It Could Happen Here - Hormone Replacement Therapy: Part One

Episode Date: April 21, 2022

Garrison is joined by Dr. Victoria Grieve to discuss HRT gender affirming care for Trans people.  https://twitter.com/VixenVVitch [e-mail]  https://diyhrt.github.io/https://hrt.cafe/https://diytrans.wiki/Main_Page https://www.them.us/story/informed-consent-hrt-map-trans-healthcareSee omnystudio.com/listener for privacy information.

You should probably keep your lights on for Nocturnal Tales from the Shadowbride. Join me, Danny Trejo, and step into the flames of fright. An anthology podcast of modern-day horror stories inspired by the most terrifying legends and lore of Latin America. Listen to Nocturnal on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Greetings, listeners, in the podcast-verse. This is It Could Happen Here, the podcast about things falling apart, and sometimes how we can put stuff back together. I'm Garrison Davis, our resident gender mess. In the past few weeks, we've been talking a lot

here on the show about the escalating war on trans people and queer folks in general. There's been a wave of bills making any gender-affirming healthcare a felony for people under the age of 18, which forcibly detransitions teenagers in multiple states. And we've had a lot of banning trans people from participating in sports and trying to ban books and discussion in schools about the existence of queer people at all. But today, we're not really going to be talking about that. We've talked about that plenty for the past few weeks. It's good to have a little bit of a break. But we'll still be talking about stuff around trans people, because with all the discussion around gender-affirming healthcare, I thought it would be a good idea to put something together talking about what HRT, or hormone replacement therapy, actually is,

since it's the most common form of trans healthcare. actually is, since it's the most common form of trans healthcare. And since many states are trying to, or already have criminalized it, perhaps I can use the pod to point people towards alternative means of receiving care, you know, in the vein of the putting stuff back together side of the show. Now, I want to clarify up front that we're not giving anyone medical advice, obviously. I'm just making observations and talking about things as they exist, and talking about things that many trans people have been doing for a long time, and that includes DIY HRT. My doctorate program is in parapsychology, not medical science, so just keep that in mind.

First, I will quickly clarify what HRT, or hormone replacement therapy, actually is for specifically non-cisgender individuals, because HRT as a term is also used for cis women to describe similar but different treatment. So HRT, as a form of gender-affirming treatment, is when someone receives sex hormone medication that produces a number of desired secondary sex characteristics. There are two broad types of hormone therapy that one would receive depending on what direction you want to go in, gender-wise. There's feminizing hormones and masculinizing hormones. Feminizing hormones produce more typically feminine traits, right? Big, big shocker there. It usually consists of a form of estrogen,

usually called estradiol. There's different types of estradiol. And also it can include anti-androgens, aka testosterone blockers. Masculinization therapy consists of taking testosterone, or androgens, and then also less commonly anti-estrogens, but usually just taking testosterone will suffice. Now, I'm no expert in hormones, despite my weekly eShot, but lucky enough, I was able to sit down with an actual expert on hormones and talk over Zoom. So what follows is segments from our conversation. I guess first, do you want to introduce yourself? Sure. I am the Reverend Dr. Victoria Luna Begreave. I am an assistant professor at the University of Pittsburgh School of Pharmacy.

My primary clinical focus is on gender-affirming hormone therapy, other kind of advocacy work in queer healthcare, and I do a lot of other stuff on the side. Pedagogy, ludic instructional design, game design, just anything that strikes my fancy, really. of trans stuff the past few weeks and months it's been mostly on like the bills and like the politics side of things i've definitely had some people like reach out and be like okay but how like why why transgender why hormones like why are hormones actually important like could you actually explain like what like you know with all of these all these states banning hormones let's i would like to kind of explain why it's such a big deal and how much these things actually are life-saving medication for so many people. Yeah, so why hormones? I love it because it's a question that as a species, we have known the answer to for like 5,000 years.

It's very funny but um hormones are okay a big part of this requires to like acknowledge something that is very wrong in in like the medical literature there's a lot of elements of health care that are coordinated between like male and female and there's a kind of like yeah obviously is a little so there's a lot i mean i mean like from like from people's i know when trans people talk about interacting with the medical system it's always like oh yes we're going to be doing this bullshit yes of course yeah well but it even goes to like a really deep level like if you're in the hospital and you get a cbc count there's a male profile and a female profile of what your hematocrit should be on like what the

level of red blood cells are. And the general understanding in like the health industry is that there's a biological anatomical difference between them. And for the longest time, certainly in this country, trans women would have, would be compared against the male profiles, but it's nonsense. It's actually should be thought of in form of hormone dominance because the vast majority of medical differences are not anatomical, they are hormonal. And that right there should give the game away a little bit. Really funny, which is why I kind of hate the term biological woman, whenever people start using that, because that's not really how

biology works right yeah i mean the joke is my nesting partner my fiancee wishes that she could be a robot and then if she were to do that and upload her brain into an immortal robot body she would no longer be a biological woman but she would still be a woman it's just cybernetic um i hate that it's like organic organic just means it has carbon in it like give me a break yes so yeah hormones what's what's what's the deal do they because i know all of people will be like well all of these trans people sure do seem sad i wonder that's how how what how can we make things better? Does this thing actually work? Oh, well, so it's somewhat multifactorial.

I have a friend who does cell imaging, and her, like, working theory, which I'm a little dubious of, is that, like, the brains of trans people, like, have receptors for hormones that the body doesn't make, and we should think of being transgender as having, like, a form of hypogonadism. Yeah, there's a lot of different trains of thought there in terms of the different theories of why trans people exist and how it's like you know girls brain boys body blah blah blah blah which all if you dig deep enough goes back to eugenics so it's all fucking yeah i've never i've always not liked that model i've always it's always i've always found it to be a little bit uncomfortable because I take hormones because I want to. And I to. So it's a very like odd thought, but putting aside all of that, if you just wanted to look at the, like why people want hormones, because when a person who wants hormones gets the

hormones they want, their suicidality goes down, their anxiety, depression goes down, gender dysphoria, if we wanted to, you wanted to talk about the problems with that, essentially goes away and they start to get treated the way they want to be treated in society. So if you want to look at it, not from the causes, but from the results, giving gender reforming hormone therapy to a person who is requesting gender reforming hormone therapy has a 99% success rate. The rate of regret from starting hormones is 1% or less, which is unbelievable in the healthcare field. Having a child biologically giving birth has a 7% regret rate. The idea of any therapy having that high of a rate of preventing

death, anxiety, depression, bullying, all of the different effects, being that successful should be a miracle. It should be looked at as the thing we in healthcare should do absolutely ethically uh and it is it is so much more complicated than that so like hormones from the results obviously make sense it aligns your body's shape and like fat deposits and the way that you feel the way that you relate to your emotions it all goes back to the way that hormones work on your body and it there's there's like the old saying that like a cis person would never want to try gender-reforming hormone therapy so like if you have the in if you want to try it you should be allowed to try it i mean like you're you're kind of a good example right care like yeah i bet if you're sitting yeah if you're sitting around a

bar with a bunch of like cis guys and you were like, hey, who wants some estrogen? They would all shrink away from it. No, absolutely. Because yeah, it's definitely a thing like, I'm not the most dysphoric change. And I'm, you know, it's, it's, I'm happy that we're moving more towards that and not having to deal with, uh, Oh, I'm so dysphoric. I want to die,

which is obviously a big thing for a lot of people. I'm not, I'm not minimizing that. Right. Um, but also a lot of trans people who've had more kind of complicated feelings on gender, whether they're like genderqueer and non-binary have in the past had made it more difficult to get gender-affirming care because they don't fit into those specific

male-female boxes as easily. And what you're talking about is really something that's relatively recent, the idea of gender euphoria, the idea that people want to take hormones because it gives them joy to like dress or act or feel a certain way. And that, I mean, healthcare is all about, at least up until, well, the reality of healthcare is that it is all about finding problems to solve and not really looking at like- Making your life just better in general. Yeah, exactly. So, you know, I know plenty of people who started hormones of any type just because they felt it would make them happier and they were correct. And that

gender euphoria is just as good of a reason to take it as the dysphoria. The problem ends up in how the medical industry treats it because dysphoria, quote unquote, is something as long. Oh my gosh, I could go into the whole history of that if you wanted. I'm sure we could talk about the DSM-IV and DSM-V's a long, oh my gosh, I could go into the whole history of that if you wanted, but I'm sure we could talk about the DSM four and DSM five for a long time. Oh, it's so frustrating. I spend, I spend a two hour session in my queer healthcare class, specifically just dunking on the DSM five definition of gender dysphoria. But the, the, the, the real problem is like this focus on this negative quality and how that actually damages a lot of the conversations around gender-affirming hormone therapy and trans people in general. Instead of seeing it as

this manifestation of people truly taking control of their lives to become authentic in the truest way. You have never met a more truly self-made man than a trans man who gets hormones like it's i mean it's and it's still something we're even we're not quite at the at the gender utopia i mean obviously because of all of the anti-trans stuff but even like even on like just purely purely the medical side like i even for for informed consent um i still needed to get diagnosed with gender dysphoria at the informed consent clinic in order to get hormones which is in part like an insurance thing and you know it has has all of these all of these bullshit reasons um but that is it is something we're still we're still definitely dealing with oh my goodness yeah and the the

better informed care clinics are the ones that they realize it's just like an effort in box ticking. So they're just like, yep, sounds good. You came here to this clinic and you asked about hormones. Sounds like gender dysphoria to me. Like we'll tell your insurance, whatever we got to say. Yes. Welcome. I'm Danny Thrill. Won't you join me at the fire and dare enter? Nocturnal Tales from the Shadows, presented by iHeart and Sonora. An anthology of modern-day horror stories inspired by the legends of Latin America. From ghastly encounters with shapeshifters

to bone-chilling brushes with supernatural creatures. I know you. Take a trip and experience the horrors that have haunted Latin America since the beginning of time. Listen to Nocturnal Tales from the Shadows

as part of my Cultura podcast network, available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Eventually we'll go into hormone blockers as well um but i want to talk about there's a lot of this is there's a lot of rhetoric that's been we're growing for a long long time about the the extremely damaging irreversible effects of of hormone replacement therapy and how they're going to permanently alter your biology if you give these to children and there's five-year-olds taking testosterone and it's gonna like you're like

you're like oh really that sounds very scary um so that's something i would like to discuss is like because a lot of people when we talk about hormones they think of this as this like big extremely life-altering thing um that has thing that has these irreversible effects on your – your bones are going to get weak and tripled and never get big again and all of this very scary stuff. What's up with that? I think a lot of it goes back to that biological essentialism because hormones, even for the people who give them, are considered partially reversible because the majority of the things that happen, one, take a long-ass time. You will know whether or not this is a good idea for the majority of people well before the physical manifestations occur uh and and considering like one of the biggest problems we have with certain formulations like in the once a week or once every other week injectable version of estrogen by the time you get to right before your next dose your estrogen is so low

you're feeling it and it's starting to like reverse some of those so like if you're feeling it after two weeks how irreversible could it be? And some of it depends on like eight timing, because if we're talking about a person who has say already gone through a testosterone mediated puberty, then some of the things are just not going to be affected. You can't change like bone size height or anything like that. There's some interesting things about like hip uh like flexation and and and pivoting i have seen more of that recently yeah actually yeah yeah and and

even like shoe size can can change because of the way the ligaments work on hormones but like the bones aren't going to change once they're done growing but that's sort of where the puberty blockers come in that we can we'll talk about later yeah um but for the for the majority of people if you are going through if you have gone through a puberty that you did not want, you can take hormones to go through a puberty you do want and get the effects that you do want. And some of the elements, sure, like, you know, growing breasts or gynecomastia, as we would call it in the cis man, which is another whole nonsense, is not irreversible. You can have them removed if you decided that you needed to detransition, which is a whole

other story. But even then, it takes five years to see their final breast size. If you're on hormones for five years and you're worried about the irreversible quote-unquote effects, what are we doing here? I mean, even I've heard from a lot of my elder trans friends that whenever they go off hormones, sometimes their breasts just kind of go away because they're not massive to begin with. Like, generally, you don't get the massive, massive honkers immediately. We're working on it. I know know we're trying um but a lot of a lot a lot of even the i know that was one of the big things that informed consent thing was like the you know a lot of these changes are reversible except for breasts these are these are these are these are a permanent change be careful and all my all my trans friends are like a little bit but i mean

like your nipples won't shrink like your nipples will definitely be bigger and that that won't change but a lot of like the size actually does fluctuate and i i can even tell that on like depending on if i like miss a dose or something being like oh yeah like there is a lot of a lot of fluctuation even like on like you know like temperature and stuff how cold it is will determine how how how how how my chest looks it is it is uh it's pretty fun i mean i am i i i just like the biohacking thing in general it is like the cyberpunk in me um but yeah i guess i guess we could talk about um hormone hormone blockers as well because this is the other kind of thing you hear a lot about when conservatives are very scared about trans people. The idea of hormone blockers making people infertile or making permanent changes to children's health or something, blah, blah, blah, blah blah blah oh my gosh that's the thing that is like really really frustrating for me specifically because puberty blockers the gonadotropin the gnrh antagonist and agonist

which have been around for like long time like ever for for i i want to say it was like 100 years but i i might be misquoting something that i'm half remembering but they've've been around for a really long time, to the point where we have generics. And in the pharmaceutical industry, that means that it's been decades, at the very least. Something that had rigorous testing, that has an indication with the FDA for precocious puberty, which just means a person who is usually cis, who for whatever reason has puberty at a very young age, with some of the specific cases that I've seen, that I've looked into, involve giving puberty blockers to a three or four-year-old because their body is trying to undergo puberty. So even the idea of like, oh, well, I don't know, this 12-year-old being on a puberty blocker for

three years, that sounds very dangerous when we have a person over here who was on it for 15 years with no ill effects, like no long lasting ill effects. The idea of anybody describing it as like experimental is absolutely a historic outside of the realm of reality. Yeah. It's basic anti-intellectualism. Because, yeah, we've been giving cis children hormone blockers

for a long time for early onset puberty. And it turns out they work and they're pretty safe. So maybe we should give those to trans kids too if they want them. Seems like something we could at least try and see if it improves mental health. It's not even a matter that we have to try it. We've been doing it for like almost 10 years. Like the, the, it was first, I think it was like 2013. There's a, there's a Ted talk.

I use in my class of a, of a physician who like pioneered the use of puberty blockers in trans kids and showed that any trans kid who got puberty blockers and then was allowed to undergo the puberty that they desired at an appropriate age, which is actually like 14, 15 at the same time as their peers. But even if they had to wait till 18, the psychological effects of having an inappropriate puberty are essentially nullified. They are otherwise psychologically and physically like identical to their, their cisgender peers. So it's like, we have actual evidence that it is extremely beneficial and extremely worthwhile. And like the one kind of long-term side effect is you might be up to an inch shorter than you otherwise be,

which is a wildly like problematic, like study that was done because like, we don't have time machines to know whether or not that worked. What would your control group be? And it's just wild. It's very bothersome to me because a lot of the gender-affirming hormone therapy, the evidence is all over the place for a variety of political reasons and historical reasons. But for hormone blockers or for puberty blockers specifically, the evidence is really solid, really strong. This is a question I actually have, because I'm actually unfamiliar with this specific thing. But yeah, if you give hormone blockers to a kid who's 10, they still kind of grow at the same rate as a lot of their peers.

And that is, it's specifically like the secondary sex characteristic changes that get put on pause. But there's just so much, yeah, there's just so much fear around, even just the hormone blocker thing, right? yeah, there's just so much fear around even just the hormone blocker thing, right? When we're getting, you know, just like prescribing hormone blockers being like a felony offense in multiple states now. You're like, it's just an extreme degree of anti-intellectualism,

just like purposeful ignorance and just extreme hatred and uh bigotry and it's it is uh i mean yeah it's a i'm kind of speaking to the choir here but well yeah of course but but but that's the trick and even like the puberty blocker thing like you were saying your body will still make human growth hormone you will still grow it's just that the modulation of that with, say, testosterone, which would increase the overall growth, just isn't there. And people talk a lot about the idea of bone mineral density because you don't have testosterone or estrogen, which are both necessary, one or the other, necessary for your bone mineral density to not

have easily fractured bones. But you don't even have that until you go through puberty. If you're just preventing one puberty, the endogenous puberty, and then providing the hormones for an exogenous puberty, they're fine. They have the hormones they need. Their bones are happy uh so yeah welcome i'm daniel won't you join me at the fire and dare enter nocturnal tales from the shadows presented by iheartart and Sonora. An anthology of modern-day horror stories inspired by the legends of Latin America. From ghastly encounters with shapeshifters to bone-chilling brushes with supernatural creatures. I know you. with supernatural creatures.

I know you. Take a trip and experience the horrors that have haunted Latin America since the beginning of time. Listen to Nocturnal Tales from the Shadows as part of My Cultura podcast network, available on the iHeartRadio app, Apple podcast, or wherever you get your podcast. I'd like to talk about, I guess, kind of access to hormones and the different models of, I mean, obviously we're not giving up medical advice, but like access to hormones and the different ways that people can go about that now through doctors, through informed consent and all of that jazz. Yeah. So the informed consent model is a much more recent option and it's not available everywhere.

I have a friend in Texas, we had to find a clinic that was like two hours away to get her hormones. But here where I live, we actually have two informed consent clinics. So it's pretty convenient, but it varies wildly by region. And the informed care clinics are great. It means you come in, they say, this is what's going to happen. Do you still want to do it? You say, yes. They take some blood. They run some tests. You come back in two weeks and they go, here you go. They work really well, depending on the clinic, I guess. But the more traditional, quote unquote, standard model would be going to your PCP or whoever and saying that you want to do this, which makes most of them very concerned because most physicians, pharmacists, nurses, they don't

get taught anything about trans people or caring for trans people or gender affirming hormone therapy in their school. Like, so they have nothing to fall back on. So that makes them very nervous to do it. And then if you, if you look at, wow, gosh, I really want to tell you about the, the guideline stuff at some point here, because it is buck wild as to why that would be a concern. But another part of it is also the insurance, America's original sin in our healthcare dystopia, if you will. The insurances historically have required, and part of this is also from antiquated guidelines that has been somewhat just grandfather grandfathered into, excuse the term, this idea of like, well, you have to go to a therapist, you have to go to a psychologist, and they have to say that you have gender dysphoria. That's why it's in the DSM. And then after you do that, some places require you to socially

transition before getting hormones or anything, which can be extremely problematic for some individuals that just increases like visibility and bullying and such in a way that it may drive people. It sort of was intentionally required back in the day to drive people to not want hormones anymore. And it's all of these gatekeeping steps. And it's even worse if you wanted to get a surgery later on where you have to have been on hormones for a certain length of time. You have to have two different generally like cisgender, right, healthcare practitioners who don't necessarily understand like the full, like everything that's going on, write you letters before the, and most insurances up until recently wouldn't even cover it. recently wouldn't even cover it. So it's just gatekeeping step after gatekeeping step, because even the big guidelines, which is WPATH, which is about to put out their SoGate guidelines, there's guidelines out of San Francisco, and the Endocrine Society has guidelines from 2017 that are, but all of those are made by cisgender people, usually with the intent to gatekeep this care, because either they're uncomfortable

with it because they're unfamiliar with it, they have some kind of ideological reason to be against it, or whatever else. There's a survey that I often quote to my students in class that they surveyed a whole bunch of trans individuals trying to get care from their physicians. And it was nearly a quarter of them said that they avoided healthcare because of discrimination. And half of them reported having to teach their healthcare practitioner how to care for them, which is wild. Like imagine going to the hospital with like heart failure and having to like talk your physician through how to care for you. Can you live for two years with heart failure and having to talk your physician through how to care for you. Can you live for two years with heart failure first before we give you treatment?

Oh my gosh. Could you imagine if we treated other things this way? I'd be like, well, are you sure that you have diabetes? Are you sure that you're like, well, we can't treat your diabetes. You're too fat. Your BMI is too high, so we can't give you the you're too fat well your bmi is too high so we can't give you the insulin like give me a break like what is happening uh seems like uh it's basically what you're saying is that we got a good system we got it we got to figure it out absolutely no notes uh 100 perfect in every way well that does it for us today. I'll make it happen here. Well, specifically, if I could, it's really interesting from the healthcare perspective, or from the practitioner's perspective, because there's essentially two kinds of treatment.

There's guideline-based medicine and evidence-based medicine. And a lot of schools, like my school, teaches a lot of their income, say, and that those guidelines actually match your patient. So it's a lot of assumptions that you're making, which can be extremely problematic. And evidence-based is where you dive into the literature and you figure it out yourself, which is very time-consuming and requires an awful lot of professional criticism in a way. But when you look at it for trans care, for gender-affirming hormone therapy, those guidelines are unbelievably compromised. To give you an example, a hotly contested issue in feminizing therapy is the use of micronized progesterone in feminizing care. It's kind of like all over

the place. There's a long history of it, of this controversy. In the upcoming WPATH SOCATE guidelines that I had like a preliminary copy to provide notes on, there's a single statement that just says that there's a controversy that exists and you should not use micronized progesterone in trans feminine care. And they list a study. Okay. If you pull up that study, the title of it is progesterone is important for transgender women's therapy, applying evidence for the benefits of progesterone in cis women. And it is like a pretty long document that concludes that it is like an ethical imperative to offer it. So the idea that the people who are writing the WPATH guidelines read this article, read this meta-analysis and went, yeah, I don't really agree with any of that.

I'm just going to say no, is just so infuriating. Again, that seems like we got a good system going here. Yeah, 100%. No notes. I guess on that note, I want to discuss some of the things that aren't talked about as much as, like, antiandrogens, progesterone, Spiro, and what all kind of those do and how they can kind of supplement a regular estradiol prescription, I guess. Regimen? Yeah. Regimen.

Regiment, yes. That sounds fancy. Sure. Sure. So generally speaking, maybe give a baseline for folks who are unaware. The way that we do feminizing therapy is we offer estradiol, which is a bioequivalent version of E2, because there's like three different versions of estrogen, and an antiandrogen because testosterone tends to be somewhat of an overriding hormone the presence of testosterone will override the effects of estrogen to a certain extent depending on doses and stuff like that which is for the transmasculine individuals why we just give testosterone it just does the job you don't need to block the estrogen uh so there's a you know there's a lot of history in just those hormones as well that we could talk about, like conjugated estrogens versus estradiol and all the different other stuff. But for the

antiandrogens that we give, historically in this country, we give spironolactone, which is a mineral corticoid. It's a potassium sparing diuretic, and it's just really good at higher levels. We usually use it in cardio issues. It can be used for hypertension and some other things. And I believe it makes you pee a lot. Yes. That's what I've heard. So it's a diuretic, meaning that it makes you urinate an awful lot.

And it's a potassium sparing because it prevents your body from eliminating potassium. No more eating bananas. Well, so that's the thing that I think is really, really wild because you're using these high levels of it. It is preventing your endogenous production of testosterone and making you pee all of the time, which, spoilers, estradiol also makes you pee more often. So that's a real fun combination. But then physicians, if they don't know what the heck they're doing, they might say something like, well, you can't eat any bananas. And like, historically, the people who are on feminizing therapy are healthy enough that their body just accommodates for it. if you have hyperkalemia, which is like too much potassium, you're going to know like your muscles are going to ache and there's going to be a lot of like telltale side effects.

Usually it's only a problem if you are like only consuming a like salt alternative that has potassium instead of sodium, which is like, not super common, not super common. Or if you have some other reason why your body is like holding onto potassium. So it's not usually an issue. And spironolactone isn't sufficient for everyone. There's plenty of people who have refractory testosterone after some time, and there are some other options. There's kind of a weird controversy about it that is sort of heralded by the San Francisco

guidelines I mentioned earlier, that spironolactone leads to, okay, wait, I want to make sure I get the wording right. It leads to premature fusing of the breast bud and overall smaller breast size, which the document that they cite for that is a real weird retrospective study from like a bunch of years ago on the rate of trans women getting breast augmentation. And it found ago on the rate of trans women getting breast augmentation. And it found that the vast majority of trans women who were on spironolactone got breast augmentation. Also get breast augmentation. Okay. But the problem is like of their sample group of like two, 300 people, almost all of them were on

spironolactone. Like there's like a sampling error. Like it sampling error. It's very silly. And also, even that premature fusing of the breast bud, I have never been able to find anything that suggests that that's a thing or even a way to explain what that statement even means. But the San Francisco guidelines, to go back to my guideline thing, actually says, has some like, maybe don't use spironolactone, even though it's something we've been using since literally like the 50s or 60s for this purpose. In other countries, you'll use what's called cyprotorone, which is a synthetic progesterone, but it's not actually approved in the States because it has a, like, there is actually some evidence that it causes increase in certain specific cancers, but it's like a pretty limited overall risk. Like it's not like something like, you know, going outside increases your risk of cancer. It's not like a huge deal, but it was enough that they don't, it's not approved in the States, but in a lot of other

countries, you'll, you might get cyprotorone, which there's a lot of, you know, controversy around that too, for those reasons. Here, the other option that we usually see is finasteride, which is a 5-alpha reductase inhibitor that essentially is preventing testosterone from being turned into dihydrotestosterone, which we use normally to prevent, quote unquote, male pattern baldness and in higher doses for prostate cancer. Cause it's real good at, because it like reverses some of the feedback loops, just reducing testosterone production. Um, so it's just fine. Like that one has like very limited side effects, but it might not have as substantial of a, um, reduction of testosterone that spironolactone does. And then the kind of third

one that we really, we don't see very often, but there's a lot of interesting evidence about is called bicolutamide. It's also a prostate cancer medication. It actually blocks all of the receptors of testosterone in your body while not reducing the production of it. So you'll see a person who has like, you know, they have like 700, their testosterone comes back as like 700, 600, whatever. But they're entirely feminized because none of it has anywhere to work. But the problem with that is bicollutamide being an anti-cancer med

primarily is ridiculously expensive. I think it's like 50 bucks a dose or something like that. What a good system we have here. It's so great. I will say, and for my gender queers out there or anyone else, you can also just take estrogen without any blockers. And you still get results as I can confirm. And for a subset of the population, just taking estrogen at sufficient dosages will also reduce your levels of testosterone. Your body knows what it's doing. It is pretty cool how much you can just change things up and your body's like, oh, we're doing this now. Okay, got it. Great. I have all these mechanisms. It's wonderful.

we're doing this now. Okay, got it. Great. I have all these mechanisms. It's wonderful. And with that, that wraps up part one of our little two-part series of episodes talking about hormone replacement therapy. Tomorrow, I'll talk more about access to gender-affirming treatment and touch on DIY HRT. Special thanks to Dr. Victoria Luna Brennan-Greave for chatting with me about gender-affirming hormonal treatment. You'll get to hear more of my discussion with her tomorrow as well, including a brief tangent about the Scythian priestesses, which I was very excited to talk about. But that does it for us today.

You can follow this show at HappenToHearPod and CoolZoneMedia on Twitter and Instagram. And you can look at my late night gender tweets at HungryBowTie on Twitter.com. So see you all on the other side. You should probably keep your lights on for Nocturnal Tales from the Shadow. Join me, Danny Trails, and step into the flames of right. An anthology podcast of modern day horror stories inspired by the most terrifying legends and lore of Latin America. Listen to Nocturnal on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.