HRT likened to ‘2nd puberty’
Convicted soldier would get hormones
Following his conviction and 35-year sentence for leaking national security documents to WikiLeaks, Army Pfc. Bradley Manning announced that he intended to live in prison as a woman named Chelsea and expected the Army to make him a female.
That request raised a host of legal and medical issues for the Army and a lawsuit is likely.
What exactly is Manning requesting?
It’s called hormone replacement therapy, or HRT. The procedure alters the body’s balance of sex hormones — estrogen for male-to-female and testosterone for female-to-male transitions.
Sometimes, male-tofemale patients will also be given progesterone, another steroid typically produced by the ovaries, as well as a testosterone blocker, such as spironolactone.
“It basically initiates a second puberty. The full effects of that will typically take two to three years,” said Marci Bowers, a California-based gynecologist and surgeon who has performed hundreds of gender-change operations over the past decade.
Not all patients getting hormone replacement therapy have surgery, either because of cost or personal preference.
Continuous doses of female hormones will cause a male to see changes within the first few months of therapy like softer skin, fat and muscle rebalancing, and breast development. Those changes start to become irreversible within six to nine months.
The degree of effects of hormone therapy varies considerably among individuals. For example, the younger a patient starts hormones, typically the better they work, said Grace Kim, a Washingtonbased psychologist who has a number of transgender patients. Bowers added that many patients continue some form of hormone therapy after surgery. Manning is 25. JoAnne Keatley, the director of the Center of Excellence for Transgendered Health at the University of California at San Francisco, calls the medication “very expensive” and can run about $400 a month for those without coverage or whose insurance won’t cover it. The hormones may come in pill or injectable form.
“It’s a legitimate medical treatment that patients need access to, and being without it can lead to negative health outcomes including suicide,” Keatley said.
However, HRT has its limits. That’s where reconstructive surgery can come into play. Masculine characteristics such as height, facial features and voice are not affected by changes in sex hormones. The Philadelphia Center for Transgender Surgery, one of only a handful of such clinics in the nation, performs breast augmentations and genital surgeries, as well as facial feminization procedures tailored to patients’ needs.
At the Philadelphia site, the total cost for male-tofemale surgery is $19,150, which covers the surgery, operating room and anesthesia fees, and three days in the hospital, according to the clinic’s website.
But before surgery, patients must live in their preferred gender role for at least a year and typically undergo hormone therapy during that time, Bowers said. A psychological evaluator will typically recommend the hormones, which are prescribed by a doctor.
Before allowing a patient to go through genital surgery, the Philadelphia Center for Transgender Surgery generally requires hormones for a year, presenting full time as the other gender for a year, and letters from two men- tal health specialists.
One of the center’s most notable patients is Renee Ramsey, an ex- GI and Green Beret who wanted to transition to a female her entire life. In 2007, the then 76-year-old had her first operation performed by surgeon Sherman Leis. At 80, she completed all her surgical procedures.