol_diacetate" title="Estradiol diacetate">Estradiol diacetate</a></li> <li><a href="/wiki/Estradiol_dibutyrate" title="Estradiol dibutyrate">Estradiol dibutyrate</a></li> <li><a href="/wiki/Estradiol_dienantate" title="Estradiol dienantate">Estradiol dienantate</a></li> <li><a href="/wiki/Estradiol_dipropionate" title="Estradiol dipropionate">Estradiol dipropionate</a></li> <li><a href="/wiki/Estradiol_distearate" title="Estradiol distearate">Estradiol distearate</a></li> <li><a href="/wiki/Estradiol_disulfate" title="Estradiol disulfate">Estradiol disulfate</a></li> <li><a href="/wiki/Estradiol_diundecylate" title="Estradiol diundecylate">Estradiol diundecylate</a></li> <li><a href="/wiki/Estradiol_diundecylenate" title="Estradiol diundecylenate">Estradiol diundecylenate</a></li> <li><a href="/wiki/Estradiol_enantate" title="Estradiol enantate">Estradiol enantate</a></li> <li><a href="/wiki/Estradiol_furoate" title="Estradiol furoate">Estradiol furoate</a></li> <li><a href="/wiki/Estradiol_glucuronide" title="Estradiol glucuronide">Estradiol glucuronide</a></li> <li><a href="/wiki/Estradiol_hemisuccinate" title="Estradiol hemisuccinate">Estradiol hemisuccinate</a></li> <li><a href="/wiki/Estradiol_hexahydrobenzoate" title="Estradiol hexahydrobenzoate">Estradiol hexahydrobenzoate</a></li> <li><a href="/wiki/Estradiol_monopropionate" title="Estradiol monopropionate">Estradiol monopropionate</a></li> <li><a href="/wiki/Estradiol_mustard" title="Estradiol mustard">Estradiol mustard</a></li> <li><a href="/wiki/Estradiol_palmitate" title="Estradiol palmitate">Estradiol palmitate</a></li> <li><a href="/wiki/Estradiol_phenylpropionate" title="Estradiol phenylpropionate">Estradiol phenylpropionate</a></li> <li><a href="/wiki/Estradiol_phosphate" title="Estradiol phosphate">Estradiol phosphate</a></li> <li><a href="/wiki/Estradiol_pivalate" title="Estradiol pivalate">Estradiol pivalate</a></li> <li><a href="/wiki/Estradiol_propoxyphenylpropionate" title="Estradiol propoxyphenylpropionate">Estradiol propoxyphenylpropionate</a></li> <li><a href="/wiki/Estradiol_salicylate" title="Estradiol salicylate">Estradiol salicylate</a></li> <li><a href="/wiki/Estradiol_stearate" title="Estradiol stearate">Estradiol stearate</a></li> <li><a href="/wiki/Estradiol_sulfamate" title="Estradiol sulfamate">Estradiol sulfamate</a></li> <li><a href="/wiki/Estradiol_sulfate" title="Estradiol sulfate">Estradiol sulfate</a></li> <li><a href="/wiki/Estradiol_undecylate" title="Estradiol undecylate">Estradiol undecylate</a></li> <li><a href="/wiki/Estradiol_undecylenate" title="Estradiol undecylenate">Estradiol undecylenate</a></li> <li><a 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title="Ethinylestradiol">Ethinylestradiol</a></li> <li><a href="/wiki/Conjugated_estrogens" title="Conjugated estrogens">Conjugated estrogens</a></li> <li><a href="/wiki/Esterified_estrogens" title="Esterified estrogens">Esterified estrogens</a></li> <li><a href="/wiki/Estrone_sulfate_(medication)" title="Estrone sulfate (medication)">Estrone sulfate</a></li> <li><a href="/wiki/Estropipate" title="Estropipate">Estropipate (piperazine estrone sulfate)</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pharmacological_body_alteration52" style="padding:3px"><table class="nowraplinks hlist mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Pharmacological_body_alteration" title="Template:Pharmacological body alteration"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Pharmacological_body_alteration" title="Template talk:Pharmacological body alteration"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Pharmacological_body_alteration" title="Special:EditPage/Template:Pharmacological body alteration"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pharmacological_body_alteration52" style="font-size:114%;margin:0 4em"><a href="/wiki/Pharmacology" title="Pharmacology">Pharmacological</a> <a href="/wiki/Body_alteration" class="mw-redirect" title="Body alteration">body alteration</a></div></th></tr><tr><td colspan="2" class="navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bodybuilding_supplement" title="Bodybuilding supplement">Bodybuilding supplement</a></li> <li><a href="/wiki/Breast_enlargement" title="Breast enlargement">Breast enlargement</a></li> <li><a href="/wiki/Clitoral_enlargement_methods" title="Clitoral enlargement methods">Clitoris enlargement</a></li> <li><a href="/wiki/Ergogenic_use_of_anabolic_steroids" title="Ergogenic use of anabolic steroids">Ergogenic use of anabolic steroids</a></li> <li><a href="/wiki/Growth_hormone_therapy" title="Growth hormone therapy">Growth hormone therapy</a></li> <li><a href="/wiki/Transgender_hormone_therapy" class="mw-redirect" title="Transgender hormone therapy">Transgender hormone therapy</a> <ul><li><a class="mw-selflink selflink">Feminizing hormone therapy</a></li> <li><a href="/wiki/Masculinizing_hormone_therapy" title="Masculinizing hormone therapy">Masculinizing hormone therapy</a></li></ul></li> <li><a href="/wiki/Penis_enlargement" title="Penis enlargement">Penis enlargement</a></li> <li><a href="/wiki/Performance-enhancing_substance" title="Performance-enhancing substance">Performance-enhancing substance</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="Estrogens_and_antiestrogens109" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Estrogens_and_antiestrogens" title="Template:Estrogens and antiestrogens"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Estrogens_and_antiestrogens" title="Template talk:Estrogens and antiestrogens"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Estrogens_and_antiestrogens" title="Special:EditPage/Template:Estrogens and antiestrogens"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Estrogens_and_antiestrogens109" style="font-size:114%;margin:0 4em"><a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">Estrogens</a> and <a href="/wiki/Antiestrogen" title="Antiestrogen">antiestrogens</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">Estrogens</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:10em;;text-align:center;"><a href="/wiki/Estrogen_receptor" title="Estrogen receptor"><abbr title="Estrogen receptor">ER</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Estrogen receptor agonists</th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Steroidal: <a href="/wiki/Alfatradiol" title="Alfatradiol">Alfatradiol</a></li> <li>Certain <a href="/wiki/Androgen" title="Androgen">androgens</a>/<a href="/wiki/Anabolic_steroid" title="Anabolic steroid">anabolic steroids</a> (e.g., <a href="/wiki/Testosterone_(medication)" title="Testosterone (medication)">testosterone</a>, <a href="/wiki/List_of_androgen_esters#Testosterone_esters" title="List of androgen esters">testosterone esters</a>, <a href="/wiki/Methyltestosterone" title="Methyltestosterone">methyltestosterone</a>, <a href="/wiki/Metandienone" title="Metandienone">metandienone</a>, <a href="/wiki/List_of_androgen_esters#Nandrolone_esters" title="List of androgen esters">nandrolone esters</a>) (via estrogenic metabolites)</li> <li>Certain <a href="/wiki/Progestin" class="mw-redirect" title="Progestin">progestins</a> (e.g., <a href="/wiki/Norethisterone" title="Norethisterone">norethisterone</a>, <a href="/wiki/Noretynodrel" title="Noretynodrel">noretynodrel</a>, <a href="/wiki/Etynodiol_diacetate" title="Etynodiol diacetate">etynodiol diacetate</a>, <a href="/wiki/Tibolone" title="Tibolone">tibolone</a>)</li> <li><a href="/wiki/Clomestrone" title="Clomestrone">Clomestrone</a></li> <li><a href="/wiki/Cloxestradiol_acetate" title="Cloxestradiol acetate">Cloxestradiol acetate</a></li> <li><a href="/wiki/Conjugated_estriol" title="Conjugated estriol">Conjugated estriol</a></li> <li><a href="/wiki/Conjugated_estrogens" title="Conjugated estrogens">Conjugated estrogens</a></li> <li><a href="/wiki/Epiestriol" title="Epiestriol">Epiestriol</a></li> <li><a href="/wiki/Epimestrol" title="Epimestrol">Epimestrol</a></li> <li><a href="/wiki/Esterified_estrogens" title="Esterified estrogens">Esterified estrogens</a></li> <li><a href="/wiki/Estetrol_(medication)" title="Estetrol (medication)">Estetrol</a>†</li> <li><a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">Estradiol</a></li> <li><a href="/wiki/List_of_estrogen_esters#Estradiol_esters" title="List of estrogen esters">Estradiol esters</a> (e.g., <a href="/wiki/Estradiol_acetate" title="Estradiol acetate">estradiol acetate</a>, <a href="/wiki/Estradiol_benzoate" title="Estradiol benzoate">estradiol benzoate</a>, <a href="/wiki/Estradiol_cypionate" title="Estradiol cypionate">estradiol cypionate</a>, <a href="/wiki/Estradiol_enanthate" class="mw-redirect" title="Estradiol enanthate">estradiol enanthate</a>, <a href="/wiki/Estradiol_undecylate" title="Estradiol undecylate">estradiol undecylate</a>, <a href="/wiki/Estradiol_valerate" title="Estradiol valerate">estradiol valerate</a>, <a href="/wiki/Polyestradiol_phosphate" title="Polyestradiol phosphate">polyestradiol phosphate</a>, <a href="/wiki/Estradiol_ester_mixture" class="mw-redirect" title="Estradiol ester mixture">estradiol ester mixtures</a> (<a href="/wiki/Climacteron" class="mw-redirect" title="Climacteron">Climacteron</a>))</li> <li><a href="/wiki/Estramustine_phosphate" title="Estramustine phosphate">Estramustine phosphate</a></li> <li><a href="/wiki/Estriol_(medication)" title="Estriol (medication)">Estriol</a></li> <li><a href="/wiki/List_of_estrogen_esters#Estriol_esters" title="List of estrogen esters">Estriol esters</a> (e.g., <a href="/wiki/Estriol_succinate" title="Estriol succinate">estriol succinate</a>, <a href="/wiki/Polyestriol_phosphate" title="Polyestriol phosphate">polyestriol phosphate</a>)</li> <li><a href="/wiki/Estrogenic_substances" title="Estrogenic substances">Estrogenic substances</a></li> <li><a href="/wiki/Estrone_(medication)" title="Estrone (medication)">Estrone</a></li> <li><a href="/wiki/List_of_estrogen_esters#Estrone_esters" title="List of estrogen esters">Estrone esters</a> <ul><li><a href="/wiki/Estrone_sulfate_(medication)" title="Estrone sulfate (medication)">Estrone sulfate</a></li> <li><a href="/wiki/Estropipate" title="Estropipate">Estropipate (piperazine estrone sulfate)</a></li></ul></li> <li><a href="/wiki/Ethinylestradiol" title="Ethinylestradiol">Ethinylestradiol</a># <ul><li><a href="/wiki/Ethinylestradiol_sulfonate" title="Ethinylestradiol sulfonate">Ethinylestradiol sulfonate</a></li></ul></li> <li><a href="/wiki/Hydroxyestrone_diacetate" title="Hydroxyestrone diacetate">Hydroxyestrone diacetate</a></li> <li><a href="/wiki/Mestranol" title="Mestranol">Mestranol</a></li> <li><a href="/wiki/Methylestradiol" title="Methylestradiol">Methylestradiol</a></li> <li><a href="/wiki/Moxestrol" title="Moxestrol">Moxestrol</a></li> <li><a href="/wiki/Nilestriol" title="Nilestriol">Nilestriol</a></li> <li><a href="/wiki/Prasterone" title="Prasterone">Prasterone (dehydroepiandrosterone; DHEA)</a> <ul><li><a href="/wiki/Prasterone_enanthate" title="Prasterone enanthate">Prasterone enanthate</a></li> <li><a href="/wiki/Prasterone_sulfate" title="Prasterone sulfate">Prasterone sulfate</a></li></ul></li> <li><a href="/wiki/Promestriene" title="Promestriene">Promestriene</a></li> <li><a href="/wiki/Quinestradol" title="Quinestradol">Quinestradol</a></li> <li><a href="/wiki/Quinestrol" title="Quinestrol">Quinestrol</a></li></ul> <ul><li>Nonsteroidal: <a href="/wiki/Benzestrol" title="Benzestrol">Benzestrol</a></li> <li><a href="/wiki/Bifluranol" title="Bifluranol">Bifluranol</a></li> <li><a href="/wiki/Chlorotrianisene" title="Chlorotrianisene">Chlorotrianisene</a></li> <li><a href="/wiki/Dienestrol" title="Dienestrol">Dienestrol</a> <ul><li><a href="/wiki/Dienestrol_diacetate" title="Dienestrol diacetate">Dienestrol diacetate</a></li></ul></li> <li><a href="/wiki/Diethylstilbestrol" title="Diethylstilbestrol">Diethylstilbestrol (stilbestrol)</a></li> <li><a href="/wiki/List_of_estrogen_esters#Diethylstilbestrol_esters" title="List of estrogen esters">Diethylstilbestrol esters/ethers</a> <ul><li><a href="/wiki/Dimestrol" title="Dimestrol">Dimestrol (diethylstilbestrol dimethyl ether)</a></li> <li><a href="/wiki/Fosfestrol" title="Fosfestrol">Fosfestrol (diethylstilbestrol diphosphate)</a></li> <li><a href="/wiki/Mestilbol" title="Mestilbol">Mestilbol (diethylstilbestrol monomethyl ether)</a></li></ul></li> <li><a href="/wiki/Doisynoestrol" title="Doisynoestrol">Doisynoestrol (fenocycline)</a></li> <li><a href="/wiki/Hexestrol" title="Hexestrol">Hexestrol</a> <ul><li><a href="/wiki/List_of_estrogen_esters#Hexestrol_esters" title="List of estrogen esters">Hexestrol esters</a></li></ul></li> <li><a href="/wiki/Methallenestril" title="Methallenestril">Methallenestril</a></li> <li><a href="/wiki/Methestrol" title="Methestrol">Methestrol (promethestrol)</a> <ul><li><a href="/wiki/Methestrol_dipropionate" title="Methestrol dipropionate">Methestrol dipropionate (promethestrol dipropionate)</a></li></ul></li> <li><a href="/wiki/Paroxypropione" title="Paroxypropione">Paroxypropione</a></li> <li><a href="/wiki/Quadrosilan" title="Quadrosilan">Quadrosilan</a></li> <li><a href="/wiki/Triphenylbromoethylene" title="Triphenylbromoethylene">Triphenylbromoethylene</a></li> <li><a href="/wiki/Triphenylchloroethylene" title="Triphenylchloroethylene">Triphenylchloroethylene</a></li> <li><a href="/wiki/Zeranol" title="Zeranol">Zeranol</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;;text-align:center;"><a href="/wiki/Progonadotropin" title="Progonadotropin">Progonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antiandrogen" title="Antiandrogen">Antiandrogens</a> (e.g., <a href="/wiki/Bicalutamide" title="Bicalutamide">bicalutamide</a>)</li> <li><a href="/wiki/GnRH_agonist" class="mw-redirect" title="GnRH agonist"><abbr title="gonadotropin-releasing hormone">GnRH</abbr> agonists</a> (e.g., <a href="/wiki/Gonadotropin-releasing_hormone" title="Gonadotropin-releasing hormone"><abbr title="gonadotropin-releasing hormone">GnRH</abbr> (gonadorelin)</a>, <a href="/wiki/Leuprorelin" title="Leuprorelin">leuprorelin</a>)</li> <li><a href="/wiki/Gonadotropin" title="Gonadotropin">Gonadotropins</a> (e.g., <a href="/wiki/Follicle-stimulating_hormone" title="Follicle-stimulating hormone"><abbr title="follicle-stimulating hormone">FSH</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip follicle-stimulating hormone, <a href="/wiki/Luteinizing_hormone" title="Luteinizing hormone"><abbr title="luteinizing hormone">LH</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip luteinizing hormone)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Antiestrogen" title="Antiestrogen">Antiestrogens</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:10em;;text-align:center;"><a href="/wiki/Estrogen_receptor" title="Estrogen receptor"><abbr title="Estrogen receptor">ER</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Estrogen receptor antagonists (incl. <a href="/wiki/Selective_estrogen_receptor_modulators" class="mw-redirect" title="Selective estrogen receptor modulators"><abbr title="selective estrogen receptor modulators">SERMs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip selective estrogen receptor modulators/<a href="/wiki/Selective_estrogen_receptor_downregulators" class="mw-redirect" title="Selective estrogen receptor downregulators"><abbr title="selective estrogen receptor downregulators">SERDs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip selective estrogen receptor downregulators)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acolbifene" title="Acolbifene">Acolbifene</a>†</li> <li><a href="/wiki/Anordrin" title="Anordrin">Anordrin</a></li> <li><a href="/wiki/Bazedoxifene" title="Bazedoxifene">Bazedoxifene</a></li> <li><a href="/wiki/Broparestrol" title="Broparestrol">Broparestrol</a></li> <li><a href="/wiki/Clomifene" title="Clomifene">Clomifene</a>#</li> <li><a href="/wiki/Cyclofenil" title="Cyclofenil">Cyclofenil</a></li> <li><a href="/wiki/Enclomifene" title="Enclomifene">Enclomifene</a>†</li> <li><a href="/wiki/Epitiostanol" title="Epitiostanol">Epitiostanol</a></li> <li><a href="/wiki/Lasofoxifene" title="Lasofoxifene">Lasofoxifene</a></li> <li><a href="/wiki/Mepitiostane" title="Mepitiostane">Mepitiostane</a></li> <li><a href="/wiki/Ormeloxifene" title="Ormeloxifene">Ormeloxifene</a></li> <li><a href="/wiki/Ospemifene" title="Ospemifene">Ospemifene</a></li> <li><a href="/wiki/Raloxifene" title="Raloxifene">Raloxifene</a></li> <li><a href="/wiki/Tamoxifen" title="Tamoxifen">Tamoxifen</a>#</li> <li><a href="/wiki/Toremifene" title="Toremifene">Toremifene</a></li></ul> <ul><li>Exclusively antagonistic: <a href="/wiki/Elacestrant" title="Elacestrant">Elacestrant</a></li> <li><a href="/wiki/Fulvestrant" title="Fulvestrant">Fulvestrant</a></li></ul> <ul><li>Noncompetitive inhibitors: <a href="/wiki/Trilostane" title="Trilostane">Trilostane</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;;text-align:center;"><a href="/wiki/Aromatase_inhibitor" title="Aromatase inhibitor">Aromatase inhibitors</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li>First-generation: <a href="/wiki/Aminoglutethimide" title="Aminoglutethimide">Aminoglutethimide</a></li> <li><a href="/wiki/Testolactone" title="Testolactone">Testolactone</a></li></ul> <ul><li>Second-generation: <a href="/wiki/Fadrozole" title="Fadrozole">Fadrozole</a></li> <li><a href="/wiki/Formestane" title="Formestane">Formestane</a></li></ul> <ul><li>Third-generation: <a href="/wiki/Anastrozole" title="Anastrozole">Anastrozole</a></li> <li><a href="/wiki/Exemestane" title="Exemestane">Exemestane</a></li> <li><a href="/wiki/Letrozole" title="Letrozole">Letrozole</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;;text-align:center;"><a href="/wiki/Antigonadotropin" title="Antigonadotropin">Antigonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Androgen" title="Androgen">Androgens</a>/<a href="/wiki/Anabolic_steroid" title="Anabolic steroid">anabolic steroids</a> (e.g., <a href="/wiki/Testosterone" title="Testosterone">testosterone</a>, <a href="/wiki/List_of_androgen_esters#Testosterone_esters" title="List of androgen esters">testosterone esters</a>, <a href="/wiki/List_of_androgen_esters#Nandrolone_esters" title="List of androgen esters">nandrolone esters</a>, <a href="/wiki/Oxandrolone" title="Oxandrolone">oxandrolone</a>, <a href="/wiki/Fluoxymesterone" title="Fluoxymesterone">fluoxymesterone</a>)</li> <li><a href="/wiki/D2_receptor" class="mw-redirect" title="D2 receptor">D2 receptor</a> <a href="/wiki/Dopamine_antagonist" title="Dopamine antagonist">antagonists</a> (<a href="/wiki/Prolactin" title="Prolactin">prolactin</a> releasers) (e.g., <a href="/wiki/Domperidone" title="Domperidone">domperidone</a>, <a href="/wiki/Metoclopramide" title="Metoclopramide">metoclopramide</a>, <a href="/wiki/Risperidone" title="Risperidone">risperidone</a>, <a href="/wiki/Haloperidol" title="Haloperidol">haloperidol</a>, <a href="/wiki/Chlorpromazine" title="Chlorpromazine">chlorpromazine</a>, <a href="/wiki/Sulpiride" title="Sulpiride">sulpiride</a>)</li> <li><a href="/wiki/GnRH_agonist" class="mw-redirect" title="GnRH agonist"><abbr title="gonadotropin-releasing hormone">GnRH</abbr> agonists</a> (e.g., <a href="/wiki/Leuprorelin" title="Leuprorelin">leuprorelin</a>, <a href="/wiki/Goserelin" title="Goserelin">goserelin</a>)</li> <li><a href="/wiki/GnRH_antagonist" class="mw-redirect" title="GnRH antagonist"><abbr title="gonadotropin-releasing hormone">GnRH</abbr> antagonists</a> (e.g., <a href="/wiki/Cetrorelix" title="Cetrorelix">cetrorelix</a>, <a href="/wiki/Elagolix" title="Elagolix">elagolix</a>)</li> <li><a href="/wiki/Progestogen" title="Progestogen">Progestogens</a> (e.g., <a href="/wiki/Chlormadinone_acetate" title="Chlormadinone acetate">chlormadinone acetate</a>, <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a>, <a href="/wiki/Gestonorone_caproate" title="Gestonorone caproate">gestonorone caproate</a>, <a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">hydroxyprogesterone caproate</a>, <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">medroxyprogesterone acetate</a>, <a href="/wiki/Megestrol_acetate" title="Megestrol acetate">megestrol acetate</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;;text-align:center;">Others</th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Mixed mechanism of action: <a href="/wiki/Danazol" title="Danazol">Danazol</a></li> <li><a href="/wiki/Gestrinone" title="Gestrinone">Gestrinone</a></li></ul> <ul><li>Androstenedione immunogens: <a href="/wiki/Androvax" title="Androvax">Androvax (androstenedione albumin)</a></li> <li><a href="/wiki/Ovandrotone_albumin" title="Ovandrotone albumin">Ovandrotone albumin (Fecundin)</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist"> <ul><li>#<a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li>‡<a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li>†<a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li>§Never to phase III</li></ul></li></ul> </div> <dl><dt>See also</dt> <dd><a href="/wiki/Template:Estrogen_receptor_modulators" title="Template:Estrogen receptor modulators">Estrogen receptor modulators</a></dd> <dd><a href="/wiki/Template:Androgens_and_antiandrogens" title="Template:Androgens and antiandrogens">Androgens and antiandrogens</a></dd> <dd><a href="/wiki/Template:Progestogens_and_antiprogestogens" title="Template:Progestogens and antiprogestogens">Progestogens and antiprogestogens</a></dd> <dd><a href="/wiki/List_of_steroidal_estrogens" class="mw-redirect" title="List of steroidal estrogens">List of estrogens</a></dd></dl></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="Androgens_and_antiandrogens491" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Androgens_and_antiandrogens" title="Template:Androgens and antiandrogens"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Androgens_and_antiandrogens" title="Template talk:Androgens and antiandrogens"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Androgens_and_antiandrogens" title="Special:EditPage/Template:Androgens and antiandrogens"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Androgens_and_antiandrogens491" style="font-size:114%;margin:0 4em"><a href="/wiki/Androgen" title="Androgen">Androgens</a> and <a href="/wiki/Antiandrogen" title="Antiandrogen">antiandrogens</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Androgen" title="Androgen">Androgens</a> (incl. <a href="/wiki/Anabolic%E2%80%93androgenic_steroid" class="mw-redirect" title="Anabolic–androgenic steroid"><abbr title="anabolic–androgenic steroid">AAS</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip anabolic–androgenic steroid)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Androgen_receptor" title="Androgen receptor"><abbr title="Androgen receptor">AR</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Androgen receptor <a href="/wiki/Agonist" title="Agonist">agonists</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Testosterone derivatives: <a href="/wiki/Androstenediol_dipropionate" title="Androstenediol dipropionate">Androstenediol dipropionate</a></li> <li><a href="/wiki/Boldenone_undecylenate" title="Boldenone undecylenate">Boldenone undecylenate</a></li> <li><a href="/wiki/Clostebol" title="Clostebol">Clostebol</a></li> <li><a href="/wiki/Clostebol_acetate" title="Clostebol acetate">Clostebol acetate</a></li> <li><a href="/wiki/Clostebol_caproate" title="Clostebol caproate">Clostebol caproate</a></li> <li><a href="/wiki/Clostebol_propionate" title="Clostebol propionate">Clostebol propionate</a></li> <li><a href="/wiki/Cloxotestosterone_acetate" title="Cloxotestosterone acetate">Cloxotestosterone acetate</a></li> <li><a href="/wiki/Prasterone" title="Prasterone">Prasterone (dehydroepiandrosterone, DHEA)</a></li> <li><a href="/wiki/Prasterone_enanthate" title="Prasterone enanthate">Prasterone enanthate (DHEA enanthate)</a></li> <li><a href="/wiki/Prasterone_sulfate" title="Prasterone sulfate">Prasterone sulfate (DHEA sulfate)</a></li> <li><a href="/wiki/Quinbolone" title="Quinbolone">Quinbolone</a></li> <li><a href="/wiki/Testosterone_(medication)" title="Testosterone (medication)">Testosterone</a>#</li> <li><a href="/wiki/List_of_androgen_esters#Testosterone_esters" title="List of androgen esters">Testosterone esters</a> (e.g., <a href="/wiki/Testosterone_cypionate" title="Testosterone cypionate">testosterone cypionate</a>, <a href="/wiki/Testosterone_enanthate" title="Testosterone enanthate">testosterone enanthate</a>, <a href="/wiki/Testosterone_propionate" title="Testosterone propionate">testosterone propionate</a>, <a href="/wiki/Testosterone_undecanoate" title="Testosterone undecanoate">testosterone undecanoate</a>, <a href="/wiki/Testosterone_ester_mixture" class="mw-redirect" title="Testosterone ester mixture">testosterone ester mixtures</a> (<a href="/wiki/Deposterona" class="mw-redirect" title="Deposterona">Deposterona</a>, <a href="/wiki/Omnadren" class="mw-redirect" title="Omnadren">Omnadren</a>, <a href="/wiki/Testosterone_propionate/testosterone_phenylpropionate/testosterone_isocaproate/testosterone_decanoate" title="Testosterone propionate/testosterone phenylpropionate/testosterone isocaproate/testosterone decanoate">Sustanon</a>, <a href="/wiki/Testoviron_depot" class="mw-redirect" title="Testoviron depot">Testoviron Depot</a>))</li></ul> <ul><li>Dihydrotestosterone derivatives: <a href="/wiki/Androstanolone" title="Androstanolone">Androstanolone (stanolone, dihydrotestosterone, DHT)</a></li> <li><a href="/wiki/List_of_androgen_esters#Dihydrotestosterone_esters" title="List of androgen esters">Androstanolone esters</a></li> <li><a href="/wiki/Bolazine_capronate" title="Bolazine capronate">Bolazine capronate</a></li> <li><a href="/wiki/Drostanolone_propionate" title="Drostanolone propionate">Drostanolone propionate (dromostanolone propionate)</a></li> <li><a href="/wiki/Epitiostanol" title="Epitiostanol">Epitiostanol</a></li> <li><a href="/wiki/Mepitiostane" title="Mepitiostane">Mepitiostane</a></li> <li><a href="/wiki/Mesterolone" title="Mesterolone">Mesterolone</a></li> <li><a href="/wiki/Metenolone_acetate" title="Metenolone acetate">Metenolone acetate (methenolone acetate)</a></li> <li><a href="/wiki/Metenolone_enanthate" title="Metenolone enanthate">Metenolone enanthate (methenolone enanthate)</a></li> <li><a href="/wiki/Stenbolone_acetate" title="Stenbolone acetate">Stenbolone acetate</a></li></ul> <ul><li>19-Nortestosterone derivatives: <a href="/wiki/Bolandiol_dipropionate" title="Bolandiol dipropionate">Bolandiol dipropionate</a></li> <li><a href="/wiki/List_of_androgen_esters#Nandrolone_esters" title="List of androgen esters">Nandrolone esters</a> (e.g., <a href="/wiki/Nandrolone_decanoate" title="Nandrolone decanoate">nandrolone decanoate</a>, <a href="/wiki/Nandrolone_phenylpropionate" title="Nandrolone phenylpropionate">nandrolone phenylpropionate</a>)</li> <li><a href="/wiki/Norclostebol" title="Norclostebol">Norclostebol</a></li> <li><a href="/wiki/Norclostebol_acetate" title="Norclostebol acetate">Norclostebol acetate</a></li> <li><a href="/wiki/Oxabolone_cipionate" title="Oxabolone cipionate">Oxabolone cipionate (oxabolone cypionate)</a></li> <li><a href="/wiki/Trenbolone_acetate" title="Trenbolone acetate">Trenbolone acetate</a></li> <li><a href="/wiki/Trenbolone_hexahydrobenzylcarbonate" title="Trenbolone hexahydrobenzylcarbonate">Trenbolone hexahydrobenzylcarbonate (trenbolone cyclohexylmethylcarbonate)</a></li></ul> <ul><li>17α-Alkylated testosterone derivatives: <a href="/wiki/Bolasterone" title="Bolasterone">Bolasterone</a></li> <li><a href="/wiki/Calusterone" title="Calusterone">Calusterone</a></li> <li><a href="/wiki/Chlorodehydromethyltestosterone" title="Chlorodehydromethyltestosterone">Chlorodehydromethyltestosterone (CDMT)</a></li> <li><a href="/wiki/Fluoxymesterone" title="Fluoxymesterone">Fluoxymesterone</a></li> <li><a href="/wiki/Formebolone" title="Formebolone">Formebolone</a></li> <li><a href="/wiki/Metandienone" title="Metandienone">Metandienone (methandienone, methandrostenolone)</a></li> <li><a href="/wiki/Methandriol" title="Methandriol">Methandriol (methylandrostenediol)</a></li> <li><a href="/wiki/Methandriol_bisenanthoyl_acetate" title="Methandriol bisenanthoyl acetate">Methandriol bisenanthoyl acetate</a></li> <li><a href="/wiki/Methandriol_dipropionate" title="Methandriol dipropionate">Methandriol dipropionate</a></li> <li><a href="/wiki/Methandriol_propionate" title="Methandriol propionate">Methandriol propionate</a></li> <li><a href="/wiki/Methyltestosterone" title="Methyltestosterone">Methyltestosterone</a></li> <li><a href="/wiki/Methyltestosterone_3-hexyl_ether" title="Methyltestosterone 3-hexyl ether">Methyltestosterone 3-hexyl ether</a></li> <li><a href="/wiki/Oxymesterone" title="Oxymesterone">Oxymesterone</a></li> <li><a href="/wiki/Penmesterol" title="Penmesterol">Penmesterol</a></li> <li><a href="/wiki/Tiomesterone" title="Tiomesterone">Tiomesterone (thiomesterone)</a></li></ul> <ul><li>17α-Alkylated dihydrotestosterone derivatives: <a href="/wiki/Androisoxazole" title="Androisoxazole">Androisoxazole</a></li> <li><a href="/wiki/Furazabol" title="Furazabol">Furazabol</a></li> <li><a href="/wiki/Mebolazine" title="Mebolazine">Mebolazine (dimethazine)</a></li> <li><a href="/wiki/Mestanolone" title="Mestanolone">Mestanolone</a></li> <li><a href="/wiki/Oxandrolone" title="Oxandrolone">Oxandrolone</a></li> <li><a href="/wiki/Oxymetholone" title="Oxymetholone">Oxymetholone</a></li> <li><a href="/wiki/Stanozolol" title="Stanozolol">Stanozolol</a></li></ul> <ul><li>17α-Alkylated 19-nortestosterone derivatives: <a href="/wiki/Ethylestrenol" title="Ethylestrenol">Ethylestrenol</a></li> <li><a href="/wiki/Mibolerone" title="Mibolerone">Mibolerone</a></li> <li><a href="/wiki/Norethandrolone" title="Norethandrolone">Norethandrolone</a></li> <li><a href="/wiki/Normethandrone" title="Normethandrone">Normethandrone (methylestrenolone, normethisterone)</a></li> <li><a href="/wiki/Propetandrol" title="Propetandrol">Propetandrol (propethandrol)</a></li></ul> <ul><li>17α-Vinyltestosterone derivatives: <a href="/wiki/Norvinisterone" title="Norvinisterone">Norvinisterone (vinylnortestosterone)</a></li></ul> <ul><li>17α-Ethynyltestosterone derivatives: <a href="/wiki/Danazol" title="Danazol">Danazol</a></li> <li><a href="/wiki/Gestrinone" title="Gestrinone">Gestrinone</a></li> <li><a href="/wiki/Progestin" class="mw-redirect" title="Progestin">Progestins</a> (e.g., <a href="/wiki/Ethisterone" title="Ethisterone">ethisterone (ethynyltestosterone)</a>, <a href="/wiki/Levonorgestrel" title="Levonorgestrel">levonorgestrel</a>, <a href="/wiki/Norgestrel" title="Norgestrel">norgestrel</a>, <a href="/wiki/Norethisterone" title="Norethisterone">norethisterone (norethindrone)</a>, <a href="/wiki/Lynestrenol" title="Lynestrenol">lynestrenol</a>, <a href="/wiki/Norgestrienone" title="Norgestrienone">norgestrienone</a>)</li> <li><a href="/wiki/Tibolone" title="Tibolone">Tibolone</a></li></ul> <ul><li>Progesterone derivatives: <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">Medroxyprogesterone acetate</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Progonadotropin" title="Progonadotropin">Progonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antiestrogen" title="Antiestrogen">Antiestrogens</a> (e.g., <a href="/wiki/Tamoxifen" title="Tamoxifen">tamoxifen</a>, <a href="/wiki/Clomifene" title="Clomifene">clomifene</a>)</li> <li><a href="/wiki/GnRH_agonist" class="mw-redirect" title="GnRH agonist">GnRH agonists</a> (e.g., <a href="/wiki/Gonadotropin-releasing_hormone" title="Gonadotropin-releasing hormone">GnRH (gonadorelin)</a>, <a href="/wiki/Leuprorelin" title="Leuprorelin">leuprorelin</a>)</li> <li><a href="/wiki/Gonadotropin" title="Gonadotropin">Gonadotropins</a> (e.g., <a href="/wiki/Luteinizing_hormone" title="Luteinizing hormone"><abbr title="luteinizing hormone">LH</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip luteinizing hormone, <a href="/wiki/Human_chorionic_gonadotropin" title="Human chorionic gonadotropin"><abbr title="human chorionic gonadotropin">hCG</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip human chorionic gonadotropin)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Antiandrogen" title="Antiandrogen">Antiandrogens</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Androgen_receptor" title="Androgen receptor"><abbr title="Androgen receptor">AR</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Androgen receptor <a href="/wiki/Receptor_antagonist" title="Receptor antagonist">antagonists</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Steroidal: <a href="/wiki/Abiraterone_acetate" title="Abiraterone acetate">Abiraterone acetate</a> <a href="/wiki/Niraparib/abiraterone_acetate" title="Niraparib/abiraterone acetate">+niraparib</a></li> <li><a href="/wiki/Canrenone" title="Canrenone">Canrenone</a></li> <li><a href="/wiki/Chlormadinone_acetate" title="Chlormadinone acetate">Chlormadinone acetate</a></li> <li><a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">Cyproterone acetate</a></li> <li><a href="/wiki/Delmadinone_acetate" title="Delmadinone acetate">Delmadinone acetate</a></li> <li><a href="/wiki/Dienogest" title="Dienogest">Dienogest</a></li> <li><a href="/wiki/Drospirenone" title="Drospirenone">Drospirenone</a></li> <li><a href="/wiki/Medrogestone" title="Medrogestone">Medrogestone</a></li> <li><a href="/wiki/Megestrol_acetate" title="Megestrol acetate">Megestrol acetate</a></li> <li><a href="/wiki/Nomegestrol_acetate" title="Nomegestrol acetate">Nomegestrol acetate</a></li> <li><a href="/wiki/Osaterone_acetate" title="Osaterone acetate">Osaterone acetate</a></li> <li><a href="/wiki/Oxendolone" title="Oxendolone">Oxendolone</a></li> <li><a href="/wiki/Potassium_canrenoate" title="Potassium canrenoate">Potassium canrenoate</a></li> <li><a href="/wiki/Spironolactone" title="Spironolactone">Spironolactone</a></li></ul> <ul><li>Nonsteroidal: <a href="/wiki/Apalutamide" title="Apalutamide">Apalutamide</a></li> <li><a href="/wiki/Bicalutamide" title="Bicalutamide">Bicalutamide</a></li> <li><a href="/wiki/Cimetidine" title="Cimetidine">Cimetidine</a></li> <li><a href="/wiki/Darolutamide" title="Darolutamide">Darolutamide</a></li> <li><a href="/wiki/Enzalutamide" title="Enzalutamide">Enzalutamide</a></li> <li><a href="/wiki/Flutamide" title="Flutamide">Flutamide</a></li> <li><a href="/wiki/Ketoconazole" title="Ketoconazole">Ketoconazole</a></li> <li><a href="/wiki/Nilutamide" title="Nilutamide">Nilutamide</a></li> <li><a href="/wiki/Seviteronel" title="Seviteronel">Seviteronel</a>†</li> <li><a href="/wiki/Topilutamide" title="Topilutamide">Topilutamide (fluridil)</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Steroidogenesis_inhibitor" title="Steroidogenesis inhibitor">Steroidogenesis inhibitors</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/5%CE%B1-Reductase_inhibitor" title="5α-Reductase inhibitor">5α-Reductase</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alfatradiol" title="Alfatradiol">Alfatradiol</a></li> <li><a href="/wiki/Dutasteride" title="Dutasteride">Dutasteride</a></li> <li><a href="/wiki/Epristeride" title="Epristeride">Epristeride</a></li> <li><a href="/wiki/Finasteride" title="Finasteride">Finasteride</a></li> <li><a href="/wiki/Saw_palmetto_extract" title="Saw palmetto extract">Saw palmetto extract</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Others</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Abiraterone_acetate" title="Abiraterone acetate">Abiraterone acetate</a> <a href="/wiki/Niraparib/abiraterone_acetate" title="Niraparib/abiraterone acetate">+niraparib</a></li> <li><a href="/wiki/Aminoglutethimide" title="Aminoglutethimide">Aminoglutethimide</a></li> <li><a href="/wiki/Bifluranol" title="Bifluranol">Bifluranol</a></li> <li><a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">Cyproterone acetate</a></li> <li><a href="/wiki/Flutamide" title="Flutamide">Flutamide</a></li> <li><a href="/wiki/Ketoconazole" title="Ketoconazole">Ketoconazole</a></li> <li><a href="/wiki/Nilutamide" title="Nilutamide">Nilutamide</a></li> <li><a href="/wiki/Seviteronel" title="Seviteronel">Seviteronel</a>†</li> <li><a href="/wiki/Spironolactone" title="Spironolactone">Spironolactone</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Antigonadotropin" title="Antigonadotropin">Antigonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/D2_receptor" class="mw-redirect" title="D2 receptor">D2 receptor</a> <a href="/wiki/Dopamine_antagonist" title="Dopamine antagonist">antagonists</a> (<a href="/wiki/Prolactin_releaser" class="mw-redirect" title="Prolactin releaser">prolactin releasers</a>) (e.g., <a href="/wiki/Domperidone" title="Domperidone">domperidone</a>, <a href="/wiki/Metoclopramide" title="Metoclopramide">metoclopramide</a>, <a href="/wiki/Risperidone" title="Risperidone">risperidone</a>, <a href="/wiki/Haloperidol" title="Haloperidol">haloperidol</a>, <a href="/wiki/Chlorpromazine" title="Chlorpromazine">chlorpromazine</a>, <a href="/wiki/Sulpiride" title="Sulpiride">sulpiride</a>)</li> <li><a href="/wiki/Estrogen" title="Estrogen">Estrogens</a> (e.g., <a href="/wiki/Bifluranol" title="Bifluranol">bifluranol</a>, <a href="/wiki/Diethylstilbestrol" title="Diethylstilbestrol">diethylstilbestrol</a>, <a href="/wiki/Estradiol" title="Estradiol">estradiol</a>, <a href="/wiki/List_of_estrogen_esters#Estradiol_esters" title="List of estrogen esters">estradiol esters</a>, <a href="/wiki/Ethinylestradiol" title="Ethinylestradiol">ethinylestradiol</a>, <a href="/wiki/Ethinylestradiol_sulfonate" title="Ethinylestradiol sulfonate">ethinylestradiol sulfonate</a>, <a href="/wiki/Paroxypropione" title="Paroxypropione">paroxypropione</a>)</li> <li><a href="/wiki/GnRH_agonist" class="mw-redirect" title="GnRH agonist">GnRH agonists</a> (e.g., <a href="/wiki/Leuprorelin" title="Leuprorelin">leuprorelin</a>)</li> <li><a href="/wiki/GnRH_antagonist" class="mw-redirect" title="GnRH antagonist">GnRH antagonists</a> (e.g., <a href="/wiki/Cetrorelix" title="Cetrorelix">cetrorelix</a>)</li> <li><a href="/wiki/Progestogen" title="Progestogen">Progestogens</a> (incl., <a href="/wiki/Chlormadinone_acetate" title="Chlormadinone acetate">chlormadinone acetate</a>, <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a>, <a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">hydroxyprogesterone caproate</a>, <a href="/wiki/Gestonorone_caproate" title="Gestonorone caproate">gestonorone caproate</a>, <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">medroxyprogesterone acetate</a>, <a href="/wiki/Megestrol_acetate" title="Megestrol acetate">megestrol acetate</a>)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;">Others</th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Androstenedione immunogens: <a href="/wiki/Androvax" title="Androvax">Androvax (androstenedione albumin)</a></li> <li><a href="/wiki/Ovandrotone_albumin" title="Ovandrotone albumin">Ovandrotone albumin (Fecundin)</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist"> <ul><li>#<a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li>‡<a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li>†<a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li>§Never to phase III</li></ul></li></ul> </div> <dl><dt>See also</dt> <dd><a href="/wiki/Template:Androgen_receptor_modulators" title="Template:Androgen receptor modulators">Androgen receptor modulators</a></dd> <dd><a href="/wiki/Template:Estrogens_and_antiestrogens" title="Template:Estrogens and antiestrogens">Estrogens and antiestrogens</a></dd> <dd><a href="/wiki/Template:Progestogens_and_antiprogestogens" title="Template:Progestogens and antiprogestogens">Progestogens and antiprogestogens</a></dd> <dd><a href="/wiki/List_of_androgens/anabolic_steroids" class="mw-redirect" title="List of androgens/anabolic steroids">List of androgens/anabolic steroids</a></dd></dl></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="Progestogens_and_antiprogestogens153" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Progestogens_and_antiprogestogens" title="Template:Progestogens and antiprogestogens"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Progestogens_and_antiprogestogens" title="Template talk:Progestogens and antiprogestogens"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Progestogens_and_antiprogestogens" title="Special:EditPage/Template:Progestogens and antiprogestogens"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Progestogens_and_antiprogestogens153" style="font-size:114%;margin:0 4em"><a href="/wiki/Progestogen_(medication)" title="Progestogen (medication)">Progestogens</a> and <a href="/wiki/Antiprogestogen" title="Antiprogestogen">antiprogestogens</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Progestogen_(medication)" title="Progestogen (medication)">Progestogens</a> (and <a href="/wiki/Progestin" class="mw-redirect" title="Progestin">progestins</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="PRTooltip_Progesterone_receptor_agonists408" scope="row" class="navbox-group" style="width:8em;;text-align:center;"><a href="/wiki/Progesterone_receptor" title="Progesterone receptor"><abbr title="Progesterone receptor">PR</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Progesterone receptor <a href="/wiki/Agonist" title="Agonist">agonists</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Progesterone derivatives: <a href="/wiki/Progesterone_(medication)" title="Progesterone (medication)">Progesterone</a></li> <li><a href="/wiki/Quingestrone" title="Quingestrone">Quingestrone</a></li></ul> <ul><li>Retroprogesterone derivatives: <a href="/wiki/Dydrogesterone" title="Dydrogesterone">Dydrogesterone</a></li> <li><a href="/wiki/Trengestone" title="Trengestone">Trengestone</a></li></ul> <ul><li>17α-Hydroxyprogesterone (and closely related) derivatives: 17α-Hydroxylated: <a href="/wiki/Acetomepregenol" title="Acetomepregenol">Acetomepregenol (mepregenol diacetate)</a></li> <li><a href="/wiki/Algestone_acetophenide" title="Algestone acetophenide">Algestone acetophenide (dihydroxyprogesterone acetophenide)</a></li> <li><a href="/wiki/Anagestone_acetate" title="Anagestone acetate">Anagestone acetate</a></li> <li><a href="/wiki/Chlormadinone_acetate" title="Chlormadinone acetate">Chlormadinone acetate</a></li> <li><a href="/wiki/Chlormethenmadinone_acetate" title="Chlormethenmadinone acetate">Chlormethenmadinone acetate</a></li> <li><a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">Cyproterone acetate</a></li> <li><a href="/wiki/Delmadinone_acetate" title="Delmadinone acetate">Delmadinone acetate</a></li> <li><a href="/wiki/Flugestone_acetate" title="Flugestone acetate">Flugestone acetate (flurogestone acetate)</a></li> <li><a href="/wiki/Flumedroxone_acetate" title="Flumedroxone acetate">Flumedroxone acetate</a></li> <li><a href="/wiki/Hydroxyprogesterone_acetate" title="Hydroxyprogesterone acetate">Hydroxyprogesterone acetate</a></li> <li><a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">Hydroxyprogesterone caproate</a></li> <li><a href="/wiki/Hydroxyprogesterone_heptanoate" title="Hydroxyprogesterone heptanoate">Hydroxyprogesterone heptanoate</a></li> <li><a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">Medroxyprogesterone acetate</a>#</li> <li><a href="/wiki/Megestrol_acetate" title="Megestrol acetate">Megestrol acetate</a></li> <li><a href="/wiki/Melengestrol_acetate" title="Melengestrol acetate">Melengestrol acetate</a></li> <li><a href="/wiki/Methenmadinone_acetate" title="Methenmadinone acetate">Methenmadinone acetate</a></li> <li><a href="/wiki/Osaterone_acetate" title="Osaterone acetate">Osaterone acetate</a></li> <li><a href="/wiki/Pentagestrone_acetate" title="Pentagestrone acetate">Pentagestrone acetate</a></li> <li><a href="/wiki/Proligestone" title="Proligestone">Proligestone</a>; 17α-Methylated: <a href="/wiki/Medrogestone" title="Medrogestone">Medrogestone</a>; Others: <a href="/wiki/Haloprogesterone" title="Haloprogesterone">Haloprogesterone</a></li></ul> <ul><li>19-Norprogesterone derivatives: 17α-Hydroxylated: <a href="/wiki/Gestonorone_caproate" title="Gestonorone caproate">Gestonorone caproate (gestronol hexanoate)</a></li> <li><a href="/wiki/Nomegestrol_acetate" title="Nomegestrol acetate">Nomegestrol acetate</a></li> <li><a href="/wiki/Norgestomet" title="Norgestomet">Norgestomet</a></li> <li><a href="/wiki/Segesterone_acetate" title="Segesterone acetate">Segesterone acetate (nestorone, elcometrine)</a>; 17α-Methylated: <a href="/wiki/Demegestone" title="Demegestone">Demegestone</a></li> <li><a href="/wiki/Promegestone" title="Promegestone">Promegestone</a></li> <li><a href="/wiki/Trimegestone" title="Trimegestone">Trimegestone</a></li></ul> <ul><li>Testosterone derivatives: Estranes: <a href="/wiki/Danazol" title="Danazol">Danazol</a></li> <li><a href="/wiki/Dimethisterone" title="Dimethisterone">Dimethisterone</a></li> <li><a href="/wiki/Ethisterone" title="Ethisterone">Ethisterone</a></li></ul> <ul><li>19-Nortestosterone derivatives: Estranes: <a href="/wiki/Allylestrenol" title="Allylestrenol">Allylestrenol</a></li> <li><a href="/wiki/Altrenogest" title="Altrenogest">Altrenogest</a></li> <li><a href="/wiki/Dienogest" title="Dienogest">Dienogest</a></li> <li><a href="/wiki/Etynodiol_diacetate" title="Etynodiol diacetate">Etynodiol diacetate</a></li> <li><a href="/wiki/Lynestrenol" title="Lynestrenol">Lynestrenol</a></li> <li><a href="/wiki/Norethisterone" title="Norethisterone">Norethisterone (norethindrone)</a>#</li> <li><a href="/wiki/Norethisterone_acetate" title="Norethisterone acetate">Norethisterone acetate</a></li> <li><a href="/wiki/Norethisterone_enanthate" title="Norethisterone enanthate">Norethisterone enanthate</a></li> <li><a href="/wiki/Noretynodrel" title="Noretynodrel">Noretynodrel</a></li> <li><a href="/wiki/Norgesterone" title="Norgesterone">Norgesterone</a></li> <li><a href="/wiki/Norgestrienone" title="Norgestrienone">Norgestrienone</a></li> <li><a href="/wiki/Normethandrone" title="Normethandrone">Normethandrone (methylestrenolone)</a></li> <li><a href="/wiki/Norvinisterone" title="Norvinisterone">Norvinisterone</a></li> <li><a href="/wiki/Oxendolone" title="Oxendolone">Oxendolone</a></li> <li><a href="/wiki/Quingestanol_acetate" title="Quingestanol acetate">Quingestanol acetate</a></li> <li><a href="/wiki/Tibolone" title="Tibolone">Tibolone</a>; Gonanes: <a href="/wiki/Desogestrel" title="Desogestrel">Desogestrel</a></li> <li><a href="/wiki/Etonogestrel" title="Etonogestrel">Etonogestrel</a></li> <li><a href="/wiki/Gestodene" title="Gestodene">Gestodene</a></li> <li><a href="/wiki/Gestrinone" title="Gestrinone">Gestrinone</a></li> <li><a href="/wiki/Levonorgestrel" title="Levonorgestrel">Levonorgestrel</a>#</li> <li><a href="/wiki/Norelgestromin" title="Norelgestromin">Norelgestromin</a></li> <li><a href="/wiki/Norgestimate" title="Norgestimate">Norgestimate</a></li> <li><a href="/wiki/Norgestrel" title="Norgestrel">Norgestrel</a></li></ul> <ul><li>Spirolactone derivatives: <a href="/wiki/Drospirenone" title="Drospirenone">Drospirenone</a></li></ul> <ul><li>Others: <a href="/wiki/Anabolic%E2%80%93androgenic_steroid" class="mw-redirect" title="Anabolic–androgenic steroid">Anabolic–androgenic steroids</a> (e.g., <a href="/wiki/Nandrolone" title="Nandrolone">nandrolone</a> and <a href="/wiki/Nandrolone_ester" class="mw-redirect" title="Nandrolone ester">esters</a>, <a href="/wiki/Trenbolone" title="Trenbolone">trenbolone</a> and <a href="/wiki/Trenbolone_ester" class="mw-redirect" title="Trenbolone ester">esters</a>, <a href="/wiki/Ethylestrenol" title="Ethylestrenol">ethylestrenol</a>, <a href="/wiki/Norethandrolone" title="Norethandrolone">norethandrolone</a>, others)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Antiprogestogen" title="Antiprogestogen">Antiprogestogens</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:8em;;text-align:center;"><a href="/wiki/Selective_progesterone_receptor_modulators" class="mw-redirect" title="Selective progesterone receptor modulators"><abbr title="Selective progesterone receptor modulators">SPRMs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Selective progesterone receptor modulators</th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Telapristone" title="Telapristone">Telapristone</a>§</li> <li><a href="/wiki/Ulipristal_acetate" title="Ulipristal acetate">Ulipristal acetate</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:8em;;text-align:center;"><a href="/wiki/Progesterone_receptor" title="Progesterone receptor"><abbr title="Progesterone receptor">PR</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Progesterone receptor <a href="/wiki/Receptor_antagonist" title="Receptor antagonist">antagonists</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aglepristone" title="Aglepristone">Aglepristone</a></li> <li><a href="/wiki/Mifepristone" title="Mifepristone">Mifepristone</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist"> <ul><li>#<a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li>‡<a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li>†<a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li>§Never to phase III</li></ul></li></ul> </div> <dl><dt>See also</dt> <dd><a href="/wiki/Template:Progesterone_receptor_modulators" title="Template:Progesterone receptor modulators">Progesterone receptor modulators</a></dd> <dd><a href="/wiki/Template:Androgens_and_antiandrogens" title="Template:Androgens and antiandrogens">Androgens and antiandrogens</a></dd> <dd><a href="/wiki/Template:Estrogens_and_antiestrogens" title="Template:Estrogens and antiestrogens">Estrogens and antiestrogens</a></dd> <dd><a href="/wiki/List_of_steroidal_progestogens" class="mw-redirect" title="List of steroidal progestogens">List of progestogens</a></dd></dl></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="GnRHTooltip_Gonadotropin-releasing_hormone_and_gonadotropins662" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:GnRH_and_gonadotropins" title="Template:GnRH and gonadotropins"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:GnRH_and_gonadotropins" title="Template talk:GnRH and gonadotropins"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:GnRH_and_gonadotropins" title="Special:EditPage/Template:GnRH and gonadotropins"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="GnRHTooltip_Gonadotropin-releasing_hormone_and_gonadotropins662" style="font-size:114%;margin:0 4em"><a href="/wiki/Gonadotropin-releasing_hormone" title="Gonadotropin-releasing hormone"><abbr title="Gonadotropin-releasing hormone">GnRH</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Gonadotropin-releasing hormone and <a href="/wiki/Gonadotropin" title="Gonadotropin">gonadotropins</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Gonadotropin-releasing_hormone_modulator" title="Gonadotropin-releasing hormone modulator"><abbr title="Gonadotropin-releasing hormone">GnRH</abbr> modulators</a> (incl. <a href="/wiki/Gonadotropin-releasing_hormone_analogue" class="mw-redirect" title="Gonadotropin-releasing hormone analogue">analogues</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0;background:#DDDDFF;"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Gonadotropin-releasing_hormone_agonist" title="Gonadotropin-releasing hormone agonist">Agonists</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Peptide: <a href="/wiki/Azagly-nafarelin" title="Azagly-nafarelin">Azagly-nafarelin</a></li> <li><a href="/wiki/Buserelin" title="Buserelin">Buserelin</a></li> <li><a href="/wiki/Deslorelin" title="Deslorelin">Deslorelin</a></li> <li><a href="/wiki/Fertirelin" title="Fertirelin">Fertirelin</a></li> <li><a href="/wiki/Gonadorelin" title="Gonadorelin">Gonadorelin</a></li> <li><a href="/wiki/Goserelin" title="Goserelin">Goserelin</a></li> <li><a href="/wiki/Histrelin" title="Histrelin">Histrelin</a></li> <li><a href="/wiki/Lecirelin" title="Lecirelin">Lecirelin</a></li> <li><a href="/wiki/Leuprorelin" title="Leuprorelin">Leuprorelin (leuprolide)</a></li> <li><a href="/wiki/Nafarelin" title="Nafarelin">Nafarelin</a></li> <li><a href="/wiki/Peforelin" title="Peforelin">Peforelin</a></li> <li><a href="/wiki/Triptorelin" title="Triptorelin">Triptorelin</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Gonadotropin-releasing_hormone_antagonist" title="Gonadotropin-releasing hormone antagonist">Antagonists</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Peptide: <a href="/wiki/Abarelix" title="Abarelix">Abarelix</a></li> <li><a href="/wiki/Cetrorelix" title="Cetrorelix">Cetrorelix</a></li> <li><a href="/wiki/Degarelix" title="Degarelix">Degarelix</a></li> <li><a href="/wiki/Ganirelix" title="Ganirelix">Ganirelix</a></li></ul> <ul><li>Non-peptide: <a href="/wiki/Elagolix" title="Elagolix">Elagolix</a></li> <li><a href="/wiki/Linzagolix" title="Linzagolix">Linzagolix</a>†</li> <li><a href="/wiki/Relugolix" title="Relugolix">Relugolix</a> (<a href="/wiki/Relugolix/estradiol/norethisterone_acetate" title="Relugolix/estradiol/norethisterone acetate">+estradiol/norethisterone acetate</a>)</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;"><a href="/wiki/Gonadotropin" title="Gonadotropin">Gonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0;background:#DDDDFF;"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Preparations41" scope="row" class="navbox-group" style="width:9em;;text-align:center;"><a href="/wiki/Gonadotropin_preparation" class="mw-redirect" title="Gonadotropin preparation">Preparations</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Follicle-stimulating_hormone" title="Follicle-stimulating hormone">Follicle-stimulating hormone</a></li> <li><a href="/wiki/Human_chorionic_gonadotropin" title="Human chorionic gonadotropin">Human chorionic gonadotropin</a></li> <li><a href="/wiki/Luteinizing_hormone" title="Luteinizing hormone">Luteinizing hormone</a></li> <li><a href="/wiki/Menotropin" title="Menotropin">Menotropin</a></li> <li><a href="/wiki/Urofollitropin" title="Urofollitropin">Urofollitropin</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;text-align:center;">Others (indirect)</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0;background:#DDDDFF;"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:8em;;text-align:center;"><a href="/wiki/Progonadotropin" title="Progonadotropin">Progonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Sex steroid antagonists (via disinhibition of the <a href="/wiki/Hypothalamic-pituitary-gonadal_axis" class="mw-redirect" title="Hypothalamic-pituitary-gonadal axis"><abbr title="hypothalamic–pituitary–gonadal">HPG</abbr> axis</a>): <a href="/wiki/Antiandrogen" title="Antiandrogen">Antiandrogens</a> (e.g., <a href="/wiki/Flutamide" title="Flutamide">flutamide</a>, <a href="/wiki/Bicalutamide" title="Bicalutamide">bicalutamide</a>, <a href="/wiki/Enzalutamide" title="Enzalutamide">enzalutamide</a>)</li> <li><a href="/wiki/Antiestrogen" title="Antiestrogen">Antiestrogens</a>/<a href="/wiki/Selective_estrogen_receptor_modulators" class="mw-redirect" title="Selective estrogen receptor modulators"><abbr title="Selective estrogen receptor modulators">SERMs</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip Selective estrogen receptor modulators (e.g., <a href="/wiki/Tamoxifen" title="Tamoxifen">tamoxifen</a>, <a href="/wiki/Clomifene" title="Clomifene">clomifene</a>, <a href="/wiki/Enclomifene" title="Enclomifene">enclomifene</a>)</li> <li><a href="/wiki/Aromatase_inhibitor" title="Aromatase inhibitor">Aromatase inhibitors</a> (e.g., <a href="/wiki/Anastrozole" title="Anastrozole">anastrozole</a>)</li> <li><a href="/wiki/GnRH_agonist" class="mw-redirect" title="GnRH agonist"><abbr title="gonadotropin-releasing hormone">GnRH</abbr> agonists</a> (e.g., <a href="/wiki/Gonadotropin-releasing_hormone" title="Gonadotropin-releasing hormone"><abbr title="gonadotropin-releasing hormone">GnRH</abbr></a><span class="sr-only" style="border: 0; clip: rect(0, 0, 0, 0); clip-path: polygon(0px 0px, 0px 0px, 0px 0px); height: 1px; margin: -1px; overflow: hidden; padding: 0; position: absolute; width: 1px; white-space: nowrap;">Tooltip gonadotropin-releasing hormone)</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:8em;;text-align:center;"><a href="/wiki/Antigonadotropin" title="Antigonadotropin">Antigonadotropins</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"> <ul><li>Sex steroid agonists (via negative feedback on the <a href="/wiki/Hypothalamic-pituitary-gonadal_axis" class="mw-redirect" title="Hypothalamic-pituitary-gonadal axis"><abbr title="hypothalamic–pituitary–gonadal">HPG</abbr> axis</a>): <a href="/wiki/Androgen" title="Androgen">Androgens</a>/<a href="/wiki/Anabolic_steroid" title="Anabolic steroid">anabolic steroids</a> (e.g., <a href="/wiki/Testosterone_(medication)" title="Testosterone (medication)">testosterone</a>, <a href="/wiki/Nandrolone_ester" class="mw-redirect" title="Nandrolone ester">nandrolone esters</a>, <a href="/wiki/Oxandrolone" title="Oxandrolone">oxandrolone</a>)</li> <li><a href="/wiki/D2_receptor" class="mw-redirect" title="D2 receptor">D2 receptor</a> <a href="/wiki/Dopamine_antagonist" title="Dopamine antagonist">antagonists</a> (<a href="/wiki/Prolactin_releaser" class="mw-redirect" title="Prolactin releaser">prolactin releasers</a>) (incl., <a href="/wiki/Domperidone" title="Domperidone">domperidone</a>, <a href="/wiki/Metoclopramide" title="Metoclopramide">metoclopramide</a>, <a href="/wiki/Risperidone" title="Risperidone">risperidone</a>, <a href="/wiki/Haloperidol" title="Haloperidol">haloperidol</a>, <a href="/wiki/Chlorpromazine" title="Chlorpromazine">chlorpromazine</a>, <a href="/wiki/Sulpiride" title="Sulpiride">sulpiride</a>)</li> <li><a href="/wiki/Estrogen_(medication)" title="Estrogen (medication)">Estrogens</a> (incl., <a href="/wiki/Bifluranol" title="Bifluranol">bifluranol</a>, <a href="/wiki/Estradiol_(medication)" title="Estradiol (medication)">estradiol</a>, <a href="/wiki/Estradiol_ester" class="mw-redirect" title="Estradiol ester">estradiol esters</a>, <a href="/wiki/Ethinylestradiol" title="Ethinylestradiol">ethinylestradiol</a>, <a href="/wiki/Diethylstilbestrol" title="Diethylstilbestrol">diethylstilbestrol</a>, <a href="/wiki/Paroxypropione" title="Paroxypropione">paroxypropione</a>)</li> <li><a href="/wiki/Progestogen" title="Progestogen">Progestogens</a> (incl. <a href="/wiki/Progestin" class="mw-redirect" title="Progestin">progestins</a>, e.g., <a href="/wiki/Chlormadinone_acetate" title="Chlormadinone acetate">chlormadinone acetate</a>, <a href="/wiki/Cyproterone_acetate" title="Cyproterone acetate">cyproterone acetate</a>, <a href="/wiki/Hydroxyprogesterone_caproate" title="Hydroxyprogesterone caproate">hydroxyprogesterone caproate</a>, <a href="/wiki/Gestonorone_caproate" title="Gestonorone caproate">gestonorone caproate</a>, <a href="/wiki/Medroxyprogesterone_acetate" title="Medroxyprogesterone acetate">medroxyprogesterone acetate</a>, <a href="/wiki/Megestrol_acetate" title="Megestrol acetate">megestrol acetate</a>)</li></ul> <ul><li>Others (mixed or unknown mechanism of action): <a href="/wiki/Danazol" title="Danazol">Danazol</a></li> <li><a href="/wiki/Gestrinone" title="Gestrinone">Gestrinone</a></li> <li><a href="/wiki/Metallibure" title="Metallibure">Metallibure</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><td colspan="2" class="navbox-list navbox-even hlist" style="width:100%;padding:0;background:#DDDDFF;"><div style="padding:0 0.25em"><div class="hlist"> <ul><li>#<a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li>‡<a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li>†<a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li>§Never to phase III</li></ul></li></ul> </div> <dl><dt>See also</dt> <dd><a href="/wiki/Template:GnRH_and_gonadotropin_receptor_modulators" title="Template:GnRH and gonadotropin receptor modulators"><abbr title="gonadotropin-releasing hormone">GnRH</abbr> and gonadotropin receptor modulators</a></dd> <dd><a href="/wiki/Template:Androgens_and_antiandrogens" title="Template:Androgens and antiandrogens">Androgens and antiandrogens</a></dd> <dd><a href="/wiki/Template:Estrogens_and_antiestrogens" title="Template:Estrogens and antiestrogens">Estrogens and antiestrogens</a></dd> <dd><a href="/wiki/Template:Progestogens_and_antiprogestogens" title="Template:Progestogens and antiprogestogens">Progestogens and antiprogestogens</a></dd></dl></div></td></tr></tbody></table></div>    </div><noscript><img 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