This information I received from the Vancouver Hospital Gender Dysphoria Clinic. It is given to male to female transsexuals undergoing hormonal treatment.
Hormonal Treatment of Gender Dysphoria - Male To Female
Before sex re-assignment surgery, the hormonal treatment of gender dysphoria, male to female, has two main objectives:
1. To reduce the amount of testosterone ( Male Hormone ) the testicles produce.
The testicles make testosterone in response to the action of a hormone called Luteinizing Hormone or LH which is made by the pituitary gland at the base of the skull. If this LH can be suppressed, very little testosterone will be made.
We use estrogen in the form of Premarin(R) (Conjugated Equine Estrogen ) and Progesterone in the form of Provera(R) ( Medroxyprogesterone acetate ) to reduce ( suppress ) this output of LH from the pituitary.
This is possible because LH output is reduced by either Estrogen, Progesterone or Testosterone.
2. To develop female body characteristics including softer skin, less beard, less body hair, breast development, female fat distribution to thighs, buttocks and abdomen ( below umbilicus ).
These changes take many years - breast development takes at least six years. The process cannot be hurried by taking doses greater than that which the biological female body produces. Estrogen and Progesterone act to develop these female characteristics.
The most difficult change is to decrease male hormone effects on hair ( facial hair, loss of head hair ) is usually that of beard growth. After many years of testosterone action, unfortunately even very small amounts of testosterone can cause continued hair growth. Also, the body makes testosterone in the adrenal glands. Besides, under stress, the adrenal glands can make weaker hormones that have a testosterone-like effect.
The testosterone that remains can be antagonized at its site of action by the drug called Spironolactone. Spironolactone is a hormone-blocking drug - its original use in medicine was to reduce the fluid content of the body when it accumulates in abnormal amounts and to reduce blood pressure. It was found to have an additional effect of antagonizing the male hormone, testosterone.
Testosterone become "useless" - the action of Testosterone on the hair follicle is blocked by Spironolactone.
BY USING SPIRONOLACTONE WE ARE ABLE TO TREAT YOU WITH DOSES OF ESTROGEN AND PROGESTERONE THAT ARE SIMILAR TO THOSE PRODUCED BY A NORMAL BIOLOGICAL FEMALE BEFORE THE MENOPAUSE.
IMPORTANT FACTS TO REMEMBER WHEN USING PREMARIN, PROVERA, AND SPIRONOLACTONE.
1. Premarin may increase the "stickiness" of the blood in certain people. It is essential that you never smoke as cigarette smoking plus taking Premarin significantly increases the risk of heart attack, stroke, clot in the vein which could break off to the lungs and death.
If you are sedentary for long periods, e.g. - a prolonged air flight, make sure you repeatedly move your feet up and down to allow the blood to flow efficiently from your feet and calves back to the heart and lungs.
If you have elective surgery, you must discontinue the Premarin one month before surgery ( do not discontinue the Spironolactone and Provera ). You should not re-start the Premarin until you are back to normal activity after surgery.
Keep up or start regular exercise. The regular exercise lessens your chances