In general any type of hormonal anything is probably dangerous. Endocrine system is incredibly complex and connected in many different, mostly unknown ways.
And contraceptives play with hormones that are central to what makes women women.
These hormones are not just limited to regulating when eggs are released from ovaries, they take part in a lot of other processes. It is absolutely not surprising then that there will be other effects of long term hormonal supplementation.
I think the best course of action would be to work on other, non-hormonal contraceptive alternatives.
A large part of the risk can be mitigated by the fact that trans HRT uses bioidentical hormones and that you change the delivery route to transdermal or injections. The risk was substantial 30-40 years ago when trans HRT also used syntehtic hormones, but seemed to have leveled out to near nothing now.
Varying levels (big spikes, big valleys) are an issue too, but very few people are interested in doing anything about it. I'd love to be offered polyestradiol phosphate for instance. But such drugs are very rarely offered to anyone trans, because even after years of HRT, I could suddenly want to detransition and then this lasts too long. Or something.
It’s already suspected though not proven (as far as I know) that estradiol increases breast cancer risk, but I imagine most of that is because it encourages significant breast tissue growth.
HRT as applied to gender dysphoria in transgender women absolutely causes breast tissue growth. That is one of the desired effects. Seeing as 99% of breast cancers occur in women, and HRT causes the patient to have very female like breasts, it would be surprising if the patient did not see an increased risk of breast cancer compared to not taking HRT.
Weather or not their risk is higher than the baseline risk for women is less obvious.
> In general any type of hormonal anything is probably dangerous. Endocrine system is incredibly complex and connected in many different, mostly unknown ways.
By that logic sugar should be a controlled substance and we should all be gonadectimized. Gonadectimized animals almost always live longer.
> And contraceptives play with hormones that are central to what makes women women.
Weirdly estrogen in utero is central to what makes male mice male mice, and adult men adult men (20–55 pg/mL estradiol in adult men or about 1/10th the level of adult women). Estradiol plays many important roles in the body of all human adults.
> These hormones are not just limited to regulating when eggs are released from ovaries, they take part in a lot of other processes. It is absolutely not surprising then that there will be other effects of long term hormonal supplementation.
> I think the best course of action would be to work on other, non-hormonal contraceptive alternatives.
Maybe, maybe not, since chronic use of any medication will result in chronic side effects and physical interventions such as copper IUDs are also associated with a host of serious side effects. The best course of action would be to develop interventions that are safe in animal models, give them to humans for a while, and monitor the outcomes, which is what is going on here.
I'm surprised that the outcomes observed aren't worse, given how strongly carcinogenic estrogens are on a dose-dependent basis in animal models. Hormones are strange. Women with many children have reduced amounts of breast cancer despite being exposed to absolutely enormous levels of estrogens and progesterone during and after pregnancy.
And contraceptives play with hormones that are central to what makes women women.
These hormones are not just limited to regulating when eggs are released from ovaries, they take part in a lot of other processes. It is absolutely not surprising then that there will be other effects of long term hormonal supplementation.
I think the best course of action would be to work on other, non-hormonal contraceptive alternatives.