Feel tricked by my endocrinologist...

[Mermaid]

Alright, so I started my HRT recently, but I can't help feel like stuff outside my control is going on... I know people aren't allowed to discuss dosages here, but my country has a reputation in the Trans community for having transphobic doctors, so I want to make sure I'm not being deceived here... I won't post any dosages but I really need help...

I'm doing Cyproterone, that's the only medication I'll be doing for the first two months. However, another transsexual from my country started her HRT with Cyproterone, Spironolactone and Estradiol.

I can add that her dosage of Cyproterone is double what mine is, and she's approximately 20 years older.

Am I getting the short end of the stick here? Is my endocrinologist playing fair with me? Did anyone else start their treatment with only anti-androgens for two months, and a dosage that seems so low?

Please help =/ Getting a bit desperate, specially after hearing about transphobic doctors here... It took me almost 2 years to get where I am, it's no joke...

[latoya rayne]

Every persons body is different with how it responds to hormones, what one persons dosage might not work for another but like my doctor said, higher dosages don't mean quick results just the pill itself being in your system enough is what will work, I have never heard of the pill you're taking but most here are on spironolactone and estrodial. Myself as well

[Ms Grace]

It's dangerous to compare your dosages to other people, for whatever reason it will vary from person to person. I started on a low dose of E for six weeks, before it was pushed up a bit and Spiro added. The doc wanted to make sure my body could take the strain of the HRT. Don't equate low dosage with transphobia. For all you know, the person you heard about could have been prescribed a reckless dosage by a transphobic endo. For what you've said of your starting dosage it sounds about right, see how you go after the next session before drawing too many conclusions.

[Mermaid]

Every persons body is different with how it responds to hormones, what one persons dosage might not work for another

Well yeah, but they're endocrinologists, not fortune-tellers. They can't anticipate how anyone will respond to HRT, I'd assume two healthy people wanting to transition into the other sex would undergo the same treatment? Sure, maybe down the line if spironolactone doesn't work for me, swap it for cyproterone, I don't know, but right off the bat our treatments are completely different, my dosage isn't half of hers, she has two anti-androgens and started estrogen right away. Did you start estrogen on your first month? That'd be helpful to know, I'm not really asking what people usually take. What did your endocrinologist start you off with... just an anti-androgen?

It's dangerous to compare your dosages to other people, for whatever reason it will vary from person to person. I started on a low dose of E for six weeks, before it was pushed up a bit and Spiro added. The doc wanted to make sure my body could take the strain of the HRT. Don't equate low dosage with transphobia. For all you know, the person you heard about could have been prescribed a reckless dosage by a transphobic endo. For what you've said of your starting dosage it sounds about right, see how you go after the next session before drawing too many conclusions.

Oh, I know, but my country sucks and I'm stressed... you need two reports to be eligible for HRT, I got both and spent quite a bit of money traveling for it since we don't have multidisciplinary sexology teams everywhere, and then what happens is that the hospital away from my city haven't yet sent their report to confirm my GID...

Just scared, is all, keep listening to horror stories from other TS people here...

[Hideyoshi]

I started slow too, but maybe on your next appointment, try to get on more stuff?

[nikkit72]

I am UK based where the medical fraternity are quite trans friendly. I am on AA only at the moment. I know how you feel. I can remember driving home from my appointment questioning what had  just happened. I can only assume that my endo wants to rid me of T before prescribing me a relevant dose of E. A baseline of sorts. Maybe it is the same for you ? Different endos have different ways of doing things. Anyhow, definately a question to ask at your next appointment.

Nikki

[JamesG]

The race is not to the swift.

You should ask your endo why you are starting so low.

[Mermaid]

The race is not to the swift.

You should ask your endo why you are starting so low.

I did and he asked me if I was interested in preserving my liver. Can't counter-argument that...

[Evelyn K]

I did and he asked me if I was interested in preserving my liver. Can't counter-argument that...

I find that ironic considering cypro has a liver toxicity side effect.

"Unfortunately, the uses of both cyproterone acetate and flutamide have been associated with hepatotoxicity,"
http://en.wikipedia.org/wiki/Cyproterone_acetate#Side_effects

Whereas spironolactone seems to way much safer.
http://en.wikipedia.org/wiki/Spironolactone#Side_effects

"Spironolactone is a potent antagonist of the androgen receptor as well as an inhibitor of androgen production."

"Spironolactone is frequently used as a component of hormone replacement therapy in trans women undergoing sex reassignment therapy, usually in addition to an estrogen. It is generally recommended to be prescribed at a dose of -redacted- mg per day for this purpose by the major transgender healthcare guideline bodies"

"There are very few available options for androgen receptor antagonist drug therapy. Spironolactone, cyproterone acetate, and flutamide are the most well-known and widely used agents. Compared to cyproterone acetate, spironolactone is considerably less potent as an antiandrogen by weight and binding affinity to the androgen receptor. However, despite this, at the doses in which they are typically used, spironolactone and cyproterone acetate have been found to be generally equivalent in terms of effectiveness for a variety of androgen-related conditions; though, cyproterone acetate has frequently shown a slight though non-statistically significant advantage in many studies."

"Unfortunately, the uses of both cyproterone acetate and flutamide have been associated with hepatotoxicity, which can be severe with flutamide and has resulted in the withdrawal of cyproterone acetate from the US drug market for this indication. Gonadotropin-releasing hormone (GnRH) analogues are another very effective option for antiandrogen therapy, but have not been widely employed for this purpose due to their high cost and limited insurance coverage despite many now being available as generics. Thus, spironolactone may be the only practical, safe, and available option in many cases."

(not that I accept everything I read on teh interwebs as gospel)

[Ms Grace]

I did and he asked me if I was interested in preserving my liver. Can't counter-argument that...

That's right. I should add that I was started on a low does of E as a means of reducing my T. But that might not work for everyone, I already had mid to low levels of T to begin with.

[Mermaid]

My T was within the normal range, right in the middle. So I guess average.

And well, perhaps he's starting me off on cyproterone alone to figure out how my liver responds to it? Then if it's all fine, he'll add estrogen? Could explain it.

[Evelyn K]

My T was within the normal range, right in the middle. So I guess average.

And well, perhaps he's starting me off on cyproterone alone to figure out how my liver responds to it? Then if it's all fine, he'll add another anti-androgen? Could explain it.

Does he have experience with trans' health needs?

[Mermaid]

Does he have experience with trans' health needs?

Of course, he's part of a multidisciplinary sexology team. I'd say all the cases he treats are transpatients.

"The most serious potential side effect is liver toxicity, and patients should be monitored for changes in liver enzymes, especially if taking a high dose (200–300 mg/day)."

My dosage is not as high. Perhaps he just wants to lower my T quickly, swap me to Spiro and then drop E. I would hope that's it.

[Evelyn K]

You two need to sit down and outline a treatment road map.

IMO

Then perhaps get a second opinion...

[Mermaid]

Sounds like an utopia, this country doesn't work like that. HRT is behind a steel gate and you've to convince the gatekeepers to let you through.

I cannot go to a private endocrinologist for hormones, and even if I could, I then wouldn't be able to change my name and birth sex on my ID, I need to go the legal route and these are the people I have to convince.

I agree I need to ask him a bit more questions about the future, but it feels like every answer I get is "one step at a time", and well, he decides if I get treatment or not, I can't just say I'll walk out the door or go to someone else unless we do it my way, this is the endocrinologist I got and this is what I'm stuck with, unless I want to take 300km trips towards North and spend tons of money on appointments (that's if they accept to treat me there, and I'd be going on the off-chance that their endocrinologist is any better).

[Ms Grace]

And well, perhaps he's starting me off on cyproterone alone to figure out how my liver responds to it? Then if it's all fine, he'll add estrogen? Could explain it.

I think that is most likely the case.

[Evelyn K]

Sounds like an utopia, this country doesn't work like that. HRT is behind a steel gate and you've to convince the gatekeepers to let you through.

I cannot go to a private endocrinologist for hormones, and even if I could, I then wouldn't be able to change my name and birth sex on my ID, I need to go the legal route and these are the people I have to convince.

I agree I need to ask him a bit more questions about the future, but it feels like every answer I get is "one step at a time", and well, he decides if I get treatment or not, I can't just say I'll walk out the door or go to someone else unless we do it my way, this is the endocrinologist I got and this is what I'm stuck with, unless I want to take 300km trips towards North and spend tons of money on appointments (that's if they accept to treat me there, and I'd be going on the off-chance that their endocrinologist is any better).

What about doing your own blood work at a private lab, get your baselines for liver, test, etc ... and go from there based off transsexual standards of care?

A lot of 'medicine' is reference sheets you know...

[Mermaid]

What about doing your own blood work at a private lab, get your baselines for liver, test, etc ... and go from there based off transsexual standards of care?

A lot of 'medicine' is reference sheets you know...

Then I'd end up with the body of a woman and a male name on my ID. The system we have here's really a huge clusterfu-...

If I don't follow the guidelines and get medical supervision on all fields, I won't be granted permission for changing my identity later on.

Furthermore, I don't even want to think about what HRT would cost without prescriptions, nor do I know if any place would sell this stuff to me. Ordering it online is out of the question, it's so much more costly... With the added fact that there's no way you can be sure of what's inside those pills anyway, don't trust any of it. Prescription drugs from overseas, with hefty costs and no guarantees? Uhm...

[Evelyn K]

Here in the US it's pretty easy to get stuff tested (i.e. mass spectrometry) it's been done to test finasteride authenticity for instance.

Not knowing where you hail from, but with investigation most modern cities should have resources available to you.

Regarding cost - well yeah. The price for convenience as they say.

I also read you on the ID situation. Bummer.

[Sarah leah]

Sorry to be rude but what country are you in?