FAQ - Frequently asked questions : FTM hormone discontinuation
MEDICAL, FERTILITY and PASSING issues.
by Dylan,
who is FTM and besides a chemist and who is looking forwards to hearing from others via
fasterthanlife_2000@ at yahoo.com.
1. What happens if I as a female to male transsexual stop testosterone hormone treatment ?
This varies from person to person and will mainly depend on your medical history.
I will try to explain the most common effects, but it would be also of advantage to discuss it with your physician
or endocrinologist.
But as most of those have no experience with this situation I have written this FAQ. I searched prior this on the
web and found basically nothing. (Neither about Germany’s Mann zu Frau Transsexuelle (FzM) nor about male-
to female transsexuals (FTM) in English.) However please bear in mind, that it is you that is responsible for your
health and the risks you take not me. The answers given here relate to the experience of transgendered fellows
who stopped testosterone treatment and whom I encountered over the last years (about 10) and may be not
representative for your case. The last section deals with side effects of testosterone and general questions
concerning certain medical conditions.
1. Passing issues
2. Will I be able to continue to pass as male ?
If you have taken hormones long enough to induce a drop of the pitch of your voice this will help that you can
pass. Also beard growth stays but becomes thinner and grows slower with time.
However passing is how people perceive you in communication. So your clothing, mannerisms etc. will all add to
the perception people have from you.
For smooth interaction with strangers it is of high advantage to present the most gender congruent image you can
project. Otherwise you confuse people and people will blame you for their confusion in this world.
If you cannot pass constantly as male now, you will in all likelihood not pass as male after stopping hormones,
unless you change a lot of your outwards appearance with other means.
3. Will I be able to pass as female again ?
I know of five cases where this was the aim of hormone interruption. It was possible in all of them, although
some, who continued to present as masculine lesbian, sometimes encountered harassment from people who did
not like transgenendered folks and read them as feminine, gay men. If you have significant beard growth, you may
have to undergo electrolysis to remove it, which is quite painful. In other cases close shaving will do. If you have
developed severe male pattern baldness you may need a wig.
If you dress femininely, tend to feel happy as a woman having started hormones should not stop you from
discontinuing them if you prefer to present as a woman and live as such. Your body odour will become female as
well. And last not least a lot of MTF pass without any problem as female.
4. I am lesbian/straight, will I be attractive for other lesbians/straight men?
Sure. Depending what kind of surgery you had, this might limit some chances. But most of us are smaller and of
lighter built than nontransgendered folks and thus you might appear petite and cute, regardless.
And there are always men who prefer somebody who is a bit like the male best buddy and still female enough to
make them feel straight and in accord with mainstream society.
5. Will it stop baldness ? Will I grow my hair again ?
You will not grow any significant amounts of new hair. But your hairloss will lessen and in all likelihood
eventually stop. As hairloss proceeds over a certain time, a lot of hairroots already dying will continue to do so. It
may take more than a year until your hairloss stops. Some people have regrown some hair.
Conclusion: if you are extremely unlucky you could not prevent baldness if it is already too far progressed.
Anti-hair loss treatments usually have sideeffects that could affect your endicronological equilibrium, and may
also impede testosterone function, so it might be a motivation to stop testosterone treatment - apart from the
money asked for such lotions or medication.
6. Will I age at the same speed as before?
Ageing, from the point of view of a spectator who perceives you as a man can be slower. You might look much
younger, be perceived as more boyish for some time.
Of course nobody looks like a teenager or midtwenty forever.
7. Will I loose weight ?
Many people on testosterone gain weight. If you exercise and eat a bit less it happens. Be aware that weight
distribution is slower with older people. You are now older than at the time you started hormones.
Thus you will not instantly gain your former weight, just for stopping testosterone.
8. Will my body look more feminine again ?
You will get about the same shape as before hormones from the fat distribution.
9. Will my face look more feminine ?
Yes. But this can be compensated by appropriate haircuts, the masculine hairline you might have developed,
clothing, voice. I shave now only every third day. Another trick, if you shave, shave at nighttime. So in the
morning there will be some stubble already grown.
10. Will I smell more feminine, what can I do about it ?
Yes, you will, unfortunately. Shower before work, use a shampoo or bodylotion with distinct male perfume. Also
note that your sense of your smell as well as the odour its you while discontinuing hormones might be severely
but only temporarily increased. Afterwards both effects are much lessened and return back to normal. Sense of
smell is dimmer in males, so your male colleagues might notice less than you on a conscious level. If you are
attracted to bisexual men, it could however be even of advantage.
2. FERTILITY issues
1. I want to discontinue hormones to have a baby, is that possible ?
Yes. It has worked for others, so it could work for you, even after more than 10 years of testosterone treatment.
Of course about 10-20 % of the western population over 35 are clinically infertile, needing medical treatment for
conception or being unable to conceive at all.
2. My period stopped and I also use testosterone as contraceptive, do I have to worry about getting
pregnant if I stop ?
Yes. Also keep in mind that sexual diseases are not prevented by any hormone treatment, testo or be it the pill.
Use condoms. In a relationship be open and honest to your partner who trusts you.
3. If I stop and get no period, does that mean that contraception is not possible ?
No, due to the rebound effect you could be even extra fertile. In fact, before more sophisticated treatment was
available, doctors gave testosterone to women to increase first their libido and after discontinuation trigger the
body to produce a sufficient amount of female hormones.
4. How long will it take until the full female cycles (period etc.) sets in again?
Between 1 and 12 months. Not that due to the normal atrophy of the muccal skin in the uterus first the period
might be spotting only. Afterwards, due to the rebound effect it might be much heavier than you used to have it,
before testosterone treatment.
5. Could it be that it never comes back ?
Theoretically: yes. (Don’t count on it though). This will also depend on your age, the closeness to the
menopausal age, which again varies a lot in the population. Even early onset at around 30 has been reported. It
could be that the testosterone treatment you had even postponed menopause, no studies exist in scientific
literature about that.
You will undoubtedly find out.
If you had bottom surgery you will stay infertile, get no period and will usually be in need of some
supplementary hormone treatment. Consult your physician.
6. If you cannot conceive, experience pain etc. do not hesitate to see medical aid. You can later start
hormones again, but do not change back and forth frequently, decide what you want and what purpose it is aimed
at and then decide what to do. Do not be tempted by small discomfort to go back to whatever it was, but rather
consult a medical doctor to treat the symptoms, as some might be only temporarily. This brings us to the section
of the medical issues.
3. MEDICAL ISSUES
There are some medical risks and minor or major hassles which may occur. I will explain them. If you feel unwell
please consult a medical doctor. Please do not hesitate to include an appropriate second specialist. Also not that
some the following effects are stronger, more serious for those with lower surgery in advance: blood pressure
shifts, bone density loss and risk for depression. Those guys need to consider an appropriate hormone
replacement treatment in any case.
Positive effects: There are also beneficial side effects: lower risk of heart disease due to overproduction of red
blood cells as well as lower risk of onset of diabetes due to higher blood sugar levels are lowered. Some people
feel more balanced and those to be single might welcome the reduced libido as a blessing.
Do not rely only on the FAQ, but you may bring it along to the doctor. Also do not hesitate to get a second
medical opinion if you are not happy with the answers your physician provides. If you experience any
side effects not mentioned here, which might be possible, please let me know, via the sci-fi webpage part:
www.oocities.org/fasterthanlife_2000
1. Should I stop or should I rather discontinue hormones slowly ?
It is better to discontinue over a certain period of about 2-4 months, first by lowering the hormone dosage, at the
end by just applying the testesteroneester to skin in the genital area.
You can also stop all at once, but this might be not as good. Do not however prolong the withdrawal time too
long as you might create a regime that will resemble that of polycystic ovarian disease. Cysts in the ovary are
often painful and while in most cases a few small ones are harmless, polyovarian syndrome has been linked to
increased rates of cancer. If any rebound in taken place and detected endicrinologically stop testosterone.
Endicronological monitoring might be paid by your health insurance and is strongly advisable if you have the
following risk factors: heart disease, either very low or very high blood pressure, osteoporosis, cancer, previous
clinical depression, diabetes.
Otherwise and if there is no doctor around that you can trust, you can of course also wait if you develop side
effects.
The discontinuation of ftm testosterone treatment may be accompanied by the following side effects, of which
none, some or in some cases all may be encountered with a varying degree of severity:
Development of ovarian cysts. Their growth may be painful or not even noticed. They can be easily observed by
ultrasonic diagnosis. In most cases harmless and deserving no treatment, they can be removed surgically, also
using microinvasive technology. NOTE: In some rare cases they grow with pregnancy and might even endanger
the foetus. I know of one such case. Thus check this before getting pregnant and discus it with your
gynaecologist.
Some FTM develop them in any case, or have them before treatment, because very often our body chemistry is not
fully female to begin with.
Often they are, however, a side effect of non-regular hormone treatment, out of laziness, forgetfulness or
needle-phobia. Here the body is triggered by testosterone withdrawal to produce huge amounts of female
hormones, ovulation sets in but is blocked than in a later stage by the rise of testosterone levels. There is thus a
small risk to develop cysts at the onset of testosterone treatment, if testosterone is added inappropriately.
So a frequent on-off of testosterone is not to be recommended. It might also have the opposite effect you with on
the hairloss, hairloss, apart from the genetically disposition can be triggered by the increase of testo-levels rather
than the absolute amount.
If you have cysts have 1-2 times a year a check with the obgyn or have them removed. The full removal of ovaries
is however a health problem in itself and a part removal is also associated with some minor risks. Without ovaries
you will be also infertile and susceptible to osteoporosis and the other side effects of this list. There is also other
helpful medication to combat the symptoms available.
Blood pressure changes
Your blood pressure might change or shift while your testosterone level decreases but your own natural
production has not yet set in. Thus you can encounter difficulties associated with very low blood pressure.
Especially in the first months but before the hormone production of your body peaks up, you might encounter:
dizziness, black spots in your field of vision when changing position, but also more severe effects could be
theoretically possible. If you have any reason to suspect something problematic or have a family or personal
history with carviscular disease consult a physician.
Note that most of these effect can disappear after your hormone regime normalises. Also note that during rebound
phase for a short time all effect associated with use of the pill may occur.
If you had bottom surgery and had ovaries removed please consult a physician if any of the above symptoms either
worsen or are of persistent nature. These symptoms can also impede your ability to drive a car, to operate
machinery or work physically at great heights.
If you had a low blood pressure, for example got prior testo treatment white fingers in cold water, cold weather
without experiencing pain, but only a certain numbness you will be more likely to experience symptoms
associated with the lowering of the blood pressure.
Reversal of anabolic effects
You will loose muscle mass. This will be mostly visible in the pectoral area. Exercise to combat it or just develop
a different self image of your body. Wear appropriate clothing and nobody will know. If your desire is to look
more feminine you might even welcome this effect. This effect may also trigger back pain however.
General Mental effects
It is possible to experience an increase in the need of sleep. You will loose the energy boost of testosterone, some
ftm also report lowering of aggressiveness. You might however also feel more aggressive, especially this is also
depending to the largest degree of you personality disposition and obviously your personal circumstances.
Sensations:
Your sense of smell, unless you are a heavy smoker, will be increase. Food may take better or more intensive.
You might become more susceptible to cold. You might feel really chilly in moderately heated rooms even.
Sexual orientation etc.
This might not change, although there is a possibility that is does, especially when it changed already in your
past.
Your sex drive may disappear or be at least reduced but will increase again after time but to a lower level.
Depression:
You might experience a phase of low mood, lack of initiative, sadness or even a full depression until your bodes
endocrinology kicks in. If not to troublesome and symptoms are mild just accept it. Try to see it from a distanced
position, do not worry to much.
As a precaution you can try to establish a habit of regular exercise and time walking in fresh air before
discontinuation of testosterone treatment. Joining a sports club, getting a walking, jogging buddy can make a
tremendous difference. Be outdoors under UV light/daylight frequently. Also holding a job, caring for a family,
meeting friends on a regular schedule is good. Do not change this schedule, because of lack of initiative.
-If you feel that you might be at higher risk, a slower outphasing of testesterone might be beneficial.
- The use of libido reducing antidepressiva might prolong the duration of this side effect. Be careful
If you have had bottom surgery you might need hormone treatment to counter this effect.
Bone loss/ Karies
You might have an increased risk of vacancies. Visit your dentist for a regular check-up. Consider fluoride
treatment. Caries can be very fast, but dentists have good treatments to offer for those who can pay (cerec inlays
etc.)
If you had bottom surgery your risk of both osteoporosis and karies will be significantly increased. Consider a
hormone replacement therapy. Otherwise your risk is very low. If your period has not returned after 8 months
consult a endocrinologist / gynaecologist and also mention this risk, even if you are otherwise symptom free.
You can lower the risk by frequent physical exercise.
Arthritis/Back pain: This risk is related in some cases to bone loss. See section above. There are however a lot
of other risk factors and note that it is a very common health problem anyway. Keep warm and exercise regularly,
keep a balanced diet. IF you hold a mostly sitting position at work, back pain might be related to loss of muscle
mass. Sitting cross-legged, even on an office chair usually helps to maintain a more upright position and to
strengthen your muscles.
Loss of body hair on legs, arms, upper body.
Testosterone induced hairgrows in this regions will slow. Some people will loose all hair they managed to grow
there, some will keep most of it.
Beard growth
Will not stop, but slow down. See section passing.
Acne
Rare, but could happen.
Headaches, Migraines:
related to changes in muscle tension or blood pressure. It is more likly however that you tendency towards
headaches decreases, especially if an
increase during testosterone treatment has occurred previously.
GENERAL CONSIDERATION to modify testosterone dosage
If I change from one hormone brand to another, should I make a break in the treatment?
No, a longer than necessary break would be a bad idea. Also do not change the formulation (brand of medication)
without any good reason. Too slow physical changes at the beginning of the treatment are no reason.
Severe acne or general feeling of feeling not well may be reasons for change. If you are not allergic to peanut oil
sustanone 250 is a good choice. After 1-2 years the initially higher dosage should be adjusted to just body
weight. Trust the feeling of your body to get it right, but also include the expertise of an endicronological
specialist, your red blood cell counts etc.
Use of phychopharmace, diagnosis of borderline personality etc. is that a problem?
Especially if you take any other medication, especially drugs to treat schizophrenia, depression or borderline
personality not undergo an on/off type kind of eratic testosterone treatment. Such can be really dangerous. You might
have other hormonal imbalances that might be triggered and that could also have impeding physical
consequences: severe rapid weight loss and muscle atropia and other funny things requiring even hospitalisation.
Other people tell me I need surgery but there is no medical indication, what should I do?
Never schedule a gender alignment surgery under the influence of phsychopharmaca or because a therapist or
fellow transgendered person claims you should although you would prefer to have no surgery.
I personally know someone who now really wishes he had had no surgery for Mtf and now is a very unhappy ftm,
because he was castrated just because his doctors thought is was a good idea.
If you could imagine discontinuing testosterone, do not have your reproductive system removed.
I have increased red blood cell count, frequently a read head and neck etc. what should I do?
This can be dangerous and lead to heart problems. Possibly your testosterone dosage is too high. A reduction to
about 0.6 ml of sustanon 250 every 17 -19 days for a body weight of about 60-65 kg can help. This is more effective
and also better for the general well-being than e.g. 1.0 ml sustanon 250 every 4 weeks.
You have been diagnosed with a symptoms of schizophrenia or phobias concerning meeting people in
crowed places, subways etc., should you refrain from transitioning?
No, as presenting a more gender congruent image to third parties will reduce the feelings of strong gender related
aversion other people project and which you, as a very sensitive person are disposed to pick up much more
strongly than others. IF you are lucky, your problems will be decreased and your life will become better.
You likelyhood to hear voices of god and spririts will decrease and you may feel connected towards
humanity instead in a new way.
Other conditions where anectdotical cases of remission or lessening of symptoms have been reported with FTM testesterone
treatment:
Lupus, chronic fatigue syndrome, mild cases of bipolar disorder.