Posted by
u/Ambrosia25
3 years ago
A ranking of AAs in terms of Safety, Effectiveness, Tolerability and Cost (inexpensiveness)
The safest way? That would be transdermal estradiol. The former is an [estrogen](
https://en.wikipedia.org/wiki/Estrogen_(medication)) and will cause feminization (e.g., breast development, feminine fat distribution, mental changes, etc.) while the latter is essentially an
antiandrogen and will turn off sex hormone production by your gonads and reduce your
testosterone levels by about 95%. This combination is about as safe as you can get (not really differing much from what cisgender women have from a safety standpoint) and wouldn't really have any risks. It would also probably be the best regimen you could be on in terms of effectiveness and side effects.
That regimen might be pretty expensive though. The risks with hormones for transgender people overall are actually pretty low in general. There are other things that you could take that technically would be more "risky" but that would still have very low absolute risk and that might be much less expensive. Examples include oral or sublingual estradiol and other antiandrogens like
spironolactone,
cyproterone acetate, and
bicalutamide.
Of these antiandrogens, spironolactone and bicalutamide are reasonably safe (although potassium monitoring is recommended with the former and liver monitoring is recommended with the latter) whereas cyproterone acetate has higher risks. Here is how I'd roughly rank the antiandrogens in terms of safety, effectiveness, tolerability (side effects), and cost (all in combination with an estrogen):
- Safety: GnRH analogues > Spironolactone ≥ Bicalutamide >> Cyproterone acetate.
- Effectiveness: GnRH analogues > Cyproterone acetate > Bicalutamide > Spironolactone.
- Tolerability: GnRH analogues = Bicalutamide > Spironolactone > Cyproterone acetate.
- Cost (inexpensiveness): Cyproterone acetate > Spironolactone > Bicalutamide >> GnRH analogues.
As an alternative, you could do
higher-dose estrogen without an antiandrogen or with only a low dose of bicalutamide. Estrogens are actually antiandrogens themselves and can suppress testosterone levels by 95% similarly to GnRH analogues (
link. However, you need higher estradiol levels than usual to achieve that. These higher levels may come with some safety risks like an increased risk of blood clots. However, the absolute risk would still be very low and that is particularly true for someone your age. [Note: the age of the OP which this comment was replying to is 17/18. The thread this post first appeared in can be read
here.]
The pages linked above plus [this](
https://en.wikipedia.org/wiki/Hormone_replacement_therapy_(male-to-female)) article would be good places to start reading up on hormones.