A: Even for menopausal women, oral hormones should be avoided because of the clotting & stroke risks they particularly carry compared with non-orals, due to passing selectively more through the liver, but in the trans woman, where the doses are significantly higher, this is urgently true, & to a far greater extent.  In addition, oral HRT reduces feminizing potential and selectively fuels edema, depression, weight gain, pancreatitis, high triglyceride levels and gall stone formation.  And alternatives are easily available.

Pending.

A: By precision I mean precise dosing & precise patterning.  Individual persons vary widely from one to the other in terms of their rates of excretion for estrogen.  So a one size fits all approach makes no sense.  And the balance between estrogen & progesterone dosages also matters, varying with different types of patients.  Beyond hormonal balancing there is the matter of hormonal pattern, whether stable or erratic & whether there are many dips & surges in hormonal levels.  Many important medical problems can be driven by erratic hormone levels or by unsuitable balances between the hormones so this idea of precision is critical to obtaining a safer yet more effective source of hormones. 

A: Indeed high potency feminizing HRT can fuel generous facial feminization (FF) when used consistently, & this kind of facial softening may be enough in many trans women.  There's a lot more to facial femininity than the facial bones.  The eyes are the most important source of feminine beauty, and surgery doesn't change them.  Hormones on the other hand powerfully beautify the eyes, make them larger & glowing.  Hormones also complement & polish the results of surgical FFS, giving it a more natural, finely defined finish.  Less aggressive surgery complemented by HRT is far better than ending up with the lizard look that so many patients, both transgender & otherwise, end up with these days.  More is less & less is more.  The more natural appearing your face is, the better especially when the surgeon belongs in the top tier. 

A:  A local plastic surgeon tells his patients that one has to be specially skilled to perform plastic surgery, whereas anybody in his opinion can give hormones.  In those words alone, he shows his abject, irresponsible ignorance. A surgeon may need good hands but an endocrinologist needs a good mind.  Endocrinology is one of the most complex areas in medicine and whereas bad surgery may ruin your appearance, bad hormonology can ruin your life or even end it prematurely. 

A: I would assume that its out of sheer ignorance.  Believe it or not, many physicians still use oral hormones, even in the treatment of menopause and even in women over 60, as well as in trans gender women, at a much higher dosage.  But the risk is amplified along with the dosage in trans women, opening them up to clots, strokes, heart attacks & sudden death, which non-oral treatment greatly reduces. Oral estrogens should undoubtedly in my opinion never be given to transgender patients.

A: Yes, indeed we do, & in the same non-robotic, thoughtful manner that we treat male to female patients, but in far fewer numbers. Many trans-men take testosterone injections,  a primitive form of therapy in that much of the administered testosterone converts into estrogen, both defeating the purpose of the exercise and increasing the risk of endometrial cancer & breakthrough bleeding. About 80% of trans-men have an underlying hormonal disorder called polycystic ovary disease but testosterone doesn't address this hormonal imbalance or the insulin problems that often underlie it. 

A: Heck no, not in my opinion.  Hormone function is extremely complex & our understanding of its powers & complexities are growing exponentially from day to day.  The non-specialist usually knows little of nothing about this newly appreciated, remarkable complexity & unfortunately is also too ignorant to realize it.

A:  Indeed, when feminizing therapy is administered precisely, with the right balances, dosage & pattern & via optimal delivery systems, mental & emotional complications can be avoided, in fact mental benefits rather than side-effects may ensue.  Some illegal injectables from South & Central America often trigger mood swings, anger, even irrational behavior bordering on psychosis. Estrogen protects women from schizophrenia & bipolar disorder.  Patients with a history of both these conditions will often improve dramatically on precision HRT, with clearer thinking and less need for heavy handed drug therapy. All the more reason to seek treatment from a trained endocrinologist who is expert in hormonal care rather than a practitioner flying by the seat of his or her pants.