Will my transition reverse after my first 30 days?

[Annaiyah]

Hi guys.

I'm mtf. 4/23/14 was my first day on HRT. My doctor prescribed me with Spirolactone and estradiol. After a conversation i had with my mum, I'm worried that after my thirty days is up (mind you I'm taking the exact dosages she prescribed), I'm afraid the little bit of estrogen in my body will revert back to testosterone and i won't have any more testosterone blockers left.

The thing is, i got my meds from the Mazzoni Clinic in Philadelphia. My last appointment there was on 4/23/14. My next appointment with my doctor will not be until the first Wednesday in June. The 30 days will be up by then.

The thing I'm worried about is this:
If i stop taking my E within a certain period of time, will that reverse my transition?

Should you always stay on E until you're finished transitioning?

Will i always need to stay on estrogen for the rest of my life? Even after my transition completes?

I have seen mtf girls go on and off hormones but if at all possible, i'd like to stay on my mones until my transformation is done. The thing is though, I'm transitioning on a tight budget and i am currently unemployed. I'm led to thinking i need something new on my 31st day of transitioning. Please tell me that's false!

[Ms Grace]

It's probably best to stay on a steady dose, stopping and starting might thrown things into some disarray - is it not possible for them to give you a script to cover you until you can come back? Alternatively they might be able to recommend a dosage that will allow you to use what you have without it running out until your next visit. As you are just starting the amount of changes you'd expect on E and AA will be fairly limited, some breast tenderness and the like, but you will probably revert to male level hormonal levels within a few weeks of stopping. The back slide won't be too dramatic at this early stage but better to avoid it if you can, especially in the longer term.

[JamesG]

Yeah flipping to low-dose would be better than going cold-turkey.  Actually, if you just started HRT, you are most likely on low-dose already (that is where endos like to start).

Didn't the doc specify you to come in after the first 30 days and do a blood test to see what your hormone levels are?  They would then adjust your dosage based on that. I am surprised that they would leave you hanging like that, unless with the blood workup, the doc has delegated adjusting and re-issuing your script to a nurse practitioner or the like.

If you really are being left out to dry and/or are low on funds (aren't we all) and want to continue your transition, the online pharma suppliers are an option. You already know the dosage you need, and the costs will be substantially less.  Do a search here for more info.

[androgynouspainter26]

I know first hand that some things will change back after one moth, and others won't.  I went off E for about one and a half months last summer, and in that time about six months of (meager) breast growth managed to slip away.  I noticed my facial hair growth had increased slightly as well (though nowhere near what it was before).  You will experience a real setback if you've been on them for a while; but after only a month of hormones, there won't really be any notable changes in the first place.  You should call the clinic's office and ask them about refills, or what to do in general-most LGBT friendly health centers have some sort of case management department to help people who are in situations like yours!

And please, do not self medicate!  It's dangerous, and the risks vastly outweigh the benefits.

[Rachel]

Are you getting your meds at Walgreens next door to mazzoni? Make sure they know you are a patient at Mazzoni. I get my meds there and they cut the price significantly. Your spironolactone and Estradiol should run about $36/month without insurance. 

I go to the patient portal and under your medications you can click need refill.

Use the portal to ask questions to you assigned PA.

Mazzoni can help if you are 25 or under with the trans kids program. Go to the trans site and read up on the program.

Your meds are important so you get what you need. If you are thinking of altering use the portal and all your questions will be answered by a PA.

[teeg]

In my opinion once someone starts HRT they really shouldn't stop unless they shows psychological problems or displeasure in what's going on (which should be explained by a psychologist and really of course knowing you're transgender anyway).

HRT is a serious and permanent step. You don't want to go messing around taking a little estrogen here or there and stopping. It's totally converting the hormone structure of your body, not just something to feel better about transitioning. Your Endocrinologist absolutely should've wrote you a prescription to supply you until your next appointment, but equally your HRT should be overseen by a responsible Endocrinologist.

[Annaiyah]

I wasn't given any script. What exactly is that?

Yes, i did get my medicine from the next-door Walgreens. The thing is that my doctor asked to see me 30 days from when i started the medicine so i went to the front lobby and scheduled my month-later appointment. She scheduled me for June which is longer than 30 days so i need to reschedule for an earlier date.

I'm not stopping and starting! I'm taking the same dosages i was given! 

[L G]

Do what Cynthia said, use the patient portal to contract who you saw and ask her what you should do. They are more then willing to respond to any questions you might have.

[teeg]

I believe estradiol has a half life of around a day when taken sublingually, two days when swallowed. After this time a sufficient level of estrogen will not be in your body unless you take more estradiol. The same goes with spironolactone, after you stop taking it and its half life expires your testosterone will no longer be blocked and will rise eventually to its natural levels.

Males transitioning into females of course need to stay on estrogen their entire lives, as do females transitioning into males need to stay on testosterone for the rest of their lives. The male endocrine system doesn't naturally produce the amount of estrogen females naturally have, and visa versa. The only exception is when someone undergoes SRS there's no need for Spironolactone anymore since there's no testosterone to block.

Finances shouldn't be an issue. Most all hospitals offer 'free-care' which allows patients who don't have either private or state insurance to get medical coverage for whatever they need. With that you could get proper oversight on your HRT treatment where all of this should have been explained to you.

Like in my previous post, HRT should be a permanent treatment. Transitioning to a certain point and then stopping doesn't work. Say if you have breast development, then stop, like painter said above that will go away as the maintenance of your development is just as important as the start of it. If a male lost his testosterone he'd get lazy, lose muscle mass, become unmotivated, etc. If a female lost her estrogen she'd be a mess. Only being prescribed 30-days worth of hormones, then checking in is inappropriate in my opinion. HRT is not like trying sleeping, or anxiety medications, where you try them for a week or two, see if it makes a difference, and continue or stop. My endocrinologist wrote my first script for 6 months, and then a year's worth ever since I started with 6 month check-ups.

[KayXo]

I believe estradiol has a half life of around a day when taken sublingually, two days when swallowed.

Actually, oral estradiol has a half-life of 13-17 hours whereas sublingual it's much much less, 2-3 hours about. Sublingually, levels peak and drop quite quickly. 

After this time a sufficient level of estrogen will not be in your body unless you take more estradiol. The same goes with spironolactone, after you stop taking it and its half life expires your testosterone will no longer be blocked and will rise eventually to its natural levels.

I would think that probably within 2-3 weeks, substance should be out of your system and estradiol levels back to baseline levels whereas with testosterone, it could take awhile longer before it comes back as strongly as before. Spiro reduces androgen (testosterone, DHT) and weakly blocks it.

[teeg]

Actually, oral estradiol has a half-life of 13-17 hours whereas sublingual it's much much less, 2-3 hours about. Sublingually, levels peak and drop quite quickly.

This has me a bit confused.

If the half life is 2-3 hours, is that estrogen only in my body for 4 to 6 hours at a reasonable dose? If in taking estradiol twice per day sublingually, does that then mean my body is only seeing 8 to 12 hours of a reasonable dose of estrogen per 24 hours?

[KayXo]

Levels just start really high on sublingual and then fall quite quickly but still remain higher relative to levels found on an equivalent dose of oral estradiol, up to 24 hours after sublingual intake. It's just that there is much more fluctuation with sublingual so that by hour 3-4, levels haven fallen by more than 50% of what they were at hour 1 whereas with oral, levels are much more constant from hour to hour but still lower than what they would be on sublingual, at same dose.