Medical Transition - the mechanics of it all - medication

if you have  read my other posts about  medical transition you 'll be aware that  one of the results of my  private sector assessments  was  the decision to start  medical transition proper. 
for transgender women  there are two main  thrusts to medical  transition 
1. causing  feminisation
2. preventing  and  to some extent  reversing masculinsation

Point 1 above is relatively easily achieved by administering Oestrogens, typically as pills or transdermal patches / gels.
point 2 can be more complex, in that some people's  testosterone production is well suppressed by a therapeutic  dose of Oestrogen but in some people it's not.  If that is the case the current UK practice is to use a GnRH analogue to fool the body's  self regulatory  systems into  shutting down production of  sex hormones. 

Sheffield's core guidelines  for hormones  for trans women 

NHS national care pathway
I don't have a link to an internet copy of CX's guidelines or an electronically shareable copy  of the document Dr Seal works from, but it along with most of the UK GICs  is all pretty similar to the document from Sheffield I link to above  one of the main differences being choice of  GnRH analogue 

Dr Seal recommended Decapeptyl (Triptorelin) to my GP, where Sheffield's initial recommendation is Leuprorelin.

Generally the  aim is to get  Oestrogen levels to  300- 600 pmol/l and to get testosterone levels under 1.8 nmol/l  these are  typical  values of a cisgender woman in the follicular phase of her cycle.

How you get there is generally by  trial and error titrations, starting from 2mg  / day  and then test  bloods every 8- 12 weeks  to see what the levels are doing , while my oestrogen levels were coming up nicely  my testosterone levels  stuck in double figures - hence the decision to commence a GnRH analogue in  December  2018.

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