Questions and Worries

[Stretch81]

My husband started hormones a few weeks ago. How does all that work? Will he become like I become with PMS? He previously had bilateral blood clots in the lungs. I understand that hormones put anyone at greater risk for clots, especially with a history of embolism. Is a baby aspirin really enough? I really wish he would have taken me to the doctor...I ask more questions than he does. Will the hormones effect sex? Will it still work? I figure coming here is a heck of a lot easier than looking all this up (yes, lazy, I know) but...there's plenty of people here that know first hand. Any information would be appreciated:)

[Xhianil]

She might start PMSing, though not exactly how you do. Ask her doctor, if they say its fine then trust it will be, though next time make a point of how much you want to go. Yes and no, it differs from person to person though she'll likely be less fertile.

[Jamie D]

My husband started hormones a few weeks ago. How does all that work? Will he become like I become with PMS? He previously had bilateral blood clots in the lungs. I understand that hormones put anyone at greater risk for clots, especially with a history of embolism. Is a baby aspirin really enough? I really wish he would have taken me to the doctor...I ask more questions than he does. Will the hormones effect sex? Will it still work? I figure coming here is a heck of a lot easier than looking all this up (yes, lazy, I know) but...there's plenty of people here that know first hand. Any information would be appreciated:)

These really are questions for a medical authority.

I can only relate to you my own personal experience.  Because I had a history of coronary artery disease, my prescribing physician required that I be on some sort of medication to help prevent clots.  I was on Plavix.

It seems that risk of deep vein thrombosis or arterial clots is lower with the use of bioidentical 17-beta estradiol, than with congugated estrogens (such as Premarin) or Ethinylestradiol.

HRT can affect libido and sexual performance, but not always.

[Crackpot]

My wife has been on Estrogen for 3 months now (she just started the T Blockers a few days ago), and I can say that with her she has gotten a little more crabby than before. It hasn't been a significant change, but yes there has been some.

I'm no help as far as the blood clots, that is most definitely something to talk to the doctor about. I am in nursing school though and some things that they teach us to help is wearing compression socks, trying to avoid sitting with your legs crossed a lot, and when sitting for a while doing some leg exercises. My wife does heel lifts when sitting at her desk at work, or while she's playing video games. Might not hurt to bring them up to your spouse.

As far as intimacy, we did notice a reduction in function. It started with a decrease in the "morning wood" and then progressed. Granted my wife was uncomfortable using that body part immediately after she decided to begin transition so that very well may have a huge factor. She can still force it, but when she does it's to make sure the skin stays elastic not for intercourse. It does all vary from person to person, so I'm just letting you know our experience.

Hope that helps!

[JoanneB]

She might start PMSing, though not exactly how you do. Ask her doctor, if they say its fine then trust it will be, though next time make a point of how much you want to go. Yes and no, it differs from person to person though she'll likely be less fertile.

Assuming, of course, that the doc was told or already knew about the emboli.

[blueconstancy]

Blood clots are definitely an issue, and that's something her doctors will have to be well aware of. I'm not sure how much greater the risk is compared to birth control pills, but even on that it's enough that doctors warn cis women routinely to be on the lookout.  It's frustrating that you couldn't be there to ask the doctor! I kind of did make my wife take me along on appointments for this same reason.

My wife didn't have "PMS" unless her estrogen levels were fluctuating (which makes sense - that's what triggers it in cis women too!), but she definitely did have some mood changes. Mostly to be calmer and happier overall, but also more prone to emotion in the very beginning.

Whether an erection is still possible varies from person to person. My wife was still capable up until the end, but not willing to use it, so it didn't matter anyway. There's a lot of things you can do in bed that don't involve one, including an artificial replacement. Be warned that a) sterility is a possible side effect and b) you still can't *count* on that (don't forgo birth control if you're having penetrative sex with original equipment).

[Stretch81]

Thank you for all of the input! From my experience as a nurse, I have learned to go straight to the source for information, and so far, it has worked out for the last 10 years or so! He said that he told the doctor about the emboli and the doctor did put him on estradiol . I just wish he would have told me all this was going down, because I ask more questions. Maybe next time...there are follow up visits, I assume? A lot of this makes me nervous...in the last 10 years, I have had only one trans patient (that I know of, of course) and his issue was not trans related. So...it is out of my scope and that makes my stomach hurt. I am very fearful of those clots returning. That was horrifying! Do the doctors draw labs? Clotting factors? Yes, indeed, next time I will force my way into the appointment! Thank you again, for all the information and honesty.

[blueconstancy]

There should be follow-up visits; every three months is typical early on (tapering to every six months and then every year once the person and dose are stable).

They should draw a number of labs, but I don't think clotting factors are standard. They *might* be for a patient with previous clotting issues, though. For what it's worth, some studies suggest that bioidentical estrogen is a lower clotting risk than the version used in many birth control pills (which is actually the most dangerous form of estrogen, ethinyl estradiol)  Also, anticoagulant therapy is contraindicated in pre-menopausal women with a history of blood clots because it can trigger extreme menstrual bleeding, but this is clearly not an issue for someone without a uterus; presumably at that point anticoagulant therapy has merely the same risks as it does for men and menopausal women. There's also this : http://www.ncbi.nlm.nih.gov/pubmed/2960241 the implication of which is that it's often the progestins or progesterone implicated in DVT and not estrogen. Lastly, there's some evidence that estrogen administered by patch does has a lower clotting risk than orally : http://www.sciencedaily.com/releases/2009/03/090326134024.htm

Standard tests include a basic liver function, CBC, cholesterol, and renal tests and also check for elevated prolactin levels. Most endos will also test testosterone and/or estrogen levels for dosage titration, but that's not as relevant to health concerns per se.

[JoanneB]

There should be follow-up visits; every three months is typical early on (tapering to every six months and then every year once the person and dose are stable).

They should draw a number of labs, but I don't think clotting factors are standard. They *might* be for a patient with previous clotting issues, though. For what it's worth, some studies suggest that bioidentical estrogen is a lower clotting risk than the version used in many birth control pills (which is actually the most dangerous form of estrogen, ethinyl estradiol)  Also, anticoagulant therapy is contraindicated in pre-menopausal women with a history of blood clots because it can trigger extreme menstrual bleeding, but this is clearly not an issue for someone without a uterus; presumably at that point anticoagulant therapy has merely the same risks as it does for men and menopausal women. There's also this : http://www.ncbi.nlm.nih.gov/pubmed/2960241 the implication of which is that it's often the progestins or progesterone implicated in DVT and not estrogen. Lastly, there's some evidence that estrogen administered by patch does has a lower clotting risk than orally : http://www.sciencedaily.com/releases/2009/03/090326134024.htm

Standard tests include a basic liver function, CBC, cholesterol, and renal tests and also check for elevated prolactin levels. Most endos will also test testosterone and/or estrogen levels for dosage titration, but that's not as relevant to health concerns per se.

A woman in my group had a pulmonary embolism back in May and spent some time in hospital. She was immediately taken off estrogen and put on cumaden (sp). She has been getting a work up every month I believe. Only now are they talking maybe letting her back on E in a few more months.

She was taking E orally. Patches or shots are safer. Shots do also tend to play a bit with you emotionally as the estrogen levels fluctuate. In my case estrogen has been an overall mood enhancer. I've been on/off low dose E several times over the past few decades since it helped a lot as a brain reseter, to help me cope or get by in male mode. I would be on it for a few months untill things started to stop working downstairs. Kinda interfered with my "I want to be a normal guy" mindset.

If you are concerned about clots, you probably can't go wrong with Vitamin E supplements. Do your homework.

[Xhianil]

Just a tip, and I'm assuming shes a MtF, stop calling her your husband and stop saying he and him, if you do you'll probably find her being a lot more open to you about the transition and take you on doc trips.

[Stretch81]

Thank you for the info and websites! I wonder if they make a chewable vitamin E supplement (he can't swallow pills)? I will look into this.

As far as calling my husband a "she", I am simply not ready yet...as he continues to function as a male. I do not mean any disrespect, but as far as I am concerned, he is still the same man I married. Now, things would be different if he were dressing, speaking, and acting as a female. At this point, he is not. I do understand that in the future, things will be different. I am simply not ready at this point. After a few months of therapy, I may be ready to take that dive, but for right now, we are taking baby steps. Or, you can chalk it up to learned behavior-it is difficult to change patterns. Again, sorry if this is offensive, but I do feel that spouses kinda get the short end of the stick and very little credit at times. It is a lot to wrap our heads around and with time, therapy, and patience, will seem more normal.

[Stretch81]

And one more side note-the decision to see a doctor, take hormones, and seek therapy were all done behind my back. I had absolutely no clue. It is not like we had a discussion about his feelings and that this is what he needs to do for his well being. In fact, in the past when I had asked about it, he said everything was fine. So now I am last to know and trying to be of assistance in the future. Again, it would be in his best interest to take me with him, but he certainly does not have to if he does not want to.

[Stochastic]

Stretch81,

I think you are a wonderful person for being involved in your spouse's well being. I hope things work our well. Just wanted to let you know that people here care about you and your spouse.

Julia

[Felice Aislin]

Just want to say "ditto" to Julia's response!

Stretch81, I just have to say, wow, and how impressive it is you have been able to respond to the circumstance with caring, wanting to learn, and help your spouse, even despite what would be anyone's natural feeling of hurt/anger.  I truly don't know how I would have responded if I found out after my spouse had already started hormones.

I can't imagine how difficult that must be to find out that way, and I can't imagine the strain your spouse was feeling to make them so afraid of being open, and yet compelled to proceed in starting hormones secretly.  That must have been close to hell...for both of you.

I just saw a sobering response online to a story of a family supporting their transgender loved one:

"This letter brought tears to my eyes. I lost my husband last year because of this issue. His son is doing his best at 7 to remember his daddy. Had the world been a more open place, had he been able to talk to his family, he would still be alive today."

It is hard to fully comprehend the two-way pressure (internal and external) that drives people to feel so unable to be open, and driven to such desperate actions.  Reading this put in perspective just how lucky I am that my spouse found the bravery to confide in me.

As far as the pronoun thing, I have run into the same issue...a lot of people who respond negatively are responding out of a place of having been hurt by family & others consciously refusing to honor their identified gender.  I get that, because it bothers me when I come across a case where someone is apparently doing this...I know how hurtful that can be to someone. 

The thing is, in the initial stages between spouses, it shouldn't be assumed that is what is going on...we may have a lot of other very valid reasons for using the old gender pronouns.  What pronouns to use and when are something that should rightly be decided between the couple, not anyone else. 

My spouse, though I would like to use the correct pronouns to honor their gender identity, is still not ready and comfortable being referred to as she/her on a regular basis, being that it just highlights the current incongruity between their body/presentation & their identity, which is uncomfortable and painful.  They are starting to get more comfortable with it, but you have to understand, people are going to feel comfortable with different things at different times. 

Gentle reminders that trying to find out and honor the pronoun usage that the trans individual prefers at the time can be a way to show respect, earn their trust, and make them feel comfortable opening up to you, are more appropriate than assuming the spouse is necessarily being purposefully (or even accidentally) disrespectful to their spouse, strait off the bat.  (I am editing this, because in re-reading, I realize that Xianhil's comment was probably intended to be more of the first than the latter. Sorry.)

Everyone needs understanding and a supportive environment, whether what you are dealing with is being transgender, or being the spouse of someone who discovers they need to transition. 

[Xhianil]

As far as calling my husband a "she", I am simply not ready yet...as he continues to function as a male. I do not mean any disrespect, but as far as I am concerned, he is still the same man I married. Now, things would be different if he were dressing, speaking, and acting as a female. At this point, he is not. I do understand that in the future, things will be different. I am simply not ready at this point. After a few months of therapy, I may be ready to take that dive, but for right now, we are taking baby steps. Or, you can chalk it up to learned behavior-it is difficult to change patterns. Again, sorry if this is offensive, but I do feel that spouses kinda get the short end of the stick and very little credit at times. It is a lot to wrap our heads around and with time, therapy, and patience, will seem more normal.

I was just suggesting you do so, it would help him and show your support, but hey, your choice hun.