Why aiming for female levels is incorrect

[Jenna Marie]

Thank you, Thylacin. I'd bowed out of this conversation because I don't see much point to continuing with someone who dismisses all counter-evidence; there's not much I could say beyond the fact that I trusted the 2 doctors overseeing my care. I'm a librarian by training, and I've researched this quite a bit and find the studies etc. on exogenous estrogen and potential strain on the liver quite convincing - but Kay clearly does not, and as neither of us are doctors, I wouldn't presume to debate her on layperson's terms. Heck, we could both be wrong.

(Oh, and I have in fact been karyotyped, b/c they wondered the same thing. Normal 46,XY. Oh well.)

[KayXo]

I've researched this quite a bit and find the studies etc. on exogenous estrogen and potential strain on the liver quite convincing

Can you cite a few of these studies? Are these studies on bio-identical estradiol and was the estradiol taken transdermally or non-orally? What about doses? Were they similar or higher than yours? Did they actually find liver damage from exogenous estrogen intake? What matters is actual facts, not speculation, not ideas, not theories.

I can cite you several studies with exogenous estrogen intake, bio-identical, non oral or oral, in genetic women, genetic men and transsexual women with no liver complications noted.

Even Harry Benjamin remarked himself in the The TRANSSEXUAL PHENOMENON
Harry Benjamin, M.D. , 1966

""The liver is the organ that metabolizes ("digests") the estrogen and it is conceivable (although not actually shown) that it may be unfavorably affected by long-continued medication. A hazard may possibly exist if there is a history of hepatitis."

Notice the underlined part. Consider that back then, estrogen was mostly high doses of ethinyl estradiol, sometimes Premarin or high doses of injectable estradiol valerate. Today, we are taking a safer form of estrogen and usually much lower doses.

This is why I question what your doctors said. Doctors are human, they can make errors. There is nothing wrong in questioning professionals and seeking facts, finding out what is true from what is not. I don't care to argue or be right. I care about facts, about what everyone can agree on and if we don't know, then let's not invent facts, do some more research and find out as much as we can. The truth cannot always be sought but we can work towards it and in the meantime, present what to this day, seems pretty strong convincing evidence.

[Jenna Marie]

As I said, I don't want to debate you about it. I sincerely doubt you'll be convinced, since you dismiss what I consider to be solid facts, and I find your facts and studies equally unconvincing.

[KayXo]

What facts did I dismiss? And why do you find the facts and studies that I presented unconvincing? What do you question? We can discuss it, there is no harm in discussing about it. This is about finding out the truth, not about being right or wrong. Putting pride, ego aside and seeking facts.

[Catherine Sarah]

Hi Kay,

Interesting topic you've contributed. I've 3 observations and 1 questions to ask if you don't mind.

Firstly I agree on your statement regarding the lack of TS hormone understanding/teaching in the medical faculty.
Secondly, my own personal experience with respects to HT levels. In the initial HT regime (oral progesterone, Spiro & patch E) I struggled to make post menopausal levels and development was slow. Six months into the programme the regime changed to micronised bio identical P & E implants. (Similar if not identical to what College Pharmacy provide). "Feminisation" development increased quickly as did the levels. (E = 2,500 pmol/L). Endo held no concerns at all.

Thirdly. There is a perceived subconscious theme running through this thread that pays little deference to the effect of HT on brain "alteration."  Depending on the period the brain has been "marinated" in HT and the associated effects of enriching, atrophied E receptors and atrophying T receptors together with all associated "roll-on" effects, (dopamine's, proteins, enzymes etc) which probably have not been research. Leaves a substantial gap in understanding the total "system" effects, HT imposes.

Similar to investigating a plane crash based purely on what the electrical system was doing during the pre crash phase. Without taking into consideration what the other systems (mechanical, hydraulic, IT, structural, physics etc) contributed to the event.

This is not a criticism, it purely an observation as no doubt such research has not been undertaken.

My question is: are you able to make a comment based on your finding to date, how the results/effects would change, if at all, based on the use of micronised, bio-identical Oestrogen and Progesterone implants? I'm uncertain as to the actual composition of the products bio-identical nature, but would assume it similar to the College Pharmacy product. In fact one of my doses was supplied by them until my Endo sourced a local compounding chemist.

Appreciate your comments

Huggs
Catherine

[Missy~rmdlm]

There is a huge range of estradiol...

One could read a "good" number at between 20 and 500 on there. There is a known risk at higher doses, not to be dismissed.

[KayXo]

My question is: are you able to make a comment based on your finding to date, how the results/effects would change, if at all, based on the use of micronised, bio-identical Oestrogen and Progesterone implants?

Are you asking how using pellets would differ in terms of its effects on the body and brain vs other routes like oral or injectables? Or how using bio-identicals would differ from other forms of estrogens/progestogens? Or just a general question about how hormone therapy would change us neurologically?

[KayXo]

There is a huge range of estradiol...

Yes. And ranges vary from one lab to another so that even ranges are not the same everywhere.

There is a known risk at higher doses, not to be dismissed.

What are the risks? Pregnant women have extremely high levels (up to 75,000 pg/ml). http://cebp.aacrjournals.org/cgi/content-nw/full/12/5/452/T1. Some women experience pregnancy several times during their lives. Our species is still alive and growing! Prostate cancer patients are prescribed very high doses of transdermal/injectable estradiol. None appear to have suffered increased complications from this. In fact, one study noted this

J Urol. 2005 Aug;174(2):527-33; discussion 532-3.

Transdermal estradiol therapy for prostate cancer reduces
thrombophilic activation and protects against thromboembolism

"These results suggest that transdermal estradiol reduces thrombophilic activation in men with advanced prostate cancer, and protects against the risk of thrombosis."

This study also states...

Am J Obstet Gynecol. 1993 Dec;169(6):1549-53.
Fibrinolytic parameters in women undergoing ovulation induction.

"Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event." In this study, maximum mean estradiol was 739.8 pg/ml.

Breast cancer risk is also quite rare in transsexual women, despite decades of aggressive hormonal (non bio-identical) treatment. None were noted in prostate cancer patients.

J Sex Med. 2013 Dec;10(12):3129-34. doi: 10.1111/jsm.12319. Epub 2013 Sep 9.
Breast cancer development in transsexual subjects receiving cross-sex hormone treatment.

"We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure)"

"Among MtF individuals one case was encountered, as well as a probable but not proven second case."

"The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development."

Am J Surg Pathol. 2000 Jan;24(1):74-80.
Short-term and long-term histologic effects of castration and estrogen treatment on breast tissue of 14 male-to-female transsexuals in comparison with two chemically castrated men.

"so far, only four cases of breast cancer in male-to-female transsexuals have been documented."

From The TRANSSEXUAL PHENOMENON
Harry Benjamin, M.D. , 1966

"In my own clinical material of 152 male transsexuals, 141 of whom were treated with medium to fairly large doses of estrogen, some over several years, no incident of breast or any other cancer was observed. One may argue that these are mostly young men, less apt to develop a malignancy. The experiences of urologists, however, who treated elderly and old men with even much larger doses of estrogen for cancer of the prostate, must then be recalled. With the exception of one disputed case of breast cancer (it may have been a metastasis of the prostatic cancer) reported in the medical literature, no such incident was observed in hundreds if not thousands of cases. In a personal communication from Dr. Elmer Belt, one of the outstanding and most experienced urologists in the country, he said:

    In regard to the taking of Stilbestrol as a cause for cancer of the breast, we have placed several hundred men on this material (I imagine if we were to search our records we would find the number to be in excess of two thousand) and in all of these cases we have not seen a single occurrence of cancer of the breast, although the dosages we used were of a very high level. "

Also, one acnedotal report from a transwoman

""Well, I went down yesterday and had blood drawn using privatemdlabs.com and today I already have the results:

Estradiol: 1079.0 pg/mL
Prolactin: 55.3 ng/ML

I also had a full CBC and Metabolic panel done and EVERYTHING was in the "normal" zone. Even those things that were out of balance on my last blood test before starting E and P!  Even the liver tests, which were a tad on the high side before HRT were now in the middle of the normal zone."

[Catherine Sarah]

Hi Kay,

Are you asking how using pellets would differ in terms of its effects on the body and brain vs other routes like oral or injectables? Or how using bio-identicals would differ from other forms of estrogens/progestogens? Or just a general question about how hormone therapy would change us neurologically?

Essentially I'm asking how using pellets would differ in terms of its effect on the body vs other routes. Let keep the neurological aspect out of this conversation. That's a minefield all of its own.

Huggs
Catherine

[KayXo]

From this study, Pharmacology of estrogens and progestogens: influence of different routes of administration, CLIMACTERIC 2005;8(Suppl 1):3–63

Subcutaneous implants (pellets) yield a ratio close to the natural ratio (2:1) of premenopausal genetic females, a 1.5:1 ratio of estradiol:estrone ratio.

Levels tend to slowly rise the first 4 months, reaching a peak around 4 months, then slowly decline to low levels around 9 months. (Dusterberg and Nishino, 1982)

"In contrast to the transdermal treatment with estradiol which showed large intra- and interindividual variations, the administration of estradiol pellets was associated with relatively small fluctuations during the 6 months after implantation"

"Implants of estradiol showed only minor effects on lipid metabolism with a slight decrease in LDL cholesterol and a slight increase in HDL cholesterol" compared to the oral route, as expected since it is non-oral. "LDL cholesterol, total cholesterol and triglycerides did not change", according to another study.

"In women with supraphysiological estradiol levels during treatment with implants, no adverse effects on lipid metabolism, but a reduction in LDL cholesterol and fasting insulin were observed." and yet another indication that high levels of estradiol don't necessarily equate to higher risk! and actually improve health markers.

Basically, with pellets, you get a more constant level vs other methods often used. Which may be good for mood but may over time desensitize estrogen receptors from too constant levels, I'm not sure. It's debatable. You avoid the first-pass liver effect and all the exaggerated hepatic effects seen with oral estrogens, especially non-bio-identical.

That's pretty much it. The important thing in the end is how you feel on them and your development. Cost must also be taken account for results obtained vs other routes that might be cheaper and as effective/as safe.

Hope this helps,

[Catherine Sarah]

Thank you very much Kay,

A very informative reply. Just for the record, I'm getting roughly 15 months out of my E and 8 months out of my P, implants. Based on Aussie prices for pharmaceuticals that is about 25% cheaper to go this way. Apart from the fact I don't have to remember to take or stick something to myself every day.

Doesn't affect the mood situation much. I'd be taking home gold in the Olympics if they had a lacrimal sac races. I still gauge a movie by the tissues used. Half a box for watching Philomena today. Tears ran when I both laughed and cried. Just comes with territory.

It was interesting to note the close ratio to premenopausal women. Not surprised to see the large variation using transdermal patch. Electrolytes, body temperature, skin conductivity, Ph conditions etc fluctuate by the hour, which would have to have a major effect in this form of delivery.

Thank you once again

Huggs
Catherine