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Ke Ala Koho Kaua
the path we follow

Gay, Lesbian, Bi-Sexual and Transgender


Community, Religion, Civil Rights, Legal, Education and Employment,
Transgender (SRS) related Surgery and Therapy
 information that addresses the needs and questions of mahu lifestyle



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                                  Kulia Na Mamo

Miss Utopia
Washington Post

Kaiwakiloumoku 
Halau Lokahi

Utopia Hawaii
Lokahi Charter School  

Kulia Na Mamo
Ke_Kulana_He_Mahu













Kulia Na Mamo is a social justice organization established in 2001 to help disadvantaged people of color - with particular focus on Hawaii's transgenders. Our mission is to obtain services to help transgenders not only survive, but fully participate in the economic and civic life of Hawaii. Like their sisters throughout the world, Hawaii's transgenders live under conditions that include: prostitution; discrimination and harassment; poor health and early mortality; poverty and homelessness; low self-esteem; and lack of access to mainstream health and social services. Mahuwahine (male -to-female transgenders), mahu and aikane (same sex relationships) were accepted among indigenous, non-westernized people, as in Native American and Polynesian societies. Legends of pre-contact Hawaii indicate that dual-genderism and bisexuality were accepted among the Hawaiians of old. Today's Native Hawaiian scholars refer to historical records that document bisexuality among ruling chiefs as well as commoners (Kameeleihiwa, 1999). Perhaps for this reason, the local transgender population is overwhelmingly Native Hawaiian. Not fully accepted in today's mainstream economy, mahuwahine have maintained a subculture of survival through welfare/SSI supplemented by hustling, drag entertainment, small jobs and care giving for children and the elderly. Although the term has been used pejoratively, transgenders now use mahu as a blanket term to refer to "gay" men and transgenders; they coined the word mahuwahine (mahu-woman) to refer only to male-to-female transgenders. Kulia Na Mamo's sole interest is to obtain needed services for Mahuwahine. Kulia's executive director and management officer have over 12 years experience working for mahuwahine, including the annual Malaekahana retreats and publications of Diva News, Hawaii's transgender newsletter



U.T.O.P.I.A.

The United Territories of Polynesian Islanders Alliance

PolyUtopia
Utopia Hawaii










 
 
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Education, Degrees and Occupations
highlighting the education and careers of mahuwahine
   Anita
         Retail / Marketing Manager
         Speaker & Mentor for  Transgender thru Nonprofits
             
I have a career transition into Nonprofits as Transgender Outreach Worker with API  Community of San Jose as
              of Nov.15th . Shall have a support group & employment training / job search classes in future. The classes is to
              prepare the girls with quest  to get off street as a sex worker, interview skills, resume writing,and what one needs
              to do to get the job.This just a partime position, however I have my foot in the door with Dani

         Asian Pacific Wellness Center Volunteer , HIV EDUCATION & Mentor Training
         Nurse's Aid Training-Alaska
         
Certified Dog Groomer-Portland,Oregon
         Hollywood Beauty School-Honolulu
         Aiea High 1971
     Natalie
          Seeking employment in the feild of Finance
          Recent Graduate from the University of Hawaii, Manoa -BA Finance   
  Tavena
       
  Realestate/Commercial Services
          Hawaii Business College- Business Administration Degree

  Tatiana
           Transgender Health Educator
           Hawaiian Kumu        
  Melenie
        Transgender Health Program Coordinator
  Shelley
        Billing Coordinator
        Bookkeeper, Pharmacy Assistant

        Shoreline Community College AA 1992 -American Sign Language
        Edmonds Community College -Business
        Honolulu Community College -Fashion Arts
        Brigham Young University at Laie -Speech and Drama
       
Kailua High School 1967  



Employment


Employment Tips 
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Employment Discrimination

Grinnell College Career Resources  







 Legal Resources and Services


Transgender Legal.com
National Transgender Coalition
Transgender Law and Policy

NOW  
Transgender Lawyers' Association
Lance D. Collins (Maui)

American Civil Liberties Union
Human Rights Campaign





Social Justice or the Lack Thereof in the Prison Industrial Complex

             Human Rights in any society are simple and basic, so it seems.  Our transgender subculture, oftentimes, is not afforded even the simple right, not privilege, to basic human rights.  Transgender subculture is very diverse and, therefore, much misunderstood by mainstream society.  While many of us survive, thrive, and progressively articulate our values and ethics as human beings in an unforgiving society while ever being labeled by and segregated under mainstream society´s "transgender umbrella", others of us continue to live in fear and face daily oppression and persecution.
            Is it any wonder, then, why unification of transgender community is so difficult to engender and gentrify?  As powerful a collective community voice we have as activists and advocates, we are not always heard.  Many of us are empowered to articulate the social injustices brought to bear upon us as a fringed and further subcultured community for those who cannot because of fear or other societal factors.  My work in HIV/AIDS prevention and transgender community is, by contrast, minimized by the value I feel from the current work I´ve been trying to do in social justice in the very same communities but in the prison population.  Dehuminization and oppression of the transgender community in the prison industrial complex runs rampant and without proper check and balance even here in California where activism and advocacy is extremely strong.
            Perspectives of privilege change dramatically when seen through the eyes of incarcerated transgender women.  Vacaville prison is a medium- to high-security correctional medical facility (CMF) located about a one-hour drive northeast of San Francisco.  Transgender/variant In Prison (TIP) committee is comprised of female-to-male (FTM) and male-to-female (MTF) transgender men and women as a solidarity group of social justice activists and advocates.  My privilege as a member of TIP was to rent a 14-passenger van for our visit to Vacaville CMF on September 30, 2005.  While my view of privilege seems so entrenched in community volunteerism, it pails in comparison to the privilege the transgender inmates incarcerated in Vacaville CMF felt with anticipation, empowerment, hope, and blessings of our 9-member legal team visit.  These women humbled me to the depths of my very soul and gave much value to TIP´s mission and work ethic.
            As a Hawaiian, I was raised with great family values and ethics by my wonderful parents.  Therefore, it came as no surprise to me that I was endearingly called a soccer mom when planning the logistics of our road trip which all seemed normal and automatic to me anyway.  Seven of our 9-member team was FTM.  Speak about feelings of privilege being accompanied by my esteemed TIP colleagues, two of whom have Juris Doctorates (JDs).  Again, I have to reiterate that everything pailed in comparison to the privilege I felt in empowerment by these women for whom we coordinated our visit.
            Earlier, I mentioned how my perspective of privilege dramatically changed and it was never more evident than during our dialogue with our first inmate.  "T" as I will call her to protect her and maintain confidentiality, was so empowered by the team´s visit.  T is one of five inmates who formed the Vacaville CMF Transgender Task Force.  At TIP's pre-visit meeting, we were already empowered by this group of phenomenally amazing women who truly embody the strength of transcendence from their current living and social conditions.  T communicated to us how blessed, excited, empowered, and hopeful they all felt because of our visiting them.  Little did they know until expressed to them how much we were humbled by and so in awe of them as activists and advocates in their own individual and collective rights.
            What was once my perspective of feelings of being "underprivileged" as an unemployed member of FREE society, dramatically changed to one of feelings of being "overprivileged" when refocusing through these women´s perspective in an oppressed and militaristic social setting while not being able to make unmonitored choices in one´s life.  This very perspective reminded me to remain humble and to value what I have as opposed to what I don´t have in my privileged life of freedom.  Humbly, I acknowledge that very freedom and lack thereof these women experience on a daily basis while confined to their cells in Vacaville CMF.
            As oppressed as these women are being subjugated to inhuman standards of treatment and socialization, they were truly amazed by the reflection of change in the staff´s behavior as the power and fear dynamics shifted by our very visit.  It did seem inherently strange that the prison staff as high up the chain to the Lieutenant in charge of our group were as amenable and accommodative of our needs as a legal team as well as their seemingly kind treatment of the inmate group we were visiting.  It made for a very interesting and enlightening first visit for this novice of the implications of social justice work.
            Hope is a sumptuous fruit seeded by anguish and despair.  While these women were ever hopeful in spite of prison conditions and because of our visit, it is we TIP members who remain humbly hopeful.  We have been rejuvenated in value of the true benefits of our individual and collective activism and advocacy in pursuit of egalitarian social justice for all, not just some.  It is with faith and hope for all of us in community that I humbly ask you to consider as you read this narrative the benefits of involving yourselves in your passions along your paths in life while serving in community to assist others less fortunate than you.  Already being impuned for their societal indiscretions, these women, I feel, deserve to be treated as human beings and not as caged animals as they are being treated without social justice in place. Melenie


Hawaii bars anti-transgender hate crimes by Ahmar Mustikhan, Gay.com published Tuesday, December 28, 2004

    Without the governor's signature, Hawaii's legislature extended the hate crimes law to protect transgender people in the scenic state, the Associated Press reported on Tuesday.
    Amid opposition of three GOP senators and eight House members, the bill automatically became law without Gov. Linda Lingle's signature, 10 days after she received it on April 1.

    The original hate crimes law protected victims of hate crimes based upon race, religion, disability, ethnicity, national origin or sexual orientation by increasing the jail term of the perpetrators.

    In hearings with representatives of Hawaii's transgender community, the lawmakers felt sexual orientation was different from gender identity, thus motivating the amendment.

   After the law's enactment, the AP quoted Lingle as saying, "It was just not something that I felt strongly about, but I know there was controversy on both sides. ... This seems a reasonable addition."

   Vanessa Edwards Foster, chair of the Washington, D.C.-based National Transgender Advocacy Coalition, told the Gay.com/PlanetOut.com Network, "We are overjoyed. This is something really long overdue."

    She lamented the torture-assault of a transgender person who was found unconscious on a Hawaii beach over a year ago, adding, "We only wish these penalties that have just been enacted were in place then."

     Commenting on the GOP members' opposition, Foster said, "Truthfully there is a lot of rhetoric that seeks to utilize LGBT people as hot-button topics. Much of it is motivated by people who wish to divide the country on moral differences."

    According to the language of the amended law, "Gender identity or expression includes a person's actual or perceived gender, as well as a person's gender identity, gender-related self image, gender-related appearance or gender-related expression."

The Civil Unions Civil Rights Movement in Hawaii had lobbied for the legislation and was instrumental in getting the hate crimes bill approved in 2001. Skip Burns, chairman of the movement, told AP his organization will next ask lawmakers to pass a bill barring discrimination in housing, restaurants and public places on the basis of a person's sexual orientation or gender identity.

    November 30, 2004

    GLADD Wins Tax Deduction for Sex Reassignment Surgery

    (Boston) The Internal Revenue Service has concluded that a transsexual woman represented by Gay & Lesbian Advocates & Defenders (GLAD) may deduct expenses for sex reassignment surgery as a necessary medical expense. The decision  overturned a tax examiner’s refusal to allow Rhiannon O’Donnabhain’s claimed deduction because he viewed her sex reassignment surgery as “cosmetic”.

    As the Appeals Officer determined, however, Ms. O’Donnabhain’s surgery was medically necessary and an integral part of a professionally prescribed course of treatment for her diagnosed condition. The decision has important implications for other government programs as well as for private contracts of insurance.

    “This important decision recognizes that sex reassignment can be as medically necessary for some people as an appendectomy or heart bypass surgery,” said GLAD attorney Karen Loewy, who represented Ms. O’Donnabhain in her appeal. “Any notion that medical treatment for a transgender person is purely cosmetic is based on misunderstanding and prejudice, not medical science.”

    Rhiannon O’Donnabhain underwent sex reassignment surgery in 2001 after having been diagnosed with gender dysphoria.  She and her health care providers determined that sex reassignment surgery was a medically necessary step to enable her to live her life as a woman.

    “I am greatly relieved by the Appeals Officer’s decision,” said Ms. O’Donnabhain. While the money was important to me, so too was the underlying principle. I hope this case sends a clear message that transgender people deserve dignity, respect and equal treatment for our medical care.”



Bill of Gender Rights
It is time for the transgendered community to take a stand, a strong stand, against all gender-based discrimination simply because some people are different and simply because some people do not fit into current social norms of gender roles.  It is time the gender-based community articulate this stand in words that clearly define exactly what our gender rights are.  It is time to stand alongside other minority rights movements to declare these gender rights as follows:

The Right To Assume A Gender Role
Every human being has within themselves an idea of who they are and what they are capable of achieving. That identity and capability shall not be limited by a person's physical or genetic sex, nor by what any society may deem as "masculine" or "feminine" behavior. It is fundamental, then, that each individual has the right to assume gender roles congruent with one's self-perceived identity and capabilities, regardless of physical sex, genetic sex, or sex role.Therefore, no person shall be denied their Human and/or Civil Rights on the basis that their gender role or perceived gender role is not congruent with their genetic sex, physical sex, or sex role.

The Right To Freely Express Gender Roles
Given that each individual has the right to assume gender roles, it then follows that each individual has the right to freely express gender roles in any manner that does not infringe on the freedom of another individual.  Therefore, no person shall be denied their Human and/or Civil Rights on the basis that a private or public expression of a gender role or perceived gender role is not congruent with their physical sex, genetic sex, or sex role.

The Right To Make One's Body Congruent With Gender Role
Given that each individual has the right to assume gender roles, it then follows that each individual has the right to change their body or alter its physiology so it better fits a gender role. These changes may be cosmetically, chemically or surgically induced, provided these changes are supervised by an appropriate licensed professional and the individual accepts sole responsibility for their actions in this regard.  Therefore, no person shall be denied their Human and/or Civil Rights on the basis that they changed or wish to change their body, cosmetically, chemically, surgically or any combination of these, to better fit a gender role.

The Right To Sexual Expression Congruent With Gender Role
Given that each individual has the right to assume gender roles, it then follows that each individual has the right to express their sexuality within a gender role.  Therefore, no person shall be denied their Human and/or Civil Rights on the basis of sexual orientation or perceived sexual orientation. Further, no individual shall be denied their Human and/or Civil Rights for expressing a gender role through private sexual acts between consenting adults in any manner that does not infringe on the freedom of another individual.

- JoAnn Roberts Ph.D., December, 1990

   Transgender Healthcare


Transgender Health
Medical Resources
Transgender Care









  Transgender Articles and Web Postings


An oral History by Andrew Matzner  
She' s Not There
Gone Fishing by Genevieve Hockin  

Waria_Gallery  
The Christie Lee Littleton Story
The Mak Nyahs

Moss-Fritch.com
Dr. Biber   
Katoy

Lynn Conway  
Dr Becky Allison 
Sandimari

Winni Daniels  
Aleshia_Brevard 
Hershae

Gender History of the South Pacific
Outlook  News Article
Fa'a Fafine,  Hazy

Fakaleiti     
Polynesians 
Serenity Spotlight  

Fa'a Fafine, Cindy
Just Evelyn
Berdache

Asian Pacific Islanders Human Rights
TRANS
Trans History

Mely D. Siverio, Ph.D.

New York Cop





Gender Reassignment not a Deductible Medical Expense   
January 27, 2006 (PLANSPONSOR.com) -

The Internal Revenue Service (IRS) issued a memorandum that costs for gender reassignment surgery and related medications, treatment, and transportation may not be deducted as medical expenses under IRC Section 213.      The memo referred to a man who suffered from Gender Identity Disorder (GID) since childhood and, upon the diagnosis and recommendation of his therapist and a doctor, entered into hormone therapy, lived as a woman, and eventually had gender reassignment surgery to become a female.
  
 The IRS said that IRC Section 213 does not include cosmetic surgery under the term medical care unless the procedure is necessary to correct a deformity directly related to a congenital abnormality, an injury resulting from an accident or trauma, or a disfiguring disease.  According to the IRS, the code defines cosmetic surgery as a procedure that is directed at improving a person's appearance and does not promote the proper function of the body, or treat illness or disease, as the term medical care requires.
  
 The IRS concluded that, "Without an unequivocal expression of Congressional intent that expenses of this type qualify under section 213, allowing the medical expense deduction is not justified in this case."
  
 The IRS memo from the Office of the Chief Counsel is here.

  Surgery Clinics and Doctors Worldwide


Male to Female
Dr. Eugene Schrang
Dr. Michael Brownstein

Dr. Marci Bowers
Dr. Pichet Rodchareon  
Dr. Eugene Schrang

Dr. Chettawut  
Dr. Lazaro Camarena
Dr. Suporn Watanyusakul

Dr. Sanguan Kunaporn
Dr. Preecha 
Dr. Sirachai Jindarak

Dr. Scott Yarish
University of MIchigan
Dr. Harold M. Reed

Yanhee Hospital
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Vaginoplasties 

Dr. Gary J. Alter    
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FF Surgery

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SRS Bangkok Hospital
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Dr. Garth Fisher

Thailand SRS
So You Wanna.com
Dr Attaran

Dr Grover
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Dr Robert Rey

Dr. Zukowski







Female to Male
Adventures of a Small Guy
Changing Me

Better Living Through Chemistry
Boy Afraid
Adventures of Riley Boiwonder

Alice Doesn't Live Here Anymore
Boy Avoids World
Jack's Angel Club

The Evolution of Austin Job
Geschlechtsanpasung
Casey's Corner of the Universe

A Boy Named Jesse
Devin's World  
Western Boys

Majordomo  
Alex's Page
Transboy Page

Den of the Darkwolf
Bailey's Pad





Breast Augmentation and Enhancement
silicone implants and injectables

Injectable Silicone is not approved for cosmetic use in the United States. In 1991 the FDA banned its use for the treatment of wrinkles and facial defects. Injectable silicone tends to harden, migrate and cause inflammation and skin necrosis.

The American Academy of Dermatology counsels members to abide by the position of the Food and Drug Administration (FDA). In the past, the Academy has neither reviewed the use of liquid silicone for cosmetic purposes nor taken a position on its efficacy or safety. The FDA has raised important issues pertaining to the health and safety of patients in whom the material is used. Until these issues are resolved, Academy officers support the FDA position.

In December 1991, the US Food and Drug Administration announced through the FDA Medical Bulletin that the agency is concerned about the use of liquid silicone injections for cosmetic purposes. The FDA emphasized that it has not approved the use of liquid silicone for cosmetic purposes and "prohibits manufacturers or physicians from marketing or promoting unapproved products such as liquid silicone."

This was the first official indication that the FDA intended to halt the use of liquid silicone for cosmetic purposes. The FDA’s concern pertains to potential adverse effects of liquid silicone injections, ‘including possible movement of silicone to other parts of the body, inflammation and discoloration of surrounding tissues and the formation of granulomas.’

AAD Association.org Policy on Injectablel Silicone
Silicone Injections Injuries

Injectable Silicone Complications
ASAPS News Release on Liquid Silicone Injections
Are you looking for a Doctor to remove the silicone that you pumped in your cheeks, hips , and etc?  A number of girls who were pumped from 5 to 25 years ago ARE CURRENTLY HAVING IT REMOVED DUE TO PROBLEMS .     It may look good for now however, it does travel baby , with time you will see.   

Dr. Cardenas is the only Doctor who is currently has the most experience with this procedure of removal.
 
Island Goddess does not endorse having  injectable
silicone
'pumped' into the body issues.  It is illegal and not safe!
 
Aunty Anita

 Facial Wrinkles and Reconstruction with Injectables

Restylane and Injectables-at-a-Glance
Shorelaser Augmentation-Collagen and Restylane

Injectables and Fillers
Silicone Facial Aesthetics

Hormone Therapy
 

HRT (hormone repalcement cream)  
Menest
Isoflavanoids -plant estrogen hrt

Herbal HRT  
Hamilton Center HRT
I




          Anne , Tina and I have had our SRS since 76/77 . After a woman reaches 40-45  her natural  hormonal
          makeup changes. We have found the following combination has worked for us . It has changed our lives in
          many ways. Our libido is like when we were younger. Consult your Doctor and feel free to speak or email me.
     
     This has been a godsend for me and others.  Anita
         These are the medications:
         1} Premarin = 1.25 mg -take 2 orally daily
         2).Estratest =  1 tablet -take orally daily
         3).Premarin Vaginal cream w/applicator -apply within 1 to 2x a week
  Estrogen Therapy for MTF Transsexuals
      This issue I thought I'd digress from my usual "do it yourself" topics to something you should not "do yourself"
       - the use of estrogens by transsexuals. Most of this admittedly technical information I obtained from research
      at the Santa Clara Valley Medical Center library, though literature is scarce on the subject even there.

     Estrogens are powerful steroid hormones, chemicals which affect the form and function of the body and its organs.

     There are three basic human estrogens: estradiol, estrone, and estrial. Estradiol is the most active form and estrial is
     the least active. In women, large amounts of estrogen are produced by the ovaries, and in men a small amount is
     present due to chemical conversion of testosterone.

     Once you are grown and genetic male traits are fully developed, the only way your body organs have of knowing
     what sex you are is by the levels of male and female hormones which are present. Changing the hormone balance
     from male to female with drugs causes tissues which are supported by male hormones to diminish and stop
    functioning and those which are supported by female hormones to develop and begin functioning.

     If your doctor has prescribed estrogens for you, it is probably in the form of Estinyl (ethinyl estradiol), Premarin
     (conjugated estrogens, a mixture of the three estrogens plus estrogen breakdown products) or injections (such as
     estradiol valerate). Though it would seem to be desirable, no suppository form of estrogen is available except as
      in the form of D.E.S, a drug which is not in favor today.  The most powerful single oral dose is the 0.5 milligram
     Estinyl tablet, but faster results can be obtained by using two or even all three of the Estinyl, Premarin, and injections.
     Any of the three will produce in time a certain amount of bodily feminization. (Note: Premarin alone has been shown
     to be unable to reduce blood testosterone levels to a female normal, though Premarin alone does produce feminizing 
     effects, albeit slowly.

      Also: generic Premarin has become suspect as to its quality, potency, and purity - many pharmacists discourage
     use of the generic, or suggest that dosages of the generic be increased relative to the dosage of the brand name
      Premarin product.) The effects include breast development (usually slight to average development; occasionally
      nearly none or quite a lot, depending on genetics and body type), reduction in size and firmness of the testicles and
      prostate gland, some reduction and repatterning of body hair, softening of the skin, recontouring of the body due to
      accumulating layers of feminine body fat, a considerable reduction or elimination of (masculine) sex drive, and
      improved effectiveness of facial hair removal by electrolysis.

      Testosterone levels in the blood drop to very low levels due to effects of estrogen on the brain and directly upon
      the testicles. Since testosterone tends to fuel the male emotional characteristics of aggression and competition,
      many patients report feeling more mild or tranquil. Reduction of male hormone levels may also clear up acne and
      excessively oily skin. Little or no changes in voice quality can be expected, though sometimes a slight increase in
      range is noted.

      The cost of oral hormone supplements is not excessive. Typical prices are: Provera 10 mg. 100 units, $40
      (generic medroxyprogesterone HCL is much less.); Premarin 2.5 mg 100 units, $45 (generic less but not
       recommended);  and Estinyl 0.5 mg 100 units, $55 (no generic available). Injections may run $15-40 plus office
      visit charges. Black market prices for the above begin at about three times the pharmacy cost.

      Choice of an endocrinologist is best made by personal referral, either by a friend or therapist. The regimen and
      requirements of doctors varies widely, as does their level of experience in this very specialized field. Many
      doctors require concurrent counseling by a psychiatrist or psychologist.

       If you experience any dissatisfaction with your therapist or doctor, a consultation with another may produce
       different results. There is little concrete knowledge of transhormonal therapy in the medical profession, and research
       on the subject is scarce - your doctor's expertise is probably mostly due to his or her experience. At the very least,
       your doctor should have good general experience in the administration, effects, and side effects of female hormones, and
       be aware of the Standards of Care (the Harry Benjamin International Gender Dysphoria Association criteria for surgical
       and hormonal treatment of transsexuals.)

       Your doctor may be cautious in prescribing large amounts of estrogens to you if you have any of the following
        history or symptoms: high blood pressure, any heart disease or defects, clotting disorders such as phlebitis, stroke
        or cerebrovascular disease, liver function abnormalities, a history of heavy alcohol intake, kidney disease, migraine
        headaches or seizures, diabetes, family history of breast cancer, obesity, or heavy smoking.

       Periodic checkups with your doctor are required to spot early signs of certain dangerous conditions. Among these
       are: benign or malignant tumors of the liver, breast, pituitary gland (in the brain), and kidney, along with phlebitis
       and elevation of blood pressure. Heart attack (myocardial infarction) and stroke have been reported in relatively
       young transsexuals receiving estrogens, especially those with clotting disorders. Changes in a part of the prostate
       gland known as the verumontanum can cause blockage of the urinary tract after long term use - this must be
       corrected surgically. Lactation or discharge from the breasts can be a sign of a potentially dangerous pituitary
       gland condition.

      Your doctor will administer periodic blood tests and may check the following: testosterone (should be less than 85
       nanograms per 100 milliliters), prolactin (should be less than 45 ng/ml), liver function scans, and clotting time. He
       may also feel your breasts for lumps and listen to blood flow in your major veins and arteries.

       Once you have been using estrogens for a year or more, some effects may become irreversible even if estrogen
       intake is ceased. Certain chemical processes in the brain remain in a female pattern permanently, and changes in
       brain wave patterns have been reported. These effects may or may not be associated with emotional and personality
       changes. Breasts and female fat distribution may not subside after administration of estrogens, and sex drive may  
       remain relatively low. For these reasons, it is important to be certain of your committment to feminization of your
       body.

       Sudden changes in dosage of estrogens, either increasing or decreasing, have been known to produce severe
       mood changes. The effects may be likened to going through menopause, puberty, and pregnancy at the same
       time. Lethargy, depression, anxiety, difficulty in concentration, headaches, abdominal cramping, nausea, and other
       symptoms have been noted for periods of days or weeks. It may be wise to change dosages as gradually as
       possible. (Despite what your doctor may tell you!)

       Changes in metabolism are common, with weight gain, water retention, and increased appetite as the major effects.
        Estrogen reduces the ability of the body to eliminate certain drugs such as Valium so that smaller dosages of these
        medications become as effective as larger dosages were before. This is also true for alcohol so be sure to reassess
        your limits - this explains why the tolerance for alcohol of women is typically less than that of men. Any physician
        you deal with should know of any medications you are taking - with surgery this can be critical due to the effects of
       estrogen on the blood clotting rate.

       After genital surgery, estrogen doses may be greatly reduced if the desired degree of feminization has been
       achieved. Since the testicles are now absent, it is no longer necessary to suppress testosterone production. Risk
       factors are believed to be in proportion to dosage, so the minimum effective dose is preferred for long term use.
       This means reducing dosage by a factor of one fifth to 1/20th of previous levels.

       Risks of estrogen use can be minimized by having injections alone. Injections of Delestrogen, Estradurin, etc.
       cause the estrogen to enter the bloodstream directly, without the first pass through the liver. This means the liver
       works much less hard in metabolizing the estrogen, and can return to doing the normal work that the liver does in
      digesting food and eliminating toxins. Injections are given deep into the muscle tissue of the buttocks, once a week
       to once a month. The effects are similar to the higher doses of oral hormones, and sometimes it appears that
       feminization progresses further with injections than with orals. If the injections are done at a doctor's office, the
       costs may be about equal to the cost of oral pills - but individual doctors' rates and charges vary a lot in this area.

       Generally, an endocrinologist who prescribes injections can be persuaded to teach you to administer the injections
        yourself, with a short training session. By doing the injections yourself, and buying generic versions of the
       injectables, you can save up to 90% of the costs of oral hormones, making this by far the least expensive
       alternative. If you are going to be using hormones the rest of your life, and wish the safest, most effective, and
       cheapest method, then make self-injection your goal.

       It is thought that estrogens should be taken along with a progestin (a chemical with effects similar to progesterone)
       such as Provera (medroxyprogesterone). A progestin will tend to maximize breast development due to enlargement
       of the milk sacs themselves (as opposed to breast fatty tissue) and will approximate more closely the natural female
       hormone balance. A more natural hormone balance may provide some shielding against some of the hazards
       mentioned previously. Also progestins greatly reduce male sex drive. I could find no agreement in the literature as
       to the recommended dosage but higher dosages seem to pose no known risk.

       REAL progesterone in the form of capsules is now available, but rather expensive ($1.25 to $5.00 per daily dose).
       Real progesterone is available as an injection also, at a very low price - the disadvantage is that the effects last
       only 3-4 days, so an injection twice a week might be called for. Real progesterone has ALL the benefits of
       progesterone, instead of only some of them as with progestins. Most doctors who give injections use Delalutin
       (hydroxyprogesterone caproate) instead of real progesterone, but the TS giving herself her own injections might
       consider using real progesterone instead, because of the reduced costs.

       Proper medical management of estrogen administration can reduce the hazards and maximize the benefits of
       transhormonal therapy. It makes good sense to know the facts and follow medical advice when using these
       powerful drugs.
     
       SOURCE: FEMINET