Please answer this

[Amy1988]

I can't seem to find answers to some questions about transdermal estrogen.  Maybe someone here knows.  My question is does transdermal E go through the liver at all and if so does it stimulate clotting chemicals?  If there is a first pass then what is the second pass?

[ErinWDK]

Amy,

Transdermal Estrogen (either patches or gel) does NOT have an initial pass through the liver.  For us older girls (meaning me) it is a better bet than oral as it does not have the clotting effect.


Erin

[TaoRaven]

What Erin said. I use the patch exclusively, due to being "older" and the fact that I like the "slap-it-on-and-forget" aspect of patches. I also like the even, consistent delivery of E that they seem to provide. No weird spikes and lulls. 

[Claire (formerly Magdalena)]

Amy,

I was told it would by my Endocrinologist. As it is I am tested monthly or more for my clotting levels (INR), so keeping an eye on any changes was already part of my life. I have been using the patch since the beginning and I've suffered nothing negative at all. On the last test my blood was a little too thick, but the variation wasn't very great and no panic ensued. As long as your doctor is aware of all medical conditions and able to monitor, you shouldn't have reason not to begin the patch or gel.

And the unclenching of my soul when E hit my system... Amazing.

-Claire

[Amy1988]

Amy,

I was told it would by my Endocrinologist. As it is I am tested monthly or more for my clotting levels (INR), so keeping an eye on any changes was already part of my life. I have been using the patch since the beginning and I've suffered nothing negative at all. On the last test my blood was a little too thick, but the variation wasn't very great and no panic ensued. As long as your doctor is aware of all medical conditions and able to monitor, you shouldn't have reason not to begin the patch or gel.

And the unclenching of my soul when E hit my system... Amazing.

-Claire

So your doctor told you that transdermal E does cause an increase in clotting factors?

[Claire (formerly Magdalena)]

That is what she said, yes. Individuals here have said differently. I can't say which one to believe, I just think you should be aware of all sides.

My condition (Lupus Anticoagulant) is so serious that I had a clot blocking 99% of one of my arteries, I was only 40 at the time. I probably should have died, to be honest. My point is that all the warnings about any source E increasing my clotting to the point of danger have all been untrue. That said, YMMV and you should definitely proceed under close medical supervision.

I remember you asking questions along these lines before. What's going on? Do you have clotting issues?

-Claire

[Amy1988]

That is what she said, yes. Individuals here have said differently. I can't say which one to believe, I just think you should be aware of all sides.

My condition (Lupus Anticoagulant) is so serious that I had a clot blocking 99% of one of my arteries, I was only 40 at the time. I probably should have died, to be honest. My point is that all the warnings about any source E increasing my clotting to the point of danger have all been untrue. That said, YMMV and you should definitely proceed under close medical supervision.

I remember you asking questions along these lines before. What's going on? Do you have clotting issues?

-Claire

I don't know if it's clotting issues or what but the estrogen make my right upper leg ache.  Aspirin reduces the pain to nothing but it come back everyday so I have to keep taking aspirin.  It's always the right upper leg.  Never anywhere else.  It's really strange.  Actually though it seems to be mostly in the pelvic joint. 

[Claire (formerly Magdalena)]

E rarely increases blood clots in people who don't normally have problems, my doctor told me that, too. Correlation isn't causation. Just because the timing is coincidental doesn't mean that E is necessarily the cause. Have you seen your doctor about this?

[Amy1988]

E rarely increases blood clots in people who don't normally have problems, my doctor told me that, too. Correlation isn't causation. Just because the timing is coincidental doesn't mean that E is necessarily the cause. Have you seen your doctor about this?

I'm afraid if I tell him he'll cut me off and then it's back to buying off the internet.

[Claire (formerly Magdalena)]

I understand your fear, but you have to tell the doctor. Don't do permanent damage because you're scared to speak up. You have rights under WPATH standards of care. He can't just cut you off and send you packing.

http://www.wpath.org/site_home.cfm

Check it out. You're protected.

Then let me know how it went with the doctor. I'll worry. It's what I do.

with love,
-Claire

[Amy1988]

I understand your fear, but you have to tell the doctor. Don't do permanent damage because you're scared to speak up. You have rights under WPATH standards of care. He can't just cut you off and send you packing.

http://www.wpath.org/site_home.cfm

Check it out. You're protected.

Then let me know how it went with the doctor. I'll worry. It's what I do.

with love,
-Claire

I don't think WPATH is legally binding is it?

[teeg]

I don't think WPATH is legally binding is it?

If you don't trust your physicians, keep them separate.

Talk to your endocrinologist about HRT related things. Talk to your PCP or a specialist about your leg pain. They can't talk with each other without you consenting to it. But in my opinion it's pretty irresponsible of you not to mention the leg pain to your endocrinologist if those symptoms came about when you started HRT. Physicians can't read minds, so if you don't work with them and tell them what you're experiencing they won't be able to help completely. I suppose this is the risk people who self-medicate take.

Also I think patches are meant for birth control uses, not hormone replacement. You'll have to wear multiple patches over your body, they lose contact, etc. There's better methods out there.

[Amy1988]

If you don't trust your physicians, keep them separate.

Talk to your endocrinologist about HRT related things. Talk to your PCP or a specialist about your leg pain. They can't talk with each other without you consenting to it. But in my opinion it's pretty irresponsible of you not to mention the leg pain to your endocrinologist if those symptoms came about when you started HRT. Physicians can't read minds, so if you don't work with them and tell them what you're experiencing they won't be able to help completely. I suppose this is the risk people who self-medicate take.

Also I think patches are meant for birth control uses, not hormone replacement. You'll have to wear multiple patches over your body, they lose contact, etc. There's better methods out there.

Well actually I use estrogel which I rub on the arm.  I guess a worse case would be to keep taking the spironolactone and very low dose estrogen.  I couldn't see my doctor having a problem with that.  Of course it's 3 months until the next visit so I'll have to keep taking the aspirins until then.

[Jessica Merriman]

Amy if you keep this up you are going to harm yourself. It does not matter if you suspect "E" or not, but you need to get your problem looked at now. Plenty of people have told you this could be a problem and to seek medical assistance with it. You take too much aspirin and you open another can of worms with NOT being able to clot. A car accident or accidental cut on your body and the bleeding may not be controllable. Even patients on an Aspirin regimen do not exceed a low dose every day. If you are using off the shelf not especially designed for that it is probably high dose Aspirin. See a doctor and disclose what you are doing. You are basically gambling with your life.

[Claire (formerly Magdalena)]

What Jess said. She's more knowy about medical stuff than me. Please see your doctor soon. I want you to be around long enough to turn into one of those feisty old ladies that can say whatever they want.

[peky]

I can't seem to find answers to some questions about transdermal estrogen.  Maybe someone here knows.  My question is does transdermal E go through the liver at all and if so does it stimulate clotting chemicals?  If there is a first pass then what is the second pass?

only estrogen PLUS progesterone rises the risk of thrombosis (formation of clots), estrogen alone by any way does not increase your risk of thrombosis

Fertil Steril. 2010 Mar 1;93(4):1267-72. doi: 10.1016/j.fertnstert.2008.12.017. Epub 2009 Feb 6.

Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy.

Ott J1, Kaufmann U, Bentz EK, Huber JC, Tempfer CB.



Author information



Abstract

OBJECTIVE:

To evaluate the incidence of venous thromboembolism (VTE) in transsexual patients and the value of screening for thrombophilia in this population.

DESIGN:

Retrospective cohort study.

SETTING:

Academic research institution.

PATIENT(S):

Two hundred fifty-one transsexuals (162 male-to-female [MtF] and 89 female-to-male [FtM] transsexuals).

INTERVENTION(S):

Screening for activated protein C (aPC) resistance, antithrombin III, free protein S antigen, and protein C deficiency.

MAIN OUTCOME MEASURE(S):

Incidence of thrombophilic defects and VTE during cross-sex hormone therapy.

RESULT(S):

Activated protein C resistance was detected in 18/251 patients (7.2%), and protein C deficiency was detected in one patient (0.4%). None of the patients developed VTE under cross-sex hormone therapy during a mean of 64.2 +/- 38.0 months. There was no difference in the incidence of thrombophilia comparing MtF and FtM transsexuals (8.0% [13/162] vs. 5.6% [5/89], respectively).

CONCLUSION(S):

VTE during cross-sex hormone therapy is rare. General screening for thrombophilic defects in transsexual patients is not recommended. Cross-sex hormone therapy is feasible in MtF as well as in FtM patients with aPC resistance.

[Amy1988]

only estrogen PLUS progesterone rises the risk of thrombosis (formation of clots), estrogen alone by any way does not increase your risk of thrombosis

Fertil Steril. 2010 Mar 1;93(4):1267-72. doi: 10.1016/j.fertnstert.2008.12.017. Epub 2009 Feb 6.

Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy.

Ott J1, Kaufmann U, Bentz EK, Huber JC, Tempfer CB.



Author information



Abstract

OBJECTIVE:

To evaluate the incidence of venous thromboembolism (VTE) in transsexual patients and the value of screening for thrombophilia in this population.

DESIGN:

Retrospective cohort study.

SETTING:

Academic research institution.

PATIENT(S):

Two hundred fifty-one transsexuals (162 male-to-female [MtF] and 89 female-to-male [FtM] transsexuals).

INTERVENTION(S):

Screening for activated protein C (aPC) resistance, antithrombin III, free protein S antigen, and protein C deficiency.

MAIN OUTCOME MEASURE(S):

Incidence of thrombophilic defects and VTE during cross-sex hormone therapy.

RESULT(S):

Activated protein C resistance was detected in 18/251 patients (7.2%), and protein C deficiency was detected in one patient (0.4%). None of the patients developed VTE under cross-sex hormone therapy during a mean of 64.2 +/- 38.0 months. There was no difference in the incidence of thrombophilia comparing MtF and FtM transsexuals (8.0% [13/162] vs. 5.6% [5/89], respectively).

CONCLUSION(S):

VTE during cross-sex hormone therapy is rare. General screening for thrombophilic defects in transsexual patients is not recommended. Cross-sex hormone therapy is feasible in MtF as well as in FtM patients with aPC resistance.

There is so much conflicting information out there I honestly don't think anyone really knows.

[Jessica Merriman]

Your doctor does know, but you have to be honest with him with what you are taking.

[Amy1988]

Amy if you keep this up you are going to harm yourself. It does not matter if you suspect "E" or not, but you need to get your problem looked at now. Plenty of people have told you this could be a problem and to seek medical assistance with it. You take too much aspirin and you open another can of worms with NOT being able to clot. A car accident or accidental cut on your body and the bleeding may not be controllable. Even patients on an Aspirin regimen do not exceed a low dose every day. If you are using off the shelf not especially designed for that it is probably high dose Aspirin. See a doctor and disclose what you are doing. You are basically gambling with your life.

It'll be ok.  I'll just cycle on and off the E while taking the spiro. 

[Jessica Merriman]

ARGH!