Questions on my questionable hormone therapy routine. Help! :(

[l0nghairdontcare]

So Ive been posting about this quite a lot and I haven't really had a lot of answers and I'm just getting used to this sure since I'm new here. So my endo has put me on a 3 month Lupron injection as well as elestrin daily and Avodart every other day. I had my first injection on October 14th and am getting blood work done on January 14th. He told me that if my testosterone level was still high we would do another injection and after that I wouldn't need anti-androgen medication since estrogen would be the dominant hormone in my body. I would continue to take Avodart since hair loss is my biggest fear by far and my biggest area of dysphoria. My question is is my endo correct in this situation? Will this be enough to keep my testosterone at castrate levels or close to it? I am just confused as to why if this was true why others here wouldn't just use this method instead of taking spiro and other anti androgen medications? And if this is true why do other people that I've seen here that use GnHR get injections constantly instea of using this method? Any info would be great as this is my body and future I am talking about.

[l0nghairdontcare]

Anyone?

[anjaq]

If estradiol in combination with progesterone is taken, it should not be needed unless the blood values will tell you so, to take antiandrogens. Progesterone by the way is a more effective blocker of the Testosterone to DHT conversion than antiandrogens (it blocks 90% instead of 60% approx) and DHT is what causes the hair loss.

[l0nghairdontcare]

thanks for the info. I have no problem taking an anti-androgen and i could continue lupron i'm just scared of lupron's side effects if i have to take it continually like this until i get/afford an orchiectomy which could be more than a year from now. My therapist seemed mis informed as well she had been telling me she had clients that were doing what i was doing all along until today when i mentioned it to her and she texted one of her clients about it and they told her that they'll be on lupron until surgery as well. she also gave me an ignorant answer about people online not being qualified to answer questions like this and as far as saying that i could be being purposefully lied to to scare me. she also mentioned the client that was given the same story as me with lupron who now is saying they are taking it regularly is bigger physically then me and that could be the problem. i do not believe that obviously. my endo has been treating trans patients for 40 years and i thought i could trust him but it seems like im being used as a guinea pig.i just feel lied to, misled and confused. i feel like someone i was trusting my health, body and life has no idea what they are doing when they claim to be one of the most knowledgeable people in the US on this subject.

not to mention i found out from a different forum that the dose of my Elestrin is irregularly low for someone who has testes that are shut down totally by lupron.

I was also told by my endo that spiro is a very ineffective anti androgen and while it does produce results it takes a long time to lower testosterone and that it is infrequent and taxing on the liver and effects femenization.

[SunKat]

I'm sorry you haven't been getting many replies on this thread.  I think most folks are a little leery about giving advice on drug regimens. 
Especially since there is so much of your medical history that we aren't privy to.  There is some logic behind what your endo is doing, but whether it is right for you... there is no way to tell from out here. 

It sounds like trust has become an issue in your current treatment, so the best advice I can give you is to get a second opinion from another endocrinologist. If your endo is the only one in town, you can consult one online.  Just be sure to gather up all the info from your recent bloodwork and let them know your concerns about your current regimen. 

[l0nghairdontcare]

thanks sunkat i appreciate your answer. I am not familiar with anyone else in CT who would be able to treat me. I do not want to list my dr.'s name. I have another appointment in January so i am going to ask more questions this time since I have gained more knowledge since my last appointment.

You say that there is some logic to what he is doing, could you elaborate on that?

[Ms Grace]

When I started HRT my endo said he be able to knock out most of my T using E. It did do that, although he's since moved me onto Spiro too. I guess I would say that if what your endo is doing works then it is the right thing for you. From what I've gleaned through this forum is that ends really tailor the HRT to suit the person. Just because some folk are on Spiro doesn't mean you need to be.

[Jennygirl]

If estradiol in combination with progesterone is taken, it should not be needed unless the blood values will tell you so, to take antiandrogens. Progesterone by the way is a more effective blocker of the Testosterone to DHT conversion than antiandrogens (it blocks 90% instead of 60% approx) and DHT is what causes the hair loss.

^ THIS!

YES!

[anjaq]

Of course people online have an opinion, based on their experiences and those of others and recommendations by different doctors and all kind sof opinions exist, if you ask 3 endocs you also get 4 opinions.

My opinion is that while we hate testosterone, it is more important to get estrogen and progesterone up instead of testosterone down. Women have testosterone as well. Think of it that way - your goal is to feminize the body - how is killing testosterone helping that? You wont de-virilize because of a low T and you wont virilize that fast because of an elevated T (taking womens regular levels as a reference) - what needs to be stopped is DHT which is created from T via an enzyme which is what Androcur and Spiro and others do block - but P can block it even better. DHT is what makes the hair fall out in one place and grow in another place. Simplified...
Many patients seek to kill T because they have that experience about T shaping their body in puberty, because the see it as a symbol for male, because they do not want to have a sex drive for the time being. Not because having some T left would still (after being in the mid 20ies at least) make them grow taller or such. Because it does not.

I think these antiandrogens all have some side effects that are not great - they are having effects on stomach, liver, kidneys, your libido or your blood pressure. If they are not needed, they should not be taken or only in minor dosages.

I still wonder if there are any studies done that support the claim by some people that you need antiandrogens to feminize if you take Estradiol (and then of course you do not need Progesterone because you have no Uterus). In what way would this really interact? Testosterone is actually converted into Estradiol by the body. The female body has much more Testosterone than Estradiol - did you know that? In contrast there is solid evidence that Progesterone is needed for Estradiol to work properly. Antiandrogens simulate some of the properties of Progesterone IIRC , so maybe they can help some things, but honestly why take such a thing if P is available...

But that is just my opinion now - formed by recent explorations and support after taking the stupid combination of Estradiol and CPA (antiandrogen) pre-op and Estradiol only post-op and having not feminized as much as it would have been possible with that therapy and even lost some passability 10 years into Estradiol monotherapy.

[l0nghairdontcare]

If estradiol in combination with progesterone is taken, it should not be needed unless the blood values will tell you so, to take antiandrogens. Progesterone by the way is a more effective blocker of the Testosterone to DHT conversion than antiandrogens (it blocks 90% instead of 60% approx) and DHT is what causes the hair loss.

So why are there all these debates about Progesterone? If it blocks that much DHT why isn't it a standard in a regemine? My endo also said that Progesterone had nasty side effects and wasn't worth it for the results. I have also heard that Progesterone has a androgenic effect and increases testosterone and DHT?

and by the blocking of DHT principle you had brought up doesn't Avodart block 90-95% DHT? So wouldn't it be just as effective is not a little more if it was blocking 95%? I know that DHT is the issue and i am more concerned about eradicating it than i am testosterone because it causes hair loss.

You have piqued my interest in Progesterone and i am considering asking about taking it, I just want to make sure there aren't any adverse side effects like with E, The last thing i need is to find out is has an increased risk to give me some medical condition that wouldn't allow me to be one ANY HRT at all.

[Jenna Marie]

I don't have an opinion about the drug regimen, but I can recommend Dr. Browne-Martin at Baystate as a second opinion endocrinologist; she's very experienced in trans care AND willing to do research when she doesn't know something already.

[l0nghairdontcare]

thank you jenna i will consider her even though she may be a little farther than i would like it is a reasonable distance for my health and well being.

[anjaq]

i am not aware of nasty side effects of progesterone. Progestins, which are often claimed to be equivalent and sold as "modified progesterone" or something like that, can increase cancer risk. Progesterone has a lot of health benefits as it seems. If your T is very high, you may need something in addition, but i think most other drugs have more side effects that are nasty.
Here is some reading material on the blocking of DHT formation and the cancer risk:
http://www.ncbi.nlm.nih.gov/pubmed/15551359
http://www.ncbi.nlm.nih.gov/pubmed/1828548
And
http://upload.wikimedia.org/wikipedia/commons/thumb/1/13/Steroidogenesis.svg/2000px-Steroidogenesis.svg.png
shows how the hormones can be converted. To make T from P it takes a few steps... I think that risk of T going up as a result of P exists, so one should look out for it in the blood tests...This only happens however if the body desires to produce T anyways - which should not be the case if enough Estradiol is in the body at all times (not just for 30 minutes after taking a pill)

[SunKat]

As to the logic...
As you mentioned, the Lupron has some very nasty side effects.  My guess is that your endo is using the Lupron to quickly knock your T level down and then taking you off again to avoid long term side effects.  Once your T is down it sounds like they are hoping the rest of the regimen will keep you stable.  If it doesn't, they can always adjust it after the next set of bloodwork. 

As far as additional meds or dosages to your regimen... they may be starting simply and at lower dosages to see how your body reacts. 

Is this a good approach? It depends on your age, your health and a number of other factors. If you are young and healthy you might tolerate a longer course of Lupron, esp. if the goal is to delay puberty prior to hormone therapy.  If you are older with an iffy heart Lupron would be more risky.  Your body could like E and a lower dose is enough, or you could be resistant and need a higher dose.  Everyone is different.

Again, please don't take this as support or condemnation for what your endo is doing.  I'm making some assumptions here about how your endo is proceeding and I can see this working based on those assumptions.  Just remember you're entitled to an explanation of your treatment from your doctor and if your aren't satisfied with the answers seek a second opinion.