2 months back at trading (update) and some new questions
Hi all, I posted a thread back a few months ago when I started getting seriously back into trading after 20 years away. I thought I'd post an update with some notes on how I'm progressing. I like to type, so settle in. Maybe it'll help new traders who are exactly where I was 2 months ago, I dunno. Or maybe you'll wonder why you spent 3 minutes reading this. Risk/reward, yo. I'm trading 5k on TastyWorks. I'm a newcomer to theta positive strategies and have done about two thirds of my overall trades in this style. However, most of my experience in trading in the past has been intraday timeframe oriented chart reading and momentum stuff. I learned almost everything "new" that I'm doing from TastyTrade, /options, /thetagang, and Option Alpha. I've enjoyed the material coming from esinvests YouTube channel quite a bit as well. The theta gang type strategies I've done have been almost entirely around binary event IV contraction (mostly earnings, but not always) and in most cases, capped to about $250 in risk per position. The raw numbers: Net PnL : +247 Commissions paid: -155 Fees: -42 Right away what jumps out is something that was indicated by realdeal43 and PapaCharlie9 in my previous thread. This is a tough, grindy way to trade a small account. It reminds me a little bit of when I was rising through the stakes in online poker, playing $2/4 limit holdem. Even if you're a profitable player in that game, beating the rake over the long term is very, very hard. Here, over 3 months of trading a conservative style with mostly defined risk strategies, my commissions are roughly equal to my net PnL. That is just insane, and I don't even think I've been overtrading. 55 trades total, win rate of 60%
33 purely directional trades - 57.5% win
18 long call or long put positions, +692, 55% win
15 call or put verticals, -121, 60% win
22 neutral / other trades
13 iron condors, +345, 77% win rate
7 strangles, -163, 71% win rate
1 straddle, -310, 0% win rate
1 butterfly, -83, 0% win rate
PTON call purchased and held through earnings, sold the morning of announcement +410
Trading the range on the daily chart in GLD from 158 up to 165, a mix of various calls +245
NKLA 30 put purchased before the close on the day it went north of 100, just a pure fade +215
EWZ 22/26 strangle that I held just way too long as it beat me up day after day from May 20-Jun 3, -316
ZM pre earnings vertical, fading another 2 SD move (the day it hit 200 for the first time). Was expecting a post-earnings selloff given the magnitude of the up move. Stock basically hasn't had a down tick since. Max loss -247
EWW 29 straddle, put on around the same time as the EWZ strangle. Rolled from Jun to Jul to no avail. Out at a -310 loss.
This is pretty much where I expected to be while learning a bunch of new trading techniques. And no, this is not a large sample size so I have no idea whether or not I can be profitable trading this way (yet). I am heartened by the fact that I seem to be hitting my earnings trades and selling quick spikes in IV (like weed cures Corona day). I'm disheartened that I've went against my principles several times, holding trades for longer than I originally intended, or letting losses mount, believing that I could roll or manage my way out of trouble. I still feel like I am going against my nature to some degree. My trading in years past was scalping oriented and simple. I was taught that a good trade was right almost immediately. If it went against me, I'd cut it immediately and look for a better entry. This is absolutely nothing like that. A good trade may take weeks to develop. It's been really hard for me to sit through the troughs and it's been even harder to watch an okay profit get taken out by a big swing in delta. Part of me wonders if I am cut out for this style at all and if I shouldn't just take my 5k and start trading micro futures. But that's a different post... I'll share a couple of my meager learnings:
Larger bid/ask spreads make it almost impossible to trade the higher priced names, even if you have a correct assumption. I have traded some bigger underlyings during this time like LULU and NVDA. They are just tough fills, both getting in and getting out. I almost want to say that you shouldn't even bother trading underlyings bigger than a 10 cent bid/ask spread with a small account.
Get an idea of the timeframe you're interested in holding before putting anything on. Have a plan for entering and exiting everything that goes beyond "I'll take this trade off at 50%". You can use TA, you can use a news catalyst, a binary event, just have something. Countless sources out there talk about trading a plan. It doesn't have to be the perfect plan, it just has to be "a" plan.
Undefined risk trades in tiny accounts need hard stops. Yes, some of the studies say that you'll do better without having fixed stop loss rules (50% of max loss, 100% of max loss) -- but what the studies don't say is the effect that it will have on you, mentally. I got pretty bent out of shape over how badly EWZ and EWW went against me -- much more than I expected. It made no sense, as I've lost way more on the turn of a card in .5 seconds and been unfazed. I was unprepared for the mental toll that it took waking up day after day, watching positions move further and further against me. Great time to be short calls during the mother of all rallies.
My initial plan for undefined risk trades in my account was that I would only do them in ETFs. Logic being that I'm just not going to wake up to an accounting scandal or a buyout and take a $1k loss on the chin. I later expanded my range into lower priced underlyings like BBBY, TLRY, and yes, AAL. But these ETFs can and do move (I learned the hard way) and can soak up a surprising amount of BP. It might be better to have 5 iron condors taking up $1000 of BP @ 200 each instead of 2 strangles @ 500 each.
My new questions :
My big wins felt like I simply leaned on my TA background or got lucky. My big losses, I sure felt like I earned those, through mistakes I've definitely since identified. The stuff in the middle, I'm just not sure. I'm up money, but it feels like I'm just spinning my wheels. My win rate is good, but I still struggle with expectations about how quickly a trade should progress. What is the next step of the process for a newer options trader? I've read some stuff on narrower spreads + more contracts vs. wider spreads and fewer contracts. Is there a number where I should just keep doing what I'm doing until I reach a specific # of occurrences? Should I even think about branching out into different strategies yet (ratio spreads, jade lizards, etc) or continue to work on these basics?
I still feel like I am super weak in delta management. In some cases I feel like I've taken a loss simply because I didn't know what the proper management techniques were. I understand the concept of rolling out in time for a credit, but I just don't think it's in my nature to hold trades for longer than a month, and even that is hard for me. At what delta is it appropriate to start thinking about hedging?
Every time I put on a credit spread for a 2-3 day move and am directionally correct, I often wish that I had just bought a naked option. I've caught several big moves this way in things like AAPL; most recently I bought the FB dip to the 50 day MA around 215 and took it off today at 225 (which was always my plan) -- it leads me to wonder if my expectations for credit spreads are completely out of line. I can't lie, it feels bad to catch a 10 point move and only make $40, haha. What is the ideal timeframe for a credit spread to be left on? Is it better to just buy premium with a stop loss and have a more profitable risk/reward equation for situations like the above where the only intent is to hold for a couple days?
Here's a random question -- other than when the BPR hit is too much (ie names over $50) for undefined risk, would you rather hold 1) a strangle for 10-14 days or 2) an iron condor for 25-30 days? So far my criteria for IC vs strangle has largely been driven by the risk profile and BPR and not so much profit potential in X number of days. If you're collecting the standard 1/3rd on the IC and taking the trade off at 50% (if you're lucky) , it seems like it takes about a month to get there, most of the time.
That's enough of this wall of text for now. If you made it this far, I salute you, because this shit was even longer than my last post.
A trans person's measured take on the trans sports issue
So first of all this post was inspired by GGExMachina's brief statement on the issue:
For example, it is objectively the case that biological men have a physical advantage over women. Yet if someone points this out and suggests that transgender people shouldn’t be allowed to fight in women’s UFC, or women’s soccer or weightlifting competitions or whatever, suddenly you’re some kind of evil monster. Rather than saying that of course trans people shouldn’t be bullied and that we could perhaps have a trans olympics (like the Paralympics and Special Olympics), we are expected to lie.
I've found that this position is incredibly popular among liberals/left-leaning people, especially here on reddit. It seems like, once or twice a month, like clockwork, a thread stating more or less the same thing on /unpopularopinion or /offmychest will get thousands of upvotes. And while I completely understand the thought process that leads otherwise left-leaning people to come to such conclusions, I feel like the issue has been, broadly speaking, dishonestly presented to the general public by a mixture of bad-faith actors and people who have succumbed to the moral panic. And, as I've seen, there are plenty of people in this subreddit and elsewhere who are itching to be as supportive as they possibly can to the trans community but find themselves becoming very disillusioned by this particular issue. By making this post I hope to present a more nuanced take on the issue, not only in regards to my personal beliefs on what kinds of policies are best to preserve fairness in women's sports but also in regards to shining a light on how this issue is often times dishonestly presented in an attempt to impede the progression of pro-trans sentiments in the cultural zeitgeist.
Sex & Gender
The word "transgender" is an umbrella term that refers to people whose gender identities differ from those typically associated with the sex they were assigned at birth. According to the 2015 U.S. Transgender Survey, the approximate composition of "the trans community" in the United States is 29% Transgender men (Female-to-Male), 33% Transgender women (Male-to-Female), and 35% non-binary. (The remaining 3% were survey respondents who self-identified as "crossdressers", who were still included in the survey on the grounds of being gender non-conforming) While non-binary people, as a group, are probably deserving of their own separate post. the focus of this post will be on trans men and trans women. I will also be primarily focusing on transgender people who pursue medical transition with Hormone-Replacement-Therapy, as they are most relevant to the issue of sports. (Mind that while the majority of binary trans people fit into this camp, there is a sizable minority of trans people who do not feel the need to medically transition.) What do trans people believe about Gender? The views of transgender people in regards to Gender are actually pretty varied, although the most prominent positions that I've personally seen are best summed up into two different camps:
The "Trans-Medical" camp
Transgender people who fall into this camp usually consider Gender Dysphoria to be the defining factor of what makes somebody trans. The best way I can describe this camp is that they sort of view being transgender akin to being intersex. Only whereas an intersex person would be born with a disorder that affects the body, a trans person is born with a disorder that affects the brain. Trans people in this camp often times put an emphasis on a clinical course for treatment. For example, a person goes to a psychologist, gets diagnosed with gender dysphoria, starts hormone replacement therapy, pursues surgery, then emerges from this process of either cured of the gender dysphoria or, at the very least, treated to the fullest extent of medical intervention. This position is more or less the original position held by trans activists, back in the day when the word "transsexual" was used instead of "transgender". Though many younger trans people, notably YouTuber Blaire White, also hold this position. Under this position, sex and gender are still quite intertwined, but a trans man can still be considered a man, and a trans woman a woman, under the belief that sex/gender doesn't just refer to chromosomal sex and reproductive organs, but also to neurobiology, genitalia, and secondary sex characteristics. So someone who is transgender, according to this view, is born with the physical characteristics of one sex/gender but the neurobiology of another, and will change their physical characteristics, to the fullest extent medically possible, to match the neurobiology and therefore cure the individual of gender dysphoria. Critics of this position argue that this mentality is problematic due to being inherently exclusive to transgender people who do not pursue medical transition, whom are often times deemed as "transtrenders" by people within this camp. Many people find it additionally problematic because it is also inherently exclusive to poorer trans people, particularly those in developing nations, who may not have access to trans-related medical care. Note that there are plenty of trans people who *do* have access to medical transition, but nevertheless feel as if the trans community shouldn't gatekeep people who cannot afford or do not desire medical transition, thus believing in the latter camp.
The "Gender Identity" camp
I feel like this camp is the one most popularly criticized by people on the right, but is also probably the most mainstream. It is the viewpoint held by many more left-wing trans people, (Note that in the aforementioned 2015 survey, only 1% of trans respondents voted Republican, so trans people are largely a pretty left-wing group, therefore it makes sense that this position would be the most mainstream) but also notably held by American Psychological Association, the American Psychiatric Association, GLAAD, and other mainstream health organizations and activist groups. While people in this camp still acknowledge that medical transition to treat gender dysphoria can still be a very important aspect of the transgender experience, it's believed that the *defining* experience is simply having a gender identity different from the one they were assigned at birth. "Gender identity" simply being the internal, personal sense of being a man, a woman, or outside the gender binary. Many people in this camp, though, still often maintain that gender identity is (at least partially) neurobiological, but differ from the first camp in regards to acknowledging that the issue is less black & white than an individual simply having a "male brain" or a "female brain", but rather that the neurological characteristics associated with gender exist on more of a spectrum, thus leaving the door open to gender non-conforming people who do not identify as trans, as well as to non-binary people. This is where the "gender is a spectrum" phrase comes from. "52 genders" is a popular right-wing meme that makes fun of this viewpoint, however it is important to note that many trans and non-binary people disagree with the idea of quantifying gender identity to such an absurd amount of individual genders, rather more simply maintaining that there are men, women, and a small portion of people in-between, with a few words such as "agender" or "genderqueer" being used to describe specific identities/presentations within this category. It's also noteworthy that not all people in this camp believe that neurobiology is the be-all-end-all of gender identity, as many believe that the performativity of gender also plays an integral role in one's identity. (That gender identity is a mixture of neurobiology and performativity is a position held by YouTuber Contrapoints) Trans people and biological sex So while the aforementioned "Gender Identity" viewpoint has become quite popularized among liberals and leftists, I have noticed a certain rhetorical mentality/assumption become prevalent alongside it, especially among cisgender people who consider themselves trans-allies: "Sex and Gender are different. A trans woman is a woman who is biologically male. A trans man is a man who is biologically female" When "Sex" is defined by someone's chromosomes, or the sex organs they were born with, this is correct. However, there is a pretty good reason why the trans community tends to prefer terms like "Assigned Male at Birth" rather than "Biologically Male". This is done not only for the inclusion of people who are both intersex and transgender (For example, someone can be born intersex but assigned male based on the existence of a penis or micropenis), but also due to the aforementioned viewpoint on divergent neurobiology being the cause for gender dysphoria. Those reasons are why the word "Assigned" is used. But the reason why it's "Assigned Male/Female At Birth" instead of just "Assigned Male/Female" is because among the trans community there exists an understanding of the mutability of sexually dimorphic biology that the general population is often ignorant to. For example, often times people (especially older folks) don't even know of the existence of Hormone Replacement Therapy, and simply assume that trans people get a single "sex change operation" that, (for a trans woman) would just entail the removal of the penis and getting breast implants. Therefore they imagine the process to be "medically sculpting a male to look female" instead of a more natural biological process of switching the endocrine system form male to female or vice versa and letting the body change over the course of multiple years. It doesn't help that, for a lot of older trans people (namely Caitlyn Jenner, who is probably the most high profile trans person sadly), the body can be a lot more resistant to change even with hormones so they *do* need to rely on plastic surgery a lot more to get obvious results) So what sexually dimorphic bodily characteristics can one expect to change from Hormone Replacement Therapy? (Note that there is a surprising lack of studies done on some of the more intricate changes that HRT can, so I've put a "*" next to the changes that are anecdotal, but still commonly and universally observed enough among trans people [including myself for the MTF stuff] to consider factual. I've also put a "✝" next to the changes that only occur when people transition before or during puberty) Male to Female:
Breast development and nipple/areolar enlargement, including in some people, the development of mammary glands and the ability to breastfeed
Thinning/slowed growth of facial/body hair
Cessation/reversal of male-pattern scalp hair loss
Softening of skin/decreased oiliness and acne
Decreased muscle mass/strength
Widening and rounding of the pelvis
Changes in mood, emotionality, and behavior (anecdotally crying is way easier to do)
Decreased sex drive (anecdotally, taking progesterone helps a lot in regards to regaining sex drive, though attraction is often noted as being experienced a bit differently than how it feels with testosterone)
Decreased sperm production/fertility
Decreased testicle size
Decreased penis size
Decreased prostate gland size
Voice changes (As far as I've heard, most people only experience minor changes from transitioning in adulthood, so it's common to do vocal training on top of everything to actually get a female-passing voice. I'll add a ✝ here since vocal changes seem to be a lot stronger in people who transition before/during puberty)
Changes in body odor (It's been documented that men and women often times have different smelling body odor, and trans people commonly notice a change in this regard) *
Changes in how arousal, sexual pleasure, and orgasms are experienced *
Changes in facial complexion *
Slight changes in hair color, texture, or curl *
Slight changes in eye color *
Changes in alcohol/drug tolerance *
Experiencing pubescent skeletal development and bodily growth along female-typical lines, including both bodily size/shape and facial bone/cartilage features ✝
Female to Male:
Growth of facial/body hair
male pattern scalp hair loss (in some individuals)
Roughening of the skin and prominence of veins
Increased muscle mass/strength
Changes in mood, emotionality, and behavior (I forget the source for this sadly but I remember reading that trans men are significantly more likely to commit crimes and get into fights after starting HRT)
Increased sex drive
Cessation of ovulation and menstruation
Acne (especially in the first few years of therapy)
Alterations in blood lipids (cholesterol and triglycerides)
Increased red blood cell count
Deepening of the voice
Enlargement of the clitoris
Changes in body odor *
Changes in how arousal, sexual pleasure, and orgasms are experienced *
Changes in facial complexion *
Slight changes in hair color, texture, or curl *
Slight changes in eye color *
Changes in alcohol/drug tolerance *
Experiencing male pubescent skeletal development and bodily growth along male-typical lines, and closure of growth plates ✝
Often times, when the whole "transgender people in sports" discussion arises, a logical error is made when *all* transgender people are assumed to be "biologically" their birth sex. For example, when talking about trans women participating in female sports, these instances will be referred to as cases of "Biological males competing against females". As mentioned before, calling a trans woman "biologically male" strictly in regards to chromosomes or sex organs at birth would be correct. However, not only can it be considered derogatory (the word "male" is colloquially a shorthand for "man", after all), but there are many instances where calling a post-HRT transgender person "biologically [sex assigned at birth]" is downright misleading. For example, hospitals have, given transgender patients improper or erroneous medical care by assuming treatment based on birth sex where treatment based on their current endocrinological sex would have been more adequate. Acute Clinical Care of Transgender Patients: A Review
Conclusions and relevance: Clinicians should learn how to engage with transgender patients, appreciate that unique anatomy or the use of gender-affirming hormones may affect the prevalence of certain disease (eg, cardiovascular disease, venous thromboembolism, and osteoporosis), and be prepared to manage specific issues, including those related to hormone therapy. Health care facilities should work toward providing inclusive systems of care that correctly identify and integrate information about transgender patients into the electronic health record, account for the unique needs of these patients within the facility, and through education and policy create a welcoming environment for their care.
Some hosptials have taken to labeling the biological sex of transgender patients as "MTF" (for post-HRT trans women) and "FTM" (for post-HRT trans men), which is a much more medically useful identifier compared to their sex assigned at birth. In regards to the sports discussion, I've seen *multiple threads* where redditors have backed up their opinions on the subject of trans people in sports with studies demonstrating that cis men are, on average, more athletically capable than cis women. Which I personally find to be a pathetic misunderstanding of the entire issue. Because we're not supposed to be comparing the athletic capabilities of natal males to natal females, here. We're supposed to comparing the athletic capabilities of *post-HRT male-to-females* to natal females. And, if we're going to really have a fact-based discussion on the matter, we need to have separate categories for pre-pubescent and post-pubescent transitioners. Since, as mentioned earlier, the former will likely have different skeletal characteristics compared to the latter. The currentInternational Olympic Committee(IOC) model for trans participation, and criticisms of said model (I quoted the specific guidelines from the International Cycling Union, but similar guidelines exist for all Olympic sports)
Elite Competition At elite competition levels, members may have the opportunity to represent the United States and participate in international competition. They may therefore be subject to the policies and regulations of the International Cycling Union (UCI) and International Olympic Committee (IOC). USA Cycling therefore follows the IOC guidelines on transgender athletes at these elite competition levels. For purposes of this policy, international competition means competition sanctioned by the UCI or competition taking place outside the United States in which USA Cycling’s competition rules do not apply. The IOC revised its guidelines on transgender athlete participation in 2015, to focus on hormone levels and medical monitoring. The main points of the guidelines are: Those who transition from female to male are eligible to compete in the male category without restriction. It is the responsibility of athletes to be aware of current WADA/USADA policies and file for appropriate therapeutic use exemptions. Those who transition from male to female are eligible to compete in the female category under the following conditions: The athlete has declared that her gender identity is female. The declaration cannot be changed, for sporting purposes, for a minimum of four years. The athlete must demonstrate that her total testosterone level in serum has been below 10 nmol/L for at least 12 months prior to her first competition (with the requirement for any longer period to be based on a confidential case-by-case evaluation, considering whether or not 12 months is a sufficient length of time to minimize any advantage in women’s competition). The athlete's total testosterone level in serum must remain below 10 nmol/L throughout the period of desired eligibility to compete in the female category. Compliance with these conditions may be monitored by random or for-cause testing. In the event of non-compliance, the athlete’s eligibility for female competition will be suspended for 12 months.
Valid criticisms of the IOC model are usually based on the fact that, even though hormone replacement therapy provokes changes to muscle mass, it does *not* shrink the size of someone's skeleton or cardiovascular system. Therefore an adult-transitioned trans woman could, even after losing all levels of male-typical muscle mass, still have an advantage in certain sports if she had an excessively large skeletal frame, and was participating in a sport where such a thing would be advantageous. Additionally, the guidelines only require that athletes be able to demonstrate having had female hormone levels for 12-24 months, which isn't necessarily long enough to completely lose musculature gained from training on testosterone (anecdotally it can take 2-4 years to completely lose male-typical muscle mass) So the IOC guidelines don't have any safeguard against, for example, a trans woman training with testosterone as the dominant hormone in her body, and then taking hormones for the bare minimum time period and still having some of the advantage left. Note that, while lower level sports have had (to the glee of right-wing publications sensationalizing the issue) instances of this exact thing happening, in the 16 years since these IOC guidelines were established, not a single transgender individual has won an Olympic medal Also note that none of the above criticisms of the IOC policy would apply in regards to the participation of pre-pubescent-transitioned trans women. After all, male-pubescent bone structure and cardiovascular size, and male-typical muscle levels, can't possibly exist if you never went through male puberty to begin with. What could better guidelines entail, to best preserve fairness in female sports while avoiding succumbing to anti-trans moral panic?
The most extreme way for female sports to reasonably go about addressing this issue would be to only allow for the participation of transgender women who are documented to have, with puberty blockers, carried out their transitions without having gone past Tanner Stage II or III of male puberty.
Sports leagues willing to be a bit looser could accept adult transitioners under the stipulation that their bodily measurements in regards to certain skeletal features fit within a standard deviation of the cis-female average
Sports leagues willing to be even looser could copy the IOC guidelines, but require documentation of having gone through HRT for a greater period of time rather than just the 12 months, (3 years would probably be better) to guarantee full loss of male muscle mass
In my personal opinion, sports leagues should pick one of the three above options depending on what best fits the nature of the sport and the eliteness of the competition. For example, extremely competitive contact sports might be better off going with the first option, but an aerobic sport such as marathon running would probably be fine with the third option.
How this issue has been misrepresented by The Right
Right-wing rhetoric surrounding this issue assumes that the issue exists as an innate consequence of trans activism (Ie. "This is what the left is pushing!") rather than as a result of individual sports leagues failing to have solid rules for participation. Often times, certain low-level sports leagues have failed to even measure trans athlete's hormone levels, and have, in some cases, let completely male-bodied athletes participate as women. This is obviously the fault of these specific sports leagues failing to implement or enforce reasonable rules for participation, but right-wing articles surrounding such instances will act as if these occurrences are an ideological goal of the pro-trans left. This runs off of the assumption that a majority of trans people and "the left" are specifically pushing for muscular males (who merely "identify" as women, and nothing more) to dominate female sports. When, in reality, we really had nothing to do with these occurrences, and the majority of trans people would even likely agree with the sentiments expressed in this post. Additionally, accepting the gender identities of trans people is something you can do irregardless of your opinion on the sports issue.
Over-exaggeration of the problem. The issue is often sensationalized to the extent of coming off as a call to action, to stop the trans activists and their SJW bullies from ruining female sports! They're coming after your daughter's lacrosse team! In reality, out of the hundreds of thousands (perhaps even more) of sports competitions that exist in the United States and throughout the world, an incredibly small percentage of them are actually ruined by trans participants. You hear the stories of the 6'5'' trans woman with the broad frame winning a weightlifting competition, but not of the hundreds of more average-sized trans-female athletes turning out more mediocre performances. This isn't to say that the niche cases don't present a problem that indeed needs to be fixed, but presenting the problem as more prevalent than it actually is acts as a rhetorical strategy meant to provoke anger as well as a more dramatic response. Buying into this rhetorical strategy, especially if you're is already somewhat ignorant to the issue to begin with, will make it much easier to convince you of accepting drastic solutions to the problems. Ie. "ONLY XX CHROMOSOMES ALLOWED IN FEMALE SPORTS", instead of any of the three more measured approaches suggested above. The provoked response of anger is also meant to turn people off of accepting trans rights in general.
Infuriatingly, I've noticed that right-wing rhetoric usually doesn't even mention pre-pubescent transitioners at all. Like, these people are fine with acknowledging the existence of puberty blockers when they're trying to make them illegal, but they refuse to talk about them in regards to the sports issue. There have been cases where conservative jurisdictions have banned the participation of all transgender students in girl's sports, period. Meaning a transgender girl who never went through male puberty at all, and has pre-pubescent hormone levels as a result of puberty blockers, could be banned from participating in girl's sports, while in reality said trans girl could possibly even be at a disadvantage compared to the cis girls, as a result of not even having started puberty yet. Nonsensical. And liberal allies are at fault of this too, I've noticed. I've seen countless reddit threads where left-leaning people voice their take on the trans sports issue without mentioning the existence of pre-pubescent transitioners. It's honestly ridiculous.
The sports issue is also used as an excuse to say derogatory things about trans women that would be less justifiable in other instances.
I'll use Joe Rogan as an example of this last thing:
She calls herself a woman but... I tend to disagree. And, uh, she, um... she used to be a man but now she has had, she's a transgender which is (the) official term that means you've gone through it, right? And she wants to be able to fight women in MMA. I say no f***ing way. I say if you had a dick at one point in time, you also have all the bone structure that comes with having a dick. You have bigger hands, you have bigger shoulder joints. You're a f***ing man. That's a man, OK? You can't have... that's... I don't care if you don't have a dick any more... If you want to be a woman in the bedroom and you know you want to play house and all of that other s*** and you feel like you have, your body is really a woman's body trapped inside a man's frame and so you got a operation, that's all good in the hood. But you can't fight chicks. Get the f*** out of here. You're out of your mind. You need to fight men, you know? Period. You need to fight men your size because you're a man. You're a man without a dick. I'm not trying to discriminate against women in any way, shape, or form and I'm a big supporter of women's fighting. I loved watching that Ronda Rousey/Liz Carmouche fight. But those are actual women. Those are actual women. And as strong as Ronda Rousey looks, she's still looks to me like a pretty girl. She's a beautiful girl who happens to be strong. She's a girl! [Fallon Fox] is not a girl, OK? This is a [transgender] woman. It's a totally different specification.
Calling a trans woman a "man", and equating transitioning to merely removal of the dick, and equating trans women's experiences as women as "playing house" and "being a woman in the bedroom". These things are obviously pretty transphobic, and if Rogan had said these things about just any random trans woman his statements would have likely been more widely seen in that light. But when it's someone having an unfair advantage in sports, and the audience is supposed to be angry with you, it's much more socially acceptable thing to say such things. But the problem is, when you say these kinds of things about one trans woman, you're essentially saying those derogatory things about all trans women by extension. It's the equivalent of using an article about a black home invader who murdered a family as an excuse to use a racial slur. Now, I'm not saying that Rogan necessarily did this on purpose, in fact I'm more inclined to believe that it was done moreso due to ignorance rather than having an actual ideological agenda. But since then, many right wing ideologues who do have an ideological agenda have used this issue as an excuse to voice their opinions on trans people while appearing to be less bigoted. Ie. "I'm not trying to be a bigot or anything and I accept people's rights to live their lives as they see fit, but we NEED to keep men out of women's sports", as a sly way to call trans women "men". Additionally, doing this allows them to slip in untrue statements about the biology of trans women. I mean, first of all in regards to the statement "You have bigger hands, you have bigger shoulder joints", obviously even in regards to post-pubescent transitioners, not every trans woman is going to have bigger hands and shoulder joints than every cis woman (My hands are actually smaller than my aunt's!). It's just that people who go through male puberty on average tend to have bigger hands and shoulder joints compared to people who go through female puberty. But over-exaggerating the breadth of sexual dimorphism, as if males and females are entirely different species to each-other, helps to paint the idea of transitioning in a more nonsensical light. I hope this thread has presented this issue in a better light for anyone reading it. Let me know if you have any thoughts/criticisms of my stances or the ways I went about this issue.
Please be cautious when considering (and especially when recommending) finasteride.
Hey, everyone. So I wanted to make a quick post regarding Finasteride as I've seen some discussion about it here and in other trans communities. As much as I would love to announce a once-a-day pill that stops balding, that's not the case here, but it seems to be how Finasteride is often framed when brought up in spaces for trans men and transmasculine people. Finasteride will stop male pattern hair loss, but it doesn't work on the follicles of the scalp, specifically. What it's actually doing is blocking dihydrotestosterone (DHT.) DHT is indeed the culprit behind male pattern balding, so letting people know about the option of blocking it when they're worried about hair loss is great, but please keep in mind that DHT is also responsible for body and facial hair growth, and plays an important role in genital development as well. DHT, specifically, is pretty essential for developing features we associate with adult males, which is part of why Finasteride is sometimes used in hormone therapy for trans women. Like many, many things impacting AFAB trans people, there is a woeful lack of research on the subject. This is one of the only sources from an actual trans guy who tried it for himself that I was able to find: https://transguysupply.com/blogs/news/ftm-hair-loss The rest is anecdotal (though I guess the above is, as well), so take it with a grain of salt, but of the guys I know who tried it, the following problems were encountered (cw for cycle terminology): - No facial/body hair growth (which health care providers should warn about) - Possibly delaying muscle development - Possible interference with bottom growth - Menstruation not stopping - Menstrual cycles that stopped returning shortly after going on Finasteride I should mention that I do know of one non-binary transmasculine person who went on it to prevent scalp hair loss and has been happy with the results, as far as I know. As with everything else in this journey, ymmv. If anyone has personal experience and is comfortable sharing, please feel free to comment below so we can get more info out there. Tl;dr: Finasteride will stop scalp hair loss, but might also interfere with other changes people are hoping to get out of their transitions. Partake with caution, and please try to give people an honest, whole picture if you recommend it to them. Thanks, friends.
[LONG] My Story of Disillusionment with and Disappointment in the World and Myself
Intro. This might be a long one. I hope someone reads the thing, I put like 3 hours into writing it. A brief story of my life and how it all led up to this moment, where I am disillusioned with my self-image, my life choices, and certain aspects of the world, and have no idea what to do next. Warning: this whole thing might be a little depressing to read. Childhood. I am a 20yo Russian male. During my childhood, I was made to believe that I am capable of doing something great and doing better than anyone. At the same time I developed a very non-conformist life stance and very often rejected things and ideas simply because they were too popular for my taste, and I couldn't feel special whilst enjoying them. Of course, in turn, society rejected me, as it does with anyone who doesn't play by the rules. Oh well. My only redeeming quality was that I considered myself pretty smart. Which is even easier to assume, when at the same time you think that you're different from everyone else. Now, I know that to some extent, I was indeed smarter than most people in certain areas. Unlike most people I knew back then, often with bare minimum efforts I was able to maintain near perfect grades at school. I was also enjoying learning new things and reading more than an average person. So, let's just say, I had a basis to assume I was a smart dude. I wasn't happy and content with my life, though. I never had real friends, because I only hung out with people when they were my classmates/roommates/co-workers, and after we parted ways, I rarely if ever contacted them afterwards. I always enjoyed doing things you usually do in solitude more, because when I was alone, I wouldn't be afraid that someone could hurt me for being different. Because of that, I was never in a romantic relationship. High School. Still, life was going okay. By the end of school, I kind of accepted my social deficiency and I wanted to focus on improving the world and become a successful person - for myself. I was facing a dilemma, though. Despite the fact that I was doing great in school, the idea of having to invest four years of my time into studying something really specific, and then having to work another 20-30 years on the same job was terrifying, because I had no idea what I liked to do! Nothing seemed interesting to me, I didn't have a passion for doing anything... Thanks to my video game addiction, which made me lazy as fuck, probably. I also needed to meet my criteria for success with my future job, which included being financially successful. I grew up in top 1% income family, so... I always felt the pressure to outperform or at least match my parents' income. Enter trading. My dad discovered investing several years ago (we don't live in US, so most of the people aren't as financially savvy, so he never thought about investing before then). I was always curious about financial independence and markets, but now I was seeing it all done in front of me, I realized that it might be a good opportunity to make a lot of money and become successful without being socially adept, which is something absolutely required in business or politics. So, I asked my father to open a brokerage account for me in the US, and started swing trading (trading in weekly/monthly time frames). I could only trade slow and small because of the trade restrictions put on accounts <$25k and <21yo in the US. Still, it was going well, but in hindsight I was just lucky to be there during a great bull market. Even before I thought trading and more importantly investing were the ways smart people make money. I thought simply because I was conventionally smart, I had a talent or an innate ability to pick innovative stocks and do venture investing when I grow some capital. I truly believed in that long before I was introduced to financial markets, I believed that my surface level understanding of multiple areas of cutting edge and emerging technology would give me an edge compared to all the other investors. US Community College and Return Back. In the end, I've decided I want to go to a US community college and study finance and become a trader and later an investor, but I didn't want to work for a fund or something like that (lazy ass). I wanted to use my knowledge and skill and my own money to grow my net worth and make a living. I didn't really like the process of trading, I just needed the money to live by while I was trying to figure out what else to do with my life. Because I thought I were smart, I thought this would come easily to me. Boy was I wrong. From the nicest of conditions in my hometown, I was suddenly moved into a foreign setting, on the other side of the planet away form my family and mates, with a video game addiction and laziness that ruined my daily routine and studying as well. The fact that I didn't like my major was not helping. My grades fell from A- in the first quarter to C+ in the last. I gained +30% from my normal weight. I was stressed out, not going outside and sitting at my computer desk for days at a time, skipping all the classes I could if they were not absolutely essential for my grades, living on prepared foods. I never got out of my shell and barely talked to anyone in English, all of my friends were Russian speaking. I wasted an opportunity to improve my speaking, although aside from that my English skills satisfy me. By the end of community college, last summer, I was left with B grades that wouldn't let me transfer anywhere decent, and the extreme stress that I put myself through started taking a toll on my mental health. I was planning to take a break and go back to Russia for several months, and transfer back to a US uni this winter. Needless to say, you can't run from yourself. It didn't really become much better after a few months in Russia. I didn't want to study finance anymore, because it was boring and I was exhausted. I still had the video game addiction, still was lazy and gained some more extra pounds of weight. I was not sleeping at all, extremely sleep deprived for months. Because of this and lack of mental stimulation I started to become dumber. And all that was happening where I didn't really have to do anything: not study or work, just sit around the house and do whatever I wanted. Turns out, these conditions didn't help me to get out of the incoming depression. Finally, around November, when I already sent out all of my transfer applications and already got some positive answers from several universities, I knew I didn't have much time left at home, and I had to leave soon. But I really, really didn't want to go back. It was scarier than the first time. I was afraid of new changes, I just wanted for the time to stop and letting me relax, heal... I was having suicidal thoughts and talked about it with my family and my therapist. They were all supportive and helped me as much as they could. But I was the only person who could really help myself. If I wanted to breathe freely, I had to admit defeat and not go back to the US to continue my education. It was extremely hard at first, but then I just let go. I decided to find a temporary job as an English tutor and give myself time to think. Then I remembered that I had a bunch of money in my trading account. I still thought that I was pretty smart, despite failing college, so I figured, why not try move it to Russian brokers who don't have trading restrictions, and do it full time? Which is exactly what I did. And I started to study trading all by myself at a fast pace. I was now trading full time and it was going sideways: +10% in December, -20% in January. Then, something incredible happened. I was already in a shitty place in life, but I still had some hope for my future. Things were about to get much worse. I'm in the late January, and I discovered for myself that the whole financial industry of the world was a fraud. Brief Explanation of My Discoveries. In the image of the financial industry, there are several levels of perceived credibility. In the bottom tier, there is pure gambling. In my country, there were periods when binary options trading and unreliable Forex brokers were popular among common folk, but these were obvious and unsophisticated fraudsters who were one step away from being prosecuted. There are also cryptocurrencies that don't hold any value and are also used only for speculation/redistribution of wealth. There is also a wonderful gambling subreddit wallstreetbets where most users don't even try to hide the fact that what they are doing is pure gambling. I love it. But the thing is, this is trading/investing for the people who have no idea what it is, and most people discredit it as a fraud, which it, indeed, is. These examples are 99% marketing/public image and 1% finance. But these offer x10-1000 returns in the shortest time span. Typical get-rich-quick schemes, but they attract attention. Then, there is trading tier. You can have multiple sub levels here, in the bottom of this tier we would probably have complex technical analysis (indicators) and daily trading/scalping. I was doing this in the DecembeJanuary. At the top would be people who do fundamental analysis (study financial reports) and position trade (monthly time frames). Now, there is constant debate in the trading community whether technical analysis or fundamental analysis is better. I have a solid answer to the question. They work in the same way. Or rather, they don't work at all. You'd ask: "Why you didn't discover this earlier? You were in this financial thing for several years now!" Well, you see, unlike on the previous level, here millions of people say that they actually believe trading works and there is a way to use the available tools to have great returns. Some of these people actually know that trading doesn't work, but they benefit from other traders believing in it, because they can sell them courses or take brokerage fees from them. Still, when there are millions around you telling you that it works, even a non-conformist like me would budge. Not that many people actually participate in the markets, so I thought that by being in this minority made me smart and protected from fraudsters. Lol. All it took for me to discover the truth is to accidentally discover that some technical indicators give random results, do a few google searches, reach some scientific studies which are freely available and prove that technical and fundamental analysis don't work. It was always in front of me, but the fucking trading community plugged my ears and closed my eyes shut so I wasn't able to see it. Trading usually promises 3-15% gain a month. A huge shock, but surely there was still a way for me to work this out? Active investing it is! The next level, active investing, is different from trading. You aim for 15-50% yearly returns, but you don't have to do as much work. You hold on to stocks of your choice for years at a time, once in a while you study the markets, re balance your portfolio, etc. Or you invest your money in a fund, that will select the stocks of their choice and manage their and your portfolio for you. For a small fee of course. All of these actions are aimed at trying to outperform the gain the market made as a whole, and so called index funds, which invest in basically everything and follow the market returns - about 7-10% a year. And if I ever had any doubts in trading, I firmly believed that active investing works since I was a little kid (yes I knew about it back then). And this is where the real fraud comes in. The whole Wall Street and every broker, every stock exchange in the world are a part of a big fraud. Only about 10-20% of professional fund managers outperform the market in any 15 year period. If you take 30 years, this dwindles to almost nothing, which means that no one can predict the markets. These people have no idea what they are doing. Jim Cramer is pure show-business and has no idea what's going on. Warren Buffet gained his fortune with pure luck, and for every Buffet there are some people who made only a million bucks and countless folks who lost everything. Wall Street. They have trillions of dollars and use all that money and power and marketing to convince you that there is a way to predict where the stocks are going without being a legal insider or somehow abusing the law. They will make you think you can somehow learn from them where to invest your money on your own or they will make you believe that you should just give it to them and they will manage it for you, because they know how everything works and they can predict the future using past data. They won't. They don't. They can't. There are studies and statistics to prove it countless times over the span of a 100 years. But they will still charge you exchange fees, brokerage fees and management fees anyway. And they also manipulate certain studies, lobby where and when they need it, and spread misinformation on an unprecedented scale, creating a positive image of themselves. And everyone falls for that. Billions of people around the globe still think it's all legit. Passive index investing is the last level. You just put your money in the market and wait. Markets will go up at a predetermined rate. If there's a crisis, in 10 years no one will even remember. Markets always go up in the end. But passive index investing can only give you only 7% inflation-adjusted returns a year. Not enough to stop working or even retire early, unless you have a high-paying job in a first-world country. I don't. Despite all that, to put it simply, this is the only type of investing that works and doesn't involve any kind of fraud or gambling. It's the type of investing that will give you the most money. If you want to know why it is like that and how to do it, just go to financialindependence. They know this stuff better than any other sub. Better than investing, trading or any other sub where non-passive-index investing is still discussed as viable strategy. Back to me. My whole being was fucked over, my hopes and dreams and understanding of success and how this world works were shattered. I realized, I had no future in financial industry, because only middlemen make money in there, and I quit college needed to get there. Frankly, I wouldn't want to work there even if I had the opportunity. The pay is good, but the job is boring and I wouldn't want to be a part of this giant scheme anyway. But even if I wanted to go back, I also couldn't. Russia is in a worsening crisis and my parents could no longer afford a US university and now with coronavirus it's even worse. Good thing I quit before it all happened. I learned a valuable lesson and didn't lose that much money for it (only about 10% of my savings). God knows where it would lead me if I continued to be delusional. But now that my last temporary plans for the future were scrapped, I had no idea what to do next. The future. With the reality hitting me, I would lie if I say it didn't all come full circle and connect to my past. I realized that I was stupid and not intelligent, because I was living in a made-up world for years now. But even if I were intelligent, pure wit would not give me the success and fortune that I was craving, because trading and active investing were a no-go for me, and business/politics require a very different, extroverted mindset, different education and interest from my own. My only redeeming quality in a hopeless introvert world, my perceived intelligence was taken away from me and rendered useless at the same time. Besides, failing at that one thing made me insecure about everything and now I think of myself as an average individual. So, if 8 out of 10 businesses fail, I shouldn't start one because I will probably fail. And if most politicians don't get anywhere, why should I bother? If average salary in my country is X, I shouldn't hope for more. I stopped believing in my ability to achieve something. First, I failed at education and now I failed... Professionally? I don't know how to describe it, but my life recently was just an emotional roller coaster. I just feel like a very old person and all I want calmness and stability in my life. I was very lazy before just because, but now I feel like I also don't want to do anything because I feel I would just fail. It feels better now I don't have to worry about trading anymore and I got rid of that load... But I am still miserable and perhaps worse than ever, maybe I just don't understand and feel it because I've become slow and numb. The only positive thing that happened to me recently, is that I finally started losing weight and about 1/4 of the way back to my normal weight. As for my future, am looking at several possibilities here. So far the parents are allowing my miserable life to continue and they let me live with them and buy me food. I don't need anything else right now. But it can't go on like this forever. The thought of having a mundane low-paying job in this shithole of a country depresses me. I will probably temporarily do English tutoring if there's demand for such work. My old school friends want me to help them in their business and my dad wants me to help him in his, I and probably should, but I feel useless, pathetic and incapable of doing anything of value. And business just seems boring, difficult and too stressful for me right now. Just not my cup of tea. I am also looking at creative work. I love video games, music, films and other forms of art. I love the games most though, so I am looking into game dev. I don't really like programming, I have learned some during school years, but the pay would probably be higher for a programmer than an creator of any kind of art. However, I think I would enjoy art creation much more, but I don't have any experience in drawing and only some limited experience in music production. And I am not one of these kids who always had a scrapbook with them at school. Having to make another life choice paralyzes me. I am leaning towards art. I don't feel confident in my ability to learn this skill from scratch, but I think it's my best shot at finding a job that would make me happy. So perhaps, when this whole pandemic is over, I'll go to Europe and get my degree, get a job there and stay. American Dream is dead to me, and Europe is cheaper, closer, safe and comfortable. Just the thing for a person who feels like they are thrice their real age. Outro. Thanks for coming to my TED Talk. Special thanks if you read the whole thing, it means a whole lot to me, an internet stranger. But even if no one reads it, feels good to get this off my chest. I actually cried during writing some parts. Holy shit, this might be the longest and smartest looking thing my dumbed down head could manage to generate since college. I hope that you're having a great day. Stay healthy and be careful during this fucking pandemic. All the best.
Hormone Therapy for Transfeminine Non-Binary Individuals and Femboys 101
In the last few years there has been increasing interest in transfeminine hormone therapy for non-binary individuals. The goal of this form of hormone therapy is often to induce some but not all aspects of demasculinization and/or feminization. Sometimes the aim is to achieve a more androgynous or completely androgynous appearance. Other times it's to achieve a partially or fully feminine body with the sole exception of breast development. In some cases, the person may not even identify as "transgender" but rather as, e.g., a femboy. These are cisgender males who don't want genital reassignment surgery nor generally want decreased sexual function but nonetheless want to have more feminine bodies. See femboy, feminineboys, and femboytransition for relevant subreddits. Whatever the goal, these non-conventional transfeminine non-binary and even cisgender individuals are increasingly deciding to act on their feelings and pursue hormonal changes. I am a transgender woman, but I totally sympathize with these individuals, whether transgender or cisgender. Since this approach is very new and there is very little available that's written on this topic (including close to nothing in the published literature), I thought that I would do a write up on the topic. In this thread, I'll go over the various possibilities for non-conventional feminizing hormone therapy for non-binary individuals and femboys. It should be noted that the content in this thread is experimental and preliminary. There have been no studies of non-conventional hormone therapy for non-binary individuals as of present, and there are no standards or guidelines to inform this kind of hormone therapy. Instead, all of the information in this thread is extrapolated from theory and from research in other patient populations, such as cisgender men with prostate cancer and/or gynecomastia and transgender women. The content of this thread should be considered an exploratory "white paper" of sorts rather than as therapeutic recommendations or anything of the sort.
Conventional feminizing hormone therapy
In conventional hormone therapy for transgender women, otherwise known as male-to-female hormone replacement therapy (MtF HRT), the goal is to produce complete demasculinization and feminization. This is achieved by suppressing testosterone levels into the normal female range and increasing estrogen levels into the normal female range. It's generally done by administration of estrogens, which induce feminization and suppress testosterone levels (thereby providing demasculinization and permitting full feminization), and optionally by administration of antiandrogens or progestogens, which block or suppress any remaining testosterone that persists even with estrogen therapy. Medications used in MtF HRT include estrogens like estradiol and estradiol esters such as estradiol valerate; antiandrogens like bicalutamide, spironolactone, and GnRH agonists/antagonists; and progestogens like cyproterone acetate and progesterone. 5α-Reductase inhibitors like finasteride and dutasteride have been used as targeted antiandrogens that inhibit only specific androgenic effects, namely in skin and hair follicles. For a thorough introduction to feminizing hormone therapy for transgender women that covers the effects, medications, routes, and dosages, see Hormone Therapy for Transgender Women 101. In addition, see the Medications#Medications) section of the Transgender hormone therapy (male-to-female)) article on Wikipedia. If a non-binary transfeminine person or a femboy doesn't mind complete demasculinization and feminization, including breast development, then conventional feminizing hormone therapy can be employed. If this is not the case however and prevention or minimization of feminization or breast development are desired, things become more complex...
Achieving androgen deprivation
If the goal of non-binary hormone therapy is simply to achieve an androgynous appearance with minimal or no feminization, this can be achieved via deprivation of testosterone without concomitant administration of an estrogen. There are a number of ways to achieve androgen deprivation or testosterone suppression in people assigned male at birth. These include high-dose progestogen therapy, medical and surgical castration with GnRH agonists/antagonists or orchiectomy, high-dose androgen receptor antagonist therapy, and a few other miscellaneous possibilities. In this section, I'll discuss androgen deprivation largely from the standpoint of efficacy. There are issues with androgen deprivation alone in terms of tolerability and safety due to the co-consequence of estrogen deficiency however, which I'll discuss in the subsequent section. Testosterone suppression with high-dose progestogens Androgen deprivation can be achieved with high doses of progestogens, which suppress testosterone levels by up to 70 to 80%. This is a substantial decrease in testosterone levels, but isn't quite into the female range. Androgen receptor antagonists can additionally be included to block the remaining 20 to 30% of testosterone that isn't suppressed if desired. For these purposes, low-dose cyproterone acetate (e.g., 5.0–12.5 mg/day; link) plus bicalutamide (e.g., 12.5–50 mg/day) or spironolactone (e.g., 200–400 mg/day) is likely to be an effective regimen. As an alternative to cyproterone acetate, high doses of other progestogens, such as just about any other progestin, or alternatively rectal progesterone (link), can be used instead. Testosterone suppression with medical or surgical castration Another option for androgen deprivation is the use of a GnRH agonist or antagonist. These medications suppress testosterone levels by about 95%, or into the normal female range or male castrate range (<50 ng/dL). However, GnRH agonists and antagonists are very expensive, although there may be some viable options for obtaining them more cheaply (e.g., purchasing from certain online pharmacies/vendors). Alternatively, a gonadectomy, or surgical removal of the gonads, can be performed. However, this is expensive (a few thousand dollars USD), requires minor surgery, can be difficult to obtain. Most surgeons require letters from gender therapists and real-life experience; informed-consent surgeons do exist however. It's also irreversible, notably resulting in permanent loss of testes and sterility. With that said however, gonadectomy is far less expensive and much more convenient than GnRH agonists and antagonists in the long run. Testosterone blockade with androgen receptor antagonists High-dose bicalutamide monotherapy (e.g., 150–300 mg/day) is an option for androgen deprivation therapy (link). However, bicalutamide monotherapy increases testosterone and hence estradiol levels. The testosterone will be blocked by bicalutamide and will not have effects, but estradiol is increased to a concentration range that allows for marked or full feminization, including breast development. In addition, bicalutamide alone, even at very high doses, might not be enough to completely block male-range testosterone (link). With these considerations, if the goal is full demasculinization with no feminization or breast development, bicalutamide monotherapy is not something that, at least alone, can achieve this. High-dose bicalutamide is expensive and potentially cost-prohibitive. High-dose spironolactone monotherapy is not a good option for this route as it is a relatively weak antiandrogen and likely falls far short of being able to handle male-range levels of testosterone (at least 200 mg/day appears to be required to fully block female testosterone levels; source; sixth paragraph specifically). Concomitant partial suppression of testosterone and estrogen levels via additional use of a progestogen (e.g., cyproterone acetate) may be a more feasible option than an androgen receptor antagonist alone. Some potentially major advantages of high-dose bicalutamide monotherapy are that in contrast to marked or full suppression of testosterone levels, bicalutamide monotherapy largely preserves sexual desire and erectile function and likely does not result in infertility. Other options: lower doses, 5α-reductase inhibitors, and nandrolone decanoate Another option is only partial demasculinization, which can be achieved essentially by using lower dosages of the medications discussed above (e.g., cyproterone acetate, bicalutamide). If desired, 5α-reductase inhibitors can be added in this context to more substantially decrease scalp hair loss and body hair growth. Note that if testosterone is more fully suppressed or blocked however, there is likely to be little or no benefit with 5α-reductase inhibitors. Yet another possibility could be to incorporate low-dose nandrolone decanoate, an androgen receptor agonist and anabolic–androgenic steroid (AAS) with much less masculinizing/androgenic effect in skin and hair follicles (link). This drug will help to suppress and hence replace testosterone levels. Nandrolone decanoate might also have the benefit of helping to maintain sexual desire and function. However, nandrolone decanoate was recently discontinued in the United States. Oxandrolone is another, similar AAS, but has been associated with liver toxicity.
Avoiding estrogen deficiency
While androgen deprivation therapy is effective for achieving the desired changes – specifically demasculinization without feminization – it is not recommended by itself. This is because estradiol is produced from testosterone and hence androgen deprivation results in estrogen deficiency as well. Estrogens are essential for maintaining bone density in both men and women, and without them, a person will quickly lose bone mass, eventually develop osteoporosis, and be at a high risk for bone fractures. Skeletal/postural disfigurement will also eventually occur (image, image). In addition, the person is likely to experience other menopause-like symptoms, such as hot flashes, mood and sleep issues, sexual dysfunction (e.g., low sexual desire, erectile dysfunction), and accelerated aging of the skin (link). An increased risk of weight gain, type 2 diabetes, cardiovascular disease, and dementia is associated with androgen/estrogen deficiency as well. As such, extended deprivation of both androgens and estrogens with no estrogenic supplementation is not advisable in the slightest. With that said, a couple of clarifications should be made. Due to preservation of estradiol levels, high-dose bicalutamide monotherapy has minimal to no risk of bone density loss or most other menopausal symptoms. In addition, the low-dose cyproterone acetate plus low-dose bicalutamide option may have less of a risk of menopausal symptoms and possibly osteoporosis as well. This is because high-dose progestogens (of which "low-dose" cyproterone acetate certainly qualifies) can help treat certain menopausal symptoms such as hot flashes and possibly bone density loss, and also because some estradiol will be preserved (since testosterone will only be suppressed by 70 to 80% rather than more fully). With that said however, in the latter case, it's probably best not to take any risks. Selective estrogen receptor modulators (SERMs) Instead of only androgen and estrogen deprivation, the inclusion of so-called partial estrogens, or selective estrogen receptor modulators (SERMs), can be employed. These medications are partial agonists of the estrogen receptor, and have mixed estrogenic and antiestrogenic effects depending on the tissue. For example, the SERM raloxifene has estrogenic effects in bone, fat tissue, and the liver, but antiestrogenic effects in the breasts. In general, SERMs reduce bone density loss and osteoporosis risk while not causing breast development (and actually blocking it). A full list of SERMs can be found here. However, practically speaking, only raloxifene (Evista), tamoxifen (Nolvadex), and toremifene (Fareston) are available, inexpensive, and commonly used. For an overview of the estrogenic and antiestrogenic effects of the different SERMs in different tissues, see here. In general, SERMs have a fairly similar pattern of effects. Although we have some idea of the differential tissue effects of SERMs, in many cases we do not know how they behave in specific tissues. For example, only a single clinical study has shown that a SERM, specifically raloxifene, has estrogenic effects in fat tissue (link). In addition, it's less clear how SERMs behave in, for example, skin, or in most of the brain. SERMs also have various side effects. For instance, SERMs commonly produce hot flashes as an adverse effect. However, the fairly recently introduced combination of bazedoxifene/conjugated estrogens (Duavee) has been found to reduce the incidence of hot flashes in postmenopausal women (source). It is still on-patent and hence is expensive however. In any case, SERMs are also likely to produce other menopause-like symptoms. Additionally, SERMs have estrogenic effects in the liver and therefore increase production of coagulation factors and decrease production of insulin-like growth factor-1, among other potentially undesirable changes. Due to the increase in coagulation with SERMs, they have a notable risk of blood clots and cardiovascular complications like stroke. Some SERMs, like tamoxifen, also have unique off-target actions and risks, like rare liver toxicity. Raloxifene is probably among the safer SERMs. SERMs are effective for maintaining bone density. However, they are, unfortunately, only partially effective for this purpose; significantly more so than no treatment at all, but less so than estrogens. Indeed, SERMs have actually been found to significantly antagonize the effects of estradiol on bone (source). In addition to SERMs, other measures to maintain bone mineral density, such as bisphosphonates like alendronic acid, calcium supplementation, and/or vitamin D supplementation, could be included for further benefit to bone health (source, source). Bisphosphonates have adverse effects and risks however. Weight-bearing exercise is also beneficial for bone density (source). Interestingly, probably due to its off-target antimineralocorticoid activity, spironolactone may be an option to prevent bone density loss; it was found at 100 mg/day in one randomized controlled trial to fully prevent GnRH agonist-induced bone density loss in women (source). However, this was a single small study that has yet to be replicated, and hence supporting evidence is weak. Low-dose estrogen supplementation An alternative to partial estrogens is low-dose estrogen therapy. The problem with this route however is that, in the absence of testosterone, estrogens are highly effective at inducing feminization even at low levels. For example, late pubertal girls and cisgender women with complete androgen insensitivity syndrome (CAIS) have estradiol levels of only 30 to 50 pg/mL (high male range or just above it) yet have complete feminization, including full breast development. See here and here for information and photographs of CAIS women to get an idea. A dosage of oral estradiol of roughly 2 mg/day or estradiol levels of about 30 to 50 pg/mL are what are needed for complete prevention of bone density loss, yet such levels of estradiol are able to induce full feminization (source, source). With that caveat however, estradiol has a much better tolerability and safety profile than SERMs. But taking estradiol in conjunction with marked androgen deprivation, even at only low doses, would essentially be a full transition. It may be feasible to take it at very low doses, achieving estradiol levels of only maybe 20 pg/mL, however. But this would not adequately protect against bone density loss and other menopause-like symptoms, and would likely still produce at least partial feminization. (Even GnRH agonists/antagonists and orchiectomy alone have a rate of mild gynecomastia of as high as 15%; source.) Onset and reversibility of bone density loss Somewhat reassuringly, bone density has been found to substantially or fully recover within a few years following discontinuation of progestogen-only birth control (and consequent marked but partial suppression of estradiol levels) in young premenopausal women (source). Hence, a limited-duration treatment period, for instance to try out non-binary/femboy hormone therapy, might be reasonably safe in terms of bone health. However, long-term therapy should definitely ensure adequate measures against bone density loss.
Prevention or minimization of breast development
Suppression or blockade of estrogens If the goal is to produce full demasculinization and some or full feminization with the sole exception of breast development, there are a number of ways to possibly achieve this. Androgen deprivation without estrogen supplementation will achieve demasculinization without any feminization or breast development (except for bicalutamide monotherapy of course). However, it's not recommended for reasons described above and wouldn't provide feminization. SERMs are an option; in addition to their capacity to treat osteoporosis, they are used to treat gynecomastia in men, and are capable of fully blocking gynecomastia induced by estrogens when used at sufficient doses (source). However, SERMs may allow for only partial feminization rather than full. Aromatase inhibitors, in contrast to SERMs, have no apparent place in this form of hormone therapy, as they are, surprisingly, poorly effective for prevention of gynecomastia (source, source). A problem with SERMs: increased testosterone levels A problem with the use of SERMs to prevent breast development is that when they are used in a person assigned male at birth in whom the gonads are intact and testosterone levels are not suppressed, they will induce a substantial increase in gonadal testosterone production and hence circulating testosterone levels. In men with hypogonadism (low testosterone levels), the SERMs clomifene (20–50 mg/day) and enclomifene (12.5–25 mg/day) increase testosterone levels from about 200–300 ng/dL to about 450–600 ng/dL (a change of about 2.0- to 2.5-fold, with an absolute increase of 250–400 ng/dL in this patient population) (source, source). Because they are so effective at increasing testosterone levels, SERMs are used to treat male hypogonadism as an alternative to exogenous testosterone administration. Worse still, SERMs appear to cause even greater increases in testosterone levels in non-hypogonadal men. One study found that 50 mg/day clomifene increased testosterone levels by about 850 ng/dL in healthy younger men and by about 500 ng/dL in elderly men (source). If testosterone levels are suppressed, increases in testosterone levels with SERMs will, depending on the degree of testosterone suppression, be less applicable (e.g., with high-dose progestogen therapy) or not applicable at all (e.g., with medical/surgical castration). However, if a SERM is combined with, say, bicalutamide alone, the situation may become even worse. This is because bicalutamide itself produces considerable increases in testosterone levels similarly to SERMs. In elderly men with prostate cancer, bicalutamide monotherapy induces a 1.5- to 2.0-fold rise in testosterone levels, increasing them from about 300–400 ng/dL to about 500–600 ng/dL (an absolute change of about 150–250 ng/dL in this patient group) (source). In healthy younger men, bicalutamide has been reported to increase testosterone levels to the "upper end of the normal male range" (presumably into the range of around 900–1,200 ng/dL) (source). As bicalutamide is a competitive antagonist of the androgen receptor, its efficacy is fundamentally both dose-dependent and dependent on testosterone levels. Consequently, in combination with a SERM, it is possible that testosterone levels will become too high for bicalutamide to block. Moreover, endogenous androgens and estrogens are together responsible for maintaining normal homeostatic negative feedback on the hypothalamic–pituitary–gonadal axis (HPG axis) in people assigned male at birth. It seems logical that with little to suppress the axis, gonadal production and hence circulating levels of testosterone and estradiol may simply continue to rise until they overwhelm bicalutamide and/or the SERM it's combined with and restore negative feedback on the HPG axis. For these reasons, it's possible that the combination of bicalutamide and a SERM alone might not be a practical option for non-conventional feminizing hormone therapy. With all of that said however, the combination of bicalutamide and tamoxifen has been assessed in various studies in men with prostate cancer (source), and increases in testosterone levels have, rather surprisingly, not been a problem in these studies. In terms of the findings, bicalutamide and tamoxifen together do, as expected, increase total testosterone levels. However, the rise in total testosterone levels is not much different from that which occurs with bicalutamide alone. Moreover, free testosterone levels are either increased to a certain degree or are not actually raised at all (source, source, source). This is thought to be due to the fact that SERMs have potent estrogenic effects in the liver and result in increased production of sex hormone-binding globulin (SHBG), consequently reducing the fraction of free and hence bioactive testosterone in the circulation. This serves to offset the biological influence of the increase in total testosterone levels. In accordance, and reassuringly, unfavorable changes in markers of androgen receptor signaling, like higher prostate-specific antigen (PSA) levels, have not been observed relative to bicalutamide alone in the studies. It's not clear why studies of bicalutamide plus tamoxifen have observed increases in total testosterone levels that are not that different from those of bicalutamide alone. Whatever the reason, these studies suggest that the combination of bicalutamide and tamoxifen (or certain other SERMs) might actually be feasible still for non-conventional feminizing hormone therapy. With that said however, elderly men are a different patient population than non-binary transfeminine people and femboys. Older men have diminished increases in testosterone levels with bicalutamide and SERMs compared to healthy young men. In relation to this, the combination might not be as favorable for younger people assigned male at birth. Tamoxifen very well may be exchangeable with raloxifene for use in combination with bicalutamide. However, it should be noted that in contrast to tamoxifen, raloxifene has never been studied in combination with bicalutamide. Or, at least, not in gonadally intact men; one study of bicalutamide with raloxifene in castrated men with prostate cancer does exist, but that doesn't provide much in the way of useful information (source30260-9/fulltext)). Nor has raloxifene actually been properly studied for prevention of gynecomastia. A single retrospective chart review reported that it was effective for pubertal gynecomastia in boys (source). But that's all the data we have. Conversely, there are many high-quality studies of tamoxifen for prevention of gynecomastia, including in combination with bicalutamide. In any case, used by themselves in men, raloxifene has been found to result in lower increases in testosterone levels than tamoxifen or toremifene (source). As such, bicalutamide and raloxifene together may indeed be similar in terms of testosterone levels relative to the combination of bicalutamide and tamoxifen. This might just be due to raloxifene having lower efficacy as a SERM than tamoxifen or toremifene at the relevant clinical doses however (source). Topical androgens Another possibility for prevention of breast development is topical application of a non-aromatizable androgen (i.e., an androgen that can't be converted into an estrogen), such as dihydrotestosterone (DHT; Andractim), to the breasts. Androgens substantially oppose the actions of estrogens in the breasts, and have been shown to be effective in the treatment of gynecomastia similarly to SERMs (example). Unfortunately, pharmaceutical topical DHT is only available today in France (link). Some compounding pharmacies in certain countries might provide topical DHT preparations. However, DHT is reportedly not available from any compounding pharmacies in the United States (source). In contrast to DHT, testosterone readily converts into estradiol via aromatization and can actually induce some gynecomastia due to excessive estrogenic exposure. As such, unlike non-aromatizable androgens like DHT, use of testosterone for this purpose isn't appropriate. There are few or no other options for topical androgens besides testosterone and DHT, so the practicality of this route is limited. In contrast to SERMs, topical androgens may not be fully effective for preventing breast development. In addition, topical application of androgens to the breasts is very likely to cause local body hair growth and other local androgenic effects (e.g., masculine skin changes, oily skin, acne), which for many transfeminine individuals is probably unacceptable. Lastly, there is a risk of systemic distribution of the topically applied androgen (example) and hence androgenic or masculinizing effects elsewhere in the body. This risk would be lessened in combination with an androgen receptor antagonist like bicalutamide however, although androgen receptor antagonists also risk blocking the local effects of the topical androgen. Breast removal surgery and breast irradiation Two non-medication-based alternatives for prevention of breast development are prophylactic surgical breast removal and prophylactic breast irradiation. If there is no excess skin, mastectomy, or breast removal surgery, can remove the breasts without leaving obvious scars, as was the case in this young transgender man. Mastectomy is a highly effective means of preventing breast development. Of course, it requires surgery however. Exposure of the breasts to radiation inhibits subsequent breast development (photos). Irradiation of the breasts is an inexpensive, easy, and effective technique that is commonly used as prophylaxis against gynecomastia in men with prostate cancer treated with estrogens or high-dose bicalutamide monotherapy (source00080-6/fulltext)). It is less effective than SERMs however and generally only reduces the severity of gynecomastia rather than fully prevents it (source00080-6/fulltext)). More concerningly, there is a theoretical increased risk of breast cancer with exposure of the breasts to radiation (source30220-7/fulltext)). Research has observed a 100-fold higher incidence of breast cancer in young women whose breasts were exposed to radiation during childhood as a consequence of radiotherapy for cancer when compared to other young women (source). On the other hand, limited available evidence so far suggests minimal if any increase in breast cancer incidence in elderly men treated with breast irradiation to prevent gynecomastia (source30220-7/fulltext), source00080-6/fulltext)). We have no data on what breast cancer risk might be like in young breast-irradiated transfeminine people. In addition to theoretical cancer risk, low incidences of heart and lung issues have also been associated with breast irradiation in elderly men with prostate cancer (source, source). Due to these health risks, breast irradiation for prevention of breast development may be an inadvisable option. An obvious drawback of breast development prevention with both surgical breast removal and prophylactic breast irradiation is that they are irreversible. If the person ever changes their mind about not wanting breasts or eventually decides to fully transition (a not uncommon occurrence), there is no going back on the choice to permanently negate breast development. Degree, onset, and reversibility of breast development For reasons that are not entirely clear, it's notable that transgender women tend to have suboptimal/poor breast development (source, photo examples). The reason for this is not entirely clear, but there are various theoretical possibilities (link). Likewise, in generally elderly men with prostate cancer, high-dose bicalutamide monotherapy and high-dose estrogen therapy both cause high rates of gynecomastia but produce only mild-to-moderate gynecomastia in 90% of cases (source, source). (Whether their advanced age is a factor here or not is uncertain though.) Hence, any person who was assigned male at birth should, generally speaking or on average, not necessarily expect a marked degree of breast development. There are always exceptions however, with a subset of transgender women experiencing considerable breast development. Hence, the degree of breast development is a matter of chance, and caution should be advised. There are a few things to note about breast development. One is that it occurs slowly and is not something that happens overnight. Another is that it's not going to progress further if medications are withdrawn. And finally, it seems to be at least partially reversible if medications are discontinued within a certain amount of time (e.g., one year) (source, source). For these reasons, it should be entirely feasible for a given person to self-monitor their breast development, and, if it becomes too much for their liking, to alter their medication regimen as desired in order to prevent further or reverse existing breast growth. Hence, breast growth is not necessarily something that should be feared excessively.
Summary of main potential treatment options
For full demasculinization and partial to full feminization with the exception of minimal or no breast development, here is a review of the major potential treatment options for feminizing hormone therapy for non-binary people and femboys discussed above:
High-dose progestogen (e.g., low-dose cyproterone acetate) + androgen receptor antagonist (e.g., bicalutamide or spironolactone) + SERM or low-dose estradiol
GnRH agonist/antagonist or orchiectomy + SERM or low-dose estradiol
High-dose bicalutamide + SERM (possibly)
And variations thereof based on the above discussion as well (e.g., 5α-reductase inhibitors, prophylactic mastectomy, additional bone density interventions, etc.). As some of the commenters have touched on, low- to moderate-dose estradiol monotherapy, resulting in only some or partial suppression of testosterone levels, may also be a useful approach. At least partial breast development is likely to occur with such a route however.
Obtaining care and medications
It may be difficult to find a physician who offers transgender hormone therapy and is familiar with non-conventional hormonal therapy approaches for non-binary transgender people. It can likewise be difficult to find such a physician who is actually willing to treat such people. And this is probably extremely difficult for cisgender femboys, who may best be served by simply claiming to be non-binary or transgender but just wanting an atypical transition. With these considerations, do-it-yourself (DIY) hormone therapy may oftentimes be the most or only real practical option in this particular situation. For materials on DIY hormone therapy, see the Wiki at TransDIY, which includes a list of no-prescription-needed online pharmacies.
While browsing Roll20, I happened across a post by someone that represented a group of players looking to branch out from D&D5e. As someone who has run 5e previously, I figured I would understand some of their preconceptions, so I made a post with a few choices I would be willing to run. They chose Godbound, which is a system I have loved from afar but never had the opportunity to run. This is how it went. (Wall of text.) Setting/Premise:
Initially, the players would begin as mortals on some nameless world. The gods of this world vanished long ago, magic is in decline, and things have become more mundane.
The players would become divine and somehow be transported to Faerun, shortly after the Time of Troubles. Exact time-frame TBD. Due to their background, I figured stomping around Faerun as demigods would appeal to them.
I stole a page from the excellent Beyond the Wall to lend backstory to the characters. The PCs would be childhood friends that ventured beyond their unremarkable village to save it, becoming heroes in the process. One of the players got zealous and created a PC almost immediately, forcing me to adapt these plans. Still, most of it remained workable.
Due to the setting swap, the PCs would forgo a Relationship Fact and receive an artifact in its place, something that materialized on their person when they became divine. In return, they will have to take a Relationship Fact at 2nd level, to show how their first moves in Faerun are perceived.
Mortière: A commoner whose father was a sheep herder, Mortière rose to become a great general in his kingdom's army and was bestowed a noble title. He returned to his home village on leave following a successful but brutal campaign. As a mortal, Mortière is cunning and a tactical master, but his ability to bond with and lead men leaves something to be desired. Bonded to Dragon, Lich, and War. Plans to become a sort of Eternal Dracolich of Conquest.
Cristoph: A tinker and builder that found a book from an ancient secret order. It detailed runes and enchantments for enhancing constructions, which he used to become a chief siege engineer in the king's army, serving alongside Mortière. Before joining the army, Cristoph had already begun to create crude golems, animated by runic magic, though devoid of sentience or the ability to make complex decisions. He wields a rifle powered by spark powder. Bonded to Artifice, Bow, and Endurance.
Liliana: As a young girl, Liliana was touched by a dark apocalyptic prophecy that drove her insane. She ended up apprenticing herself to the village witch, where she learned herbalism and basic magics. She was shunned and mocked for her insane ramblings by the rest of the village though, including the other PCs. Has a raven familiar named Poe. Bonded to Madness, Intoxication, and Knowledge.
The story picks up in the village of Kirkwall, in a nameless kingdom on a nameless world. Mortière and Cristoph are home on leave. Liliana never left. The village has experienced some strange activity in the last few weeks, which the PCs have helped with to some degree. These are background events pulled from a Beyond the Wall scenario and are used to give the sense that things have been a little off before we join our heroes. Each event has a skill check associated with it and appropriate consequences for success or failure.
The grass is brown and the crops are dying. Cristoph used his expertise to build a new canal from a nearby river, increasing the water and nutrients available to the crops. They are still unnaturally weak, seemingly being drained of life, but it has at least delayed the famine. Cristoph succeeded here. Had he failed, rations for the PCs would have been hard to come by. Liliana asked to use her witch training to help as well and also succeeded spectacularly. Between the two of them, I opted to completely ignore this event going forward, assuming it had largely taken care of.
Mortière received a palm reading from a traveling fortune teller. She told him of some great calamity, but he was unable to get more than a cryptic warning and a demand for payment. Lacking charm, Mortière was unable to convince the fortune teller to expand upon her warning. If this were Beyond the Wall, Mortière would begin the game short a Fortune Point. As it is not, I instead reserved the right to inflict something horrible upon him at the worst possible time. This would become important later.
Last week, a traveling scholar came to the inn. He claimed to be in the area searching for the burial site of the First King of this nameless kingdom. Liliana was able to convince him to reveal its suspected whereabouts: a day's ride east of the village, past the statue of the Nameless God. I was glad this event came up. Without it, they would have had to search for the barrow and I was worried that might bog down the game. There was enough to get through without adding that and I likely would have ended up handwaving it.
There have been general rumors of ghosts and other hauntings, though the PCs have yet to see anything personally.
The three begin by questioning the village witch (who Liliana refers to as grandma), to see if she knows anything about the strange happenings in the village. She confirms their suspicions that the burial site could be involved. She explains that though magic has begun to fade from their world, the enchantments on the barrow are from a previous age and it is possible that they are capable of things not seen in an age. Mortière and Cristoph decide to investigate, while Liliana accompanies them because she suspects it might be related to the apocalyptic nightmares she has for the last decade. Mortière convinces the captain of the town guard to lend him the guardsmen for the expedition. Meanwhile, Liliana gathers poisonous mushrooms which Cristoph places in clay jars with small amounts of spark powder to create makeshift poison grenades. They aren't sure it will be useful against the undead, if their suspicions prove correct, but they aren't sure what else they might encounter out there. This takes the greater part of the afternoon, so the PCs pack their belongings and settle in for the night, planning to rest and then leave at first light. In the wee hours of the morning, the bell atop the lone guard tower begins to ring. Mortière, living nearby, is the first to answer the call. Captain Dishan, Mortière's mentor as a child, warns of shadowy figures moving beyond the east end of town, in the fields. By this time Cristoph has arrived and together the three of them come up with a plan. Mortière takes three of the guards to the fields just behind the mayor's house, where they set up makeshift barricades. Cristoph heads home with the last guard to warn his parents and attempt to activate a clay golem with brass clockwork innards he had been working on. He isn't sure it will work, but his last hurried rune is a success and the golem springs to life, albeit without a modicum of intelligence or self-direction. Cristoph asked if he could have had a crude golem he had been working on. I readily agreed, reasoning that it could have been an experiment he was working on with his book before he enlisted. I told him he would have to make a skill check and that if it failed, it might have unpredictable results. He succeeded and suddenly the party gained a golem. Meanwhile, Liliana wanders amongst the dead trees, talking to herself and her raven about dark visions and the end of the world. As the barricades are set in place and Cristoph joins the defenders, she finally decides to investigate the noise. She sends Poe up to survey the field and count the intruders. The raven spots ten skeletal figures, moving in two groups of five, headed straight for the barricades. She relays this information to her friends who, together with the guards and the golem, prepare to meet the attack. Dishan puts his trust in his pupil Mortière, now a famed general, letting him direct the men. The leading group reaches the barricades, while the trailing group is a few dozen yards out. The first exchange is uneventful, with Mortière and the guards attempting to stab the skeletons through the barricades with sword and spear and mostly failing. The skeletons mindlessly attack the barricades. Cristoph orders the golem to plug a hole between two barricades, which it succeeds at, but nobody manages to inflict much damage on the risen dead. Then Liliana weaves her dark magic, summoning a pack of rats out of the fields that begin to carry of pieces of the skeletons for their nests. The skeletons make no attempt to fight against the rats or even seem to register their presence, continuing to beat on the barricades mindlessly. Still, the rats weaken them. I believe everyone missed during the first round, aside from the NPC guards, which didn't feel right. I opted to have the guards panic a bit, seeing as they are unused to combat, let alone the undead. The guards, having taken down one weakened skeleton, rush around the barricades to press their advantage. Mortière and Dishan shout at them to get back, but it is too late: they are already engaged. Between the rats and the guards, two more skeletons quickly go down. The defenders make short work of the last two and turn their attention to the second group. With the first group down, they turn their tender attentions to the stragglers, still out in the field. With the first group down, the second group simply stops moving. The guards and Cristoph rain volley after volley of crossbow bolts and gunfire upon them until they are all destroyed. I had forgotten how boring roll d20 for combat can be when the players don't have many other options. Improvising can certainly improve things, but this battle taking place in a largely empty field with a few barricades didn't leave the players with many options. The guards panicking spiced things up a little, but I knew a second group would be boring as all hell to deal with, so I opted to have them simply stop moving. Boring the players this early in the session was not an option. It didn't make much sense, but the players just rolled with it, either not questioning the why of it or simply relieved that it was over. I vowed to keep that in mind for the remainder of the session, until the players got more... interesting options. Nobody got a ton of sleep after that. Mortière, Liliana, and Captain Dishan took chairs to the top of the lone guard tower to keep watch for the remainder of the night, napping in shifts. Dishan was visibly uncomfortable with Liliana's presence, but treated her more kindly and with greater respect than he had her entire life. No one addressed it directly, but it was clear she wasn't just the crazy girl anymore. Cristoph went home to check on his parents, then got some sleep, trusting in the others to keep the town safe. The party set out at first light. The directions Liliana received suggested the barrow was a day's travel away, so they would be gone for a couple of days. Captain Dishan told them that he could no longer send all the guardsmen after the attack on the village. He said he could still send one of the four if Mortière desired, but was obviously uncomfortable with the idea. Mortière agreed that the village needed its defenders, should anything else happen while they were away. The party set out alone, with only the golem and the two horses Mortière and Cristoph had on lone from the army. The day had dawned overcast and considerably colder than usual for a Spring day. A thin layer of fog lay across the ground and they heard to birds or other animals. Mid-morning, an earthquake took them by surprise. Earthquakes were almost unheard of in the region and none of them were sure they had ever recalled one happening in their lifetime. Still, by noon the fog had burned off and the sky was clear. Early afternoon they arrived at the Nameless God. The Nameless God was a local landmark, an enormous statue buried to its neck in the ground. The head was the size of a large wagon and it was made from a type of stone that had never been identified. According to legend, when the gods vanished the Nameless God was the last to remain. For reasons unknown, he petrified rather than vanish altogether and his corpse had lain here ever since, well over a millennia. There was an unusual hill nearby, some eighty feet long but only a dozen feet or so across. It was rumored that the Nameless God's sword was buried there and that upon its hilt was inscribed his name. All legends agreed that reciting the Nameless God's name would awaken him, but they disagreed upon what would happen next. He would either be the world's salvation or its demise. None had been brave enough to dig up the hill to test the theories. When the party arrived, they discovered the earthquake had disturbed the site. The statue was revealed to mid-chest now, revealing a hole in its chest containing a heart of blackest obsidian. Liliana recognized the heart from her nightmares, though in her dreams the heart glowed with purple light, shot through with veins of blue. She began to whisper cryptic apocalyptic warnings, but the party ignored her. Though unsettled, they opted to camp in the new crater, in the shadow of the Nameless God. They set the golem and raven to keep watch; the night passed uneventfully. The next morning they pressed on, hoping to reach the barrow before noon. As it happened, they were closer than they thought: half an hour into their travels they spotted it. It appeared to be a hill, being as it was simply a mound of dirt with grass growing atop it. They might have missed it were it not for the half-dozen corpses standing guard outside. They decided to attack, with zero hesitation or equivocation. They dismounted and readied themselves. Cristoph shot first, blowing the scalp off the closest zombie and nearly re-killing it in the process. Though the party had military horses, the undead and the earthquake already had them unsettled. When Cristoph's gun went off, they panicked. The party had secured the horses to pitons they hammered into the ground, but Mortière's horse managed to pull free and ran off to the north, perpendicular to the party and the zombies. The zombies ignored the gunshot and turned to pursue the food source. After that first battle, I had already come up with a plan that would let the party circumvent this fight if they didn't attempt to do so themselves. I clarified whether they dismounted and they explain that they secured the horses. There were no trees to tie them to, but one of them suggested they might have pitons which surprised me. I made strength checks for the horses and one rolled quite well. To be clear, had this not worked out, I would have let the fight play out. In a sandbox game, it is important that the players make their own choices and I not force their hand. Though this first adventure was a little more on rails as many introductions are, I needed to make sure the precedent was set. They debated chasing after the horse for some time, with Cristoph worried that the army might force them to reimburse the cost of the animal. Liliana happily assured them that it wouldn't matter for much longer anyway. Ultimately they decided to take the opportunity the horse had given them and approached the barrow. The opening into the barrow was a narrow dirt tunnel with a low ceiling, descending into darkness. There were stone stairs cut into the floor, but dirt had settled onto them, creating a treacherous ramp. Luckily the tunnel was narrow enough that they could hold onto the walls quite easily, minimizing the danger. The tunnel was far too narrow for the seven-foot tall, burly golem however. They left it to guard the entrance and tied the remaining horse to the golem. Cristoph described more complex instructions like this being given by writing it on a slip of paper that he slips into the golem's mouth, which was a pretty cool image. I suggested that the text might be book-ended by runes that signal to the golem it is a legitimate command. Just before they entered, they noticed that the sky seemed dimmer, even though there were no clouds to obscure the sun. The stars were also out and shone strangely bright. Mortière lit a torch and they descended into darkness, the general leading the way and Liliana bringing up the rear. Soon after they entered, another earthquake rocked the land. Dirt from the ceiling fell on them and settled onto the stairs. This earthquake was more violent than the last as well as longer, continuing for nearly a minute. Once it passed, they pressed on. Eighty feet in, they encountered a small dirt room with another dark passage on the other side. The floor and ceiling were still dirt, but the walls here had roughly cut stone blocks set into the dirt to keep the structure in place. Mortière stepped into the room with his torch to get a better look and promptly passed out. He fell face down in the center of the room. His torch clattered a few feet away, but stayed lit. Mortière got a Spirit save but failed it. Liliana warned Cristoph that she sensed a magical enchantment in the room that put Mortière to sleep. Cristoph knew from experience that such an enchantment was likely powered by a rune somewhere in the room. They checked the walls as best they could without sticking their heads in the room, but could see nothing. Liliana asked if Poe, being a magical familiar, would be affected by the enchantment. I told her she was unsure. Liliana wanted to send the raven in to have a look around, but wanted to tie a rope around it in case it fell asleep. They realized they couldn't tie it around the bird's leg, as it was far too tiny and the rope was far too thick. She suggests she might simply tie the rope around the bird and throw it in (Like a football?, I ask.), but quickly abandon the idea. Poe squawks angrily at them for the mere suggestion. Eventually I suggest that one of them might have string with them, which Liliana realizes she likely has to bundle the herbs she gathers for the witch. Mortière snores blissfully. Liliana ties a string to Poe's leg and sends him into the room. He refuses to fly, realizing the danger, and simply hops into the room... and promptly falls asleep. Liliana pulls him back into the stairway and unties the string. The raven wakes up and flies a few feet farther up the stairs and begins to squawk angrily at all of them. Liliana recognizes it as some very unkind cursing. Finally, Cristoph realizes the only portion of the room they can't really see is the ceiling just inside the room, as the ceiling in the room is higher than the low ceiling of the stairway. They tie a rope around each of their waists. Cristoph removes his armor and Liliana dons it, as best she can, to give her more weight and leverage should Cristoph pass out. Cristoph leans into the room and manages to resist the enchantment long enough to spot two runes carved into a stone block set into the otherwise dirt ceiling, directly above the door. He recognizes the runes as meaning "sleep" and "chamber". They formulate a plan: the duo leave Mortière alone for a few minutes and retreat back upstairs into the open air, whereupon Cristoph opens one of the poison grenades he had made, empties out the poisonous mixture, and then packs it full of spark powder he had set aside for his firearm. They return to the room and steel themselves for what they must do. Cristoph leans into the room, Liliana braces herself to hold his weight, and then he flings the explosive at the runes. I had Cristoph make a new saving throw to make sure he would stay awake long enough to fling the makeshift grenade. I planned on this being a sliding scale, rather than a binary proposition. Should he fail quite badly, he might pass out before he threw... and the grenade was designed to explode on impact. It was a tense couple of minutes. Luckily, Cristoph passed and all went as planned. The explosion damaged both runes, immediately ending the enchantment. Unfortunately, they had used more spark powder than they needed and the explosion slammed Cristoph into the ground. A piece of red-hot clay shrapnel embedded itself into Cristoph's cheek; he could feel the point sticking into his mouth. He yelled out despite himself. As he picked himself up, Liliana got her herbs out and began mixing some together, explaining that she could make a poultice for the wound. About this time, Mortière woke up and climbed to his feet. When he turned around, Cristoph and Liliana could see that his left eye was missing entirely, gouged out by a rock on the ground when he had fallen upon it. The wound had not been visible from the angle he was laying. I decided to call in the bad luck Mortière had earned from the fortune teller prior to the game opening. I narrated him getting up with a black eye from the fall, intending to simply play it for the humor value. Mortière had another suggestion. When they became divine beings and Mortière transformed into a dracolich, his artifact would be a magical purple gemstone in the place where his left eye should be. His suggestion for his eye to be gouged out was perfect foreshadowing for what was to come and I eagerly agreed. I also told Mortière that he had had nightmares while under the sleep enchantment and had him make a Spirit save to see if he could recall them. He failed and remembered only fleeting images, apocalyptic visions and a flickering blue light in a large room. He mentioned nothing to the others. "It's happening," Liliana whispered. Unsettled, the others told her to shut up. They spent some time removing the useless remains of Mortière's eye and applying poultices to the eye and to Cristoph's cheek. At this point, Cristoph thought they should retreat so they could regroup. He also wanted to check on the village and his parents. Mortière insisted they press on and finish this. Liliana giggled again. Poe, still upset with Liliana and concerned for Cristoph's injury, opted to ride on his shoulder, squawking occasionally in his ear. Liliana was hurt, but said nothing. It's happening! It's happening! They continued on. The tunnel began to change as they descended deeper into the earth: first the walls, then the ceiling began to transition to the same roughly cut stonework they had observed in the room above. The stairs began to switchback, working itself back and forth but always ever deeper. As they rounded a bend, Mortière spotted the end: the stairs opened into another room. Though he could not see into the room from his vantage on the stairs, he got the sense that it was large from the way their steps echoed and the breeze that touched his cheek. The breeze carried the stench of death. The opening shone with a faint blue light. They readied themselves for battle and then rushed into the room. They found themselves in an enormous chamber, lined entirely in stone. They themselves stood on a raised stone platform with stairs descending on either side of them to the floor some thirty feet below. The ceiling was high and supported at regular intervals by simple stone pillars. The pillars were set with bronze sconces in which glowed enchanted blue flames. Between the pillars, skeletons stood at attention, holding polearms and staring sightlessly ahead. There were at least three dozen. An honor guard. At the far end of the chamber, a hundred feet away, there was a raised dais, and upon it was an ornate throne, and upon that sat the First King. He was a withered dried corpse, preserved by the dry air. His flesh had not rotted away and twin specks of red light shone where his eyes should be. His right arm rested on the throne's armrest, while his left supported a massive ornate battleaxe. Unlike the skeletons, his armor was intact, an intricately covered plate mail set with gemstones and trimmed in gold. A gold crown, set with sapphires and rubies sat upon his head. The negotiations were brief. "What do you want with the village? How do we end these attacks?", Mortière asked. "There will be no parley! Bring me the head of Uwhu Ghiirk. He will die for disturbing my tomb," the First King demanded. Uwhu Ghiirk was known to all of them as a scholar of their village. He was friendly with all of them as children and known to sometimes sing at the tavern in town. "I will make no sacrifice of my village!" "Then you will die." At his last word the honor guard slammed the butts of their weapons on the stone floor in unison, creating a deafening noise, then turned toward the platform as one. They began to march toward the stairs. Mortière and Cristoph debated briefly. Mortière wanted to position himself in the doorway to hold them off while the others escaped. Cristoph insisted they must all leave to warn the village and attempt to defend it. Liliana laughed maniacally. Poe took off, flying back upward without waiting. The trio quickly followed, with the skeletal army in pursuit. After what felt like an eternity, they emerged back into the daylight. Strangely, though there was still light in the sky, the sun was nowhere to be found. The stars blazed like fire. Another earthquake struck then, more violent than any before. The burial mound collapsed, inverting into a broad, shallow crater. "Maybe it's over?", Cristoph said hopefully. As if in response, a single skeletal hand emerged from the dirt in the center of the crater. The skeleton dug itself free, then another, and another. They swarmed out of the ground like ants. Cristoph shouted for Mortière to take Liliana on the last horse and ride ahead to warn the village. He climbed onto the back of his golem and instructed it to take him home, praying it would work. The golem carried him with ease, but though faster than a man, it could not keep up with a horse at a full gallop. Mortière and Liliana reached the Nameless God a few hundred yards ahead of Cristoph. They descended into the crater to find that the statue was now unburied down to the waste. In addition, the hill had been disturbed, revealing a colossal sword. As they reached the bottom of the crater and started up the far side, they spotted rotting figures standing on the lip of the crater, between them and the village. Liliana recognized one of them as a woman from the village that had died last year. Mortière tightened his grip on his spear and spurred the horse on. Liliana lost her grip and tumbled into the dirt. Mortière rode on, hoping that Cristoph would be able to pick her up. Liliana asked if she should make a save to keep her grip. I gleefully agreed. She made a Hardiness save and failed, falling off the horse. I was delighted to see Liliana lean into the fiction here, knowing what 'should' happen and what would make for a good story. Mortière's spear broke as he impaled one of the zombies through the head with enough force to decapitate it. He threw the useless piece of wood away and rode on, free of the crowd of zombies. Back at the Nameless God, Liliana approached the massive sword, mumbling to herself. Cristoph passed through the crater around this time. A quick glance over his shoulder revealed a skeleton army over a hundred strong, rather than the few dozen they had spotted in the throne room. At the head of the horde rode the First King atop a skeletal horse. He looked at Liliana and shook his head. He couldn't afford to detour so far. He instructed the golem to run on. There were words written on the hilt, just as in the legends. It was the language used by those that founded their kingdom, long since fallen into disuse, placing it at over a thousand years old. Further, the dialect suggested that it was even more ancient. She did not know this language, but the words swam before her eyes and somehow she knew what the words meant. Mors Omnia. The End of All Things. Liliana spoke the words aloud. The earth began to shake again, violently, and this time it did not stop. Liliana turned to climb onto the statue for shelter to find it moving, reaching for her. She laughed and jumped up onto its hand then climbed onto its wrist. It was then that she realized it was not reaching for her: it was reaching for the sword. As the Nameless God grasped its massive blade and began to lift it high, Liliana scrambled onto the giant's shoulder. She began to laugh, tears streaming down her face. "It was real! It was all real! I was right" Liliana continued to laugh. The Nameless God, still buried to the waist, leaned forward and braced itself on the ground with its left hand. With sightless stone eyes it targeted the First King. The first blow from the sword buried the king and left a crevasse eighty feet long and twenty deep in the ground. It raised its sword and prepared to strike again. Liliana threw her head back and looked at the sky. The afternoon had plunged into complete darkness, lit only be the stars which now blazed like fire. Tears streaming from her eyes and still laughing, Liliana allowed herself to fall. Time warped and stretched. Mortière found himself near the village. The village was surrounded by another skeletal army, this one numbering in the thousands. The witch and her apprentices, two young girls from the village, were drawing runes around the perimeter of Kirkwall. The runes had formed a barrier that kept the undead for now, but it would not hold them forever. The skeletons beat at the air, as if hammering an invisible wall. As Liliana fell, she passed the chest of the Nameless God. Its heart was glowing purple, shot through with blue veins. She saw a detail she had not noticed in her dreams: the heart was cracked and began to crumble before her eyes. Just as she passed the heart it exploded. A beam of coruscating energy enveloped her, propelling her miles across the sky. She slammed into the ground on the west side of the village, leaving a crater. Her body was a broken, smoking wreck. The beam of the last god swept across the battlefield and where it passed, undead were incinerated instantly. The energy passed over Mortière and then Cristoph. The horse's heart, tired from galloping and overwhelmed with terror, gave out; it collapsed beneath Mortière. He didn't have time to worry as he began to burn as he was dumped into the dirt. Cristoph's golem was incinerated the same as every other unliving creature. Somehow, Cristoph and Mortière lived. Cristoph, fearing his life is at an end, crawls weakly toward the village, still burning from his injuries. On the far side of Kirkwall, Liliana stood up and walked out of her crater. At this point we moved to combat time. Each round after the first, I asked the players to choose one of their Words that they would manifest and then encouraged them to think up a miracle related to that Word to use that round. I encouraged them to ignore their gifts for the time being and left out Effort to explain later, figuring that riding high on their newfound divine power, the players would temporarily be wielding limitless power. I had initially planned on this being a tutorial for how Godbound combat differed, using the damage table and how damage was applied directly to Hit Dice instead of hit points. Mortière and Cristoph had already studied the rule book to some degree, so I altered my plans. However, I had forgotten that Liliana joined late and wasnotas familiar with the rules. This failed to go as smoothly as I hoped as a result. Liliana should have received more guidance. Still, once Mortière began to explain how damage worked in the second round, I realized my error. With some suggestions from myself and the other players, we got some cool stuff figured out. All in all, it came out okay, but I regret not having been better prepared. Mortière was the first to act. He felt himself filled with untold strength. Unfortunately, the only weapon he had left was a dagger; his battleaxe was on his horse that ran off and his spear was broken and discarded. He drew his dagger and charged into battle without hesitation. The first skeleton he encountered blocked his puny spear. When Mortière resorted to his training and attempted to kick the skeleton back to unbalance it, the undead foe exploded from the force. Mortière kicked its dropped sword, a rusted and pitted blade, up into his hand. Mortière missed his attack, but his fray die killed it anyway. Liliana moved toward the center of town and attempted to target the skeletons near the others with another plague of rats. The spell, overwhelmed by her fresh divinity, malfunctions and she merely releases a bolt of uncontrolled arcane energy. Half a dozen skeletons were consumed in spellfire. I was caught with my pants down. I had brainstormed how I would handle Faerunian magic in a general sense, but hadn't hammered out the details yet. I figured I had time. Neither Cristoph nor Mortière were primarily spell casters, so I wasn't worried. Liliana was a late arrival and ended up devoting a fact to being the Witch's Apprentice, which made her magic more central to her concept. I didn't realize until this moment that I was unprepared to deal with how that would interface with her divinity. I've since worked out the details, but I admit I panicked a bit here. Cristoph, realizing he was okay, picked himself up and sprinted into the village, using the opening the beam of energy had created in the undead to get to his parents. He ran up to the door, but finding it locked as he had instructed, began to pound on it. His parents, unable to hear his shouts over the battle, began to scream. He kicked the door off its hinges. He poked his head into the room and his father nearly shot it off with a rifle Cristoph had made for him. "Cristoph! I nearly killed you boy!" "I'm glad you're okay..." Back on the battlefield, Mortière suddenly found himself filled with more knowledge about War than even his experienced mind was used to. He could sense the position of the enemy, seething all around him. He called out to the town guard to join him, hoping to buy the witch time to reinforce the barrier. To his surprise, the guards appeared around him, materializing in a flash of light. They weren't happy about their sudden move, but they grimly set their jaws and then set to work defending Mortière. One of them was quickly cut down, but the other three remained standing, hacking away. Mortière quickly cut down two more skeletons. The wight-blade he wielded had transformed into a perfect blade, fresh off the forge and glowing with bright yellow light. War. Something inside Liliana finally snapped. The madness of her childhood, the mockery she had received all her life, and now finally seeing that her visions were true: it was the end of the world. She began to laugh maniacally. And then she wielded her madness like a weapon. She pointed into the crowd of undead and somehow two of the skeletons, though mindless, were overcome with contagious insanity. They stopped and pulled daggers from their rotting belts, then used them to scratch out runes carved into the roofs of their mouths. Both collapsed into dust. Madness. Cristoph is finally reunited with his family, only to be met with horror. His skin splits and then begins to peel away. Pieces of brass metalwork peeks through his flesh. His parents scream in terror and soon he joins them. Endurance. Lighting cracks across a dark, clear sky. Silhouetted against the stars, the Nameless God seems larger. He swings at the ground again and again. The earth quakes without end. In the lightning, Mortière thinks he sees his own bones through his flesh, just before it begins to rot. It doesn't hurt and he feels strangely unworried. "Get up," he snaps at the dead soldier, thinking him merely exhausted. The soldier complies, rising to his feet with a rusted blade still run through his chest. The other soldiers take a frightened step away as the undead soldier attacks the skeletons with reckless abandon. Mortière feels his heart beat one last time and then stop. Lich. Cristoph's flesh is gone now. His skeleton, still standing, appears to be made of brass. It has begun to expand and grow however. He begins to resemble a brass golem. His trusty firearm, one he built himself, transforms as well; it has become some sort of arcane rifle. Artifice. (Cristoph hasn't settled on an exact description for it yet, but I like to imagine it is covered in blue runes and fires explosive bolts of arcane energy.) Liliana closes her eyes and wills the screaming populace of Kirkwall to be calm. All will be well. They will be protected. Instantly, the mortals are calmed, albeit because they suddenly find themselves wine-drunk. The fighting men are filled with fearless, berserker fury. Intoxication. Mortière begins to grow, his armor splitting and falling away. Soon he resembles a twelve-foot tall vaguely reptilian skeleton. Most of his flesh is gone now and his eyes have rotted away, leaving only a single gleaming purple gem in one eye. "Begone!", he bellows, then exhales a wave of purple energy at the crowd. The energy strips the bound souls from the undead and atomizes their remains. Along the entire western side of the village, the enemy is obliterated, reduced to a fine gray dust that covers the ground. Dragon. Liliana is overcome with dizziness and closes her eyes. She begins to rapidly absorb information. She is filled with the collective knowledge of her village, then the region, the kingdom, and eventually the world. It only takes a few moments. When she opens her eyes, a single piece of information is fixed in her mind: the runes are wrong. She fixes her eyes on the barrier the witch and her new apprentices have been carving. The runes are wrong. But Liliana knows how to fix them. She rushes to the perimeter. Knowledge. Above it all, the Nameless God strikes the ground again and again. He now stands a mile high, his blade a mile long. Each strike opens new valleys in the shattered earth. Behind Mortière, out beyond the village, the ground begins to crumble away. Even the stars are fading. Their world is done, but the trio have hope that their new abilities might at least save their village, they might save their family and their friends. Suddenly Mortière realizes that the barrier that keeps the skeleton army at bay, now reinforced by Liliana, will keep him at bay as well. He is no longer among the living. And that's where we left off! It had gotten late so we had to call it for the night on that cliffhanger. I hope you enjoyed the wall of text. If not, that's cool too. I've hammered down how to deal with Liliana's magic, so that shouldn't be an issue going forward. Next time we will see if the village will survive and where they will go if their world is truly dead!
Hey everyone! I’m nonbinary, and today I’m going to teach y’all about hormonal options that aren’t testosterone! I noticed there’s a disappointing lack of not-T options and so I decided to cobble together what I’ve learned over time. Was originally posted on transdiy. Took out any mention of anything that even sounded DIY-ish, though the original post wasn’t heavy on it either. You may to visit the original thread to get some input on various things. This is simply copy-pasted from an amalgamation of replies I’ve made in the past few months. Let me know if the formatting needs to be adjusted any! I added everything I could think of. I’d like to add that though I’m a gender nerd, I am not a doctor and this is not meant to be medical advice. If you can double check behind me and ask your doctor about hormones and how they work, that would be fantastic. I mean for this to be informative, which is why I’ve taken out the names of certain shops and what-not. If you have any questions, feel free to ask me! cracks knuckles Let’s get this ball rolling.
Why antiestrogens aren’t as effective as you might think
First off, I’m ashamed to say that anti-estrogens do diddly-squat about body-wide estrogen, despite the naming scheme. Almost all anti-estrogens are SERMS, which (in current medical development) only block E in the breasts, and act like E in the bones— they don’t limit it body wide. SERMs are honestly only useful if you have breast cancer, fibrocystic breasts, in the prevention of osteoporosis, or are AMAB and don’t want breast growth. The other category of anti-estrogens are aromatase blockers, which prevent T from being converted to E. While this sounds great, and while a fair amount of T is converted to E in the AFAB body, this is unhelpful for premenopausal people in breast cancer treatmentif their gonads are not suppressed first. AI blockers do very little if your ovaries aren’t taken out or suppressed, or at least if E production isn't partially supressed, as AIs are hindered by the higher T production in premenopausal women, and the ovaries will produce more AI if E is lowered therefore if you aren't on T or have your E at least partially supressed through other methods (like danazol or progesterone) I would not recommend an AI at high doses.
Getting testosterone (legally)
If you’re in the US and you can hide it, you could go informed consent for T and pay out of pocket. You have to be over 18 if you have unsupportive parents. You drive to a clinic, fill out some forms, go back to a doctor’s office, they explain what T does, more forms, then you’re given a prescription in at most a few appointments, usually after blood work but sometimes before it or on the first appointment. T would range about $30-$50 without insurance, and since you’re binary and probably want what DHT offers, you can just start out on only T. Blood tests would be most expensive. Insurance sends paperwork home so if you’re 18 and still live at home with unsupportive parents, you’ll want to go uninsured for T. Plenty of insurance companies cover HRT (like BCBS Federal) and then you’d pay anywhere from $5-$20 a month, most likely. You could go and get your T shots at the clinic if you can’t keep the T vial at home and do the shots yourself or have a friend do them, and there’s a way for you to easily out get of the house.
Birth control to lower E production:
Provera is a birth control (mostly) medication that lowers your E levels by using progesterone, which basically tells the ovaries to stop producing E (by lowering levels of GnRH). how progesterone works You could tell your parents you want to go on it for birth control or because your periods are annoying. It’s somewhat important that for this purpose it be progesterone/progestin only. note: Progestin and Progesterone are a little different. Progestin is synthetic progesterone which fits into the progestin receptor, and sometimes may produce unwanted effects, while progesterone usually refers to bio-identical progesterone. They usually both prevent the period (again by messing with GnRH levels). Just progesterone would stop things like your hips widening, etc., as would a GnRH blocker, which I’ll cover in a later section. GnRH blockers may be helpful for enbies who don’t want to go on T, but make sure to go on a SERM like raloxifene after a few years, as this will help prevent osteoporosis. edit: You may want to look into more androgenic forms of birth control and take one of those, again, not as a comination pill-set. The most androgenic progestins that are used are levonogestrel and the progestin in Depo-Provera, which is too long for me spell out here.
Danazol: The Mysterious Benefactor
Danazol is a mild androgen, and a mild GnRH inhibitor— it will lower E levels (least enough to stop your period, hip widening, etc) and may give you some of the effects of T. It’s not a scheduled substance/as scheduled as T is, either. It activates both androgen and progesterone receptors. it's also shown to cause vocal changes over time as evidenced by a study from the 80s. That being said, if you decide to go on it, get your liver enzymes checked after about 6 months or so (least a year). Danazol can be a bit hard on the liver, it’s a pill. I think this is a totally viable option for AFAB enbies on its own (slow changes, no lower growth), or even to binary guys before starting T, as it will likely stop periods too. If you want to legally use it as a precursor to T and have access to a doc, I would recommend asking your doctor about it first, instead of going DIY or something. Dosages are based on what the health issue is: https://reference.medscape.com/drug/danazol-342756 mild endo: 200-400 mg, divided into twice a day moderate-severe: 800 mg, divided into twice a day fibrosystic chest tissue: 100-400 mg (divided into) twice a day Futhermore, danazol has been proven to slowly lower the voice over time and so danazol may be a viable option if you want really slow voice changes.
GnRH blockers: systematic E blockage
Another medication that’s an option is buserelin. Like progesterone, it blocks E production. It’s available as a nasal spray if you look around. It will make your E levels go up at first, but then your E levels will drop as your pituitary gland gets desensitized to GnRH overproduction. There are also other GnRH blockers, like cetrorelix, degarelix, and ganirelix (antagonists, no initial hormone spike), or leuprolide (Lupron), goserelin (Zoladex), and buserelin, which are agonists (yes hormone spike, for at most a month). Danazol, progesterone, or an GnRH antagonist may be preferred over agonists, at least initially. GnRH blockers may be helpful for enbies who don’t want to go on T, but make sure to go on a SERM like raloxifene after a few years, as this will help prevent osteoporosis. Keep your eyes peeled for relugolix. It’s a GnRH oral antagonist in development that has a pretty long half life and has proven effective in trials and tests (so far). I really do think that hormones currently under investigation (such as relugolix) will be the future of hormonal healthcare for everyone, but especially trans people!
If you've been on sites about natural transition, you may have heard of a substance called DHEA (prasterone). It is a precursor to steriodal sex hormones (largely E and T in this case), and can therefore be used to increase greatly raise levels of both T and E, which it has been proven to do in clinical studiesat high levels (1600 mg), increasing T by nine-fold, DHT by 20-fold, and estrone and estradiol by 2-fold in post-menopausal women. Despite this, I wouldn't advise taking high levels of DHEA unless you have no other options (due to it inadvertenly raising E too) and you were taking something to either supress E, or something to catalyze the production of DHEA to T, such as royal jelly.
I have a private document listing a bunch of phytoestrogens and phytoandrogens. For the link I simply ask that you PM me. I honestly kind of hesitate to put this section, simply because these are the least effective options for transitioning. One thing you may want to consider is a phytoandrogen like pine pollen (contains the closest thing to androgens you can get in a natural product) mixed with a transdermal solvent. This is to bypass the liver and increase effectiveness. It’s preferred over tea, since ingesting too many herbs (honestly like.. ounces and ounces of the stuff) can mess with liver enzymes, even if they do have effects on hormone levels. If you’re worried you’ve been taking too high of a dosage you would want to get your liver enzymes tested. In addition, here’s a list of natural sources of HRT. These are actually proven to raise T levels, though except for royal jelly and pine pollen, I suspect the rest of the substances may be aromatase inhibitors and probably shouldn’t be taken in super high/often dosages (because high amounts of aromatase blockers given to pre-menopausal people will just raise E). However, you will be fine with something like chamomile (a slight aromatase blocker) or one of the other (non pine pollen/royal jelly) herbs on the list, taken as a tea everyday or something like that, fyi. Apigenin (in chamomile and other substances) and Genistein (soy) are anti estrogenic: the reason they’re called phytoestrogens is because they activate/agonize a different estrogen receptor called ER beta that is anti-physical estrogen effects. I.E., soymilk is fine, great, even. You’d have to be eating a lot of them to see any noticeable effects, so for that it’s better to take a supplement. Don’t take licorice supplements (the actual herb is fine) as they can increase the risk of DVT. I recently found that royal jelly works by increasing DHEA to T conversion and likely does this in AFAB people too, so you may want to take RJ in conjunction with DHEA to increase its effectiveness. You will want to be careful to have clean hands while using a transdermal solvent or molecular transporter, and I would advise not getting too high of a concentration of solvent. While this method is not going to be as effective as T, it could possibly get you up to mild androgenic effects. A note on tribulus: there's no definitive proof that tribulus actually works to raise T, especially not in AFAB people, though it may help to increase muscle strength I’m not sure if any trans guys have done this before, but if you do, post the outcome if you want! It would be pretty interesting to hear about. Adding phytoestrogens to this list. Soy can somewhat inhibit ovarian function or LH/FSH, and phytoestrogens also work through decreasing gene expression of aromatase, inhibiting aromatase, or both. They include compounds like apigenin, coumestrol (strongest phytoestrogen, present in red clover), and genistein.
I couldn’t come up with a fancy name for this section, sorry! If you don’t want bottom growth, body hair growth, and want to preemptively stop possible hair loss, you may be interested in checking out DHT blockers such as finasteride or dutasteride. Fin and Duta work by permanently blocking the production of 5a reductase, which is converts T to a more androgenic form, dihydrotestosterone. DHT is associated with partial hair loss or baldness, body hair, acne, and penis/clitoral growth (as androgen receptors are located in all of these places). Blocking DHT means that (in theory) these effects should occur slowenot at all, and therefore good if you don’t want to possibly lose your hair or have acne! It will also raise your T levels a small amount. Nonbinary people may also be very interested in stopping bottom growth (I know I am), and DHT blockers will likely aid with that. A comprehensive list of natural DHT blockers is available on this SelfHacked article, which also has functions of DHT, and this wiki article. If you’re really interesting in blocking bottom growth, you may want to look at an article I wrote on limiting bottom growth . It is a little complicated, a work in progress,and largely theoretical, but despite this, I hope that someone gets something out of it!
There are substances called anabolic-androgenic steriods that have varying amounts of androgenic and anabolic properties, due to their chemical makeup. These include drugs like nandrolone, stanozolol, and esters of testerone. Nandrolone may be of particular interest to some enbies, as it has descreased effects in tissues effected by 5a reductasse/DHT meaning it would have lowered effects on hair, scalp hair loss, and possibly less bottom growth. It is an extremely scheduled substance and therefore you would need to check with your doctor to see if you can get it, and as always, if you're going to DIY, check with a doctor, get bloodwork, etc. be safe, in essence. references: to make things easier, basically all of https://madgenderscience.wiki . Other sources are noted in hyperlinks. Most of these hyperlinks are to research papers. shout out to u/sunkindonut149 for letting me know about buserelin, danazol, and progesterone! :D thanks to u/Violet191 for all that information about DHEA, 5a reductase blockers, and the points about both AIs and SERMs! edit: minor formatting and syntax corrections. thanks everyone, I hope this post gets around a bit more! edit 2: slightly changed order of the GnRH blockers section edit 3: added DHT blockers, I forgot haha! Thanks u/fruitbap ! edit 4: woah thanks everyone! added clarification on stuff, fixed section on informed consent edit 5 (12/18/2017): major overhaul of sections on aromatase inhibitors, SERMS, added section on androgenic-anabolic steriods edit 6 (1/7 and 1/8/18): edited section on birth control pills, and the section on natural hrt edit 7 (5/19/18): corrected typo, and also stated i have a document with phytoandrogens and phytoestrogens for whoever wants it, simply PM me for it!
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