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Prevention and Treatment of Side Effects of Hormone Replacement Therapy For Transgender People PDF Print E-mail

Administering, taking or changing of hormones or their dosage can have far reaching consequences for transgendered people. It can result in various negative side effects on the body. A very important question for everybody is how can one prevent and treat these problems?

Serum testosterone and oestrogen, genital hormones, both take part in the metabolism of the human body and affects many systematic physiological actions. Therefore, an imbalance of metabolism and inner organic functions would occur if the quantity of these hormones is changed. If you treat it correctly from the start your problems can be relieved, prevented or even stopped. What kinds of problems can you expect if you take genital hormones or if you are post operative?

You can expect following:

  1. The syndrome of changed sexual hormones: sexual hormones can affect the body’s metabolism, especially at the beginning of HRT. There are two different conditions which occur.

    a. The body’s metabolism is accelerated, the patient always feels hot, especially at certain times. Most people feel hot in the afternoon or at night. They feel heat sensation in their palms, soles or chests. They thirst with or without a desire to drink. They experience night sweats, restlessness, insomnia, palpitation, vertigo, pain and weakness in the lower back, flushed face and scanty yellow urine.

    b. The body’s metabolism is slowed by shortage of original sexual hormone. The patients always feel cold, especially in the limbs. They get bad conditions all over the body, aversion to coldness, lethargy, tiredness, poor appetite, bad memory, headache with empty sensation in the brain, cold pain and weakness in the lumber, pale complexion and frequently urinating.

    We call the syndrome of accelerated metabolism as Yin deficiency; and the latter is Yang deficiency. If you have these problems, you should see your doctor and check your hormone levels and then decide how to continue. You should not decide by yourself. It is very dangerous for you. You should use the lowest dosage of hormones possible (this should be decided by your doctor). After your body has become accustomed to the new dose you can increase the dosage according the doctor’s instructions.

    Treatment: If you still have this problem after you have adjusted your dosage, you can take some herbal tea to regulate Yin or Yang. Herbal tablets “Liu Wei Di Huang Wan” can nourish Yin and resolve Yin deficiency; “Jin Gui Shen Qi Wan” can strengthen Yang and strengthen your lumber.
  2. Digestive system dysfunction. This is a very common problem for everybody who is using HRT. The patients always feel uncomfortable in the chest or abdomen area. They can get indigestion easily, nausea, vomiting, diarrhoea, anoxia, lethargy, dizziness, and dull pain, full pain, burning pain and even colic pain and distension in the epigastrium or abdomen. It can be aggravated by increasing dosage or eating greasy food, etc. These symptoms are caused by digestive dysfunction. If you are checked with an endoscope, you will discover that you have a pathogenic change of gastritis. If you get serious pain in your epigastrium, you have to go see your doctor immediately, because the hormones can induce peptic ulcers and even bleeding. You should therefore understand that you should not take hormones when your stomach is empty, with alcohol or coffee, etc. If you have suffered from chronic gastritis, you must consult with your doctor and don’t stop taking your tablets for your gastritis.  

    Treatment: Ginger Tea is good for improving stomach functions and especially for vomiting, nausea and anoxia. If you feel distended, you can take “MuXiang Shun Qi Wan”(Loosening Qi Stagnation); if you have indigestion, you can use “Xiang Sha Yang Wen Wan”(Improving Stomach Function); if you have diarrhoea, you can use “Shen Ling Bai Zhu San”(Strengthening Intestinal Function). They are very effective.
  3. Irregular emotional, nervous and psychological changes. It has been proven that the change of steroid hormones can induce mental diseases, such as: schizophrenia or depression etc. If somebody experiences this problem after taking hormones, he/she must go see a psychiatrist and stop taking hormones at same time. Neurasthenia and neurosis are also common problems caused by steroid hormone. 

    Treatment: If you are irritable, always feel sad, disappointed without obvious reasons, anxious or nervous, or you get stuffy chest, pain in hypochondriac area you have neurosis due to Qi stagnation. Herbal tablets “Shu Gan Wan”(Moving Liver Qi Stagnation) or “Xiao Yao Wan”(Improving Emotion) are both very effective. If you have bad sleep, dream filled sleep, palpitation and insomnia, you have are suffering from neurasthenia due to an imbalance between Yin and Yang of the heart and kidneys. You can take herbal tablets “An Shen Wan”(Calming Shen) or  “Bu Xin Dan”(Strengthening Heart). Acupuncture and TuiNa are also effective.
  4. Thrombosis:  Thrombosis is a serious complication caused by HRT. According to statistics, about 6% of patients are diagnosed with thrombosis after taking hormones, especially oestrogen. The higher the dosage you take, the higher your risk. Coagulation always happens in the lower limbs, blocking the vessels and causing poor blood circulation and even necrosis. Sometimes the thrombus comes up to the brain and the patient can have a wind stroke, faint, become unconsciousness, and then develop paralysis in parts of the body. Another serious problem is the thrombosis blocking the vessels in the lungs resulting in serious asthma, pneumonia oedema, coughing phlegm stained with blood and even sudden death.

    In order to prevent these serious complications it is necessary for the people who are taking hormones in the beginning stages to take some herbal tablets such as “Dan Shen Pian”. A small dosage of Aspirin is also suitable. If your blood tests indicate you are at high risk of thrombosis you will develop this condition within one week of taking hormones. If you feel numb, pain, cold or have a change of colour in your lower limbs you should go see a doctor and have it checked. It could be the start of a serious condition.  You must go to hospital immediately if you feel dizziness, headaches, and coma or experience blindness suddenly.

    Treatment: If the thrombosis has already formed, the patient must stop HRT and be hospitalized for treatment. Commonly, “Dan Shen injection” is a very good drug derived from herbs and is safe and effective. Another drug is snake toxin injection. Herbal tea “Huo Xue Tang” (Remove Blood Stasis Tea) is also a very good for patients. Heparin is a common western medicine for treating thrombosis.
  5. High blood pressure: This is a common problem resulting from HRT. Some people never have this problem before taking HRT. If you always feel dizzy and have headaches have your blood pressure checked. Some people recover normally after stopping HRT but some people don’t unless treated with medicine.

    Treatment: If you have high blood pressure you should reduce your dosage. Your body may not be accustomed to the higher levels. If your blood pressure is high, you need to take some medication to regulate it. If your blood pressure is not too high, Herbal tablet “Luo Bu Ma Pian” or herb “Luo Bu Ma” can help you.
  6. Arteriosclerosis: is also a common problem due to steroid hormone, because the hormone can change the level of blood ester. This is a chronic process. For the prevention of this problem, you should not consume too much meat or animal oil or fats. You should get enough vitamins, such as vitamin C, B, E. Some teas for losing weight have work to reduce the blood ester. Herbal tablets “Dan Shen Pian” can soften and dredge vessels.
  7. Pathological change of the eyes ground: this is a big problem always occurring on the retina and macula luteal. Acute retinitis and pathological change of macula luteal are very common. Both are always caused by the change of sexual hormone. About 8 to 10 % of patients who are pregnant women or adolescents. The doctors will see the congestion, oedema and secretion covering the retina and macula luteal, and even bleeding. It is caused by the penetrating change of the retina vessels. The reasons and pathogenesis are not clear yet. But it is the main reason for youths and middle-aged people going blind. If you feel your sight has changed much more seriously than before in a short period of time you must stop your tablets and see a doctor as soon as possible. It is necessary for you to check your eye ground and take a photo, and then the doctor decides how to treat it. It would take about 6 months to treat this condition. Some patients do not recover 100%.

    Treatment: Herbal medicine is very good for these problems without any side effect. It can relieve congestion and oedema, and remove secretion on the retina and help the patients recover their sight. However, the patients will only get immediate therapeutic effects after they have taken 30 to 60 decoctions of herbal tea. There is no special treatment in western medicine for these problems.
  8. Osteoporosis: this is a chronic condition. The change of steroid hormone can affect metabolism of calcium, and cause decalcification. This process is always accompanied with the syndromes of kidney Yin deficiency or kidney Yang deficiency. You should treat kidney deficiency as soon as possible if you have this problem after taking hormones. It is also important to supplement your calcium and vitamin D intake.

Dr. Charline Wang
Cape Town, July 2007

Dr. Charline Wang is a Chinese doctor who was practicing as a professor as well as an expert for internal medicine and gynecology in China. She has published more than 40 academic articles in China over the past 20 years. Currently she is working at the University of the Western Cape (UWC) as a teacher in Chinese medicine as well as a Chinese doctor.  Dr. Charline is specialised to treat diseases of the immune and endocrine systems and is engaged in research about education of Chinese medicine and acupuncture.


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