Hormone Replacement Therapy

Overview

Hormone replacement therapy, which generally consists of taking some form of testosterone, can be very effective for men with Benjamin's Syndrome. It causes the voice to break, and facial and body hair to develop. Body fat is redistributed into male patterns, and muscle mass and bone density increases as does libido. Male pattern baldness becomes possible. If HRT is begun at an early enough age, it will cause the skeleton to grow into a normal male shape. However, once the bones have stopped growing, no amount of testosterone can change their shape, and unwanted growth (eg in the pelvis) can't be undone. It doesn't cause significant reduction in breast size.

Taking testosterone often causes problems with acne, and sometimes migraines and other unpleasant side effects. It also causes the menstrual cycle to end, which although psychologically desirable could potentially be a health risk. In the long term, HRT can result in problems with the uterus, requiring a hysterectomy. Many if not most men want a hysterectomy anyway, and it has the additional benefit of ending conflict between the HRT and the hormones produced by the ovaries, reducing side effects.

The rate of change and the long term effects from HRT are both variable, but it is normal to see some results within a couple of months, and the most dramatic changes are likely to occur within the first year or two. However, development can continue for many years.

Injections

Most men with Benjamin's Syndrome use regular injections of testosterone esters. Initially the injection is carried out by the doctor or nurse, but usually they switch to self-injection at some point, to avoid the expense and inconvenience of regular visits to the doctor. The most common forms of injectable testosterone are testosterone cypionate (brand names include Depo-Testosterone), a suspension in cottonseed oil, and testosterone enanthate (brand names include Delatestryl), a suspension in sesame seed oil. Testosterone enanthate works more slowly, but tends to cause less severe side effects. With testosterone cypionate in particular, it is important to be careful with physical activity, as the muscles develop faster than the tendons and ligaments so it is easy to hurt yourself for the first couple of years. Testosterone propionate is also available, but needs to be taken more frequently in smaller does to maintain a steady testosterone level. A typical injectable dose is 1cc of oil containing 200ml/cc of testosterone, taken every two weeks.

Normal Male Testosterone Range	9-25 nmol/l
Typical Dose of Testosterone Esters	200ml fortnightly

Other Types Of Testosterone

Testosterone can also be taken orally, or in a patch. Oral testosterone in the dosages required for men with Benjamin's Syndrome is very hard on the liver, and can also cause high blood pressure, so it is not a good option and should be used with extreme care if no alternatives are available. Sublingual use may be worth trying, which has an effect somewhere between swallowing outright and using a transdermal delivery method. Patches, eg Androderm, are a better choice than pills if you don't like needles, or cannot use injectables for some other reason. They need to be left attatched to the skin constantly, so can be a bit of a hassle with skin irritation and wrinkling or peeling of the patch. Oral testosterones include methyltestosterone (brand names include Metandren), testosterone undecanoate (brand names include Andriol), and fluoxymesterone (brand names include Halotestin).

Normal Male Testosterone Range	9-25 nmol/l
Typical Dose of Methyltestosterone	30mg daily
Typical Dose of Testosterone Undecanoate	120mg twice daily
Typical Dose of Fluoxymesterone	15mg daily
Typical Dose of Androderm	5mg, changed daily

Progestins

If menstruation is not sufficiently supressed by testosterone, it can help to take progesterone as well, or other progestins such as Provera (a brand name for medroxyprogesterone acetate). Though Provera is not recommended for women, most of the side effects associated with it are unlikely to concern men. Micronised progesterone USP is available under the brand names Prometrium and Utrogestan, and from compounding pharmacies.

Typical Dose of Provera	2.5mg daily
Typical Dose of Progesterone	50mg daily

Estrogen

Though most men are not too keen on the idea of taking estrogen, it may in some cases be desirable after the ovaries have been removed (eg a hysterectomy). The testicles do produce some estrogen, and a certain level is natural and healthy for men. However, since excess testosterone is converted into estrogen by the body, it is probably safe enough to go without supplemental estrogen.

Normal Male Estradiol Range	0-200 pmol/l
Typical Dose of Premarin	0.3mg daily
Typical Dose of Estradiol	0.5mg daily

• Hormone FAQ - information on HRT for men with Benjamin's Syndrome.