DOCTALK 

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the views or positions of DOCTALK or the TerraNet. 

(AO) Hello, ladies, gentlemen, and others! Today on DocTalk 
we have a special guest, DocTalk's own DR DOCTOR!. DR 
DOCTOR is here to talk with us about hormones--what they 
are and how to use them wisely. 

Those of you in our audience should feel free to ask DR 
DOCTOR your own questions about hormones. You can leave 
DR DOCTOR your own questions about hormones either 
publicly or privately on the DOCTALK GID conference. 

Welcome to DocTalk's GID conference, doctor. Thank you 
for coming. 

(DR) Thank you for having me, Anne. 

(AO) First of all, doctor, are you any relation to Dr. Richard 
Doctor, the author of "Transsexuals and Transvestites"? 

(DR) None at all, Anne. 

(AO) Doctor, what ARE these things we in the transgendered 
community call "hormones"? We toss around terms like
"Medroxyprogesterone Acetate", but really don't under-
stand these drugs and what do they do. 

For example, I took 2.5mg pills of Premarin, sometimes 
called "purple footballs", three times daily prior to 
surgery. What did I take, and what did that do to my 
body? On the outside, I could see and feel some of the 
changes. The fat layer under my skin got thicker, 
giving me smooth, fair "female" skin and my breasts grew 
and were sore for several months. My body hair became 
finer and lighter, but didn't go away. It didn't affect 
my voice much. I lost interest in sex and quit 
masturbating. I became weepy and irritable for the first 
few weeks. That was what I saw. Now, what was causing 
all this? 

(DR) You're asking a lot of tough questions, Anne. I'll do my 
best to answer them but I also want to preface these 
comments by a few caveats. You must realize that there 
are literally volumes written on hormones and what we 
learn about them today will be obsolete tomorrow.
Furthermore, the definition of what chemical substance is 
and is not a hormone is changing. Furthermore, I am not 
an endocrinologist nor do I claim to be anything other 
than a family practitioner so what I say will be 
simplistic and most likely open to debate. That said we 
can proceed. As traditionally defined, a hormone is a 
complex chemical substance produced in one part or organ 
of the body that initiates or regulates the activity of 
an organ or group of cells in another part of the body. 
The production of these hormones are in turn tightly 
regulated by other hormones, by neurotransmitters and by 
a whole host of feedback systems. In other words, 
hormones cause other widely dispersed organs and groups 
of cells in the body to change their behavior which in 
turn changes the production of the hormone. Sometimes 
the question, "Which came first? The chicken or the 
egg?" applies to the discussion of hormones. When I was 
going through medical school we had to memorize 
complicated relationships between cells in the brain that 
triggered the production of hormones in other organs 
(such as the thyroid gland) which in turn produced 
hormones that altered the activity of a number of organ 
systems. We then had to trace arrows back to the hormone-
producing gland and to the brain and try to memorize what 
would happen if any one of the tightly integrated bits 
would falter. It was very confusing to say the least. 
Especially since it seemed each month a new set of arrows 
and chemicals were introduced into the picture based on a 
new discovery! No matter how I tried to simplify the 
picture it only grew more and more complex. 

To make it easier to comprehend I formed an analogy that 
helps. I now think of the body as a country, like the 
good old USA. Organs represent various states, groups of 
cells are cities, and so on... Hormones in this scheme 
are laws. Some of these laws are made by the Federal 
government, some by State institutions, others by cities 
and municipalities and finally some are by individual 
families. 

With a few notable exceptions, most laws are usually 
designed to regulate the behavior of certain individuals 
and groups of people rather than everybody. They are 
usually written in response to a need. For example, 
corporate tax laws are written for corporations and do 
not apply to individuals. Laws that prohibit the owner-
ship of both television stations and newspapers was 
written to keep a few people from controlling the news. 
As such they do not apply to those who do not own tele-
vision stations or newspapers. Unfortunately, while the 
effect of a given law on a specific group of people can 
be predictable it can often produce strange effects on 
another group of people. This usually sets off a cascade 
of events that may or may not wind up in the law being 
altered or another law being written to modify the effect 
of the first law. If a person fits into a certain 
category then that law will directly affect them causing 
them to alter their behavior. Other people may never be 
bothered nor will their activity be changed by the 
presence of the law. Hormones are like that. Once 
released into the bloodstream they have wide-ranging 
effects depending on the cells in question. Some cells 
will respond to the hormones, others won't. 

How do hormones work? Well there are many differences 
but in general they work by attaching themselves to a 
given cell and switching on or off a whole series of 
chemical reactions. Some actually enter the cell. 
Others do this by changing throwing a switch (if you will) 
on the surface of the cell. 

You mentioned one hormone, Medroxyprogesterone Acetate. 
It is one of a group of hormones we conveniently call SEX 
HORMONES (specifically estrogens and progestins). 
Furthermore it is a STEROID hormone ... that is, the 
backbone of the molecule is a steroid structure formed in 
large part from cholesterol. All steroid hormones work 
in the same fashion. They generally enter a cell by 
diffusing into it through the cell membrane. Furthermore 
they then enter into the nucleus of the cell, bind to 
chromatin and activate the production of RNA which 
eventually leads to a production and manufacture of a 
host of other enzymes and proteins. These enzymes and 
proteins can change the behavior of that cell. Picture a 
cell as an automobile factory. The hormone is a new 
executive with a lot of clout. This executive enters the 
plant, starts influencing the engineers, accountants, and 
other executives who then start making a whole lot of 
design changes to the plant and viola! Before too long 
entirely different set of automobiles start rolling off 
the assembly line. All because of one little tiny 
executive. Do you start to get the picture of why such 
low doses of hormones have such wide-ranging effects? 
You can also see why it is so important that the body 
devise clever ways to stop the production of these 
chemicals and why that regulatory mechanism is so complex. 
One of the ways the body does this is to set up the 
hormone so that a change in one little part of the complex 
molecule turns it from an active hormone to an inactive 
one. That way very little energy has to be expended to 
turn it on or off thereby avoiding the complete 
destruction and rebuilding of a hormone each time it is 
needed. Why I often marvel at the economics of the body 
it is often exactly this mechanism that makes 
pharmaceutical firms angry as hell! If one were to make 
a "natural" progesterone, identical to the one the body 
produces and introduce it into the body ... it will be 
broken down and inactivated rapidly by the liver and in 
order to produce the "un- natural" changes desired very 
large doses would have to be given many times a day. On 
the other hand, "natural" chemicals might produce too 
many changes in other cells because of the large "un-
natural" doses required producing bad side effects. All 
chemists in the business know "it's not nice to fool 
mother nature!" For this reason most of the pills we 
take are LOOK-ALIKES that have been made to act on the 
target cells but are different enough so they will not 
be deactivated and usually have less side-effects than 
the "natural" chemical whose action they are mimicking. 

MEDROXYPROGESTERONE ACETATE (one of the specific hormones 
you asked about) is a PROGESTERONE look-alike. 
PROGESTERONE is mostly produced by the ovary but a small 
amount is also produced by the adrenal gland (the small 
gland located above the kidneys) and during pregnancy 
enormous amounts of PROGESTERONE along with ESTROGEN are 
produced by the placenta. ESTROGEN and PROGESTERONE 
stimulate pubertal changes (growth and maturation of the 
uterus, breasts; stimulation and then limitation of 
skeletal tissue). These hormones, later on in a woman's 
life maintain the breasts, uterus, vaginal and urethral 
lining. They also affect a persons metabolism, how 
proteins are transported and how electrolytes are balanced 
within the body. Maybe you can now get and idea why a 
woman's breast tissue decreases, the vagina dries out and 
why bones become brittle after menopause. It is also for 
these very reasons that you had all of those changes. 

You took PREMARIN, a combination of estrogenic (estrogen-
like) substances. Principally ESTRONE and EQUILIN. 
These are substances similar to the type excreted by 
pregnant mares (remember what I said about large amounts 
of estrogen and progesterone being produced during 
pregnancy by the uterus? Imagine how much a horses uterus 
would produce!). By taking this hormone you changed the 
laws for a number of cells in your body. Specifically, 
any cell that responds to estrogens and progestins. 
These include fat cells, breast tissue, hair follicles. 
You blunted or threw you libido completely out of whack 
by confusing the signals to your brain to which you 
responded sexually. Confusing the regulatory system (of 
which the brain and the chemical transmitters that relay 
messages between brain cells are an integral part) 
probably induced many of the "weepy and irritable" 
feelings you had for the first few weeks. Eventually the 
body will adapt. My big problem with this, as a 
physician, is that we often don't know what we are doing. 
We try to duplicate the regulatory actions of organs when 
a person is very ill by replacing electrolytes, fluids, 
boosting or suppressing immune systems, relaxing or 
tightening blood vessels. Often we feel as if we are 
trying to take a large rubber ball and force it into a 
cube. We can get one side flat with one hand and maybe 
another side flat. But when we press on one side another 
side bulges out. You can imagine my reluctance to go 
about and mess with a "healthy" person by changing the 
rules of the game for his body through hormones. It is 
also why I cringe when I see so many young athletes 
gobbling steroid hormones of one sort or another to 
enhance their appearance or performance. There's no 
telling what they are doing to a number of other organs... including their minds! 

Well, that's enough for now. I hope this hasn't confused 
you even more. Got another question?