At Plume, we believe all transgender people deserve the right and access to transition in order to live their best life. That means taking a non-judgmental, harm reduction approach to care. We meet all patients where they are at and strive to provide the most accurate information to your wellness questions to help you reach your transition goals. 


Please read below for frequently asked questions regarding substance use and gender affirming hormone therapy. Don’t see what you are looking for? Reach out to your Care Team with any questions or concerns, and speak with your Plume provider with any specific questions related to your treatment plan.


TABLE OF CONTENTS

Can I take hormones if I use marijuana?

We don't yet know the long term impacts of marijuana on health. There have been some studies that show elevated blood pressure after using THC containing products. Elevated blood pressure over time could increase your overall risk of cardiac events. Additionally, as more research comes out in the future regarding other health risks, we may find other concrete data that marijuana negatively impacts lung tissue or other parts of the body. While marijuana use is not a contraindication to gender affirming hormone therapy, at this time we don't condone or condemn marijuana but also recommend that anyone using it should practice moderation.


Can I take hormones and consume nicotine (cigarettes, vaping, etc)?

Patients on testosterone

While cisgender men do have higher rates of cholesterol related disorders and heart disease than cisgender women, the available research on transgender men taking testosterone has generally not found these differences. Most of the research on risk of heart disease and strokes in transgender men suggests that risk does not increase once testosterone is begun. However, longer term, definitive studies are lacking. It has been suggested that the risk of other conditions such as diabetes or being overweight is increased by masculinizing testosterone therapy, however actual research supporting these claims are limited.

Nicotine would increase the risk of cardiac issues like heart disease and stroke. While nicotine use is not a contraindication to testosterone therapy, your care team highly advises you consider quitting.


Patients on Estrogen+

The risk of things like blood clots, heart attacks, strokes, diabetes, and cancer as a result of estrogen hormone therapy are minimal, but may be elevated, especially for those with co-existing health conditions or starting hormone therapy after age 50. An increased risk of blood clots, strokes and heart attacks is possible when taking estrogen combined with cigarette smoking. The size of any increase in risk for those in good health is small, and may be offset by improvements in quality of life and reductions in stress levels once they taking hormone therapy has begun

We always recommend nicotine cessation for your long term health in all folx, whether using hormones or not.

 

What effects does alcohol have on hormones?

Tolerance or reaction to alcohol can change as your hormones change. There is no known interaction between drinking alcohol and hormones. Alcohol consumption should always be done in moderation. Organization states that men should consume 2 or less drinks a day and women should consume 1 or less drink a day. So take that into consideration when consuming alcohol.


Note: When talking about standard drinks this includes 12 ounce beer, 8 ounce malt liquor, 5 ounces of wine, and 1.5 ounces of 80 proof distilled alcohols.

 

Can I drink alcohol and take estrogen or testosterone blocker pills in the same afternoon/evening?

It is hard to give a “timeframe” on when estrogen or t-blockers pills should be taken in relation to alcohol intake. Ideally, alcohol should be avoided when on estrogen.


If you have had a drink or 2, it is safe to take your estrogen and testosterone blocker pill that same evening, waiting about 2 hours after consumption. However, the t-blocker spironolactone is considered a diuretic (aka water pill), and alcohol, especially beer, can act as such as well. If you consume a moderate to heavy amount of alcohol,you should wait about 24 hours before resuming spiro, as well as increasing your water intake to offset the loss of fluids. This issue could cause dehydration, drop in your blood pressure, and changes in your electrolytes that could be harmful to your body.


With Estrogen, proceed with caution, as estrogen increases the risk of blood clots and harm to the liver, and alcohol can as well. Again, 1 to 2 drinks is fine, but increased consumption will increase your risk of these issues. Medications used for HRT should not be consumed while actively drinking alcohol.


Note: When talking about standard drinks this includes 12 ounce beer, 8 ounce malt liquor, 5 ounces of wine, and 1.5 ounces of 80 proof distilled alcohols.

 

Can I drink alcohol on the same day I take my hormone injection? 

Everything in moderation. Consuming 1 or 2 drinks when taking hormone injections is fine. Moderate to heavy drinking can increase risks associated with taking estrogen, such as blood clots and liver injury. 


Note: When talking about standard drinks this includes 12 ounce beer, 8 ounce malt liquor, 5 ounces of wine, and 1.5 ounces of 80 proof distilled alcohols.

 

Can I take hormones if I take Ketamine? 

There are no known interactions between ketamine and testosterone, estrogen, progesterone, or blockers (spironolactone, finasteride).


Can I take hormones if I take Suboxone? 

Opioid agonists, including treatments such as methadone and buprenorphine, have known interactions with certain GAHT such as spironolactone. However, co-prescription of these medications is safe and feasible with appropriate monitoring and follow up. Of note, buprenorphine is thought to be safer and have fewer drug-drug interactions than methadone or other opioids.


Can I take hormones if I take Methadone? 

Opioid agonists, including treatments such as methadone and buprenorphine, have known interactions with certain GAHT such as spironolactone. However, co-prescription of these medications is safe and feasible with appropriate monitoring and follow up. Of note, buprenorphine is thought to be safer and have fewer drug-drug interactions than methadone or other opioids.


Do any drugs or alcohol interfere with hormones?

The scientific studies we have show that chronic heavy use of alcohol decreases production of testosterone, in particular in folks assigned male at birth.

For those on T therapy because you are taking testosterone from an outside source, this would not affect you.


As long as you aren't drinking excessively and often, it shouldn't have much effect.