Sometime soon, probably next week, I'll go do a blood test to check my hormone levels. Since after quite a long time on HRT, my chest could still easily pass as male, I'm hoping it'll reveal that my estradiol is low and justify a dose increase which would hopefully make something happen.
But assuming those blood tests say that my estradiol level is fine, then I'm going to need another explanation as for why I have to fake (small) breasts with a padded bra. And possible solutions.
I know diagnosing that sort of thing should be my endo's problem, but he won't do it. Even when it was clear that my dose was insufficient and the high estradiol levels revealed by the two last tests were mistaken, his first and only explanation was "some people don't have a lot of estrogen receptors and will have disappointing results".
Which is true, but as far as I know it should be the very last thing you consider, because not only is it (to such a degree) highly unlikely, but it's also the one cause we can't verify, and to which there is pretty much no solution apart from surgery. So keeping in mind the goal of helping the patient, logically all other reasonably possible causes should be explored before giving up and saying the case is desperate.
If you people can help me, I'll be able to present my endo with alternate theories and solutions, which might eventually maybe give me breasts. Or confirm that indeed I won't ever have any natural breasts.
So here goes. I've been on HRT for over a year and a half (see signature for the exact duration), with estradiol on a low dose in the beginning, on an even lower dose for 6 good months (mistake, took Estrogel and he prescribed a minuscule dose), and then back on the initial dose for a few months, and, since July, a medium dose.
I take Estrace, micronized estradiol in pills. My now medium dose is divided in three, one in the morning, one at 14:30, and one before bed.
As for my anti-androgen, I take cyproterone acetate, in a medium dose, all in the morning.
Let me give you some blood test results. They're given in international units, with the American units between parentheses.
(I started HRT in February 2012)
June 26 2012
___Total testosterone: 0.5 nmol/L (14.4092 ng/dL)
___17ß-hydroxy estradiol: 184 pmol/L (50.1226 pg/mL)
(First blood test after starting HRT. He was gonna increase my dose to what I take now since July 2013, but I stupidly inquired about Estrogel and he prescribed a crazy low dose of it. I got a lot of crap because of that mistake.)
November 29 2012
___Total testosterone: 0.2 nmol/L (5.7637 ng/dL)
___17ß-hydroxy estradiol: 157.4 pmol/L (42.8766 pg/mL)
(Estrogel, 24 hours after applying, because blood tests on the same day gave impossibly high results. Even though this had been reported by a patient of another trans-specialized endo's who said it's what he told every patient to do, my doctor rejected this result. This is about when I switched back to my old Estrace prescription, since I realized I could never convince him that Estrogel was giving crazy numbers and that to begin with he gave me a crazy low dose.)
February 11 2013
___Total testosterone: 0.76 nmol/L (21.9020 ng/dL)
___Bio-available testosterone: 0.19 nmol/L (5.4755 ng/dL)
___17ß-hydroxy estradiol: 214.6 pmol/L (58.4582 pg/mL)
(Test done after a while of taking Estrace again. This was finally a blood test we could both agree on that showed that my levels were too low. He didn't take my numerous messages as I meant them and there was apparently a misunderstanding, so it took until my appointment in July to get an increase though. My dose was then increased by 1/3. Sadly I haven't seen much of a difference, if any.)
Now, for the effects of HRT. So far, I've noticed a little bit of change attributed to estrogen, but in most cases it's so subtle I'm not always really sure, not to mention that losing weight and killing testosterone did a lot. My hips have widened a bit, of that I'm sure. I think I've had some (SOME - I still have quite a considerable belly) fat redistribution from my belly to my thighs and such, maybe.
Apart from that, there are changes attributed to the anti-androgen, such as a modest reduction of body hair, a loss of muscle mass, the very small amounts of hair I had begun to lose in the front that came back, the disappearance of automatic erections, and less oily and slightly softer skin.
When it comes to breasts... a few weeks after starting HRT, my nipples started to hurt and itch like crazy for a while, and I was enthusiastic that something was finally happening. But apart from a little lump underneath (which I can only faintly feel now) and occasionally "puffed" nipples, there was no real change. Recently I noticed my nipples had gotten sensitive in a sexual way.
Right now, the area is still slightly painful to pressure, but nowhere as much as last summer, when bumping into something made me want to curse. I've been wearing a stuffed bra ever since I started living as a girl, in July, and after a couple of weeks, already, my chest only got slightly uncomfortable, and only after several hours of wearing it.
As for how my chest looks, as I said earlier, my chest would still have little trouble passing as a man's if I tried. The visible changes I can note compared to when I started HRT are that now my nipples seem to have mostly fused with my areolas (the whole thing is sort of a single mound instead of the areola being flat on the rest of the "breast" and the nipple protruding alone), and that maybe with imagination my chest might look like severely malnourished breasts, the whole thing looking a little rounder and flabby. But that's partly attributable to my pectoral muscles shrinking.
And most importantly, there are no breasts to speak of. Nothing is actually hanging, and I assure you that the most "breasts" my chest can look through my shirt is something slightly droopy stolen from an old man who was getting a little fat.
I guarantee you that if I go out without my padded bra (which at best simulates small A's which just look wrong on someone like me who doesn't have a delicate build at all), I'm gonna be stared at weird. Because for every other point, assuming I've gone through the extremely extenuating task of taking care of my abundant body hair, unless someone undressed me, I generally pass pretty much 100 %. I don't think I've even ever been able to make a credible male voice.
Oh, hm, personal details.
- I'm 22. I was 20, nearly 21, when I started HRT.
- My height is 165 cm (5'5").
- My weight is 60.3 Kg (133 lbs). I probably weighed 5-10 more pounds (2.26-4.53 Kg) when I started HRT.
I think you have a fairly accurate description of my situation. Don't hesitate to ask for anything else.
Now, I'm going to completely hypothetically try to give explanations for my total absence of breasts after over a year and a half of HRT.
- Because I'm anemic, my breasts don't have the required nourishment to grow. I'm not so sure about that, though, because my anemia is slight, and even though my diet isn't exactly good, there's really worse, not to mention I take a multivitamin. For the last few months I've been mostly feeding myself with oatmeal, soy milk, whole grain bread, peanut butter, whole grain pasta with red beans and tomato sauce, orange juice, yogurt and cheese. There's definitely better, but add the multivitamin and I don't see any major and obvious deficiency.
- For some unknown reason, I'd need a higher dose than what is normally prescribed for anything to happen.
- My padded bra (which shouldn't be too tight) is keeping my breasts from growing, even though I don't wear it at night or when I stay at home (which has been more than half the time this summer and 2-3 days a week in average since school started in August).
- Actually decreasing my dose for a long time right in the middle of my HRT stunted growth permanently.
- Regularly plucking the very thick and stubborn hair that grows on my areolas since I was 12-14, for which I pinch the skin to see underneath (and pinched/twisted it pretty hard before HRT made the area sensitive), has caused damage which stunted growth.
- For some reason, I would absolutely need progesterone for anything to happen at all, while normally it should just improve growth which would have started already.
- Despite my age, despite my otherwise good ability to pass, and despite my sister being above average and my mother being very large in breast size, my chest just doesn't know what "estradiol" means and will never react to it in any significant manner.
- For some reason and despite the blood test obviously showing that the estrogen reached my blood, I would not react to oral HRT in particular. But studying this hypothesis isn't very useful for now, since in any case I cannot afford Estrogel (or any other solution than pills, the only method that's covered), and because of the misunderstandings with my doctor. (Which will normally be replaced sometime in 2014 for his retirement, which is probably good news.)
- Even though my testosterone should be well under control, I would somehow have DHT levels in my blood sufficient to compete with estradiol.
- Even though I don't take such big amounts of it, the small amounts of phyto-estrogens in my soy milk would somehow compete with my medication.
- Spreading out my doses throughout the day as I do ends up never getting my blood level high enough for growth, so it's more constant, but constant at an insufficient level.
(As a reminder, this thread is assuming that my next blood test says that my estradiol level is completely sufficient.)
Oh yeah, don't suggest that I find another endo, please. I'm already travelling 2.5 hours away to see this one, and I don't have a car. The second closest one (and only other one in the province actually) is 5 hours away, and he has a pretty long waiting list. And I've already tried to find a non-endo doctor who'd do my HRT, without success.
So, uhm, there you go. You can discuss the hypotheses I've brought, or propose others. Or give experiences. Though I've never heard of such an unlucky individual that she wouldn't get breasts at all even though she started HRT in her early twenties (early enough to get hip bone widening apparently). But really, anything is welcome.
Oh yeah, by the way, I have two questions I would like to ask:
- What are the target estradiol levels your endos have told you for your HRT? I often read recommended medication dosages, or that "normal female levels" are what are aimed for, but normal female levels are 120-1404 pmol/L (32.6886-382.4571 pg/mL) depending on when it is in someone's ovulatory cycle. And such a wide range is like no clue at all.
- When I go take my blood test, how should I schedule it? Before my medication, after? How long before/after? Skip the morning dose or not? As a reminder, I take three doses a day: morning, 14:30 and before bed.
Finally, if you say blood levels, it would be very nice for everyone if you could convert your numbers so everyone understands them. I made the effort to convert to the American format because the US are definitely the place where the most members come from, so it would be nice if you did the same for everyone, no matter in what direction.
Use this converter:
http://www.soc-bdr.org/content/rds/authors/unit_tables_conversions_and_genetic_dictionaries/conversion_in_si_units/index_en.htmlPS: Remember that we are not allowed to give the numbers for our medication dosages, but that we can absolutely give blood level numbers.
