Community Conversation > Hormone replacement therapy

How do you cope when you are forced to halt Estrogen for operations, flying etc.

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Tamara Tilly:
Hi ladies, a question for all those transitioning females who take Estrogen please.

How do you cope physically and mentally when you are forced to take a break from the regime in the run up to operations, or when flying, or for any other reasons?

I ask because I was forced to break from my estradiol and I found that after a few days being on zero hormone intake left me physically absolutely zoned out. I mean, just spaced out especially in the evenings. Energy levels likewise plunged. Like I wasn't in my own body. It's unnerving and unsettling.

So my question is whether any of you have experienced similar and what you might do to alleviate it? There's a limit to how much chocolate one can try to eat in compensation  ;) Seriously though, are there any supplements for example that might help? Or anything else one can do? It's pretty crushing for me when this happens.

xx

Allie Jayne:
Tamara, we all have different reactions to stopping Estrogen therapy. I have quite severe reactions, headache, sore eyes, stiff neck, and pain which can progress down my shoulders to my chest. My doctor spoke to my surgeon about this before my GRS, and they agreed to keep me on a low level transdermal dose through the perioperative period. When I got to hospital, they took my hormones off me and locked them up for the week I was in hospital. By day 3 post op, I could not have lights on in my room, and I was sweating so much I got a rash which was bleeding onto my sheets. They tried to dull my headache with painkillers, ironically, I didn't need any painkillers from the operation!

The tragic thing is that stopping transdermal estrogen is not necessary. It is a hangover from the now discredited Women's Health Initiative, a study which claimed strong links between thrombosis and estrogen therapy, but the study was referring to Synthetic Estrogens like Premarin, and Synthetic Progesterones like Medroxyprogesterone. These medications are not commonly prescribed nowadays as Micronised bioidentical medications do not have the thrombosis risks as the older medications. My reference for this is the University of California SanFrancisco Overview of Feminizing Hormone Therapy, which goes on to say "There is no evidence to suggest that transgender women who lack specific risk factors (smoking, personal or family history, excessive doses or use of synthetic estrogens) must cease estrogen therapy before and after surgical procedures, in particular with appropriate use of prophylaxis and an informed consent discussion of the pros and cons of discontinuing hormone therapy during this time. Possible alternatives include using a lower dose of estrogen, and/or changing to a transdermal route if not already in use."

Unfortunately it is up to us to make sure our trans health professionals get up to speed with what is currently recommended. Pass the UCSF paper on to your surgeon, and thankfully, more and more surgeons are allowing transdermal therapy to continue. It's not just trans women who are suffering, the WHI report has also affected millions of post menopausal women around the world who cannot get HRT because their doctors are not current.

Hugs,

Allie

Rakel:
I have read the UCSF paper on the Overview of Feminizating Hormone Therapy.

I agree completely with this paper.

However, whenever I needed any surgeries, I just do as my surgeon asks. Fortunately, I do not have a serious problem when I stop my Estradiol for a few weeks.

JamieH:
forgive my ignorance, but what is the problem with flying?

DianaPrince:
Estrogen can increase risk of blood clots, which can lead to deep vein thrombosis on long flights.

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