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Male-to-Female Transsexuals

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Kathoey is the term to describe transgendered men in Thailand[12]

The treatment of male to female transsexuals requires up to three hormones:

  • spironolactone to decrease androgens

  • estrogen for feminization

  • progesterone may be used to augment breast development[8]

Estrogen will cause breast development, a redistribution of body fat, skin softening, testicular atrophy, the loss of erections, decreasing body hair and a slowing of scalp hair loss. Estrogen will not cause the voice to get higher or the "Adam’s apple" to regress. It is important to remember that breast development will take over 2 years and the developing breasts may be tender for the first year or two. The size of the breasts is not proportional to the dose of estrogen used, as in biological females, breast size varies[2] [8].

The use of estrogen has serious side effects that require careful monitoring. These side effects are stroke, pulmonary embolism, myocardial infarction and breast cancer. The risk of thromboembolic events increases 20 times in those on estrogen. The use of estrogen may also cause hyperprolactinemia and galactorrhea due to an increase in pituitary prolactin production. Liver function abnormalities must be investigated and may require the discontinuation of estrogen. Due to the risks of serious side effects, the lowest possible dose of estrogen is used[2] [8].

Spironolactone is used prior to sex reassignment surgery. There are very few serious side effects associated with spironolactone use, however, low blood pressure and hyperkalaemia are risks.[8]

The use of progesterone to enhance breast development is controversial, and if it is used, it may become androgenic at high doses[8].

Surgery for MTF transsexuals includes breast augmentation, Adams apple (larynx) reduction, hip enlargement, vaginoplasty, labiaplasty, penectomy and orcheictomy[2].

In terms of prevention and screening, mammography is indicated after 10 years of estrogen use, but prostate screening is likely not needed in individuals whose testosterone levels are suppressed[8].


2. Kaiser Permanente National Diversity Council. A Provider's Handbook on Culturally Competent Care: Lesbian, Gay, Bisexual and Transgendered Population. Oakland, CA. Kaiser Permanente; 2000.

8. Oriel KA. Medical care of transsexual patients. Journal of the Gay and Lesbian Medical Association. 2000;4(4):185-194.

12. Winter S, Udimsak N. Male, Female and Transgender: Stereoptypes and Self in Thailand. The International Journal of Transgenderism, 2002;6 accessed November 28, 2005

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