Prism Blog, Transgender Wellness

The Feminizing Diet

This is a follow-up post to my post, “Nutritional Guidelines for Transgender Patients.” See the original post here. This article is an excerpt from my research paper, “Nutritional Guidelines for Transgender Patients,” which was written for practitioners of TCM to create holistic diets tailored to clients’ constitutions. It is not intended to function as medical advice. There are a few jewels tucked into this article for practitioners, if you don’t have an understanding of TCM theory you can skip over the italicized parts.


To start, proper general nutrition is important, including plenty of healthy fats, avoiding animal products raised with hormones and processed or refined foods, and adding more fresh fruits, vegetables, and high quality protein.

As long as there are not contraindications or food allergies, an estrogen and progesterone supportive diet (i.e. does not actually produce/mimic estrogen and progesterone but can help to support those hormones in your body) should be focused on ancient grains and cooked dark vegetables, and include cooked berries, eggs, dark legumes, micro-algaes, nuts and seeds, garlic, shiitake, and reishi.

This diet along with herbs and acupuncture can cause a slight elevation in estrogen levels and breast enlargement in some people. However, please understand that these diets alone will not have a significant effect. Since each individual has different goals, this diet can be adapted based on changes that each person wishes to make and any underlying conditions.

Estrogen & Progesterone Supportive Diet Suggestions

  1. Increase starchy vegetables, millet, barley, seaweed, micro-algaes, dark legumes, beets, kudzu, persimmon, cooked berries, bananas, watermelon, mollusks (limit mollusks when taking progesterone), pickled and fermented foods, eggs, and coconut milk.
  2. Grass-fed hormone-free organic milk and fermented/cultured dairy products are also a great addition.
  3. Limit meat to small amounts of duck, beef, pork, goose, rabbit, and organ meats.
  4. If not taking hormones, add raw dark fruits (blackberries, purple plums, blueberries, etc.), raw dark greens, raw bell peppers, and small amounts of real black licorice (avoid with high blood pressure, when taking spironolactone, or with hot flash or night sweat symptoms).
  5. If taking estrogen, add garlic, lemons and limes (avoid if taking progesterone), shiitake, and reishi. AVOID eating grapefruit or taking GSE with estrogen.
  6. If taking spironolactone, AVOID buchu, cleavers, dandelion, gravel root, horsetail, juniper, uva ursi, molasses, and radishes.

Yin:

Many, though by no means all, trans women taking estrogen and spironolactone have some degree of yin deficiency, and this diet can help to counteract this issue while still supporting transition goals. This is a generally mild and healthy diet safe for most people, however care should be taken in following this diet exclusively long term if yin deficiency is not present. Always talk to your healthcare provider when making dietary changes.

A yin nourishing diet should be based on millet, barley, teff, quinoa, amaranth, and other ancient grains (Pitchford, p. 65). Other appropriate yin foods that could be added to the diet include seaweed, micro-algaes, black beans, kidney beans, mung beans, sprouts, beets, string beans, kudzu (not with damp signs), persimmon, grapes, cooked berries, bananas, watermelon, dairy, eggs, clams, abalone, oysters (avoid mollusks when taking progesterone and with damp signs), and sardines (Pitchford, p. 65). Reduce meat -which is a more yang tonifying food- except for small amounts of yin and blood nourishing duck, beef, pork, goose, rabbit, and kidney (Pitchford, p. 65). Sour foods are beneficial because they tonify yin and move the blood (Caruso-Radin), which could be helpful to prevent blood clots, a common side effect of estrogen use,. Spices should mainly include milder white pepper, cilantro, and marjoram, which are yin spices (Pitchford, p. 62), rather than stronger yang spices like cayenne. When these foods are made into soups, stews, and congees they become even more yin tonifying.

Supporting Estrogen:

In designing a feminizing diet, it is necessary to think about not only the energetic and hormonal properties of foods, but also their safety for long term use. For example, eating mainly carbohydrates, starches, coffee, and soy can raise estrogen levels and lower testosterone levels (Duvall), but this can also potentially cause diabetes, hormone dependent cancers, heart palpitations, and other serious health consequences.

I would generally recommend that for those looking for natural sources of estrogen, there are many safer options than soy. For example, “flax contains substances called lignans, which have been shown to have estrogen-like qualities” (Wright & Morgenthaler). A few foods have small amounts of identical-to-human hormones [about 1-2% potency of human hormones] (Wright & Morgenthaler), including:  Rice, apples, date palm, pomegranate (estrone); and French bean seedlings (estradiol). Note that eating these foods alone will generally not be enough to noticeably increase estrogen levels.

For trans women not taking hormones, licorice could be added to the diet to increase estrogen, however it should not be taken with diuretics (such as spironolactone), by an individual with high blood pressure (Griffith, p. 345), or with symptoms of hot flashes and night sweats. The ipriflavone in soy, alfalfa, and propolis is additive when taken with estrogen (Gale Group), and should not be combined with estrogens (Gaby, p. 110), but may be useful for those not taking hormones, though only fermented soy such as tempeh should be consumed (to avoid the other detrimental effects of soy).

Supporting Progesterone:

Pregnenolone derived from diosgenin in wild yams is extracted in the body when combined with cholesterol heavy foods such as eggs, and is converted to either DHEA or progesterone (Bennett), which can balance high estrogen levels. This is known to cause breast enlargement in male assigned people (Griffith, p. 174-175), but because DHEA and progesterone can convert to either estrogen or testosterone in the body, they should not be used with synthetic hormones or without medical supervision.

Synthetic Estrogen and Food Interactions:

Trans women taking hormones should be aware that they can interact with nutrients in certain foods. Estrogen for example, has adverse interactions with the quercetin in grapefruit, which is also to a lesser extent in capers; onions; raw dark fruits like cranberries, black plums, blueberries, currants, and cherries; and raw kale, lettuce, asparagus, spinach, broccoli, and peppers (Kerns, 2014). These foods should be limited when taking estrogen and not eaten at the time of medication.

In addition to having adverse reactions with quercetin, synthetic estrogens deplete B6, which can be replaced by eating organ meats, brewer’s yeast, garlic, and whole potatoes (USDA). B6 smooths liver qi stagnation, clears heat, harmonizes wood and earth, and clears heat from the stomach and damp-heat from the gall bladder (Caruso-Radin), which can help ease negative effects of estrogen on the digestive system and emotional health.

Countering Estrogen Side Effects:

Estrogen can cause several side effects, such as circulation problems, blood clotting, and sometimes increased blood levels of cholesterol, all of which may be prevented with nutrition. Circulatory problems can be combated with the chlorophyll in dark leafy greens and micro-algaes (Balch, p.129). This can be further aided by the CoQ10 and B5 (converted to coenzyme-a, which works along with CoQ10) in organ meats, eggs, brewer’s yeast, avocado, and seeds, which together improve tissue oxygenation (Coffman). According to TCM, CoQ10 and coenzyme-a relieve liver qi stagnation, clear heat, and tonify the spleen (Caruso-Radin), perhaps allowing the spleen to create qi and the liver to move qi to prevent stagnation that could lead to blood clots and other circulatory problems.

Shiitake and reishi prevent hypertension, heart disease, and cholesterol problems (Midnight). The Vitamin C and other antioxidants in a diet full of fermented foods and a variety of fruits and vegetables prevents blood clotting (Midnight), and also clears heat, resolves toxins, and calms the shen (Caruso-Radin), potentially minimizing the toxicity of synthetic hormones and easing emotional imbalances caused by introducing new hormones to the system. Nuts and seeds, especially coconut milk, walnuts and sunflower seeds which contain both essential fatty acids and vitamin E (USDA), should also be consumed to help the body to manufacture hormones like estrogen (Balch, p. 454), and to replenish vitamin E that is depleted by synthetic estrogen (Pitchford, p. 397).

Anyone taking estrogen should include lemons or limes (avoid with progesterone), spinach, and other leafy greens to detox the liver (Duvall). Brussels sprouts and broccoli in particular also contain phyto-estrogens (Duvall), so are an especially good choice. Monitor your hormone levels with a doctor when doing a liver detox to ensure that you are maintaining the appropriate amounts for your body.

Countering Spironolactone Side Effects:

Spironolactone is the most commonly used androgen blocker in the United States. It was originally developed as a potassium sparing diuretic and therefore should not be combined with diuretic herbs like buchu, cleavers, dandelion, gravel root, horsetail, or juniper; or with foods with a lot of magnesium and potassium (Gaby, p. 243), like molasses, kelp, chocolate, bananas, or radishes (USDA), since those minerals are not excreted as easily with spironolactone use.

(Providers: Magnesium astringes yin, suppresses yang, and calms shen (Caruso-Radin), so the fact that spironolactone causes the body to retain magnesium may explain why spironolactone has a yin tonifying anti-androgenic effect. Potassium tonifies the spleen, drains damp, and clears heat (Caruso-Radin), accounting for the diuretic effects of spironolactone.)

Anyone taking spironolactone should supplement with organ meats, spinach, or asparagus which provides the folate that can be depleted from spironolactone use (Gaby, p. 243). Folate nourishes the blood, harmonizes the liver, and calms the shen (Caruso-Radin), which could potentially ease some of the emotional side effects of hormones.

Salt is also depleted and should be supplemented via cheese and pickled or fermented vegetables (UCSF). Salt tonifies the liver and kidney and astringes jing (Caruso-Radin), which can all be damaged by longer-term synthetic hormone use. A low-salt diet combined with spironolactone can cause low blood pressure. Blood pressure should be monitored frequently while taking spironolactone to ensure it is not too low, especially if you tend to experience low blood pressure.

Countering Progesterone Side Effects:

Progesterone, when taken internally, increases vitamin A. From a TCM standpoint, vitamin A tonifies the blood and jing and clears deficiency heat and stagnation, accounting for progesterone’s ability to nourish yin to counterbalance estrogen.

Progesterone also increases folate, zinc, and magnesium (Gaby), so these items should not be supplemented, however, this most likely does not apply to foods containing those nutrients. This does mean that the folate depleted by spironolactone would be balanced by progesterone and magnesium would be even more increased so should definitely not be supplemented when taking both of these medications.

Summary:

Overall, a diet for trans women could focus on ancient grains, especially millet and barley, and cooked Brussels sprouts, broccoli, and other dark greens. It should also include micro-algaes, dark legumes, cooked berries, eggs, coconut milk, grass-fed organic hormone-free dairy, walnuts, sunflower seeds, garlic, shiitake, and reishi.


All information in this blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or changing or discontinuing your medications.


Contact us to see if your insurance covers services at our office!

Join the Prism Family! Subscribe to our newsletter and get $30 off your first visit.


ix Taken as a supplement, cream, or suppository. Not usually used in food due to toxicity, though it may be found in Eden Food’s “Wild Yam Soba.”

Endometriosis, Fertility and Pregnancy, Menopause and Beyond, PCOS, Prism Blog, Transgender Wellness

The Soy Controversy

“Women consuming the equivalent of two cups of soy milk per day provides the estrogenic equivalent of one birth control pill… men who consumed the equivalent of one cup of soy milk per day had a 50% lower sperm count than men who didn’t eat soy. –Chris Kresser’s Paleo Code

Soy is often touted as a natural source of estrogen, but is it safe to use either for this purpose or as a food?

“About two ounces of soy products per day may be sufficient to ward off hot flashes and other symptoms” of menopause (Wright & Morgenthaler, Natural Hormone Replacement for Women over 45). However, as an estrogen source, it may not be the safest food option.

Soy is present in nearly every packaged and processed food in the U.S, in fact, the average American gets up to 9% of our calories from soybean oil alone. Compare this to about 2 teaspoons per day in China and 9 teaspoons per day in Japan, most of which is fermented soy, which neutralizes the toxins (like trypsin inhibitors that inhibit protein digestion and affect pancreatic function, and phytic acid, which reduces absorption of minerals like calcium, magnesium, copper, iron and zinc) that are present in most of the soy we consume in the U.S. (Chris Kresser’s Paleo Code)

Unfermented soy also increases our requirement for vitamin D and B12 (the opposite of fermented soy which provides these vitamins!), and disrupts endocrine function (potentially causing breast cancer and thyroid problems). Processed unfermented soy often actually contains carcinogens as well. (Chris Kresser’s Paleo Code)

It is not fully known how soy consumption may impact synthetic hormones, and it’s nearly impossible to avoid all soy since it’s in most of the food we consume, but it would be wise for most people to avoid eating the major processed soy foods like tofu, soy milk, and soy protein isolate. Fermented soy still contains estrogens, but is not as disruptive (or potentially carcinogenic) to our natural hormones, and is probably a safe food for most people.

I would generally recommend that people transitioning towards the masculine side of the spectrum avoid soy foods, and for those looking for natural sources of estrogen, there are many safer feminizing herbs and foods out there. For example, “flax contains substances called lignans, which have been shown to have estrogen-like qualities” (Wright & Morgenthaler). A few foods have small amounts of identical-to-human hormones [about 1-2% potency of human hormones] (Wright & Morgenthaler), including:
Rice, apples, date palm, pomegranate (estrone)
French bean seedlings (estradiol)
rice, licorice (estriol)


All information in this blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or changing or discontinuing your medications.


Contact us to see if your insurance covers services at our office!

Join the Prism Family! Subscribe to our newsletter and get $30 off your first visit.

Prism Blog, Transgender Wellness

Estrogen and Blood Clot Risk in Trans Women

Estrogen produced by the body lowers blood concentrations of several clotting factors and speeds the rate at which clots dissolve. Estrogen also suppresses production of a factor which is involved in enlarging the size of a clot, and is also beneficial to cholesterol levels. (This may be why cisgender men are about 18% more likely to develop DVT than cisgender women.)

Administered estrogen, however, actually increases plasma fibrinogen, the activity of coagulation factors, and platelet activity. This explains why estrogen medications increase blood clots (in both transgender women and cisgender women taking birth control or hormone replacement therapy). Oral estrogen also significantly increases “bad” cholesterol in trans women, while decreasing the level of “good” cholesterol, which can lead to clogged arteries, increasing chances of clots.

Highest risk: Combining antiandrogens (like spironolactone) with oral ethinyl estradiol (birth control pills) carries a much higher risk of thrombosis than any other regimen. Trans women taking birth control pills are 20 times more likely to suffer from DVT than the general population. Premarin also carries a higher risk of DVT than injectable estrogen, though not as high as birth control. This is most often the case for hormones that are procured without a prescription. Prescribed HRT for trans women in the U.S. usually includes spironolactone and 17-beta estradiol (aka micronized estradiol), rather than ethinyl estradiol. This regimen is much less likely to produce clots.

Other risk factors: lack of exercise, long periods of immobility (such as long airline flights), genetic clotting risk, injuries (broken bones especially), liver stress (support liver while taking hormones!), high blood pressure, type 1 diabetes. Aspirin therapy is often recommended if over age 40 because of increased plasma concentrations of coagulation factors. Smoking increases factor XIII, thrombin, and fibrinogen, which increase clotting risk. Smokeless nicotine does not carry the same risk, and abstention from smoking for a period of only 2 weeks significantly decreases the rate of fibrinogen synthesis. Risk is highest within the first year of estrogen use, potentially because oral estrogen is more common than injectable estrogen during this time.

Recommendations:

  • Using injectable rather than oral estrogen of any kind (if using oral estrogen make sure it’s 17-B estradiol)
  • Taking baby aspirin for the first year of HRT if over age 40
  • Supporting your liver metabolism
  • Exercise regularly
  • Quit smoking (or switch to smokeless tobacco for at least the first year of HRT)
  • Test for genetic clotting risk
  • Check blood pressure regularly and maintain safe levels

Symptoms of DVT: inexplicably warm area on your lower leg which persists for more than an hour, localized swelling, redness, pain, shortness of breath, chest pain, symptoms of stroke. CALL 911!


All information in this blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or changing or discontinuing your medications.


Contact us to see if your insurance covers services at our office!

Join the Prism Family! Subscribe to our newsletter and get $30 off your first visit.


Resources:
http://www.atsjournals.org/doi/full/10.1513/pats.200407-038MS#.VIKVP8mJkTA
http://www.ncbi.nlm.nih.gov/pubmed/2960241
http://transascity.org/deep-vein-thrombosis-and-hormone-use/
http://www.pharmacologyweekly.com/custom/archived-content/pharmacotherapy/51
http://www.sciencedaily.com/releases/2013/09/130930162226.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096855/
A Personal Story: bloodisthickerthanwaterr.wordpress.com/2015/01/13/my-blood-clot-story-2/

Prism Blog, Transgender Wellness

Herbs for Transitioning: Feminizing Herbs

This is a follow-up post to “The Basics.” Also see the transmasculine post here.

Hormones and surgery can be expensive or not accessible. Herbs can also be used if you don’t want to use hormones or undergo surgery, but still want to create changes in your body, or after being on synthetic hormones for many years to maintain the changes that you have made without the side effects of continued synthetic hormone use. Note: Most herbs are unlikely to have a significant effect without any other transition methods.

DO NOT combine these with your medications without discussing with a healthcare provider.

Vitex: The Regulating Herb:

Vitex (Vitex agnus) is a hormone normalizer that works with the pituitary gland to keep progesterone stable and prevent  it from converting to estrogen or testosterone. This helps to hold secondary sex characteristics that have developed with synthetic hormones. Vitex increases LH and reduces FSH secretion, which increases progesterone relative to estrogen and testosterone (Wright & Morgenthaler, Natural Hormone Replacement). This helps it regulate emotions, prevent acne, hormonal edema and bloating, and it can help you transition onto and off of synthetic hormones, as well as stabilize fluctuations in hormones while taking hormones.

Estrogenic, Progesterogenic, and Anti-Androgenic Herbs:

  • Example combination: Vitex, Hops, Maca, and sprouted Fenugreek
  • Rhodeola Rosea is a controversial herb, however, the most informative sources I’ve found say that it increases estrogen levels unless they are already unnaturally high (such as when taking estradiol), in which case it decreases them. Overall this is a strong herb that should be used with caution and medical supervision.
    • If you have had estrogen sensitive breast cancer, bleeding disorders, diabetes, or take acetazolamide, alpha-glucosidase inhibitors, anti-anxiety agents, antibiotics, anticancer agents, antidepressants, anti-inflammatories, antivirals, COMT inhibitors, drugs that affect the cardiovascular system or the immune system, P-glycoprotein-regulated agents, sedatives, theophylline, or stimulants, you should use caution or avoid this herb.
  • Maca is known for its effects of creating curves, has estrogenic effects, and is fairly inexpensive. It is also known for its aphrodisiac effects, and can increase erectile capacity and sperm counts, which may be a positive or negative thing for you depending on your goals. It also boosts the immune system and helps combat osteoporosis (which can be a side effect of taking spironolactone). Also available in a women’s libido blend.
  • Chaste tree berry/Vitex (Vitex agnus-castus) mimics progesterone, is also considered to be mildly estrogenic, and increases breast size by stimulating the development of milk ducts. It can therefore have a side effect of causing lactation.
  • Black cohosh/Sheng Ma (Cimicifuga racemosa) contains several compounds in its root (aceteine, formononetin, and triterpenes) that, though not estrogenic themselves, create similar effects to estrogen and can increase breast size. It decreases LH and increases estrogen in relation to progesterone [opposite of Vitex] (Wright & Morgenthaler). Only use this herb under supervision of an herbalist.
  • Fenugreek/Hu Lu Ba (Trigonella foenum-graecum) seeds contain a compound (diosgenin) that’s estrogenic and promotes breast tissue growth. Sprouted seeds contain much more diosgenin than the unsprouted seeds, so breast enlargement is more noticeable if you sprout the seeds first. Fennel works in much the same way.
  • Hops have 0.2-20% the potency of estradiol
  • Dong Quai/Dang Gui (stimulates estrogen receptors, providing some estrogen stimulus to receptor sites (Wright & Morgenthaler), however, it is not actually estrogenic itself.
  • False Unicorn (used during menopause for estrogen replacement)
  • Licorice (somewhat anti-androgenic and mimicks estrogen). Licorice also notably counteracts side effects of spironolactone (the most common anti-androgen used in the U.S.) like low blood pressure, gastic upsets, fatigue, dehydration, and frequent urination.
  • Other options from other pracititioners, I can’t vouch for any of these myself:
    • Pennyroyal (never take the oil internally!)
    • Goats Rue (promotes lactation)
    • Southernwood
    • Red Clover/Hsun Tsao
    • Caraway
    • Partridge Berry
    •  Anise
    • Raspberry Leaf
    • Mugwort/Ai Ye
    • Yarrow (encourages progesterone)
    • Cramp bark (mildly estrogenic)
    • Turmeric (mildly estrogenic)
    • Alfalfa
    • Burdock
    • Evening Primrose
    • Pau D’Arco
  • Blends:
    • Phytoestrogen Herbal from Vitanica
    • My Evanesce has several herbal blends, most of which have many unnecessary added ingredients, but their Feminol product has a more useful blend of dong quai, black cohosh, chaste tree, white kwao krua, fennel, fenugreek, licorice, kudzu, sarsaparilla, boron, plus b6, d3, and b12. They recommend taking all of their formulations at once which is not only completely unnecessary as they mostly contain the same ingredients but also could lead to dangerous dosages of the herbs. Do not do this and do your own research!
    • “HRT Companion” formula (formulated for side effects of synthetic hormones)
  • Foods:

Note: DON’T combine synthetic hormones with St. John’s wort/Guan Ye Lian Qiao, it changes the way that medications are metabolized. It also encourages bleeding, so avoid before surgery too!


All information in this blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or changing or discontinuing your medications.


Contact us to see if your insurance covers services at our office!

Join the Prism Family! Subscribe to our newsletter and get $30 off your first visit.


References include:
http://www.sfherbalist.com/holistic-health-for-transgender-gender-variant-folks/
http://midnightapothecary.blogspot.com/

Prism Blog, Transgender Wellness

Herbs for Transitioning: The Basics

Herbs can be used for many aspects of transitioning: transitioning with herbs alone, switching from synthetic hormones to herbs to maintain secondary sex characteristics, and supporting the body with herbs and nutrition to counteract side effects of synthetic hormones.

The Basics:

It’s first important to take care of your body with proper nutrition so that you can handle the changes  and stress that will accompany transitioning. All hormones are made of fat, so it’s important to eat good fats (raw oils & omega 3s especially) to help your body form and transform those hormones, and also to coat your nerve cells (their myelin sheaths are also made of fat) to help you cope with stress and stay emotionally healthy. Fats form the boundaries of our cells–they keep out and let in what we want to–we need good fats in our bodies to have good boundaries physically and emotionally!

We ALL have the same hormones, just in different amounts and we USE different amounts of them too. Furthermore, we can change how our bodies use the hormones we already have. Every body makes progesterone from cholesterol, and that progesterone can turn into estrogen OR testosterone. The estrogen and testosterone in our bodies can also convert back and forth (estrogen to testosterone and vice versa). This is the reason you want to get your hormone dosages right: if you take too much, your body is just going to convert it into another hormone to maintain balance in your system. This could actually counter the desired effects of the hormone you are taking: too much estrogen in your system and your body will start converting it to testosterone, counteracting the changes you want to make.

Coming up with a plan for your body:

There are many different options for transitioning, even when just using synthetic hormones. Progesterone itself helps to build tissue and can often be useful for developing breasts (taken externally) or muscle tissue (taken internally). Aromatase is what turns testosterone into estrogen, so you can take extra aromatase instead of (or in addition to) taking estrogen. Likewise, you can take aromatase inhibitor to prevent that testosterone from turning into estrogen, instead of taking testosterone. There are many options for prescription hormones; it’s important to talk to your doctor about what will work best for your body.
For most people, herbs aren’t going to change your hormones drastically alone, so you might choose to start out taking synthetic hormones and, once you’ve achieved the effect you want, use herbs to lower your dose of synthetic hormones or switch to herbs entirely. Herbs can maintain the hormone levels and characteristics you’ve built up with synthetic hormones. This is a good alternative to the sometimes health damaging side effects of long-term synthetic hormone use.


Contact us to see if your insurance covers services at our office!


References include:
http://www.sfherbalist.com/holistic-health-for-transgender-gender-variant-folks/


All information in this blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or changing or discontinuing your medications.


Contact us to see if your insurance covers services at our office!

Join the Prism Family! Subscribe to our newsletter and get $30 off your first visit.