Alright, so who decides when a transwoman goes on "menopause"? And what next?

[Evelyn K]

Most of us are obviously on therapeutic levels, eventually a maintenance schedule will be administered (oh, and how is that decided too?). But what about "menopause"?

I can't find any information relating to any of this, except for what's relevant to CIS women.

Is there an unknown risk to think about here? Can any long timers chime in?

[Misha]

Evelyn, you're reading my mind as I was thinking about starting a very similar topic :-) .

For a biological woman it's simple: ovaries go to sleep mode, estradiol level drops (estrogen gets mostly replaced with estron but at much lower level) along with up to few years of menopause symptoms.

For us it's quite simple as well. The most common case would be stopping estrogens before pretty much any surgery (somewhere they demand to stop one week, somewhere even six weeks before the surgery) and then again some time before it can be renewed.

And then of course it will depend whether you'll continue taking estrogens even after you reach like the age of 50. I have no idea how it works in that case. Perhaps someone with personal experience will add on this?

I'm also completely unsure whether the effects of lowering the dose after an SRS triggers an actual menopause. Again, someone with personal experience will hopefully comment. Textbook on transsexuality I've read only states this: "Patients in general react badly to lowering of the dose." And that came without any further explanation.

I'm actually going for an appendix surgery on Thursday so I'm dry for some time already. From my experience so far I can tell you the effects are pretty much identical and I'm glad that my menopause will last only until August 13th when I can go for next injection. The hot flashes, feeling tired, unstable moods, humming in the ears... It's quite annoying. Fortunately it will last in total for 2 weeks and not like 2 years :-) .

EDIT: Just noticed additional effect and that being nipples and breast lost their sensitivity.

[Ms Grace]

If you've had SRS or an orchi, if you come off HRT you will enter a form of menopause. Unless there's a health concern you probably wouldn't come off HRT anyway.

[luna nyan]

The general consensus on HRT on cis women is to minimise the period and have the therapy designed to reduce hot flashes etc and then cease.

Off the top of my head, the morbidity rate from HRT associated complications were higher than the rate of morbidity without.

For maintenance of bone density in post menopausal women, besides calcium supplements and vitamins, the drugs of choice are biophosphonates such as fosamax, or a new drug called denosumab.  I have issues with these as they basically stop bone metabolism altogether - not good if something actually breaks.  Biophosphonates also have the issue of having an extremely long half life (10 years).

I would hazard to say that most likely, if you are postop, your endo is likely to keep you on a maintenance dosage of whichever cocktail of drugs currently work for you till the age of 50.  After that, you will need to make an informed decision regarding which of the two evils you wish to risk.

Osteoporosis vs HRT associated complications.

Be aware that gerodontics for the transgender population is in its infancy.  There just isn't much information out there about what happens to us as we age.

[Cindy]

I'm going to climb on my activist soap box.
In Australia.

I can give kids puberty blocker when they reach Tanner II, as long as they, their parents and therapists agree.

At sixteen they have to apply to the Family Court for cross sex hormones, it costs about $10K, they cannot afford it. At eighteen they have the legal right to demand it.

That means they have gone 8-10 years without sex hormones. They have osteoporosis for life.

That is wrong.
That is inhumane
That is an abuse of human rights.

I'll shut up. Well I will here

[luna nyan]

Seriously?
I hadn't looked much into blocker therapy much as my personal readings lead me elsewhere.
16yo prior to cross sex?  Wth they smoking.

That's essentially dooming someone to stunted development.  I thought it was max 2 years.

The implications astound me.
Some recovery may be possible, but to place someone behind the eight ball that early in life.

*shake my head*

[Cindy]

Seriously?
I hadn't looked much into blocker therapy much as my personal readings lead me elsewhere.
16yo prior to cross sex?  Wth they smoking.

That's essentially dooming someone to stunted development.  I thought it was max 2 years.

The implications astound me.
Some recovery may be possible, but to place someone behind the eight ball that early in life.

*shake my head*

There is a reason I am becoming an activist.

I'm transgender and OK I'll deal with it.
But I will not allow trans*kids to be crippled.

[luna nyan]

Cindy,

Thank you for your passion for these kids.
I'm occupied with other projects at this point, not trans related, but still for disadvantaged members of community.

[mrs izzy]

As for the OPs question it is 2 fold

One is if someone is non op. I would say that as one ages one could slow down there HRT and just keep it at a level to keep comfort?

Other is post GCS or orchie. Well if one wants to live with hot flashes and night sweats the rest of there life they could but let me tell you no way.

My doctor now is trying to chase the E dose to keep mine at bay. Has not been much of a enjoyable side effect of the surgery.

Also to add it could be said if i want but i do not, i am in a normal cis menopausal range.

[Evelyn K]

If you've had SRS or an orchi, if you come off HRT you will enter a form of menopause. Unless there's a health concern you probably wouldn't come off HRT anyway.

We're talking about a scaled back therapeutic level, right? Say after several years of full on HRT then a dip back to normal female reference ranges?

I've heard having too much estrogen circulating is a breast cancer risk. HRT for M2F secondary sex development is way above normal reference ranges as it is.

[Cindy]

If you've had SRS or an orchi, if you come off HRT you will enter a form of menopause. Unless there's a health concern you probably wouldn't come off HRT anyway.

We're talking about a scaled back therapeutic level, right? Say after several years of full on HRT then a dip back to normal female reference ranges?

I've heard having too much estrogen circulating is a breast cancer risk. HRT for M2F secondary sex development is way above normal reference ranges as it is.

There is no medical evidence for an increase risk of BC in HRT treated trans*women.

[Misha]

Other is post GCS or orchie. Well if one wants to live with hot flashes and night sweats the rest of there life they could but let me tell you no way.

Given how much I dislike (when I put it mildly) the menopause effects already because of paused estrogens I'll certainly try to remain on HRT for as long as possible. I mean current temperature in my place is +22°C with normal humidity but I'm feeling like it's at least +30°C...

[bunnymom]

Lucky cis-me. I have been in peri-menopause for about 6 or 7 years. The last 3 have granted me roughly 4 spread out periods. It's been about 17 months since my last, so I think I'm done. I had those years of hot flashes and fatigue and roller coaster emotion and sensitivity.
I haven't had a endo blood test in years. So I can't give specifics there. I guess I'll see about one if my insurance deductible is met before the end of year.
Anyway, sex drive is lower. I am mildly concerned about bone density (another insurance issue) but I'm not interested in HRT at this time.
Calcium supplements raise CV risks.
I just hope trans women can get to the same state of wellness with time and care at a "certain age" because I feel good!

[Jenna Marie]

Personally, I think it should be up to the woman. As others have said, for anyone who has no testicle function anymore it's basically as simple as withdrawing female HRT. Possibly, though I don't know for sure, lowering the dose to menopausal levels might equally mimic what it's like for a cis woman on "normal" HRT.

The closest parallel in cis women is those who've had "surgical menopause" happen younger than the typical age - ie, ovary removal, triggering immediate complete cessation of estrogen production. (Except for the adrenals, of course.) Many, though not all, of those women choose not to discontinue HRT when they do reach typical menopausal age.

I'm considering it myself, at least right now; I'll have to see how I feel in ~15 years when I'm close to the usual age, but at the moment it seems kind of nice to imagine getting to have at least *one* of the "standard female life cycle rituals" happen at the right age. Of course, I'm already on a menopausal dose of HRT (not listing actual dosages, but it's within the range prescribed to cis women) so to get truly menopausal I might well have to go cold turkey.

[Northern Jane]

I started HRT at age 17, had SRS at 24, and continued on HRT until age 46 when my doctor (not en endocrinologist) wanted me to discontinue hormones, which I did. Over the next 10 years, I experienced a significant degree of masculinization (presumably from adrenal testosterone without counteracting estrogen). In my 50s I asked for a referral to an endocrinologist.

The endo was appalled that I had been off of all hormones for over 10 years. She immediately ordered a bone density scan and started me on the patch, bringing my estrogen levels up to normal female levels. She was right - I had early stages osteoporosis (which I corrected with calcium and exercise over the next 5 years).

When I asked my endocrinologist how long I should/could stay on the patch she said that the risks of breast cancer and other estrogen-related illnesses was a small statistical risk but if I discontinued HRT the osteoporosis WILL come back. I could therefore remain on the patch for as long as I wanted to.

When I restarted HRT, I felt younger and more vibrant and also looked 10 years younger. If I miss changing my twice-a-week patch, I usually develop PMS type symptoms within 3 or 4 days and become more sullen and moody. It is pronounced enough to remind me to change my patch!

[luna nyan]

As I said previously, it's the normal choice women have to make.
HRT and its possible issues vs
Osteoporosis

All factors being equal, I'd pick the HRT issues over osteoporosis but that's my personal preference.

[Evelyn K]

^^ That's my opinion also Luna.

I'm going to stick with therapeutic levels of HRT for two years then wind down to a normative female range. Just because there's no historical evidence for therapeutic levels of HRT being harmful in the long run doesn't mean the concern is invalidated. Thing is, we need more data to see if any trends exist. We're still a relative unknown in modern clinical practice being under researched; bearing that our health needs are currently dictated by "expert opinion" and not long term historically defined outcomes.

[Evelyn K]

BTW: I actually wonder what Susan's thoughts are on this subject too.

[Susan522]

Who decides???  What kind of a question is that?  Have you no agency?  Is it always somebody else's responsibility to make decision for you?  How about you decide!

[Evelyn K]

Who decides???  What kind of a question is that?  Have you no agency?  Is it always somebody else's responsibility to make decision for you?  How about you decide!

Wrong Susan