Trans hormones and psychoactive substances: specific interaction table
Detailed interaction table between trans hormones (estrogens, antiandrogens, progestogens, testosterone) and psychoactive substances, including mechanisms and risk levels.
How do hormones used by trans people interact with psychoactive substances?
This table shows the risk level of combining the hormones most commonly used in feminisation and masculinisation processes with psychoactive substances. Risk may vary depending on dose, route of administration, your health status, and other medicines you take.
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
Interaction table
| Substance | FEMINISATION — Estrogens (Estradiol) | FEMINISATION — Antiandrogens (Spironolactone) | FEMINISATION — Progestogens (Medroxyprogesterone acetate) | MASCULINISATION — Testosterone (enanthate, cypionate, undecanoate) | Why does it happen? Main mechanism |
|---|---|---|---|---|---|
| Alcohol | Caution: Increases the risk of liver damage and may alter hormone levels. | Caution: May increase dehydration, hypotension, and electrolyte changes. | Caution: Increases the risk of sedation and mood changes. | Caution: Increases the risk of liver damage and may raise blood pressure. | 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. | Caution: May increase appetite and drowsiness. | Additive effects on the central nervous system. |
| Cocaine | High: Increases the risk of thrombosis, hypertension, and cardiovascular events. | Moderate: May increase the risk of arrhythmias and electrolyte disturbances. | Moderate: Increases cardiovascular risk and hypertension. | High: Increases blood pressure, arrhythmia risk, and cardiovascular event risk. | Vasoconstriction, increased blood pressure, and cardiovascular overload. |
| MDMA / Ecstasy | Moderate: Risk of dehydration, hyponatraemia, and cardiovascular overload. | Moderate: May increase the risk of dehydration and hyponatraemia. | Moderate: Risk of dehydration, hyponatraemia, and mood changes. | Moderate: Increases cardiovascular risk and hyperthermia. | Changes in temperature regulation, fluid retention, and strain on the heart. |
| Methamphetamine | High: Increases the risk of cardiovascular events, hypertension, and neurotoxicity. | High: May increase the risk of arrhythmias, hypertension, and dehydration. | High: Increases cardiovascular risk and mood changes. | High: High risk of hypertension, arrhythmias, aggression, and cardiovascular events. | Intense sympathetic stimulation and increased catecholamines. |
| Ketamine | Caution: May increase blood pressure and affect liver function. | Caution: May worsen dehydration and hypotension. | Caution: May increase sedation and mood changes. | Caution: May increase blood pressure and liver damage risk. | Effects on the central nervous system and blood pressure; liver metabolism. |
| GHB / GBL | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: May worsen hypotension and deep sedation. | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Central nervous system depression and additive sedative effects. |
| Poppers (inhaled nitrites) | High: Risk of severe hypotension, dizziness, and syncope. | High: Risk of severe hypotension and fainting. | High: Risk of severe hypotension and syncope. | Moderate: May cause hypotension, dizziness, and headache. | Intense vasodilation and drop in blood pressure. |
| Opioids | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: May increase sedation and hypotension. | Moderate: Increases sedation and the risk of respiratory depression. | Moderate: Increases sedation and the risk of respiratory depression. | Central nervous system depression and additive effects. |
| 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. | No significant interactions have been reported. |
| Inhalants | Moderate: Increase the risk of liver and neurological damage. | Moderate: Increase the risk of liver damage and dehydration. | Moderate: Increase the risk of liver and neurological damage. | Moderate: Increase the risk of liver and neurological damage. | Increased liver and neurological toxicity. |
General recommendations
- Stay hydrated before, during, and after substance use.
- Do not combine hormones with substances if you have heart, liver, kidney disease, or a history of thrombosis.
- Avoid stimulants if you are using estrogens or testosterone, as they increase cardiovascular risk.
- Get regular medical follow-up to monitor your health and hormone levels.
- Always consult healthcare professionals who use an inclusive, non-discriminatory approach.
Important
- This table does not include every hormone currently in use.
- Interactions may vary depending on dose, route of administration, 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.