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The risk of elevated liver enzymes and liver failure with bicalutamide appears to be much smaller than with high doses of CPA, [88] which is the most widely used antiandrogen in transgender women in Europe and elsewhere in the world. [110] [134] [135] However, only low doses of CPA are now recommended for use in transgender women. [136]
5α-Reductase inhibitors such as finasteride and dutasteride are inhibitors of 5α-reductase, an enzyme that is responsible for the formation of DHT from testosterone. [154] DHT is between 2.5- and 10-fold more potent than testosterone as an androgen [ 155 ] and is produced in a tissue-selective manner based on expression of 5α-reductase. [ 156 ]
5α-Reductase inhibitors (5-ARIs), also known as dihydrotestosterone (DHT) blockers, are a class of medications with antiandrogenic effects which are used primarily in the treatment of enlarged prostate and scalp hair loss. They are also sometimes used to treat excess hair growth in women and as a component of hormone therapy for transgender ...
For transgender men on testosterone, physical changes include achieving a more masculine appearance (resulting in facial hair, a lower voice and other desired effects), while for transgender women ...
5α-Reductase inhibitors are sometimes used as a component of feminizing hormone therapy for transgender women in combination with estrogens and/or other antiandrogens. [ 4 ] [ 215 ] [ 70 ] They may have beneficial effects limited to improvement of scalp hair loss, body hair growth, and possibly skin symptoms such as acne.
For trans women this will typically involve taking oestrogen and anti-androgens, and for trans men taking testosterone. Oestrogen can promote breast growth and the redistribution of body fat.