Topic: Question about HRT

[Rachel Montgomery]

I naturally have very low T (my initial Free Total T was 1.3L, where the reference range is 46-224, and the re-testing done two weeks later came back below detectable levels).  Anyway, it is apparently something wrong with my pituitary.

My question regard transitioning.  I am taking medicine now that makes my T higher (though I am MTF, I am not out).  I had a lot of reservations about starting treatment, because in a very conscious way I did not want my T higher.  I did it anyway because having low T was making me feel terrible.  My cholesterol was through the roof, I was gaining weight, I had migraines, and muscle cramps daily.  I was extremely irritable, and would fly into rages.  And, I was very emotional.

My question is, would all of these symptoms return if I stopped taking everything to replace T and started taking E?  Would the E help with the migraines, the cramping and the Cholesterol?  Because, if it would I could deal with the emotional issues and the rage issues, but the feeling sick part (tired, weak, crampy and the frequent migraines) I can't really deal with.

I can't ask my Endo, because I am not "out".  I did ask one Endo, and he said he didn't know.   

[KathyLauren]

You are asking medical questions that few, if any of us are qualified to answer.  The right person to ask is your doctor or endo. 

Perhaps you should be considering when to tell them, since you don't want to be taking T supplements if you can avoid it.

[Sarah-Red]

Yeah I think it'd be better to talk about it with your endo. I don't see them judging you or anything.

The T could be useful for now, but my guess is that if your E would be high enough, it would balance out as your system would then function like an adult woman. I'm not a professional though I just think it could be a good reason to start E, if that's something you plan to do. To get it higher.

[Pammie]

Yeah I think it'd be better to talk about it with your endo. I don't see them judging you or anything.

The T could be useful for now, but my guess is that if your E would be high enough, it would balance out as your system would then function like an adult woman. I'm not a professional though I just think it could be a good reason to start E, if that's something you plan to do. To get it higher.

I would have thought the best thing to do is to discuss this with your endo. You really need professional advice.


Sent from my iPhone using Tapatalk

[AllieSF]

Rachel,

I agree that you should talk with "a transgender knowledgeable" endo.  I put those qualifications in because not all endos know much about the specific issues associated with transgender people and HRT for us, MtF and FtM.  I understand your concern about outing yourself to a doctor.  However, they are bound by HIPA in the USA, and probably something similar in other countries, to maintain your personal medical information private.  You need to trust them to do just that!  The right doctor can definitely help you by explaining what is happening now with you and explain how HRT can fit in with whatever hormone issues you have.  He?she may decide to give you a combination of hormones (T plus E plus ??) to help you get to where you eventually want to be, all in a healthy caring way.

On a plus side, you may find a way to go on HRT sooner than planned, if the doctor, knowing you are trans and plan on transitioning, can get you on a dose of E and maybe a dose of T all to treat your current non HRT issues.  No one but you and the doctor need to know it is also for HRT, and then you can tell everyone else it is for your current health issues.  Sounds like a possible win - win situation for you.  Good luck either way and please do trust your doctors.  They can actually help you, maybe much more than you realize now.

[ChrissyRyan]

Please talk with the physicians who manage your medicines and health.

I hope things will turn out very well for you. 

Hugs,

Chrissy

[Rakel]

Anyway, it is apparently something wrong with my pituitary.

This is a serious condition. Your Endocrinologist is the proper person for get the answers you need. If they say that they don't know, get a second opinion by a different Endocrinologist.

My question regard transitioning.  I am taking medicine now that makes my T higher (though I am MTF, I am not out).  I had a lot of reservations about starting treatment, because in a very conscious way I did not want my T higher.  I did it anyway because having low T was making me feel terrible.  My cholesterol was through the roof, I was gaining weight, I had migraines, and muscle cramps daily.  I was extremely irritable, and would fly into rages.  And, I was very emotional.

My question is, would all of these symptoms return if I stopped taking everything to replace T and started taking E?  Would the E help with the migraines, the cramping and the Cholesterol?  Because, if it would I could deal with the emotional issues and the rage issues, but the feeling sick part (tired, weak, crampy and the frequent migraines) I can't really deal with.

Your symptoms are too serious to diagnose here. Since I  am a Pharmacist, I can comment on a few things. Testosterone will restore a feeling of energy and strength. Women need some Testosterone and there are low dose products intended mainly for women. Masculinization is generally not observed with these low dose products. High dose Testosterone is associated with emotional rage. Body builders and football players who are taking extra Testosterone are noted for "roid rage". This is why Testosterone became a controlled drug and Estrogens are not.

Women are much more prone to migraine headaches than men and this is thought to be associated with Estrogens. If you have migraines, taking Estrogens of any sort may possibly make things worse.

I can't ask my Endo, because I am not "out".  I did ask one Endo, and he said he didn't know.

Of all the people on this planet, you should be talking to your Endocrinologist first. They are sworn to secrecy and, by law, must keep your medical records confidential. Your current Endocrinologist may be the understanding sort and may be able to differentiate the endocrine issues from the gender dysphoria issues as often times symptoms can be caused by mixed conditions. You need to open up to your Endocrinologist if you are ever going to be able to solve your problems.

[Allie Jayne]

Rachael, as with the others I’m not about to give you medical advice. I can, however, say that many of us have replaced T with E and remained quite healthy. My pituitary also stopped my T production many years ago (Hypogonadism) and I have not been healthier since going onto E.

Good luck with your research.

Allie

[Rachel Montgomery]

Yeah I think it'd be better to talk about it with your endo. I don't see them judging you or anything.

My endo would stop seeing me if I told him I am trans.  He said he doesn't do that.

[Rachel Montgomery]

Rachel,

However, they are bound by HIPA in the USA, and probably something similar in other countries, to maintain your personal medical information private.  You need to trust them to do just that! 

Well, part of the problem is that my wife is a nurse at the local hospital, all of her friends are nurses there.  If the local doctor put it in my charts, some of them might see it just doing their job.  Several of them have access to the records, and some of them are responsible for reviewing them.  So, HIPPA doesn't help my problem, because they are "inside the wire" already. 

On a plus side, you may find a way to go on HRT sooner than planned, if the doctor, knowing you are trans and plan on transitioning, can get you on a dose of E and maybe a dose of T all to treat your current non HRT issues.  No one but you and the doctor need to know it is also for HRT, and then you can tell everyone else it is for your current health issues.  Sounds like a possible win - win situation for you.  Good luck either way and please do trust your doctors.  They can actually help you, maybe much more than you realize now.

That is part of my problem.  I am not planning to ever transition.  But, I have had online trans friends who didn't plan on it and then found it necessary to do.  So, I don't say "never".  I say I don't "plan to".  I know that for me, dysphoria is sometimes worse than other times.  Sometimes, it is manageable (like now), but there have been times when it was fairly distressing, and almost obsessive.

[Rachel Montgomery]

Of all the people on this planet, you should be talking to your Endocrinologist first. They are sworn to secrecy and, by law, must keep your medical records confidential. Your current Endocrinologist may be the understanding sort and may be able to differentiate the endocrine issues from the gender dysphoria issues as often times symptoms can be caused by mixed conditions. You need to open up to your Endocrinologist if you are ever going to be able to solve your problems.

My current Endo is the only one around.  He is a very devout Christian and does not treat trans-people.  So, I would not say he is the understanding sort.

The confidentiality issues are complicated by the fact that my wife works at the local hospital (which is where he works).  All of the medical records are kept by the hospital.  I am out to my wife, but all of her friends work there too, and I am not out to them.  Some of them have the job of reviewing medical records for insurance purposes.  People who know me would probably see it even with HIPPA.  Having a good lawsuit wouldn't solve my problems then.

Because of my pituitary problem and the affects of being untreated, I NEED a doctor.  I may have to, but don't WANT to drive 2 hours to get to a doctor who will see me.  I have done just that already to no avail.  I went to two different  doctors, one who has a lot of transgender patients two hours away.  I confided to him that I am trans, but do not plan to transition.  I told him that was not to leave his office, and he said it would not.  The other is an Endo who doesn't do a lot of work with trans patients and he therefore referred me to the expert mentioned above, which I had already seen.

I asked the expert that question, and he said he didn't know.  He said it had never come up.  I asked him to research it and get back in touch with me.  He never did, so I made another appointment.  It was clear he had not researched the question.  He offered to try me on estrogen instead of T to see how things went. I didn't want to do that. I haven't been back to him.

[Sophiaprincess2019]

(though I am MTF, I am not out)....
I confided to him that I am trans, but do not plan to transition.

I'm curious how this works? I've honestly never heard anyone identify as Male to Female but not planning to transition.
I've heard people say they were Transgender but didn't plan on transitioning, but not MTF not planning to transition.

Does this mean you were assigned male at birth but identify as female and you are not seeking to transition? I'm always intrigued to learn as much as I can about the way other Transgender, non-binary, non-conforming people view themselves. I feel like such a rookie!

HUGS

Sophia

[Lucy5]

I asked the expert that question, and he said he didn't know.  He said it had never come up.  I asked him to research it and get back in touch with me.  He never did, so I made another appointment.  It was clear he had not researched the question.  He offered to try me on estrogen instead of T to see how things went. I didn't want to do that. I haven't been back to him.

Honestly given the incredibly limited amount of research there is on the subject, I suspect that working with that endo to try switching E for T may be the only way to answer your question. A lot if it will depend on your specific neural chemistry, which especially given the pituitary issues are not going to be easy to assess without trial and error and careful blood work/ symptom analysis during the process. It would be nice if we were at a point where medicine had all the anwers, but these sorts of question are only starting to be asked much less answered. Taking E, especially with your naturally low T levels will almost certainly begin to initiate some physical feminization though, so if you want to avoid that you may have no choice to stick with T until you are ready to deal with some level of physical feminization even if you aren't going to outwardly transition.

[Rachel Montgomery]

I'm curious how this works? I've honestly never heard anyone identify as Male to Female but not planning to transition.
I've heard people say they were Transgender but didn't plan on transitioning, but not MTF not planning to transition.

Does this mean you were assigned male at birth but identify as female and you are not seeking to transition? I'm always intrigued to learn as much as I can about the way other Transgender, non-binary, non-conforming people view themselves. I feel like such a rookie!

HUGS

Sophia

I don't know.  Maybe I am using the terminology wrong.  I knew I wanted to be a woman, and I liked cross dressing, but the idea of transitioning is too scary for me.  I would love to be a woman.  I would like to transition and live as a woman.  I went to a psychologist and spoke openly about my cross dressing.  She asked why I cross dress.  I explained that I don't know why.  She said that it could be that I actually want to be a woman.  I said, well I do.  That is why I like to cross dress.  After several hours she told me I was a transsexual.  I didn't agree.  I fired her and went to another psychologist.  After weeks of telling him the same basic stuff, he pulled out the DSM and showed me the definition of GID.  It was exactly what I had been describing.  He said, that means you are a transsexual. ...Oh...[deep breath]...ok.  We started work on acceptance.

I live in a conservative state.  I am a lawyer, and only licensed in this state.  I would not have enough clients to support myself as a lawyer here if I did transition, and I would not be able to practice law in another state.  I knew a lawyer in my home town who was an excellent lawyer.  She transitioned MTF and was kicked out of the firm.  When she went to court, she was jailed for contempt for dressing like a woman (she had notified the Judge she was transitioning ahead of time and included a letter from her psychologist, but that didn't stop him).  She eventually moved to New York State and never practiced law again.  She died a few years ago after years of unemployment. 

My whole family is here.  They are very Christian, very conservative, and very vocally anti-LGBT.  But, they seem to hold particularly animosity towards transgender people.  My father claims he could never be in the same room with a transgender person.  My mother says we are "the worst...disgusting...a lot worse than being gay."  So, I have not come out to them.

As for my sisters, I had hoped they would be less hostile to us, but those hopes were dashed when a friend of ours had a child who transitioned MTF.  They mocked the girl openly on FaceBook and seemed to enjoy talking about how awful it was and how they had lost all respect for our friend for supporting his child through the transition.  My older sister said the girl should have just committed suicide to keep it quiet. 

I understand that sometimes, people say things about one person that they would not say about another.  I had a gay friend who tried to come out to me, but he tested the waters by asking "what if" a particular person that we knew, I didn't like much but was friendly to, came out as gay.  I told him truthfully that I wouldn't be upset about it, that I would still welcome him around, but that I would expect to see less of him because I would assume he would want to date and such, which I assumed would mean him growing away from our group.  So, he didn't come out to me.  If I had known we were talking about him (one of my best friends) the answer would have been quite different.  It would not (and has not) had any negative affect on our friendship.  In fact, it has made us closer, in part because when he came out to me I came out as trans to him.  So, maybe my sisters wouldn't want me to kill myself?  Maybe.

I believe my wife would divorce me.  I believe the kids would never speak to me again (at least not kindly).  They are my step kids, not my biological children.  I am afraid they would be embarrassed of me.  They would be angry at me for hurting their mother, and it would hurt her.  I would have virtually no one, except my gay friend who keeps asking me to marry him.  I am not attracted to men, and I know he isn't attracted to women.  So, that isn't going anywhere.

I probably have enough money to live the rest of my life without working.  But, a lot of my assets are a 1/3 ownership in property with my sister's as co-owners.  They would probably try to screw me out of my interest.  So, my dysphoria would have to be worse than it is now.  And, at ties it has been much worse.  It might get worse again.  I will do what I have to.

[Sarah-Red]

I don't know.  Maybe I am using the terminology wrong.  I knew I wanted to be a woman, and I liked cross dressing, but the idea of transitioning is too scary for me.  I would love to be a woman.  I would like to transition and live as a woman.  I went to a psychologist and spoke openly about my cross dressing.  She asked why I cross dress.  I explained that I don't know why.  She said that it could be that I actually want to be a woman.  I said, well I do.  That is why I like to cross dress.  After several hours she told me I was a transsexual.  I didn't agree.  I fired her and went to another psychologist.  After weeks of telling him the same basic stuff, he pulled out the DSM and showed me the definition of GID.  It was exactly what I had been describing.  He said, that means you are a transsexual. ...Oh...[deep breath]...ok.  We started work on acceptance.

I live in a conservative state.  I am a lawyer, and only licensed in this state.  I would not have enough clients to support myself as a lawyer here if I did transition, and I would not be able to practice law in another state.  I knew a lawyer in my home town who was an excellent lawyer.  She transitioned MTF and was kicked out of the firm.  When she went to court, she was jailed for contempt for dressing like a woman (she had notified the Judge she was transitioning ahead of time and included a letter from her psychologist, but that didn't stop him).  She eventually moved to New York State and never practiced law again.  She died a few years ago after years of unemployment. 

My whole family is here.  They are very Christian, very conservative, and very vocally anti-LGBT.  But, they seem to hold particularly animosity towards transgender people.  My father claims he could never be in the same room with a transgender person.  My mother says we are "the worst...disgusting...a lot worse than being gay."  So, I have not come out to them.

As for my sisters, I had hoped they would be less hostile to us, but those hopes were dashed when a friend of ours had a child who transitioned MTF.  They mocked the girl openly on FaceBook and seemed to enjoy talking about how awful it was and how they had lost all respect for our friend for supporting his child through the transition.  My older sister said the girl should have just committed suicide to keep it quiet. 

I understand that sometimes, people say things about one person that they would not say about another.  I had a gay friend who tried to come out to me, but he tested the waters by asking "what if" a particular person that we knew, I didn't like much but was friendly to, came out as gay.  I told him truthfully that I wouldn't be upset about it, that I would still welcome him around, but that I would expect to see less of him because I would assume he would want to date and such, which I assumed would mean him growing away from our group.  So, he didn't come out to me.  If I had known we were talking about him (one of my best friends) the answer would have been quite different.  It would not (and has not) had any negative affect on our friendship.  In fact, it has made us closer, in part because when he came out to me I came out as trans to him.  So, maybe my sisters wouldn't want me to kill myself?  Maybe.

I believe my wife would divorce me.  I believe the kids would never speak to me again (at least not kindly).  They are my step kids, not my biological children.  I am afraid they would be embarrassed of me.  They would be angry at me for hurting their mother, and it would hurt her.  I would have virtually no one, except my gay friend who keeps asking me to marry him.  I am not attracted to men, and I know he isn't attracted to women.  So, that isn't going anywhere.

That's harsh Rachel. Well, I think this is a case where it's not about you, but your environment. I mean, it is for me too. but not that bad for sure. I just don't have it in me yet to present female in society. It's not always as bad as we think though.

The most important is always yourself, and the rest is just others' misunderstandings and bias. They shouldn't be as much of a factor, but I can't deny that survival can be important too, and it's easier when not transitioning. It sucks that it comes down to that, but sometimes the decision becomes to take the chances or not, and live how you want and stand in that truth, or do as much of that inside yourself and be strategic otherwise. Many people here have issues around them and with their wives, but they still do what they can to transition, even if it's slow. It really depends on the person and how important it is to them.

Also, if the psychologists said transsexual instead of transgender, that's weird. At least here and other places transgender is the broader term, and transsexual is for someone transitioning. To put it simply.
I think taking E could work if you had a good dose of it, but it would end up making your grow breasts, with time, so you'd have to be ready for that.

In any case, be true to you who are at heart, even if you choose not to transition. There are others who don't. You might feel differently eventually too. It's really very much about trying to find your own balance in life. Good luck

[KathyLauren]

Also, if the psychologists said transsexual instead of transgender, that's weird. At least here and other places transgender is the broader term, and transsexual is for someone transitioning.

Well, if the psychologist's copy of the DSM said GID, it is an old, out-of-date edition.  DSM-5, the current edition, has dropped GID as a diagnosis, and replaced it with Gender dysphoria (GD).  So who knows what other out of date terminology it uses.

[Allie Jayne]

My current Endo is the only one around.  He is a very devout Christian and does not treat trans-people.  So, I would not say he is the understanding sort.

The confidentiality issues are complicated by the fact that my wife works at the local hospital (which is where he works).  All of the medical records are kept by the hospital.  I am out to my wife, but all of her friends work there too, and I am not out to them.  Some of them have the job of reviewing medical records for insurance purposes.  People who know me would probably see it even with HIPPA.  Having a good lawsuit wouldn't solve my problems then.

Because of my pituitary problem and the affects of being untreated, I NEED a doctor.  I may have to, but don't WANT to drive 2 hours to get to a doctor who will see me.  I have done just that already to no avail.  I went to two different  doctors, one who has a lot of transgender patients two hours away.  I confided to him that I am trans, but do not plan to transition.  I told him that was not to leave his office, and he said it would not.  The other is an Endo who doesn't do a lot of work with trans patients and he therefore referred me to the expert mentioned above, which I had already seen.

I asked the expert that question, and he said he didn't know.  He said it had never come up.  I asked him to research it and get back in touch with me.  He never did, so I made another appointment.  It was clear he had not researched the question.  He offered to try me on estrogen instead of T to see how things went. I didn't want to do that. I haven't been back to him.

Rachel, my Endo is nearly two hours away so we do all our consultations on Skype. That way I get to see someone who is best qualified to treat me. I also do my psychiatrist consultations on Skype. Endos don’t always treat patients with the fastest way to transition, but can tailor your medication to suit your needs. In your case, small amounts of E to keep you healthy, but not in full transition range. My Endo started me conservatively and only when I stated complaining nothing was happening after 5 months did he significantly raise my dosage.

It can’t hurt to ask.

Allie

[AllieSF]

Thanks Allie, that is what I was trying to say earlier.  You said much more succinctly and clearly.

[Sophiaprincess2019]

I live in a conservative state.  I am a lawyer, and only licensed in this state.  I would not have enough clients to support myself as a lawyer here if I did transition, and I would not be able to practice law in another state.

Rachel, you are not the only trans Lawyer here! I know 2 other women who are MTF Transgender and they practice law. One is a Prosecutor and one is a Trial lawyer, I believe they are both in the Los Angeles area of CA.

After reading your rather lengthy response it sounds like you have a similar set of circumstances that a lot of others in this site have: Little to no acceptance from family, spouse will divorce, children will not speak to you, etc. It's sad reality that society is so ignorant of Transgender people and our world.

Whatever you choose I wish you the best in your endeavors. This site hosts some of the most helpful people when it comes to transition. I've been here since I started my transition and the guidance and support I've experienced here is a testament to the good nature and supportive environment here.

Much love and happiness,

HUGS

Sophia

[Rachel Montgomery]

I think taking E could work if you had a good dose of it, but it would end up making your grow breasts, with time, so you'd have to be ready for that.

Honestly, I could probably grow some breast tissue if I just stopped taking the Anastrozol.  My body seems to be very good at converting T to E.

But, I am trying to live presenting as a man.  I am trying to be a good "husband" and "step father" and "brother" and "son".  I want other people to respect me and trust me.  Growing breast (as much as I might like having them) would be embarrassing, because it would make passing as "a normal guy" that much harder.   I try to look as masculine as I can, because I don't want people to see me as feminine when I am presenting as male.  If I were to transition, I would want to look as feminine as I could.

I think I accept the fact that I am a transwoman, but that is something very few people know.  If I were to live openly as a woman, I would want to pass as a "normal woman" too.  I don't have a problem with the idea of a gender binary.  Whether fortunately or unfortunately, reality is more complicated.  Reality is analogue, and, I am not at either end of the spectrum.  I'd like to be at the female end.

Most people would say I care too much what other people think.  Maybe.  But, that doesn't change the fact that I do care what they think.  Telling me I am wrong for feeling as I do doesn't change the way I feel.  I am a social creature.  I cannot thrive on my own, separated from everyone else.  I might survive, but I would not thrive.  I have spent several years being extremely lonely.  I don't think I could do that again.  I don't think I WOULD do that again.  I was suicidal then, and would almost certainly be that way again. 

When I feel rejected, I withdraw.  And, when I withdraw I feel lonely.  And, loneliness leads to worse depression, which causes me to withdraw.  It could easily become a death spiral.  So, I need to avoid that.  Having people figure out that I am transgender would be like a nuclear bomb to my life.