The following charts indicate the known side-effects of chemical estrogen's and the known side-effects possible with herbal hormones. Please note that while these are all within the range of possibilities, not all of them are commonly found. Some are more frequently seen than others, and several are very rare. However, any of them are possible, especially when the dosage levels approach the maximum tolerance levels. Unfortunately, the tolerance levels are different for each of us, so whether you are concerned about herbals, or chemicals, there is a given range within which it is considered safe to use. Beyond this range, there are a number of overdose symptoms which become a problem, and then pathogenic.

This chart is only meant to be a guideline to inform anyone on some form of HRT, or contemplating beginning HRT for the purpose of Male to Female Transition. I have not individualized the side-effects by separate pharmaceutical, or single herbs. Many of the listed side-effects are found in more than one chemical, or herb, while some are known to be a problem with only one form of chemical, or herbal hormone. I have attempted to include all of the more common problems, and as many of the more rare ones as I can find reference to in my various medical texts.

Additionally, this chart only addresses the negative side-effects. With the herbals, there are also a number of "positive" side-effects, which provide them with the various functions we make use of in Traditional Chinese Herbal Medicine. Also, there are food qualities associated with the herbals, which are also considered by a trained Chinese Herbalist while developing an herbal formula.

[listed in alphabetical order]

change of vision
edema (fluid retention, esp in the lower extremities)
gastro-intestinal problems of various types (nausea, diarrhea, etc)
headache
hypertension
insomnia
irritability

Remember that these are just the most common chemical hormones, not the newest, and I cannot make comment about which are the most suitable for M>F Transitional therapy. If you are currently under a Physicians care in a HRT program, you might want to discuss why he has chosen the specific product for your therapy.

Some Basics
There are six (6) known Estrogen's in the female body, but three (estradiol, estrone, & estriol) are found in high concentrations. Estradiol is the most potent, and is the principal estrogen produced in the ovaries. However, it is converted into estrone, and then into estriol.

Estrogen affects the release of hormones from the pituitary gland which control the dilation of the capillaries. This may causes fluid retention, affects the breakdown of proteins in the body, and affects the calcium cycle of the body.

There are some differences as to which part of the body each of the known estrogen's affect the most. However, after adjusting the dosage differences to take into consideration the various differences in strength of each type of estrogen, they are more or less interchangeable.

Cautions & Warnings
General:
Gallbladder disease (esp, in post-menopausal women)
Increased possibility of blood clotting (if you suffer from any blood clotting disorder, talk with your Dr.)
Cancer of the breast, cervix, testes, uterus, vagina, kidney, or liver (with prolonged continuous use). If you have a family history of breast cancer, or have breast nodules, fibrocystic disease of the breast, or abnormal mamograms, consult your Dr. before using.
Blood-clotting disorders
Liver cancer, or liver tumors
High blood pressure
Glucose intolerance, or worsening of diabetic conditions
Unusual sun sensitivity
High levels of calcium

Women Only:
Endometrial cancer
Recurrent, abnormal, or persistent vaginal bleeding
Post partum painful breast milk engorgement, if you have this condition estrogen should not be used
Vaginal creams may cause, bleeding of the uterus, breast tenderness, vaginal discharge, & withdrawal bleeding when suddenly stopping the use
Heavy vaginal bleeding in women with endometriosis

Possible Side Effects ~
General:
Breast enlargement, or tenderness
Ankle & leg swelling
Loss of appetite
Weight changes
Water retention
Nausea
Vomiting
Abdominal cramps
Feeling of "bloodedness"
Rash, irritation, redness with the use of the "patch"(at the site of the patch)
Bleeding gums
Mild diarrhea
Jaundice
Rash
Loss of scalp hair
Development of new "hairy" areas
Lesions of the eye, and contact lens intolerance
Migraine headache
Mild dizziness
Depression
Stroke
Blood clot formation
dribbling, or sudden passage of urine
Loss of coordination
Chest pain
Leg pain
Difficulty breathing
Slurred speech
Changes in vision

Women Only:
Breakthrough vaginal bleeding
Vaginal spotting
Changes in menstrual flow
Painful menstruation
Pre-menstrual syndrome (PMS)
Absence of menstrual period during & after estrogen use
Enlargement of uterine fibroids
Vaginal infection with Candida
Increased sex drive

Men Only:
Decreased sex drive
Heart attack
Phlebitis
Blood clots in the lungs

Drug Interactions
There are a number of known interactions with other drugs, which you should ask your Dr. about, if you are on other medications. In general, estrogen is known to increase the toxic effects of other drugs on the Liver, especially in patients over the age of 35, or with a Liver disease.

If you are a cigarette smoker, and especially if you are over 35, there is a much greater risk of developing stroke, hardening of the arteries, or blood clots in the lungs. There is an increase in the risk of these as your age increases, and/or your tobacco usage increases.

You should not drink grapefruit juice while taking estrogens.

Special Information:
Call your doctor if you:
Develop breast pain or tenderness
Have swelling of the feet and/or lower legs
Have rapid weight gain
Chest pain
Breathing difficulties
Pain in the groin or calves
Unusual vaginal bleeding
Missed menstrual period
Lumps in the breast
Sudden severe headache
Dizziness or fainting
Disturbances in speech or vision
Weakness or numbness in the arms or legs
Abdominal pain
Depression
Yellowing of the skin, or whites of the eyes (Jaundice)
Jerky or involuntary muscle movement
If you might be pregnant
If you are using vaginal estrogen cream and develop breast tenderness, start to bleed, or have vaginal discharge

It is important to maintain good dental hygiene while taking estrogen, and use extra care when using your toothbrush or dental floss because of the risk that estrogen will make you more susceptible to infection. Dental work should be completed prior to starting estrogen therapy.