Abstract
Purpose: Chronic gender-affirming hormone therapy (GAHT) with sublingual estradiol (SLE) has not been studied. We aimed to compare GAHT with SLE only, to combined oral (CO) estradiol and cyproterone acetate, in treatment-naive trans women.
Methods: Twenty-two trans women enrolled into either the CO arm or the SLE-only arm (0.5 mg four times daily) in this 6-month prospective study. Anthropometric and laboratory variables were collected at baseline and 3 and 6 months. At the study beginning and end, body composition was measured by dual-energy X-ray absorptiometry and bioelectrical impedance, and gender dysphoria, sexual desire, and function were assessed by validated questionnaires.
Results: Subjects in the SLE were older, 26.3±5.8 years versus 20.1±2.3 years, p=0.006. All anthropometric, body composition, and laboratory variables were identical at baseline. Although dysphoria appeared greater, and sexual function lower at baseline in the CO group, this canceled out after age adjustment. Both treatments induced similar biochemical and hormonal changes. Creatinine, hemoglobin and cholesterol decreased significantly, while testosterone was suppressed to the same level in both groups: 3.22 [1.47-5.0] nmol/L in the SLE group and 2.41 [0.55-8.5] nmol/L in the CO, p=0.65. Significant changes in body composition toward a more feminine body were noted in both groups. Dysphoria did not significantly improve in either group, while sexual desire and function decreased at six months in both, p<0.001.
Conclusions: Both treatments achieved similar clinical changes. At this stage, SLE, which repeatedly induces alarming excursions of serum estradiol throughout the day, appears to offer no advantage over the CO approach.
Well, yes to a certain degree, however, most endogenic clitorises are inside the body and look like a wishbone in a way that no surgery or other medical procedures etc can currently do which is what we want, plus we believe ones created by vaginoplasty surgery don’t have the same number of nerve endings as endogenic ones. This is what we meant about sexual functioning as we want to be able to do all the things people who have them endogenically can do which isn’t possible sadly, we just feel empty and might still if we did have such surgeries.
Vaginas are similar in that we believe no current procedures can make them fully feel or function like endogenic ones inside, so we are hesitant about having surgery, it might help us, it might not.
Okay, fair about them only being needed for reproduction but we would very much like to be pregnant and would solve this situation we have gotten ourselves into where there’s probably no chance of having bio children any other way.
Yeah, we have seen that awful film about Lily Elbe, plus looked into it and it is possible but it would mean somebody with an endogenic womb dying currently as it is massive surgery and not sure whether the recipient would survive either. Given what happened to Lily Elbe, who knows. Guessing it would require some kind of crispr modification currently to be anywhere close to successful, even though that technology is nowhere near ready for that kind of modification.
We guess what we mean basically is that for us sexual functioning is tied very much to having certain body parts in an endogenic way because every time we think about any kind of sexual stuff currently we just get dysphoric and dysmorphic in a way that we aren’t sure would be solved by surgery completely.
We’re very glad if this doesn’t happen to other trans femmes though, because either it doesn’t or they don’t talk about it or they aren’t allowed to lest they get some transmisic somewhere to say some bullshit, for us though it hurts a lot and we’re glad if no others are going through this.