Feminising hormones and interactions with psychoactive substances
Interaction table between feminising hormones (estradiol, spironolactone, progesterone, cyproterone acetate) and psychoactive substances, with risk levels.
How do feminising hormones interact with psychoactive substances?
This table shows the risk level of combining the hormones most commonly used in feminisation processes with psychoactive substances. Risk may vary depending on dose, route of administration, your health status, and other medicines you take. Always consult healthcare professionals.
About feminising hormones
Feminising hormones work by reducing testosterone production and promoting feminine physical characteristics. Using them without medical supervision may increase health risks.
Risk level
- Low: no clinically relevant interaction
- Caution: mild risk, use carefully
- Moderate: important risk
- High: avoid the combination or consult your healthcare team
- Insufficient evidence
Hormones most commonly used in feminisation
| Substance | Estradiol valerate (injectable) — Progynon Depot®, Primogyn®, generics | Oral estradiol (hemihydrate) — Estrofem®, generics | Transdermal estradiol (patches) — Estradot®, Climara®, generics | Cyproterone acetate (antiandrogen) — Androcur®, generics | Spironolactone (antiandrogen) — Arlactone®, generics | Micronised progesterone (optional) — Utrogestan®, generics | Why does it happen? Main mechanism |
|---|---|---|---|---|---|---|---|
| Alcohol | Caution: Increases liver strain and estradiol levels. | Caution: Increases liver strain and thrombosis risk. | Low: No known clinically relevant interaction. | Moderate: Increases hepatotoxicity and the risk of lipid changes. | Caution: May increase hypotension and dehydration. | Caution: Increases sedation. | Shared liver metabolism and effects on blood pressure and the central nervous system. |
| Cannabis | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Caution: May increase appetite and drowsiness. | Additive effects on the central nervous system. |
| Cocaine | Moderate: Increases cardiovascular and hypertension risk. | Moderate: Increases cardiovascular and arrhythmia risk. | Moderate: Increases cardiovascular and hypertension risk. | High: Increases blood pressure, arrhythmia risk, and thrombosis risk. | High: Increases the risk of hypokalaemia and arrhythmias. | Moderate: Increases cardiovascular risk. | Vasoconstriction, increased blood pressure, and cardiovascular overload. |
| MDMA / Ecstasy | Moderate: Risk of dehydration, hyponatraemia, and thromboembolism. | Moderate: Risk of dehydration, hyponatraemia, and thromboembolism. | Low: No known clinically relevant interaction. | Moderate: Risk of electrolyte changes and cardiovascular overload. | Moderate: Increases the risk of hypokalaemia and hypotension. | Moderate: Increases fluid retention. | Effects on temperature regulation, fluid retention, and strain on the heart. |
| Methamphetamine | Moderate: Increases cardiovascular and arrhythmia risk. | Moderate: Increases cardiovascular and arrhythmia risk. | Moderate: Increases cardiovascular risk and hypertension. | High: Increases the risk of arrhythmias, hypertension, and liver damage. | High: Increases the risk of hypokalaemia and arrhythmias. | Moderate: Increases anxiety and sleep disruption. | Intense sympathetic stimulation, hypertension, arrhythmias, and organ damage. |
| Ketamine | Caution: May increase blood pressure. | Caution: May increase blood pressure. | Low: No known clinically relevant interaction. | Moderate: Possible increase in liver damage. | Caution: May increase sedation and hypotension. | Caution: Increases drowsiness. | Effects on the central nervous system, blood pressure, and liver metabolism. |
| GHB / GBL | Caution: Increases sedation and risk of respiratory depression. | Caution: Increases sedation and risk of respiratory depression. | Caution: Increases sedation and risk of respiratory depression. | Moderate: Increases sedation and the risk of hypotension. | Moderate: Increases sedation and the risk of hypotension. | Moderate: Increases sedation and the risk of respiratory depression. | Central nervous system depression, hypotension, and deep sedation. |
| Poppers (inhaled nitrites) | High: Risk of severe hypotension, dizziness, and fainting. | High: Risk of severe hypotension, dizziness, and fainting. | High: Risk of severe hypotension, dizziness, and fainting. | High: Risk of severe hypotension, dizziness, and fainting. | High: Risk of severe hypotension, dizziness, and fainting. | Moderate: May increase vasodilation. | Intense vasodilation and sudden drop in blood pressure. |
| Opioids | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Central nervous system depression and respiratory depression. |
| LSD | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | Low: No known clinically relevant interaction. | No significant interactions have been reported. |
| Inhalants | Moderate: Increases the risk of liver and neurological damage. | Moderate: Increases the risk of liver and neurological damage. | Moderate: Increases the risk of liver and neurological damage. | Moderate: Increases the risk of liver and neurological damage. | Moderate: Increases the risk of liver and neurological damage. | Moderate: Increases the risk of liver and neurological damage. | Increased liver and neurological toxicity. |
General recommendations
- Stay hydrated before, during, and after using substances.
- Do not combine hormones with substances if you have heart, liver, kidney disease, or a history of thrombosis.
- Get regular medical follow-up to monitor your health and hormone levels.
- Avoid self-medicating or changing doses without professional guidance.
- Always consult healthcare professionals who use an inclusive, non-discriminatory approach.
Important
- This table does not include every hormone or every substance.
- Interactions may vary depending on dose, route of administration (oral, injectable, transdermal), and your health status.
- Do not stop your hormones without professional guidance.
- If you have chest pain, shortness of breath, swelling in your legs, severe headache, or blurred vision, seek medical care immediately.
This information is educational and does not replace medical advice. Every body is unique and risks may change.