Progesterone

[CourtneyAngelina]

Thank you for your kind words I am VERY happy with my results so far.

I've never used any other method so I can't say for sure if they are indeed more effective (and everyone has slightly different results from HRT anyway), but everything on the web and from my endo suggests that it's true due to the slow & even release.

As far as info on pellets, the only decent one I know of is here:
http://www.collegepharmacy.com/images/download/BHRTPelletFAQ.pdf
^ this company is also where my endocrinologist orders the pellets from

It's not really that good of an article, though, because it doesn't detail pellet use for cross gender hormones. My endocrinologist (John O'Dea) is in the process of launching a new website with a plethora of information, and hopefully it will help a lot of people with their decision on which delivery method is right for them. I dunno where you are located, but he has 2 offices, one in Sacramento CA and one in LA. I would highly recommend meeting this man!

Also at the beginning of Sept when I was in for my 4th implantation, he mentioned that he is going to open up a London office

I live within 45 minutes or so of Los Angeles. When the time comes (I'm a senior in high school right now) I may try to find a way head down to LA. The only problem is I can't do that currently because my parents with almost 100% surety will be unsupportive when I tell them and even possibly kick me out. I've made the decision ( mostly due to fear ) that I won't begin HRT until school ends this June ( I might start in April or May actually, as the results probably wont be too noticeable in the first few months... but that will have to be determined down the road when I have more solid college and/or living arrangements ). But I will most definitely take a look into pellets when I begin. If you don't mind answering, what age did you begin HRT?

[A]

I don't want to sound pessimistic, but starting your HRT on pellets, when just out of high school and not thinking your parents will help... "2228.57-3342.86 $ a year. Not counting eventual antiandrogen pellets." is what I roughly calculated from Jennygirl's numbers before. I don't see anyone who's just starting out in life, unless very well off or helped by caring and rich parents, being able to get those. :/ Especially since at this point other costs of transition are likely to be weighing on you.

As for your parents... I don't know your situation, really, but I should say that so far, the vast majority of trans people being afraid or even convinced they would be kicked out by their parents if they came out, that I've read about, found that things went better than expected. Some were bracing themselves for expulsion but were confusingly greeted with support. Less extreme cases were brazing themselves for inacceptance only to find folks who needed some explanation and convincing before they understood.

On top, I was amazed when I read about the story of a (then) young trans woman who transitioned in the 1970s, whose parents didn't accept at all, and they were ashamed of "him". Yet those parents had the decency to wait until she was done with high school to disown her, and when they did, they provided her with some very minimal monthly survival funds so long as she didn't come close enough to them to embarrass them. I was like "whoa, even parents from another age who really didn't understand or support didn't completely abandon her."

I'm not saying there's no risk, and heck, for all I know, things could go anywhere from awesome to awful to you. Just, well, consider this and how many others wished they'd told their family sooner, and weigh it with the perceived risk. I may be being overoptimistic about that though, since I've amazingly been accepted at least decently by everyone so far, but I still do have a feeling that the risk is often much lower than feared.

Jennygirl: I'm curious... Repeatedly having those mini-surgeries... isn't it annoying? Or rather painful? And uh, does it leave you scars? Also... do those pellet things poke through the skin? I still don't have the money at all (and whoa, when I think of it, actually, if I did, I could affort so much electrolysis, or maybe even a tracheal shave in two years o.o).

[CourtneyAngelina]

I don't want to sound pessimistic, but starting your HRT on pellets, when just out of high school and not thinking your parents will help... "2228.57-3342.86 $ a year. Not counting eventual antiandrogen pellets." is what I roughly calculated from Jennygirl's numbers before. I don't see anyone who's just starting out in life, unless very well off or helped by caring and rich parents, being able to get those. :/ Especially since at this point other costs of transition are likely to be weighing on you.

As for your parents... I don't know your situation, really, but I should say that so far, the vast majority of trans people being afraid or even convinced they would be kicked out by their parents if they came out, that I've read about, found that things went better than expected. Some were bracing themselves for expulsion but were confusingly greeted with support. Less extreme cases were brazing themselves for inacceptance only to find folks who needed some explanation and convincing before they understood.

On top, I was amazed when I read about the story of a (then) young trans woman who transitioned in the 1970s, whose parents didn't accept at all, and they were ashamed of "him". Yet those parents had the decency to wait until she was done with high school to disown her, and when they did, they provided her with some very minimal monthly survival funds so long as she didn't come close enough to them to embarrass them. I was like "whoa, even parents from another age who really didn't understand or support didn't completely abandon her."

I'm not saying there's no risk, and heck, for all I know, things could go anywhere from awesome to awful to you. Just, well, consider this and how many others wished they'd told their family sooner, and weigh it with the perceived risk. I may be being overoptimistic about that though, since I've amazingly been accepted at least decently by everyone so far, but I still do have a feeling that the risk is often much lower than feared.

Jennygirl: I'm curious... Repeatedly having those mini-surgeries... isn't it annoying? Or rather painful? And uh, does it leave you scars? Also... do those pellet things poke through the skin? I still don't have the money at all (and whoa, when I think of it, actually, if I did, I could affort so much electrolysis, or maybe even a tracheal shave in two years o.o).

Don't worry you're not being pessimistic, if anything you're taking a logical approach. It's always good to have people who see things from different angles, it can prevent mistakes.

I'm not really loaded with a bucket of cash, but I plan on going to a university ( have it narrowed down to like 5 or 6 potential ones) in which the required university medical plan covers transition ( there are a few ). So, if I play my cards right, I will be able to transition in college paying no more than I would have had to than if I would have just gone to college without transitioning. I'm not saying that I completely rely on college for transition, but it is my best bet.

As far as my parents go, you're right that some parent's have unpredictable reactions, but after hearing my parents hate-filled rant about transgender Miss Universe contestant Jenna Talackova last year, it became pretty evident to me they aren't open-minded about trans issues. I know, with almost 100% certainty, that they will not be accepting.

[Jennygirl]

If you don't mind answering, what age did you begin HRT?

Late 28 <- yes, I was a little worried at first after what I had read everyone saying about transitioning after you turn 20, but I quickly realized that it's what YOU put into transition that makes the difference. HRT does nothing to alter your presentation, style, voice, mannerisms, or confidence living as a female.

I don't want to sound pessimistic, but starting your HRT on pellets, when just out of high school and not thinking your parents will help... "2228.57-3342.86 $ a year. Not counting eventual antiandrogen pellets." is what I roughly calculated from Jennygirl's numbers before.

Keep in mind I'm on the pedal to the metal method which is unnecessary for most. You would still have great results from half the dosage I get, it would just be a bit slower... Probably more comparable to injections or very high dose pills. I do the max # of E pellets Dr. O'Dea will prescribe along with however much progesterone I feel that I need. We have been adjusting it and now I'm very happy with my choice of: 12 estrogen pellets + 1 progesterone pellet. That comes out to roughly 1300 every 3 months. Some people can go 4 months in between implantations, it mostly depends on body fat percentage (more fat in the bum = slower release). Yes it costs quite a bit with the route I'm taking, but my rent is DIRT CHEAP for Los Angeles and therefore I'm easily able to afford the high dose, so that's what I do.. Also of note, Dr. O'Dea HATES prescribing antiandrogens. He will only do a low dose of spiro in extreme cases for people with naturally high T or overactive T receptors- which is very, very rare. Seriously, he hates that stuff and whenever I would ask about it he would get literally red in the face at the thought of so many other endo's prescribing it like it's tylenol. I stopped asking him about it Lol...

Also one more thing to note, he keeps mentioning that once orchiectomy is performed (either via SRS or straight up orchi), I will be able to drop my dose significantly- which will bring down cost a lot.

According to my therapist, he is known for "fast tracking" people and she warned me about it. Fortunately for me, that turned out to be exactly what I was looking for!

Jennygirl: I'm curious... Repeatedly having those mini-surgeries... isn't it annoying? Or rather painful? And uh, does it leave you scars? Also... do those pellet things poke through the skin? I still don't have the money at all (and whoa, when I think of it, actually, if I did, I could affort so much electrolysis, or maybe even a tracheal shave in two years o.o).

Not the least bit annoying (especially when I think of what having to keep up with a daily or even weekly dose would be like). 3 days of keeping a patch on my butt (there are no stitches involved, and it is completely painless) and then 3 months of never having to keep up with a single thing except for life itself! Never felt the pellets poking through the skin, but that would be what they would call an "ejection". I haven't had that happen yet, but I also do take care to be kind to the area for the first 3 days following an implantation.

The scar is minimal.. it looks like I had a 5mm scrape on the left inner side of my natal cleft. It's not noticeable and I don't even think about it. I've heard of some endo's using stitches, but O'Dea just uses a couple of steri-strips and dresses it with gauze. The only part that is a pain is that you have to keep that dry, so if you take a shower you must tape something around it. I usually take a shower right before going in, skip the next day or two if I can and then I'm home free.

Once I have SRS in March, I will be able to drop my E pellets to 3 and will probably keep P at 1 pellet, which comes out to about 300 every 3 months... or 100 a month. Not too bad at all!

[CourtneyAngelina]

Late 28 <- yes, I was a little worried at first after what I had read everyone saying about transitioning after you turn 20, but I quickly realized that it's what YOU put into transition that makes the difference. HRT does nothing to alter your presentation, style, voice, mannerisms, or confidence living as a female.

That makes me feel more confident that HRT will help me out alot. I know I'm still young enough for hormones to have a good effect, but I still always have that worry in the back of my mind that HRT won't work well with me. I guess I shouldn't worry about that though, worrying won't accomplish anything

Anyways... your transition has gone very well Jenny! Thanks for the advice

[Jennygirl]

That makes me feel more confident that HRT will help me out alot. I know I'm still young enough for hormones to have a good effect, but I still always have that worry in the back of my mind that HRT won't work well with me. I guess I shouldn't worry about that though. It won't accomplish anything

Anyways... your transition has gone very well Jenny! Thanks for the advice

My pleasure, glad I could help ease your mind I totally know how you feel with the pre-transition anxiety thing. Luckily, there is a wealth of inspiration here and on youtube.

And thank you, I really could not be happier with how things are turning out! Next step SRS! Sooo ready!!

[A]

I'm wondering, why does your endo oppose anti-androgens so strongly? I've heard of endos strongly opposing endos who didn't prescribe antiandrogens and then they'd prescribe huge amounts of hormones like tylenol (not what they said but I found what yours said a good line to say). Does he believe anti-androgens to be harmful, or something?

[Jennygirl]

I'm wondering, why does your endo oppose anti-androgens so strongly? I've heard of endos strongly opposing endos who didn't prescribe antiandrogens and then they'd prescribe huge amounts of hormones like tylenol (not what they said but I found what yours said a good line to say). Does he believe anti-androgens to be harmful, or something?

Yeah that was the jist of it.. because they are rough on the body and mind. He takes the standpoint that the least amount of medication is the best path for optimal mental and physical health.

Comparing the actual amount of e & p by weight in pellets vs pills is drastically different. Subdermal is a much more efficient method for delivery... and as I understand it, that is a big reason why there are less associated health risks physically. Mentally speaking, the slow steady release keeps you feeling even the whole way through. There is no jolt like you get with injections.

As cross gender hormone treatments become more widespread in practice, I would not be surprised if endocrinologists start pushing pellets as the #1 way. Right now, it does seem kind of like a "gourmet" approach- but it's the closest we might ever get to actually having ovaries in this lifetime.

[A]

Well I think pellets and other similar methods are definitely one of the best, if not the best. Thing is, it's utterly indecent to ask people to pay such an amount.

Though what makes me wonder is that to skip anti-androgens, you're gonna have to put in a loooot more estrogen. Which makes it hard to believe that it's actually less medication.

...Though seriously, being cut into several times a year would scare me like hell. I hope they can think of a more permanent kind of pellet soon.

[Jennygirl]

Though what makes me wonder is that to skip anti-androgens, you're gonna have to put in a loooot more estrogen. Which makes it hard to believe that it's actually less medication.

That's probably exactly what most endos are going to tell you. It's just not true though (when you combine progesterone and use pellets). You have to find an endo who specializes solely in transgender care. And by care, I mean that they really care Most endo's practice cross gender hormone treatment on the side of a bigger practice treating mostly cis people... so their qualification (to treat trans people) probably involved reading a few pages out of an outdated medical book.

It's a shame there isn't more info out there, but it is coming.. I can feel it!

...Though seriously, being cut into several times a year would scare me like hell. I hope they can think of a more permanent kind of pellet soon.

Amen to that. I would loooooooove a permanent hormone implant!!!!

[A]

Uhm, endos specializing in transgender care... there basically aren't any of that. Maybe one (with luck!) per huge city known for having a ton of transsexuals. That would be... eh... four? No, seriously, even in Montreal, second most populated city in Canada, with over 1.5 million people just in the main city (over 3 times more in the metro area), known for being where all LGBT people gravitate to, there's just no such person. In the whole province, there are 3 endos who see transgender patients and have had training for that one in Quebec City, two in Montreal, one of which only sees minors. Period.

Unless you expect the whole planet's transgender people to move to San Francisco, I don't think it's remotely realistic to be hoping for everyone to see an endo who specializes in an issue that only affects about 0.01 % of the population. It's a surprise that such specialists even exist.

[Jennygirl]

The solution is obviously to get general endocrinologists up to speed with an updated standards of care, which is exactly what I'm hoping will happen for the sake of people everywhere. As ->-bleeped-<- becomes more widely known and accepted, I think it very well may occur. One can at least hope- I know I do.

Even just having a single source of good medical literature online would be enough to get the ball rolling- which is why I'm so excited that O'Dea's website will soon be operational. Right now, there is nothing, nadda.

There was a girl who flew in from London to receive care from O'Dea after reading some posts like this, and he thanked me for referring her. Some people will literally go to great lengths to receive the best care. Hopefully soon it will be more at an arm's reach. Until then, we will always have the tried and true methods. And even if they aren't necessarily the most cutting edge, they do work- so it's not like anyone is completely S.O.L. unless there are underlying medical issues (in which case methods like subdermal delivery would be the clear solution).

The next 10 years will be interesting. Even in the past year or so it seems like trans issues are popping up all over the place... more than ever. Let's hope that continues to grow so we can have a bit more attention given to cross gender hormonal treatment guidelines. On one hand I think it's important for people to know there is better care out there because hopefully word will spread to the doctors and they will take it upon themselves, but on the other hand it's frustrating because I know how hard it is to change a doctor's methodologies... and in some areas there just aren't a whole lot of doctors to choose from if they just flat out refuse.

[A]

Hmm, well I admit I'm really looking forward to seeing a new endo, in 2014, after my current endo has retired. He's currently in Europe receiving training, and he'll be ready to replace mine (who should've been gone for years) soon. Mine is seriously getting old, so his ability to understand what you tell him and to think deeply are very much impaired, as I've had to experience myself.

Not to mention that most of his patients seem to be the older type that cares less if at all about passing, and he puts us all in the same bag, which makes him say that blood levels that are barely in the female range are acceptable, and makes him downplay my issues because I pass more than most of his patients to begin with. Well, I'm saying this without really knowing, but all clues seem to point towards that. And there's also how at my last appointment I walked past two other patients, one actually sort of trying to pass but with a completely male voice and one who was basically a bald man with male suit, flashy aqua glasses, heels and a purse.

Really looking forward to the next one. And I hope he's smarter and less stubborn. Thing I notice with doctors is that no matter their opinion, they'll overwhelmingly tend to be very stubborn and set on only giving the minimum amount of care. If it's not gonna kill you anytime soon, we'll let it slide. If you have anemia, we won't look into the cause with you, we'll just monitor it and consider acting if it gets worse. If you're trans, over a year and a half on HRT with tons of body hair and no breasts, we'll say it's normal, that there's worse, and not even try to diagnose it.

I really hope my new endo helps. 'Cause honestly I'm tired of being the only one who cares.

[Jennygirl]

Yikes, that does not sound like fun!

This is serious stuff, they should absolutely care about every aspect of what they're giving you... the main reason being that these hormones not only affect us physically but mentally, too. If they really don't care, even our mental health is at stake and we have to take it upon ourselves to cope with that- as if we already don't have enough to think about.

For me from the very first visit, it's been like ordering at a restaurant... "What will it be today, Ms. Girl?" Then I say, "Well, I was pretty happy with what I got last time but I did notice ____" ... that is followed by an explanation on possible reasons and solution on what we could change about dosage options to fix the issue. Sometimes he will sketch a diagram to help describe what's happening, and there is never not a solution. Occasionally I walk away thinking... "Darn, I should have recorded that!" so I could share it here.

I know that he's is in the process of training about 3 more to follow his practice (or something like that) in other cities, London being one for sure. I wonder if one of the trainees will be heading to Canada as yours' replacement?

[A]

Dunno. All I know is that as long as "it can't be helped" and "it's natural" aren't his favourite things to say, he'll be better.

As for hormones having a mental effect... Eh, I had a two-week episode of depression-ish symptoms while adjusting to my new estradiol dose, but that's all. o.o

[Eva Marie]

Unless you expect the whole planet's transgender people to move to San Francisco, I don't think it's remotely realistic to be hoping for everyone to see an endo who specializes in an issue that only affects about 0.01 % of the population. It's a surprise that such specialists even exist.

I live in the LA area. My endo specializes in transgender care, and he's not the same guy that Jenny uses. Maybe there are more of them out there than you are thinking

I'm also told by my therapist that the endo will eventually prescribe P for me. I have an appointment with him in about a week and we're going to discuss my treatment (I'm coming off of low dose HRT and putting my foot on the pedal) and I'll be sure to ask him then about the P.

[A]

Uh, to be honest I originally thought Los Angeles was an area of San Francisco. But you said that and I realized that I confused that with Beverly Hills and Hollywood.

But uhm yeah. The big cities of California are probably very special. It seems that transsexuals from the whole US (and even from outside of the US I think) just gravitate there.

[Jennygirl]

Not gonna lie, it's pretty darn good! I especially can't imagine myself living anywhere else at this point in my life... Even though I would probably still feel that way if I were cis gendered

So my recent switch to low dose progesterone pellets (rather than injections - I was getting progesterone that way at first) seems to be doing the trick. I think I've gone up to a full B in the past month or so, and for the first time since I started my nipples are very sore which signals to me that they are growing. Even my B cup bras are starting to look a bit overwhelmed.

[A]

That's pretty awesome. I'm definitely inquiring about progesterone at my next appointment. Utter flat-chestedness gets old.

[PrincessDayna]

I keep hearing of these magical pellets. I think ima ask my endo what he thinks next time i see him. I use injections, which i absolutely love, i dont have those up and down feelings on em some people speak of; but a steady implant with no more needles? Sounds amazing.