Questions for a beginner: low estrogen dose and no anti-androgen?

[Ltl89]

So, I had my first endo appointment today and finished the blood work.  If all goes well, I will be starting next week.  Yay!  Everything is looking good, except for the fact that I feel like a fatty pig fatty after weighing myself on the scale

However, there were some things I was a little concerned about that I wanted to check with others.  My endo, who is a wonderful women and incredibly accepting, wants to initially start me on a lower dose of estrogen without an anti androgen.  Is that normal? I'm guessing it may be normal not to rush things in the beginning, but  I want to make sure that is common.  I thought most people started with both estrogen and an anti androgen.  Also, I don't know if it is unusual or not to start on a lower initial dose of estrogen.  I'm a little concerned because I want to start the process as quickly as possible because I'd like to be  full time by at least early next year (hopefully sooner). Therefore, I wanted to know what everyone here thinks about my endo's plan.

Also, it was a little difficult to follow her, but she said something about getting the t levels to 55.  Those levels sound quite high to me.  Maybe she wants to get there with estrogen alone and then start an anti-androgen.  Or maybe that's the final goal.  I don't know.  Either way, how does that sound to you guys.

Anything to help prepare me for my next appointment would be great.  I want to tell my doctor what I want, but I also want to make sure I'm moving in a safe way. I know very little about these meds and how to monitor everything, so anything that could help me would be appreciated.

*** Please, no provide exact dosage suggestions because it's against the rules and I want to keep this open in order to get insight

[Naomi]

You should probably call her office and ask for clarification on what she means and why she is doing it.

Edit: Also, since I already forgot to say it XD, congratulations on starting HRT! 

[Keira]

Congratulations

I got put on Spiro only for this month, and Im going to see if I can start estrogen in a couple weeks. The biggest reason you weren't put on both at the same time  is that estrogen and anti androgens can affect everyone differently. You might not even need anti androgens if the estrogen can suppress the T.

I'm on a mid level dose of Spiro, and it has had some pretty strong effects (acne disappearing, libido dropping, hair growth slowing)...which I didn't even expect at this dosage.

They don't know whether you could be allergic to a particular drug, so it's all increase the dosage and check results. Plus, if you were pumped full of E, and your T dropped to zero overnight you would have really bad mood swings and pretty severe physiological reactions. Hence why they don't start people out at even mid range dosages, I was on a low dose of spiro for a couple weeks before it was doubled.

[Sammy]

Yeah, I was only on Spiro for slightly less than three weeks and now for four days Estrogen is being added as well. We will see how this works out, but I am definitely feeling happier while taking S + E, than S only, though these could be just my own delusions .

[Jamiep]

learningtolive,

I was hoping to be further on with Spiro experience & on Estrogen to offer some info., good other chimed in that know. I actually had hoped I could have started on both at the same time. I have one uneducated thought, I don't think I have seen your age (I know you don't have to divulge that, none of my business) but I think you are young and that could be the difference between you and I, that would allow you to go on E first were as I probably have to be started on Spiro to see how I handle this. I am sure the safe way is to start you on low dose as I am on Spiro. The Doctors make sure you get blood tests within a few weeks or a month early on to see your progress after you start. That keeps you safe.

Congratulations on starting HRT, so Happy for you! I know, you feel like jumping for joy! I celebrated with a few of my Sister friends. Great you have a wonderful Endo. Blessings on your Journey.
Hugs
Jamie

[misschievous]

As I haven't started yet, I can't really comment on dosage. I just wanted to say Congratulations and if that is what the doctor put you on then that is probably the best route for you.

Also don't worry too much about your weight now because as body fat moves around and you do some cardio, I bet you will look great.

[bethany]

Learningtolive, Congratulations on starting HRT. Every doctor has their own view on what to prescribe. My doctor is very conservative yet I am seeing great results. So my advice is to let the estrogen work its magic and if the results are not there your doctor will adjust your meds accordingly. This is not a sprint not a marathon.

[Ltl89]

Her opinion on the T level is right in line with my doctor's target.

I've had to stop the androgen blocker (spiro), my body does not react well at all to that stuff. She's likely wanting to see what estrogen alone does to your T level. It's done a lot for mine, even though it's still a bit high.

You should hear from them fairly quick on the blood test, I would wait till you get those results before inquiring.

Thanks, that makes me feel better.  I'm a bit concered about the t-levels, but I'm just beginning.

Congratulations

I got put on Spiro only for this month, and Im going to see if I can start estrogen in a couple weeks. The biggest reason you weren't put on both at the same time  is that estrogen and anti androgens can affect everyone differently. You might not even need anti androgens if the estrogen can suppress the T.

I'm on a mid level dose of Spiro, and it has had some pretty strong effects (acne disappearing, libido dropping, hair growth slowing)...which I didn't even expect at this dosage.

They don't know whether you could be allergic to a particular drug, so it's all increase the dosage and check results. Plus, if you were pumped full of E, and your T dropped to zero overnight you would have really bad mood swings and pretty severe physiological reactions. Hence why they don't start people out at even mid range dosages, I was on a low dose of spiro for a couple weeks before it was doubled.

Thanks Skye.  It's good to know starting at lower dosages is somewhat common.  I still feel concerned about controlling my t-levels, but if it can be done without an anti-androgen it'll be better.  We'll see.

learningtolive,

I was hoping to be further on with Spiro experience & on Estrogen to offer some info., good other chimed in that know. I actually had hoped I could have started on both at the same time. I have one uneducated thought, I don't think I have seen your age (I know you don't have to divulge that, none of my business) but I think you are young and that could be the difference between you and I, that would allow you to go on E first were as I probably have to be started on Spiro to see how I handle this. I am sure the safe way is to start you on low dose as I am on Spiro. The Doctors make sure you get blood tests within a few weeks or a month early on to see your progress after you start. That keeps you safe.

Congratulations on starting HRT, so Happy for you! I know, you feel like jumping for joy! I celebrated with a few of my Sister friends. Great you have a wonderful Endo. Blessings on your Journey.
Hugs
Jamie

I am now 24, so I guess my age could have something to do with it.    And yes, I do feel like jumping for joy

LTL, I like what Cindy once said about endos:  You couldn't get them to agree what day of the week it is, much less the correct approach for HRT.  HRT seems to be a black art.  If your endo has lots of experience and good results, then relax, let her do the heavy medical work.  Is there anywhere you can check her feedback from the medical system?

My therapist is transgender herself and knows a lot about these things.  She's going to help me a long the way.  While she isn't an endo, she is very knowledgeable on all different trans issues. 

As I haven't started yet, I can't really comment on dosage. I just wanted to say Congratulations and if that is what the doctor put you on then that is probably the best route for you.

Also don't worry too much about your weight now because as body fat moves around and you do some cardio, I bet you will look great.

I know I'll eventually lose the weight, but I wish it were already gone

Learningtolive, Congratulations on starting HRT. Every doctor has their own view on what to prescribe. My doctor is very conservative yet I am seeing great results. So my advice is to let the estrogen work its magic and if the results are not there your doctor will adjust your meds accordingly. This is not a sprint but a marathon.

But I hate marathons and want to sprint   I know what you mean though.  Patience is needed in these things.  I just wish I had it. 

[Theo]

My endo, who is a wonderful women and incredibly accepting, wants to initially start me on a lower dose of estrogen without an anti androgen.  Is that normal?

It certainly was for me.

Very low dose of oestrogen initially, quasi getting the body used to the idea, then stepping that up. Anti-androgens (Androcur in my case) only came into play after the first check-up after 6 weeks, when my T level had not dropped sufficiently (from 759 -> 424 ng/dl). Very low dose of them has rapidly kicked my T down to cis female levels (30 last test). There are people who will not need any anti-androgens at all, as their T production will already be inhibited sufficiently by the oestrogen alone. No need to throw stuff into the body that isn't necessary after all. 

[Ltl89]

It certainly was for me.

Very low dose of oestrogen initially, quasi getting the body used to the idea, then stepping that up. Anti-androgens (Androcur in my case) only came into play after the first check-up after 6 weeks, when my T level had not dropped sufficiently (from 759 -> 424 ng/dl). Very low dose of them has rapidly kicked my T down to cis female levels (30 last test). There are people who will not need any anti-androgens at all, as their T production will already be inhibited sufficiently by the oestrogen alone. No need to throw stuff into the body that isn't necessary after all. 

Thanks Theo.  I'm a little surprised that estrogen alone is sufficient for keeping t levels at bay.  Everything I've heard has been contrary to that; however, if it works for others here, I will take it as a positive sign.  I'm just hoping the estrogen levels will be increased in time.  I want to kick start this transition

[Jenna Marie]

I was started on low dose E and no anti-androgen, and while my results are perhaps uncommon, I had enough response that I had to move up going full-time. Including T levels between 40 and 50, which I was told was fine and within the cis female range.

(If nothing else, starting off low does give the *option* of finding out if you're lucky enough to need only estrogen and safe dosage levels of it. If so, you don't have to risk your health or juggle dosages and combine medications; if not, nothing lost except a couple months out of a hopefully very long life.)

[Ltl89]

I was started on low dose E and no anti-androgen, and while my results are perhaps uncommon, I had enough response that I had to move up going full-time. Including T levels between 40 and 50, which I was told was fine and within the cis female range.

(If nothing else, starting off low does give the *option* of finding out if you're lucky enough to need only estrogen and safe dosage levels of it. If so, you don't have to risk your health or juggle dosages and combine medications; if not, nothing lost except a couple months out of a hopefully very long life.)

I'm glad this method has worked for you   I'm hoping it will be successful for me as well, but I'm concerned.  I imagine my t level will be quite high and that estrogen alone won't lower my levels.  Though, she didn't say she wouldn't put me on an anti-androgen in the future, so I'm probably worrying about nothing.   

[Jamie Marie]

Don't worry about it. You're younger than some of us and should be quite susceptible to the hormones, heck I am and also a decade older than you. So if all goes well within a year you will see huge changes and find that you love yourself and your body more than ever. The changes come fast even if you stop. For example I went from no bust to 3/4" in just six weeks and it's increased to 1" after two months off anything but an antiandrogen, spiro, that also lowers my blood pressure. My g/f was messing with me about my side boob yesterday which is recent growth.

So everyone does have a different reaction but hope for the best and think about the body that you always wanted for a goal and it will happen because we will see it thru.

[Jenna Marie]

In the "olden days," estrogen alone was used to lower testosterone; it IS capable of it. The problem is not that it doesn't work at all, but that most people need doses of E so high that it becomes considerably more dangerous (which was also the case back then, when women were getting scary high amounts, often much more than any doctor would prescribe now).

What that means is that E alone may not work for you long-term, but it should reduce T *somewhat* in the meantime, and of course make itself available to the estrogen receptors in your body. Think of it as a down payment towards the final result.   So, worst case is you make small but not zero progress for a couple months while she makes sure your body tolerates the estrogen well; then she adds the blockers and maybe tweaks the E dose until you're both happy. That's disappointing when you wanted to get going fast - and most of us do! - but beats having a bad reaction and getting pulled off of all medication, including OTC, for weeks while you have tests run to see what went wrong. Which also happened to me, because it turns out the standard and cautious starting dose for this endo was still much, much too high for me and I wound up with major warning signs at the 2-month bloodwork that my liver was failing.

(Personally, I'm glad that I started this way and found out I'd never have to deal with the hassles of spiro! And without naming amounts, my E dose by patch is low enough that it's packaged up routinely for cis female HRT, which is also convenient when it comes to pharmacies and insurance...)

[Ltl89]

In the "olden days," estrogen alone was used to lower testosterone; it IS capable of it. The problem is not that it doesn't work at all, but that most people need doses of E so high that it becomes considerably more dangerous (which was also the case back then, when women were getting scary high amounts, often much more than any doctor would prescribe now).

What that means is that E alone may not work for you long-term, but it should reduce T *somewhat* in the meantime, and of course make itself available to the estrogen receptors in your body. Think of it as a down payment towards the final result.   So, worst case is you make small but not zero progress for a couple months while she makes sure your body tolerates the estrogen well; then she adds the blockers and maybe tweaks the E dose until you're both happy. That's disappointing when you wanted to get going fast - and most of us do! - but beats having a bad reaction and getting pulled off of all medication, including OTC, for weeks while you have tests run to see what went wrong. Which also happened to me, because it turns out the standard and cautious starting dose for this endo was still much, much too high for me and I wound up with major warning signs at the 2-month bloodwork that my liver was failing.

(Personally, I'm glad that I started this way and found out I'd never have to deal with the hassles of spiro! And without naming amounts, my E dose by patch is low enough that it's packaged up routinely for cis female HRT, which is also convenient when it comes to pharmacies and insurance...)

Don't worry about it. You're younger than some of us and should be quite susceptible to the hormones, heck I am and also a decade older than you. So if all goes well within a year you will see huge changes and find that you love yourself and your body more than ever. The changes come fast even if you stop. For example I went from no bust to 3/4" in just six weeks and it's increased to 1" after two months off anything but an antiandrogen, spiro, that also lowers my blood pressure. My g/f was messing with me about my side boob yesterday which is recent growth.

So everyone does have a different reaction but hope for the best and think about the body that you always wanted for a goal and it will happen because we will see it thru.

You're both probably right.  I just want to get there fast.  Still, my endo is looking out for my health.  She told me she's seen a trans patient who had a stroke and wants to be as cautious as possible for my health and safety.  I should probably be more happy about her caution than I should worry about it.

[Tiffanie]

Yay    Congratulations 

I started hrt less than 1 week ago.  My endo started me on spiro and estradiol.  He did not mention any specific levels, but said he wanted to get my T levels into the female range (15 - 75).

[Jamie D]

So, I had my first endo appointment today and finished the blood work.  If all goes well, I will be starting next week.  Yay!  Everything is looking good, except for the fact that I feel like a fatty pig fatty after weighing myself on the scale

However, there were some things I was a little concerned about that I wanted to check with others.  My endo, who is a wonderful women and incredibly accepting, wants to initially start me on a lower dose of estrogen without an anti androgen.  Is that normal? I'm guessing it may be normal not to rush things in the beginning, but  I want to make sure that is common.  I thought most people started with both estrogen and an anti androgen.  Also, I don't know if it is unusual or not to start on a lower initial dose of estrogen.  I'm a little concerned because I want to start the process as quickly as possible because I'd like to be  full time by at least early next year (hopefully sooner). Therefore, I wanted to know what everyone here thinks about my endo's plan.

Also, it was a little difficult to follow her, but she said something about getting the t levels to 55.  Those levels sound quite high to me.  Maybe she wants to get there with estrogen alone and then start an anti-androgen.  Or maybe that's the final goal.  I don't know.  Either way, how does that sound to you guys.

Anything to help prepare me for my next appointment would be great.  I want to tell my doctor what I want, but I also want to make sure I'm moving in a safe way. I know very little about these meds and how to monitor everything, so anything that could help me would be appreciated.

*** Please, no provide exact dosage suggestions because it's against the rules and I want to keep this open in order to get insight

Thanks for the reminder in the topic - it makes the moderators' job much easier.   

It is not unusual to start just one type of medication.  Some members started with just an anti-androgen.  Other started with just an estrogen.  And some started both.  The rationale behind starting just one is, in part, if there is a complication, then it can readily be traced to the specific medication.  If you start multiple meds simultaneously (say an AA, and E, and P), and you have, for instance, a liver complication, which one is doing it?

[Vicky]

Four years ago, I was started on an estrogen dose that many of my friends thought would be totally ineffective. Never the less, I outpaced a couple of them on development and length of time to develop.  I did not get Spiro for my HRT, I got it because another diuretic med was walloping my potassium levels.  Post op, I am on half the dose the surgeon recommends as the post op max for E, doing fine and happy.  I am better developed than two close family females are, and dead heat even with the others. AND  I am having a bit of a growth session here the past month.  I will have a new bra size for my 4th hormone birthday.