Susan's Place Transgender Resources

General Discussions => Health => Topic started by: Rachel Montgomery on December 18, 2019, 02:34:17 pm

Title: Question about HRT
Post by: Rachel Montgomery on December 18, 2019, 02:34:17 pm
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.   
Title: Re: Question about HRT
Post by: KathyLauren on December 18, 2019, 02:47:51 pm
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.
Title: Re: Question about HRT
Post by: Sarah-Red on December 18, 2019, 02:49:47 pm
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 :P I just think it could be a good reason to start E, if that's something you plan to do. To get it higher.
Title: Re: Question about HRT
Post by: Pammie on December 18, 2019, 02:54:59 pm
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 :P 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
Title: Re: Question about HRT
Post by: AllieSF on December 18, 2019, 03:55:57 pm
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.
Title: Re: Question about HRT
Post by: ChrissyRyan on December 18, 2019, 04:03:36 pm
Please talk with the physicians who manage your medicines and health.

I hope things will turn out very well for you. 

Hugs,

Chrissy
Title: Re: Question about HRT
Post by: Rakel on December 18, 2019, 04:30:16 pm
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.

Quote
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.

Quote
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.
Title: Re: Question about HRT
Post by: Allie Jayne on December 18, 2019, 04:37:21 pm
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
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 19, 2019, 02:46:02 pm
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.
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 19, 2019, 02:53:34 pm
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.
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 19, 2019, 03:06:31 pm
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.
Title: Re: Question about HRT
Post by: Sophiaprincess2019 on December 19, 2019, 03:29:44 pm
(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
Title: Re: Question about HRT
Post by: Lucy5 on December 19, 2019, 03:36:31 pm
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.
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 19, 2019, 04:26:30 pm
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.
Title: Re: Question about HRT
Post by: Sarah-Red on December 19, 2019, 04:49:51 pm
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 :)
Title: Re: Question about HRT
Post by: KathyLauren on December 19, 2019, 05:26:00 pm
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.
Title: Re: Question about HRT
Post by: Allie Jayne on December 19, 2019, 07:42:43 pm
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
Title: Re: Question about HRT
Post by: AllieSF on December 19, 2019, 07:46:48 pm
Thanks Allie, that is what I was trying to say earlier.  You said much more succinctly and clearly.
Title: Re: Question about HRT
Post by: Sophiaprincess2019 on December 19, 2019, 07:56:09 pm
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
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 20, 2019, 05:19:29 pm
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.
Title: Re: Question about HRT
Post by: Sarah-Red on December 20, 2019, 05:47:43 pm
I totally get that Rachel, unfortunately. I decided to take the risk of hormones because I couldn't stand it any longer and had to do something. In truth I'm not ready to face the world with any of this. I just know that I either try to find a way through, or die inside.

It's not true that reality is one end or the other, at least for trans people especially, and hormones take time, and someone can wear a binder, so there are ways to make it, but that doesn't mean someone will pass. It's hard for me to accept that, but I don't have a choice do I. I don't want to go back, so I have to see what I can make work by moving forward. If I can't deal with something, I'll try something else or take some steps back, but I had to at least start and be on my way. I want to see where things go and what I can do.

I care too much about what other people think too. And I frequently struggle with how I can possibly be socially expressive while not caring what they think, it seems like a contradiction, but in the end it does matter more to me what I think and feel of myself, so I may be able to find a way.

I know I spoke from my own perspective, but that's all I can do. I relate to a lot of the feelings you brought up, it wasn't easy to process some of them, and I wish it didn't come down to what it does, I wish it were easier, and that we could just jump to the other end, but until there's a way to do that, I just gotta do what I think is more important to me.

Those who matter will accept us. Those who don't ... don't matter as much. I know it's not that easy, we can care about someone who wouldn't like us as trans, but I think that ultimately, I'd rather find people I connect with that do have that openness and acceptance. Again, not saying it's easy, to look past those that judge, it's certainly one of the things I have the most trouble with, but that's how some people do it.

I think it's perfectly valid not to transition, for quite a few reasons, this society... well you know. Sometimes something forces your hand. Whether it's pressure from outside, or pressure from inside, you just do your best, and try to find happiness however you can.
Title: Re: Question about HRT
Post by: Pammie on December 20, 2019, 06:05:59 pm
I think it's perfectly valid not to transition, for quite a few reasons, this society... well you know. Sometimes something forces your hand. Whether it's pressure from outside, or pressure from inside, you just do your best, and try to find happiness however you can.
I think Sarah, that is beautifully put and as good and accurate a summary as one could hope to find xx


Sent from my iPhone using Tapatalk
Title: Re: Question about HRT
Post by: Allie Jayne on December 20, 2019, 06:16:51 pm
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.

Yep, that is where I was at this time last year! I had a great life as a man, wife, great job, children, grand children, active scuba club member and involved in community activities. I knew I was trans, but take a chance at risking my great life, no way. Along came dysphoria, and next thing I know I am seriously sick, and I have no option but to start HRT. It cures my illness, but I am faced with losing everyone. When I told them one by one of my predicament, every one of them supported me.

If you are trans, you will have dysphoria, though it may not have manifested as much more than a rising frustration. But you can expect that at some stage in your life it will increase, and you may have to do something about it. I was in your position for most of my life, and now being forced to start HRT and come out to everyone at 65, I feel like I've had to pay the price anyway, but have been robbed of decades of being my true self. I'm not saying you need to transition now, but likely at some stage it will become a significant issue in your life.

I really hope you can find your path to happiness,

Allie
Title: Re: Question about HRT
Post by: Sarah-Red on December 20, 2019, 06:36:09 pm
I think that's one more good reminder, Allie, especially that sometimes people do get much more support than we'd think. Not only that but don't leave out that a lot of things did work out for you beyond that as well, including at work and how now you've passed and gave speeches regarding being trans, and even touched people enough to make them cry :D

And Pammie I do think it's unfortunate that life can force our hand, but yeah it's come to that for quite a few people on this site for transitioning. Of course, there are always some people that don't need that to transition, but I haven't seen as many those around. And then there's those that feel better not risking it, feeling other pressures and wanting to try to be stealth. Bold people probably have an easier time.
Title: Re: Question about HRT
Post by: Julielynn on December 21, 2019, 11:10:51 am
Rachel, you and I share a very similar story.   I grew up in the bible belt so there is no possible way my family would accept anything of the sort.  Very conservative, very high class, and quick to make fun of anyone in the position.

I also had a high profile career that wouldn't tolerate it as well.  Family in the medical field so there was no going there either.  Yeah, I know HIPA exists, but people talk despite it.  Good luck suing anyone over it.  I'm sure you know what I mean. 

I didn't plan to transition either as I was married too.  Eventually, it just came to a head.  I still held off, but it was killing me.  The depression was terrible.  I went to bed a lot of nights completely drunk out of my mind spiraling out of control worse and worse.  I had a headache each morning when I woke up with or without booze. The low T did that.  I wanted live as a woman, but there was just no way I was going to deal with all that rejection, hate, and social problems that came with doing something so extreme.

Ok, this is what I did and maybe you can apply some to your situation.  I ended up slowly figuring out who would be ok with it and who wouldn't.   Unfortunately for me, it was most, if not all of them.  I slowly separated my financial interests from everyone and started setting up my own separate rental incomes and lowering my expenses at the same time.  I didn't want to admit I was really considering it, but I kept doing things as if I was.  I didn't want anyone having any control over my income.  I realized I should probably just go ahead and make sure I was financially secure and could live off it if need be.   Now keep in mind I was doing this because I was self-imploding and wanted to keep things running if I lost my job from all of my troubles. 

My marriage ended up in divorce as most do when my libido started dropping too far down.  She cheated and that was it.   I got lucky in the divorce and she just wanted to start over and took virtually nothing.  By that time, I had separated so much of my finances anyway that it didn't matter much.

I went into rentals full time, but kept the job.   I set myself up dates to try and be able to quit working, but work as long as I could.  This year, I quit working.  Rental incomes are enough.  I lowered the bills enough that I could work as a dishwasher and still have enough to eat at 5 star restaurants in NYC if I wanted to.   

After the wife left, it hit me hard.  The loneliness was terrible. I drank much more.  I dove into work even more.  Amusingly enough, it was a bald spot that started the chain.  I didn't want to go bald and it was getting big.  I decided I'd get a transplant and see what I could do to stop it.  The clinic checked my my blood pressure and it was 210/145  lmao.   Really, really bad.  They weren't going to do the transplant with that high of a BP.  My current doctor was out of the office on Thursday and Fridays and that transplant was coming up on Monday.  I had no time.  I found a Doctor willing to see me that Thursday, 4 hours away in Detroit.  It was Dr William Powers who actually specializes in Trans people.  He called me out on being trans very indirectly.  I denied it, then slowly admitted I wouldn't mind, but wouldn't actually do that.  He noticed I had a ton of the signs.  I told him I was only there because of the blood pressure and he was the only one I could find in Detroit since I was out of town there and couldn't see my own.  He just smiled, we talked more, and by the time I walked out of there I had a prescription in hand for heavy duty BP stuff, a T blocker to stop the baldness, and a little extra one for E to debate on.   Probably my own subconscious at work there.

Of course, I broke and filled them all.  It worked wonders.   The depression lifted, I feel more content with myself than I ever have.   The loneliness lightened up immensely.  So this year I quit working once things get too "cough" noticeable.   Best move I ever did.   

So yeah, I have a doctor 4 hours away.  Solved that family problem with that.   Turns out there's not a lot to it so he doesn't need to see me often.   My finances are separated from everyone.  I might miss old career, but I don't feel so bad when I sit in the Caribbean sun.  My emotions being in order was the best of all though.  I'd just consider a similar path "just in case".  You might find yourself slipping down my road eventually and you may not.  Best to be prepared either way. 
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 24, 2019, 11:39:56 am
Rachel, you and I share a very similar story.   I grew up in the bible belt so there is no possible way my family would accept anything of the sort.  Very conservative, very high class, and quick to make fun of anyone in the position.

I also had a high profile career that wouldn't tolerate it as well.  Family in the medical field so there was no going there either.  Yeah, I know HIPA exists, but people talk despite it.  Good luck suing anyone over it.  I'm sure you know what I mean. 

Yeah, HIPPA doesn't help when a high percentage of the people you don't want to see the notes are on the other side of the HIPPA firewall. 

I am sorry that things got so bad for you.  They may at some point for me too.  They have been quite bad at times in the past, but I survived.  And, there have been long stretches where surviving is the best I can say for those times.  But, right now isn't too bad.  I still have dysphoria, but I can get out of bed, leave the house, do my work.  I don't think about killing myself every day, and don't seriously consider it as an option anymore.  I still have the thoughts run through my mind a few times a month. 
Title: Re: Question about HRT
Post by: Julielynn on December 25, 2019, 09:22:56 am
Had that issue as well.  The low level HRT got rid of all my depression.  Amazingly effective for that.
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 26, 2019, 04:38:39 pm
Had that issue as well.  The low level HRT got rid of all my depression.  Amazingly effective for that.

I understand you had a similar issue with HIPPA and health care workers.  Did you also have similar symptoms with migraines, cramps, irritability, depression, etc.?
Title: Re: Question about HRT
Post by: Julielynn on December 27, 2019, 04:43:14 am
Migraines and depression, yes.   All gone though.   Honestly, I can't say if it had something to do with HRT or a new BP medicine I started at the same time, but not complaining either way.
Title: Re: Question about HRT
Post by: Rachel Montgomery on December 31, 2019, 03:36:03 pm
Migraines and depression, yes.   All gone though.   Honestly, I can't say if it had something to do with HRT or a new BP medicine I started at the same time, but not complaining either way.

I understand that your experience is anecdotal, and my millage may vary, but I am encouraged to hear that your migraines were relieved.  You know, some of it may be less stress because you stopped fighting transition, but the migraines have been a major concern because low T definitely made them more frequent.  I get one a few times a year, but with low T it was daily.  It was miserable.
Title: Re: Question about HRT
Post by: DebbySoufflage on December 31, 2019, 07:45:02 pm
E will not help with migraines. The opposite. E is generally associated with more frequently occurring migraines.

That said, YMMV.
I have always had migraines as long as I can remember. They used to start in my right eye.
Since going on HRT my migraines are less frequent.
My migraine has changed to a less chronic headache type that comes with short electric stings in the head.

Cholesterol is kept in check by a dominant sex hormone.
Menopausal women tend to have out of control levels of testosterone because they lack a sex hormone to keep it in check.

That said, replacing T with E will not heighten your risks if you do not have any kind of genetics that predispose you to a certain estrogen dependent cancer.

T carries the risk for liver damage.
E carries the risk for blood clots, although those risks are low.

One advantage you have is that if you are hypogonadal already, they will only have to administer E and not an AA.

Make an appointment with an endocrinologist in your area and explain your concerns and your medical history. Together you could work out a regimen for you that is tailored to your needs.
Please be advised that most endocrinologists will want certification from a psychiatrist that you suffer gender dysphoria and that hormone replacement therapy is recommended.

Luv,
Debby
Title: Re: Question about HRT
Post by: Julielynn on January 01, 2020, 03:29:33 pm
Quote
E will not help with migraines. The opposite. E is generally associated with more frequently occurring migraines.

It's interesting that you say that.   I wasn't one of the ones who "fought" the decision.   I made up my mind back in my 20's.   I just held out because I have a massive fear of being out of work, homeless, and starving.  I did that once.   So I waited until I had the power and money to do it without any fear.  Stress isn't really a concern in my life.

The headaches were a constant thing.  Mine were every single morning.   I had a habit of just waking up and taking advil, waiting for them to hit me.  It dulled it, but they always hit me.  Sometimes bad enough I had to stay home from work and just crumple in bed squishing a pillow to my head all day.   It may not have been E that got rid of them, but the timing sure was perfect.  Hard to say of course what did it, but I can't think of another thing I changed at the time they disappeared.
Title: Re: Question about HRT
Post by: Rachel Montgomery on January 03, 2020, 05:12:17 pm
Make an appointment with an endocrinologist in your area and explain your concerns and your medical history. Together you could work out a regimen for you that is tailored to your needs.
Please be advised that most endocrinologists will want certification from a psychiatrist that you suffer gender dysphoria and that hormone replacement therapy is recommended.

Well, I did travel to another state to see an Endo who does almost exclusively work on transitioning, and I was honest with him about being transgender (but told him he was not authorized to share that information with anyone).  I asked him about the migraines and he said he had no idea.  He could prescribe me E and we could see how it went.

I was hoping someone here had experience with it in their transition.  I understand that it might be different for me, but I still find it encouraging that at least a couple of people have had migraines be reduced when starting E. 
Title: Re: Question about HRT
Post by: Pammie on January 03, 2020, 05:18:20 pm
Well, I did travel to another state to see an Endo who does almost exclusively work on transitioning, and I was honest with him about being transgender (but told him he was not authorized to share that information with anyone).  I asked him about the migraines and he said he had no idea.  He could prescribe me E and we could see how it went.

I was hoping someone here had experience with it in their transition.  I understand that it might be different for me, but I still find it encouraging that at least a couple of people have had migraines be reduced when starting E.
Did he offer to prescribe E without any therapist letters?? Is that allowed in the US? I wouldn’t expect that in the UK x


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Title: Re: Question about HRT
Post by: Rachel Montgomery on January 03, 2020, 05:23:59 pm
Did he offer to prescribe E without any therapist letters?? Is that allowed in the US? I wouldn’t expect that in the UK
It is allowed.  He did offer.  I declined.

But, if I wanted to transition and he wanted a letter, my psychologist would be willing to write such a letter.  She has told me that, as did my last psychologist.   
Title: Re: Question about HRT
Post by: Pammie on January 03, 2020, 05:31:40 pm
It is allowed.  He did offer.  I declined.

But, if I wanted to transition and he wanted a letter, my psychologist would be willing to write such a letter.  She has told me that, as did my last psychologist.   
Gosh. I’d always assumed prescribing E is such a big thing that they would want / need a psychologist letter. - Live and learn!



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Title: Re: Question about HRT
Post by: KathyLauren on January 03, 2020, 05:45:08 pm
Gosh. I’d always assumed prescribing E is such a big thing that they would want / need a psychologist letter. - Live and learn!



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Compliance with WPATH SOC is voluntary.  Insurance companies may insist on it if you want to get your claim paid.  But a medical doctor doesn't need anyone's permission to prescribe medication if they are confident that it is the right treatment.
Title: Re: Question about HRT
Post by: Sarah-Red on January 03, 2020, 05:53:06 pm
It's also possible without a letter in Canada too, though it depends on the doc and I've been told it's better practice to have one.
Title: Re: Question about HRT
Post by: GordonG on January 03, 2020, 06:22:14 pm
Did he offer to prescribe E without any therapist letters?? Is that allowed in the US? I wouldn’t expect that in the UK x

I have not had a "letter" for anything. I've not even been to a therapist for anything trans related.
Title: Re: Question about HRT
Post by: Allie Jayne on January 03, 2020, 06:27:07 pm
I needed a referral from my psychologist before I could make an Endo appointment here in Australia, but that may be because our Medicare system pays for my Endo appointments.

Allie
Title: Re: Question about HRT
Post by: AnneK on January 03, 2020, 09:47:30 pm
I needed a referral from my psychologist before I could make an Endo appointment here in Australia, but that may be because our Medicare system pays for my Endo appointments.

Allie

I live in Ontario, Canada and our health care system covers my appointments and, because I'm over 65, my prescriptions.  I got mine on informed consent.
Title: Re: Question about HRT
Post by: Pammie on January 04, 2020, 11:15:35 am
I have not had a "letter" for anything. I've not even been to a therapist for anything trans related.
Would you not want to? I felt very confused and submerged by the sheer scope and impact of everything and absolutely had to talk to professionals to get informed insights. There was no way u could ever have been capable of just deciding by myself! X
Of course it is back to our mantra at this point “we are all on individual journeys “


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Title: Re: Question about HRT
Post by: Devlyn on January 04, 2020, 11:29:00 am
Gosh. I’d always assumed prescribing E is such a big thing that they would want / need a psychologist letter. - Live and learn!



Compliance with WPATH SOC is voluntary.  Insurance companies may insist on it if you want to get your claim paid.  But a medical doctor doesn't need anyone's permission to prescribe medication if they are confident that it is the right treatment.

Further, these are the WPATH guidelines on Informed Consent. The GICs in the UK, however, are still using earlier versions of the WPATH when administering HRT.

Relationship Between the Standards of Care and Informed Consent Model Protocols

A number of community health centers in the United States have developed protocols for providing hormone therapy based on an approach that has become known as the Informed Consent Model (Callen Lorde Community Health Center, 2000, 2011; Fenway Community Health Transgender Health Program, 2007; Tom Waddell Health Center, 2006). These protocols are consistent with the guidelines presented in the WPATH Standards of Care, Version 7. The SOC are flexible clinical guidelines; they allow for tailoring of interventions to the needs of the individual receiving services and for tailoring of protocols to the approach and setting in which these services are provided (Ehrbar & Gorton, 2010).

Obtaining informed consent for hormone therapy is an important task of providers to ensure that patients understand the psychological and physical benefits and risks of hormone therapy, as well as its psychosocial implications. Providers prescribing the hormones or health professionals recommending the hormones should have the knowledge and experience to assess gender dysphoria. They should inform individuals of the particular benefits, limitations, and risks of hormones, given the patient's age, previous experience with hormones, and concurrent physical or mental health concerns.

Screening for and addressing acute or current mental health concerns is an important part of the informed consent process. This may be done by a mental health professional or by an appropriately trained prescribing provider (see section VII of the SOC). The same provider or another appropriately trained member of the health care team (e.g., a nurse) can address the psychosocial implications of taking hormones when necessary (e.g., the impact of masculinization/feminization on how one is perceived and its potential impact on relationships with family, friends, and coworkers). If indicated, these providers will make referrals for psychotherapy and for the assessment and treatment of co-existing mental health concerns such as anxiety or depression.

The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment. This may include a comprehensive mental health assessment and psychotherapy, when indicated. In the Informed Consent Model, the focus is on obtaining informed consent as the threshold for the initiation of hormone therapy in a multidisciplinary, harm-reduction environment. Less emphasis is placed on the provision of mental health care until the patient requests it, unless significant mental health concerns are identified that would need to be addressed before hormone prescription.
Title: Re: Question about HRT
Post by: Pammie on January 04, 2020, 11:30:46 am
Compliance with WPATH SOC is voluntary.  Insurance companies may insist on it if you want to get your claim paid.  But a medical doctor doesn't need anyone's permission to prescribe medication if they are confident that it is the right treatment.


Further, these are the WPATH guidelines on Informed Consent. The GICs in the UK, however, are still using earlier versions of the WPATH when administering HRT.

Relationship Between the Standards of Care and Informed Consent Model Protocols

A number of community health centers in the United States have developed protocols for providing hormone therapy based on an approach that has become known as the Informed Consent Model (Callen Lorde Community Health Center, 2000, 2011; Fenway Community Health Transgender Health Program, 2007; Tom Waddell Health Center, 2006). These protocols are consistent with the guidelines presented in the WPATH Standards of Care, Version 7. The SOC are flexible clinical guidelines; they allow for tailoring of interventions to the needs of the individual receiving services and for tailoring of protocols to the approach and setting in which these services are provided (Ehrbar & Gorton, 2010).

Obtaining informed consent for hormone therapy is an important task of providers to ensure that patients understand the psychological and physical benefits and risks of hormone therapy, as well as its psychosocial implications. Providers prescribing the hormones or health professionals recommending the hormones should have the knowledge and experience to assess gender dysphoria. They should inform individuals of the particular benefits, limitations, and risks of hormones, given the patient's age, previous experience with hormones, and concurrent physical or mental health concerns.

Screening for and addressing acute or current mental health concerns is an important part of the informed consent process. This may be done by a mental health professional or by an appropriately trained prescribing provider (see section VII of the SOC). The same provider or another appropriately trained member of the health care team (e.g., a nurse) can address the psychosocial implications of taking hormones when necessary (e.g., the impact of masculinization/feminization on how one is perceived and its potential impact on relationships with family, friends, and coworkers). If indicated, these providers will make referrals for psychotherapy and for the assessment and treatment of co-existing mental health concerns such as anxiety or depression.

The difference between the Informed Consent Model and SOC, Version 7 is that the SOC puts greater emphasis on the important role that mental health professionals can play in alleviating gender dysphoria and facilitating changes in gender role and psychosocial adjustment. This may include a comprehensive mental health assessment and psychotherapy, when indicated. In the Informed Consent Model, the focus is on obtaining informed consent as the threshold for the initiation of hormone therapy in a multidisciplinary, harm-reduction environment. Less emphasis is placed on the provision of mental health care until the patient requests it, unless significant mental health concerns are identified that would need to be addressed before hormone prescription.
Thanks - that’s very informative and useful! X


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