Post-SRS HRT

[Agent_J]

So a few weeks ago I made the ~800 mile round-trip to another state to see a new HRT provider after striking out with three different ones in my own area.  Yesterday I finally saw my lab results...my E level was lower than the test could measure. No wonder I'd been feeling so damned miserable. My new provider is quite happy to raise my dose.

[mm]

Good you have found someone who will look at your labs results and how you feel and increase your dosage so you can feel better.  Too bad you has to travel so far.

[mrs izzy]

What i have seen and seems to have held true with me is if you had your T well under control, is that your post HRT E dose should be about the same as pre. (my dose did not change)

I was on Cyproterone acetate and was way more a super T killer then Spiro.

Isabell

[Shantel]

I think that providers tend to be way more conservative with their post-op prescription levels than is necessary or practical. Most make assumptions now that you are post-op that labs aren't as important as before since you're main T factories are gone, so generally they cut your dose in half to a standard maintenance level because they are probably overly concerned about clotting, strokes and malpractice suits. As your lab results clearly indicate, this is a big error as we are not all cookie cutter identical in so many ways and the one size fits all approach shows a lack of due diligence.

[Agent_J]

That's exactly what mine did. "Since you've had SRS you need to be off Spiro, of course, and WPATH requires that your E dose be reduced by 25-50%." The E dose reduction does have a sensible history behind it but the providers who enforce it as a hard-and-fast rule don't seem to even care why it was done (it dates to the days before T-blockers were regularly prescribed so far higher doses and of nastier forms of E were being prescribed.)

Also, this morning I heard from a friend who was still going to my first endo. Her labs showed very low E levels and the endo asserted "I believe the actual level is much higher than the lab is showing." At that point, why bother with labs at all? (I had a similar treatment from my second endo, in which she dismissed labs that showed low levels as "defective.")

[Jamie D]

So a few weeks ago I made the ~800 mile round-trip to another state to see a new HRT provider after striking out with three different ones in my own area.  Yesterday I finally saw my lab results...my E level was lower than the test could measure. No wonder I'd been feeling so damned miserable. My new provider is quite happy to raise my dose.

Good thing you got the tests done!  I hope things begin to look up.  You were basically post-menopausal.

That's exactly what mine did. "Since you've had SRS you need to be off Spiro, of course, and WPATH requires that your E dose be reduced by 25-50%." The E dose reduction does have a sensible history behind it but the providers who enforce it as a hard-and-fast rule don't seem to even care why it was done (it dates to the days before T-blockers were regularly prescribed so far higher doses and of nastier forms of E were being prescribed.)

Also, this morning I heard from a friend who was still going to my first endo. Her labs showed very low E levels and the endo asserted "I believe the actual level is much higher than the lab is showing." At that point, why bother with labs at all? (I had a similar treatment from my second endo, in which she dismissed labs that showed low levels as "defective.")

I keep a manila folder with copies of all my my lab work over the years.  When I see a new provider, I have a history with me.

[Beyond]

"Since you've had SRS you need to be off Spiro, of course, and WPATH requires that your E dose be reduced by 25-50%.

The WPATH Standards of Care are recommendations, not requirements.

Also, this morning I heard from a friend who was still going to my first endo. Her labs showed very low E levels and the endo asserted "I believe the actual level is much higher than the lab is showing." At that point, why bother with labs at all? (I had a similar treatment from my second endo, in which she dismissed labs that showed low levels as "defective.")

Seriously they should find another doctor ASAP because that one's a quack.
.

[Zumbagirl]

My endo went by my blood work and not guidelines. That being said, after surgery, I obviously dropped spiro right away, but I have been on the same dosage of estrogen.

[Agent_J]

The WPATH Standards of Care are recommendations, not requirements.

That's actually a problem with the SoC - a lot of providers, particularly in underserved areas, view it both ways - it's flexible when they want to be more strict but hard-and-fast rules whenever the flexibility would benefit the patient.

Seriously they should find another doctor ASAP because that one's a quack.

I've been suggesting other providers. That's a big change in my area since when I was dealing with that doctor - a lot more of us are freely exchanging the information about other choices. She sees the same therapist whom I saw and I will be the therapist is putting pressure on her to keep seeing that doctor. She did that to me, telling me that "only she is capable of running the right labs and supervising your HRT."

[JennX]

The whole recommendation regarding lower one's E dose post-SRS is pure BS. It's based purely on conjecture, not actual labs, physiology and biology. If you required X amount of E to maintain your E2 levels at a certain point after 2 or more years of HRT while preop... removal of the testes or SRS will not change your required dosage. Rely on your lab work, specifically your E2 serum level, and your own personal physiology. HRT is not a one-size-fits-all prescription.

In my case, my E dosage has remained exactly the same after my SRS. Which is still near the max "recommended" dosage of sublingual oral E. And my E2 levels have remained constant. Rely on science, not supposition.

[Nicolette]

This is all very strange stuff to me. I don't know what's contained within the soc or wpath. I was blissfully aware of them during my transition. I will remain so. My GP is completely unaware of them too, and she hands out the HRT. Are they commandments, directives to lead us to become good and upstanding transsexuals? I don't think I need that tyranny, thank you. Anyway, I never changed my hrt regime post-op, except to drop cyproterone acetate, of my own volition. Such heresy.

[Shantel]

This is all very strange stuff to me. I don't know what's contained within the soc or wpath. I was blissfully aware of them during my transition. I will remain so. My GP is completely unaware of them too, and she hands out the HRT. Are they commandments, directives to lead us to become good and upstanding transsexuals? I don't think I need that tyranny, thank you. Anyway, I never changed my hrt regime post-op, except to drop cyproterone acetate, of my own volition. Such heresy.

We're on the same page Nicolette, it was Benjamin's SOC in my day which I managed to do an end run around completely.

[Hikari]

The reduction in E makes alot of sense if we were still doing HRT by massive doses of Estrogen alone since there would be no need to overcome the T, but if your AA works effectively I don't see how a reduction post SRS makes much sense....

[Agent_J]

I truly wish I could have stayed unaware of the SoC. The doctors and therapists in my area, however, knew of it and used it in perverse ways (it is intentionally designed as flexible guidelines but they only see it as flexibility to be more strict, never less - e.g. my therapist told me at the end of my first session that she had no doubt transition was right for me and would gladly write my HRT letter but I had to go through 3 months of therapy first "because that's what the SoC requires.")