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(AO) Hello, ladies, gentlemen, and others! Today on DocTalk we have a special guest, DocTalk's own DR DOCTOR!. DR DOCTOR is here to talk with us about hormones--what they are and how to use them wisely.
Those of you in our audience should feel free to ask DR DOCTOR your own questions about hormones. You can leave DR DOCTOR your own questions about hormones either publicly or privately on the DOCTALK GID conference.
Welcome to DocTalk's GID conference, doctor. Thank you for coming.
(DR) Thank you for having me, Anne.
(AO) First of all, doctor, are you any relation to Dr. Richard Doctor, the author of "Transsexuals and Transvestites"?
(DR) None at all, Anne.
(AO) Doctor, what ARE these things we in the transgendered community call "hormones"? We toss around terms like "Medroxyprogesterone Acetate", but really don't under- stand these drugs and what do they do.
For example, I took 2.5mg pills of Premarin, sometimes called "purple footballs", three times daily prior to surgery. What did I take, and what did that do to my body? On the outside, I could see and feel some of the changes. The fat layer under my skin got thicker, giving me smooth, fair "female" skin and my breasts grew and were sore for several months. My body hair became finer and lighter, but didn't go away. It didn't affect my voice much. I lost interest in sex and quit masturbating. I became weepy and irritable for the first few weeks. That was what I saw. Now, what was causing all this?
(DR) You're asking a lot of tough questions, Anne. I'll do my best to answer them but I also want to preface these comments by a few caveats. You must realize that there are literally volumes written on hormones and what we learn about them today will be obsolete tomorrow. Furthermore, the definition of what chemical substance is and is not a hormone is changing. Furthermore, I am not an endocrinologist nor do I claim to be anything other than a family practitioner so what I say will be simplistic and most likely open to debate.
That said we can proceed. As traditionally defined, a hormone is a complex chemical substance produced in one part or organ of the body that initiates or regulates the activity of an organ or group of cells in another part of the body. The production of these hormones are in turn tightly regulated by other hormones, by neurotransmitters and by a whole host of feedback systems. In other words, hormones cause other widely dispersed organs and groups of cells in the body to change their behavior which in turn changes the production of the hormone. Sometimes the question, "Which came first? The chicken or the egg?" applies to the discussion of hormones. When I was going through medical school we had to memorize complicated relationships between cells in the brain that triggered the production of hormones in other organs (such as the thyroid gland) which in turn produced hormones that altered the activity of a number of organ systems. We then had to trace arrows back to the hormone- producing gland and to the brain and try to memorize what would happen if any one of the tightly integrated bits would falter. It was very confusing to say the least. Especially since it seemed each month a new set of arrows and chemicals were introduced into the picture based on a new discovery! No matter how I tried to simplify the picture it only grew more and more complex.
To make it easier to comprehend I formed an analogy that helps. I now think of the body as a country, like the good old USA. Organs represent various states, groups of cells are cities, and so on... Hormones in this scheme are laws. Some of these laws are made by the Federal government, some by State institutions, others by cities and municipalities and finally some are by individual families.
With a few notable exceptions, most laws are usually designed to regulate the behavior of certain individuals and groups of people rather than everybody. They are usually written in response to a need. For example, corporate tax laws are written for corporations and do not apply to individuals. Laws that prohibit the ownership of both television stations and newspapers was written to keep a few people from controlling the news. As such they do not apply to those who do not own television stations or newspapers. Unfortunately, while the effect of a given law on a specific group of people can be predictable it can often produce strange effects on another group of people. This usually sets off a cascade of events that may or may not wind up in the law being altered or another law being written to modify the effect of the first law. If a person fits into a certain category then that law will directly affect them causing them to alter their behavior. Other people may never be bothered nor will their activity be changed by the presence of the law. Hormones are like that. Once released into the blood- stream they have wide-ranging effects depending on the cells in question. Some cells will respond to the hormones, others won't.
How do hormones work? Well there are many differences but in general they work by attaching themselves to a given cell and switching on or off a whole series of chemical reactions. Some actually enter the cell. Others do this by changing throwing a switch (if you will) on the surface of the cell.
You mentioned one hormone, Medroxyprogesterone Acetate. It is one of a group of hormones we conveniently call SEX HORMONES (specifically estrogens and progestins). Furthermore it is a STEROID hormone ... that is, the backbone of the molecule is a steroid structure formed in large part from cholesterol. All steroid hormones work in the same fashion. They generally enter a cell by diffusing into it through the cell membrane. Furthermore they then enter into the nucleus of the cell, bind to chromatin and activate the production of RNA which eventually leads to a production and manufacture of a host of other enzymes and proteins. These enzymes and proteins can change the behavior of that cell. Picture a cell as an automobile factory. The hormone is a new executive with a lot of clout. This executive enters the plant, starts influencing the engineers, accountants, and other executives who then start making a whole lot of design changes to the plant and viola! Before too long entirely different set of automobiles start rolling off the assembly line. All because of one little tiny executive. Do you start to get the picture of why such low doses of hormones have such wide-ranging effects? You can also see why it is so important that the body devise clever ways to stop the production of these chemicals and why that regulatory mechanism is so complex. One of the ways the body does this is to set up the hormone so that a change in one little part of the complex molecule turns it from an active hormone to an inactive one. That way very little energy has to be expended to turn it on or off thereby avoiding the complete destruction and rebuilding of a hormone each time it is needed. Why I often marvel at the economics of the body it is often exactly this mechanism that makes pharmaceutical firms angry as hell!
If one were to make a "natural" progesterone, identical to the one the body produces and introduce it into the body ... it will be broken down and inactivated rapidly by the liver and in order to produce the "un- natural" changes desired very large doses would have to be given many times a day. On the other hand, "natural" chemicals might produce too many changes in other cells because of the large "un-natural" doses required producing bad side effects. All chemists in the business know "it's not nice to fool mother nature!" For this reason most of the pills we take are LOOK-ALIKES that have been made to act on the target cells but are different enough so they will not be deactivated and usually have less side-effects than the "natural" chemical whose action they are mimicking.
MEDROXYPROGESTERONE ACETATE (one of the specific hormones you asked about) is a PROGESTERONE look-alike. PROGESTERONE is mostly produced by the ovary but a small amount is also produced by the adrenal gland (the small gland located above the kidneys)and during pregnancy enormous amounts of PROGESTERONE along with ESTROGEN are produced by the placenta. ESTROGEN and PROGESTERONE stimulate pubertal changes (growth and maturation of the uterus, breasts; stimulation and then limitation of skeletal tissue). These hormones, later on in a woman's life maintain the breasts, uterus, vaginal and urethral lining. They also affect a persons metabolism, how proteins are transported and how electrolytes are balanced within the body. Maybe you can now get and idea why a woman's breast tissue decreases, the vagina dries out and why bones become brittle after menopause. It is also for these very reasons that you had all of those changes.
You took PREMARIN, a combination of estrogenic (estrogen-like) substances. Principally ESTRONE and EQUILIN. These are substances similar to the type excreted by pregnant mares (remember what I said about large amounts of estrogen and progesterone being produced during pregnancy by the uterus? Imagine how much a horses uterus would produce!). By taking this hormone you changed the laws for a number of cells in your body. Specifically, any cell that responds to estrogens and progestins. These include fat cells, breast tissue, hair follicles. You blunted or threw you libido completely out of whack by confusing the signals to your brain to which you responded sexually.
Confusing the regulatory system (of which the brain and the chemical transmitters that relay messages between brain cells are an integral part) probably induced many of the "weepy and irritable" feelings you had for the first few weeks. Eventually the body will adapt. My big problem with this, as a physician, is that we often don't know what we are doing. We try to duplicate the regulatory actions of organs when a person is very ill by replacing electrolytes, fluids, boosting or suppressing immune systems, relaxing or tightening blood vessels. Often we feel as if we are trying to take a large rubber ball and force it into a cube. We can get one side flat with one hand and maybe another side flat. But when we press on one side another side bulges out. You can imagine my reluctance to go about and mess with a "healthy" person by changing the rules of the game for his body through hormones. It is also why I cringe when I see so many young athletes gobbling steroid hormones of one sort or another to enhance their appearance or performance. There's no telling what they are doing to a number of other organs ... including their minds!
Well, that's enough for now. I hope this hasn't confused you even more. Got another question?