Did not stop HRT before SRS (although told to do so) as was having exams

[divineintervention]

Hi guys,

  so i am having my SRS with Dr. Brassard in 9 days (weet!)

  however, I was advised to stop HRT 3 weeks prior to the date, but I told the assistants that I had my exams and did not want it to affect me - they recommended 2 weeks prior to the surgery instead.

  Nevertheless, I have yet to put a stop to it as I am currently still having my examinations (tomorrow is last my paper!). I do intend to halt completely after my exams - but that only leaves me with 1 week prior to my surgery.

  The reason why I did not stop was that after trying to go off my hormones and anti-androgens for 2 days, I didn't feel energized... I felt my mood deteriorating and so was afraid it would take a toll on my results (which I can't let that happen given this is my final year at uni)

  I would like to understand what is the purpose of the halt? I understand that it is because of blood clot - and also, should I be fearful that I did not stop more than 1 week? Thank you so much for your advice - I cannot believe I'm actually getting the surgery.

  Just want to thank the forum for being such a helpful resource and for everyone's motivational words and encouragement C:

[ZoeM]

Bleeding during/after surgery, or so I gathered from Dr. Brassard's info sheet.
I'll be there the day after you are - I'm looking forward to meeting you

[kinz]

i did the exact same thing and i didn't keel over dead.

the purpose, as far as i can divine, is due to the far that oral estrogen has a tendency to encourage coagulation—this is the same reason that physicians are always nervous when people start taking estrogen p.o. right before plane trips, due to the elevated risk of dvt if the body isn't used to taking the drugs.

but you'll be fine, really. the half-life of estradiol is 13–17 hrs, which means after seven days there's between 0.012 and 0.098% of the original amount of the hormone still kicking around in your bloodstream. it's a precautionary measure, not an imminent biohazard.

[Jessica Merriman]

Clotting is the major concern. If the doctor finds out he could delay, postpone or cancel your surgery. With the cost involved in the surgery why risk ANY complications? A Pulmonary Embolism could kill you so they do have your best interest at heart. 

[suzifrommd]

I asked the doctor who prescribes my HRT. He told me he never understood it himself - he thinks stopping estradiol and spiro should be unnecessary (though he's not so sanguine about progresterone).

Please don't take this as medical advice, I'm just repeating an offhand comment my doctor made.

[eh-lyssa]

You are playing Russian roulette by not stopping hrt prior to surgery. I know from experience that estradiol can encourage blot clots during surgery (since you don't move for a long time). In my case I didn't stop hrt until 4 days before surgery due to a
Miscommunication. I ended up with a blood clot in my neck which killed function to my left vocal fold which left me nearly speechless. I don't have a history of issues with blood clots. If you survive, consider yourself lucky.

[Vicky]

'nother doctor, but my E was not stopped, just supposedly reduced to a maximum level twice my normal dose.  I did not increase my dose though but it was tempting.  Spiro was stopped 14 days ahead of time, and did put me in a pissy mood, but not too bad.  (pun intended!!). I won't snitch on you.

[MacG]

I threw a PE (blood clot in my lung) which nearly killed me. Thanks to extra estrogen a gyno had prescribed me, in addition to a common blood clotting disorder nobody knew I had. This wasn't even during/after surgery.
Extra estrogen, surgery, obesity, lying/sitting motionless all add to the risk of a blood clot (which can kill you).
I'd check in with your surgeon.

[Ms Grace]

Clotting is the major concern. If the doctor finds out he could delay, postpone or cancel your surgery. With the cost involved in the surgery why risk ANY complications? A Pulmonary Embolism could kill you so they do have your best interest at heart. 

This.

And just because someone else says they did it and were fine does not mean it applies to you too.

[mash]

First. Congrats on your surgery!!.
Why would you disregard the surgeon that is doing the surgery?
Beside it being dangerous its careless. You could have moved surgery out if you didn't want to compromise either. However you seem have decided to compromise your health,possibly  your surgery. I'm a bit baffled. Anyway whatever happens I hope you will be safe good luck!       

[angel0202]

After reading these comments id be terrified, however DONT BE. I'm not an expert at all. But generally if your young, normal weight and health you will be fine, especially if you are stopping it few days prior and are on normal doses. Good luck, just do not be terrified as in my opinion you shouldn't be.

[JLT1]

After reading these comments id be terrified, however DONT BE. I'm not an expert at all. But generally if your young, normal weight and health you will be fine, especially if you are stopping it few days prior and are on normal doses. Good luck, just do not be terrified as in my opinion you shouldn't be.

While I agree with the above, I'd recommend a blood test a day or two prior to surgery and I'd talk with the doctor.  The half-life of Estradiol (the E of concern) is 13-17 hours.  Let's use 18 because it's easier and we'll be conservative.  Start at 300 pg/mL, 18 hours later - 150, 36 hours later - 75, 54 hours later - 37.5. 72 hours later -  18.75 or low male normal.  72 hours is three days.  If you double it because there are other estrogens present, it's still only 6 days.  However, you really need to talk with the doctor.

I understand the thing about not wanting to stop E.  I've had two surgeries after I started HRT and I did feel funky.  I also didn't like it.  And I disagreed with the need to stop.  And I stopped anyway.

Hugs,

Jen   

[angel0202]

Hold on!!! I just realised that some surgeons only advise stopping a week before anyway?? Dr zukoswkis says a week before and after, I know its ffs but probably the same length of time. My rhinoplasty surgeon made me stop 4 weeks before and gave me blood clott injections afterwards for a week, which I thot was unnecessary as its very rare to find surgeons who require this.

[Donna Elvira]

I did my FFS, 2 surgeries lasting more than 7 hours each time, without any interruption to HRT as it was not required by my surgeon. As I did these surgeries quite close to home there were no long flights involved and I was also out and about doing long walks just 3 days after surgery so that certainly limits the risks.

However, after the second operation I did have an alert with a clot appearing in my left wrist about 12 days after the surgery in the area where the I.V had been
placed. It was a superficial clot and in no way life threatening but still quite scary.

I'm doing GRS this summer which will involve long flights and plan to go by the guidelines ie. stop HRT 14 days before the surgery, but really wonder about not starting again until I get home more than 3 weeks after the surgery. I still have anticoagulant shots since the superficial thrombosis (Arixtra) and imagine that a preventive shot the evening before the flight home should seriously reduce the risks involved in flying. I'll discuss with my doctor between now and then.

Otherwise, I have been on HRT for the better part of 6 years and am wondering how my body and mind will respond to 5 weeks of cold turkey. Anyone care to provide input on what that was like for them?
Hugs
Donna   

[Beth Andrea]

This.

And just because someone else says they did it and were fine does not mean it applies to you too.

I'd add the reverse is true also...just because someone else "almost died" doesn't mean you will too.

Since "low energy and depression" are a common complaint when stopping HRT, I'd think it is common for MtF`s to not stop for surgery, but no one mentions it, to avoid what has been mentioned--surgeons who will delay or even cancel the procedure.

IMHO, fwiw, YMMV etc

[Missy~rmdlm]

I had a different doctor of course. The regimen was simply reduced ht and no dose day of surgery, as part of the no food/liquid in the 12 hours before.

[Lara1969]

My wife is pregnant with twins and has an approx. 25000 pg/ml of Estradiol in her blood and it is rising daily. The twins will be born via abdominal caesarean section. So she must die for sure because she will not move much after surgery?

I think only oral Estradiol has a high risk of blood clotting. My doc recommended me to continue my HRT thorugh the surgeries and I already had my FFS. But I am healthy and it may be different if you are not healthy.

Lara

[Lauren5]

If you're in good health and are not otherwise at risk for DVT, you should be fine.

[Jessica Merriman]

If you're in good health and are not otherwise at risk for DVT, you should be fine.

Tell that to the previously healthy cis girl 18-25 year olds I have run calls on for CVA, DVT and Pulmonary Embolism just being on birth control. Some had risk factors and some did not. I am a medical professional and know cavalier attitudes about doctors telling you to do something and you disregarding it can lead to tragedy. If I was a surgeon I would cancel the procedure because if the patient cant follow the orders given how would I know they would do appropriate aftercare. More than likely they would not and then try to sue me for a botched procedure. 

It is not about if it is proper or done in every case. It is about what the surgeon expects of you, period.

[Jenna Marie]

YES, Jessica, and thank you!! I have seen cis women told to stop HRT or birth control before surgery, too; the issue seems to be specifically exogenous estrogen linked to clotting risk.