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William J. Powers, D.O. AAHIVMS is a doctor specializing in transgender health care and HIV care. His work and research on hormone replacement therapy for transgender patients, known as the Powers Method, diverges from advice promoted by major organizations such as WPATH. As of 2019, his practice in Farmington Hills, Michigan sees 10-15 transgender patients daily, and around 1500 total.

The Powers Method
Dr. Powers uses an informed consent model and requires all patients to undergo psychiatric evaluation and pre-treatment labs.

Child - transmasculine
At the onset of puberty, patients are prescribed Lupron to arrest puberty until persistence of gender dysphoria can be determined. Once confirmed, patients undergo therapy with testosterone. To allow patients to grow to their desired height before the closure of growth plates, testosterone treatment may be delayed until age 15-16, or until the patient is an inch or two away from their desired height.

Adult - transmasculine
The Powers Method for adult transmasculine patients is similar to standard WPATH practices. Patients are prescribed testosterone, typically taken intramuscularly, at dosages between 80-120mg weekly. For patients that desire it, Dr. Powers recommends the application of minoxidil to the face to accelerate facial hair growth and topical testosterone to the clitoris to assist with future metoidoplasty.

Child - transfeminine
At the onset of puberty, patients are prescribed Lupron to arrest puberty until persistence of gender dysphoria can be determined. Patients are started on estrogen treatment as early as possible to prevent irreversible height growth that may result in increased gender dysphoria.

Adult - transfeminine
As opposed to standard WPATH practices, the Powers Method takes account of and monitors the ratio between estrone and estradiol levels in the blood. Patients are prescribed oral estradiol at gradually increasing doses between 2-10mg daily until breast development reaches Tanner III, around 6-12 months. Powers argues that a predominance of estrone is important for early breast bud formation, but once Tanner III is reached, hormone levels should be inverted such that estradiol predominates, to mimic the puberty of those assigned female at birth. After Tanner III, patients are switched to intramuscular injections of estradiol as well as progesterone taken as a suppository. This course of treatment is justified by the desire to mimic breast development that occurs during natural thelarche. In this second stage, ideal levels are around 300pg/ml estradiol and 100pg/ml estrone.

Unlike many providers, Dr. Powers does not typically prescribe testosterone blockers once a patient has switched to injectable estradiol and progesterone. When prescribed, he uses bicalutamide rather than the typically prescribed spironolactone, which he claims causes visceral adiposity, polyuria, increased serum cortisol, brain fog, and prevention of future breast development.