HRT Regimen Question

[Wynternight]

I'm going to redact the dosages but does this seem excessive?

•    Estradiol : (sublingual) daily.
•    Estradiol Patch : Apply 2 patches weekly to the skin.
•    Finasteride :  (divided, morning and evening)
•    Spironolactone :
•    Progestin :  daily for 10 days of the month (optional).

Sublingual and patch, Spiro and Finasteride, and progesterone? This is on one of the sites I sent to the NP I'm seeing.

[Leila]

I am presuming you have yet to start HRT but:

Is there a specific reason that you need to take two forms of estradiol at the same time?

When you say progestin do you mean a plant based progesterone and not a synthetic progestin? Maybe perhaps progesterone such as microgest or prometrium once you have some glandular breast tissue. Provera (Medroxyprogesterone Acetate) is nasty stuff and best avoided.

[Wynternight]

I am presuming you have yet to start HRT but:

Is there a specific reason that you need to take two forms of estradiol at the same time?

When you say progestin do you mean a plant based progesterone and not a synthetic progestin? Maybe perhaps progesterone such as microgest or prometrium once you have some glandular breast tissue. Provera (Medroxyprogesterone Acetate) is nasty stuff and best avoided.

This isn't my regimen but one I found doing some research. The two forms of estradiol at the same time is the same question I have hence the posting. Plus the two different AAs.

[Hikari]

There is alot wrong with that in my view.

First there is just no need to take two forms of estradiol, just take enough from one delivery method.

Second, no need to take divided doses of finasteride, if it isn't powerful enough just take dutasteride. The differences in the study I looked at on it basically said that difference of DHT reduction between proscar and propecia (remember proscar has 5 times the finasteride propecia does) wasn't all that much, whereas the smallest sold dose of dutasteride was more effective than massive doses of finasteride.

I take:
Sublingual estradiol (estrogen)
Dutasteride (5ar inhibitor)
Bicalutamide (Antiandorgen)
Micronized Progesterone (Progesterone)

So, I do take all four types of items on that list, and I don't consider my regimen excessive (Though there are plenty of girls who just take E and an AA and get by just fine). But, I don't even understand what that regimen the OP posted was trying to accomplish with its doubled up stuff.

[Leila]

This isn't my regimen but one I found doing some research. The two forms of estradiol at the same time is the same question I have hence the posting. Plus the two different AAs.

Herein lies the danger of copying someone else's regimen when 'doing some research'. Just because someone posted up their regimen doesn't necessarily mean it is right and representative of a typical dose / cocktail, or even applicable to your own personal biological make up.

I know this point has already been made, but in the case of the example regimen above, the requirement for a synthetic progestin is outdated advice and has been where P is needed now recommended to be replaced with a natural progesterone.

We don't know when, why or how the circumstances behind this regimen was concocted; for the individual who is taking the above.

There is alot wrong with that in my view.

First there is just no need to take two forms of estradiol, just take enough from one delivery method.

Second, no need to take divided doses of finasteride, if it isn't powerful enough just take dutasteride. The differences in the study I looked at on it basically said that difference of DHT reduction between proscar and propecia (remember proscar has 5 times the finasteride propecia does) wasn't all that much, whereas the smallest sold dose of dutasteride was more effective than massive doses of finasteride.

I take:
Sublingual estradiol (estrogen)
Dutasteride (5ar inhibitor)
Bicalutamide (Antiandorgen)
Micronized Progesterone (Progesterone)

So, I do take all four types of items on that list, and I don't consider my regimen excessive (Though there are plenty of girls who just take E and an AA and get by just fine). But, I don't even understand what that regimen the OP posted was trying to accomplish with its doubled up stuff.

I concur with all your points above.

I currently only take E (patches) and an AA, but may well end up adding P as well when my breasts begin to mature more. I have been fortunate to have not suffered from any severe amounts of MPB, so it would be pointless for me to have taken finasteride or dutaseride (Unless I was really paranoid about DHT affecting me, which I am not).

[Lara1969]

I am post OP and I take two forms of Estradiol: sublingual and patch and for me it works. Only one Estradiol source did not feminizr me in a sufficient way.
I also take micronzied Progesterone. I have taken a progestin as AA.
I tried Dustasteride but I stopped it because of too much long term side effects. If your Estradiol level is high enough it will also stop DHT production. My hair is growing back under a "high" feminizing Estradiol level and I feel great. Dutasteride worked also but with the potential of serious side effects.

Lara

[KayXo]

I am post OP and I take two forms of Estradiol: sublingual and patch and for me it works. Only one Estradiol source did not feminizr me in a sufficient way.

Perhaps because you didn't take enough of the one form of estrogen that you started out with so if you had taken more of it, results would have been better. Could also have something to do with ratio of estradiol to estrone ratio, if say, you added patch where there is less estrone relative to estradiol compared to sublingual. Just speculations...who knows?!

If your Estradiol level is high enough it will also stop DHT production.

I've come across studies suggesting/indicating that

1) estrogen downregulates (reduce) androgen receptors thereby reducing DHT potency in cells

2) estrogen increases aromatase activity responsible for conversion of androgen to estrogen, thus reduced levels of DHT and,

3) finally, there is a lower concentration of the enzyme alpha-reductase in women, the enzyme responsible for converting testosterone to DHT, possibly due to a more favorable estrogen/androgen ratio in cells.

So, estradiol may well reduce DHT action but not stop it entirely.

[Wynternight]

This regimen comes not from a person but from a clinic that specialises in transgender care. They state that this their pre-op regimen. Again - this isn't mine, I'm not looking to be on it or asking for it; I thought it was excessive and posted it here for opinions, not because I want it but because it's so much. I'd worry about hepatoxicity on this amount of stuff, not to mention elevated risks for DVT.

Herein lies the danger of copying someone else's regimen when 'doing some research'. Just because someone posted up their regimen doesn't necessarily mean it is right and representative of a typical dose / cocktail, or even applicable to your own personal biological make up.

I know this point has already been made, but in the case of the example regimen above, the requirement for a synthetic progestin is outdated advice and has been where P is needed now recommended to be replaced with a natural progesterone.

We don't know when, why or how the circumstances behind this regimen was concocted; for the individual who is taking the above.

I concur with all your points above.

I currently only take E (patches) and an AA, but may well end up adding P as well when my breasts begin to mature more. I have been fortunate to have not suffered from any severe amounts of MPB, so it would be pointless for me to have taken finasteride or dutaseride (Unless I was really paranoid about DHT affecting me, which I am not).

[Lara1969]

Thanks Kay, very interesting post!

Only one addition. With the same Estradiol lwvel from one source I still had zero breast growth. With the same Estradiol level and a very similar Estrone level I have vreast growth. My doc saw this several times in the past but is not sure why we see this effect.

Lara

[Leila]

This regimen comes not from a person but from a clinic that specialises in transgender care. They state that this their pre-op regimen. Again - this isn't mine, I'm not looking to be on it or asking for it; I thought it was excessive and posted it here for opinions, not because I want it but because it's so much. I'd worry about hepatoxicity on this amount of stuff, not to mention elevated risks for DVT.

Ahh yes now that you mention it, the cocktail of meds do look like those from a certain site easily found on the internet. IMHO I think it is irresponsible for them to post such regimens without due notice as to the reasons why each element of the regimen is needed, such that someone without a clue would blindly accept the shopping list of meds and follow it probably at the maximal doses and expect the fast results their website claims.

As for hepatoxicity, the biggest worry would be the progestin that they advocate using.

Progestogens (Includes Provera) ↔ Liver Disease
Severe Potential Hazard, High plausibility
Applies to: Liver Disease
The use of progestogens, in general, is contraindicated in patients with impaired hepatic function or liver disease. There are little or no data concerning the pharmacokinetic disposition of the different progestogens in patients with hepatic disease. However, most hormones, including progestational hormones, are known to be extensively metabolized by the liver.

Progestogens (Includes Provera) ↔ Thromboembolism
Severe Potential Hazard, Moderate plausibility
Applies to: Cerebral Vascular Disorder, History - Thrombotic/Thromboembolic Disorder, Thrombotic/Thromboembolic Disorder
The use of progestogens, in general, is considered by manufacturers to be contraindicated in patients with active thrombophlebitis, cerebrovascular disease, or a current or past history of thromboembolic disorders. While the role of progestogens in the development of thromboembolic events associated with hormonal therapy is often unclear and thought to be secondary to that of estrogens, it may not be insignificant. Medroxyprogesterone, a common progestational agent, has been shown to produce a hypercoagulable state in high dosages. Whether or not this effect contributes to the development of thrombotic events is unknown. However, thrombophlebitis and pulmonary embolism have been reported with megestrol, an antineoplastic and progestational agent. In addition, an increased risk of nonfatal venous thrombosis has been associated with oral contraceptive combinations containing desogestrel or gestodene relative to those that contain other progestins (e.g., levonorgestrel, norethindrone), suggesting some degree of hemostatic effect by progestogens.

http://www.drugs.com/disease-interactions/medroxyprogesterone,provera.html

Estradiol has lower risk to liver over using ethinyl estradiol and it is good to see at least they are not advocating the latter.

[Catherine Sarah]

Hello Wynternight,

My only question regarding this specific regime you've researching, which I believe you need the answer for; is why the progestin for 10 days only out of the month?

I hope they have a well researched and convincing answer.

Huggs
Catherine

[Wynternight]

Hello Wynternight,

My only question regarding this specific regime you've researching, which I believe you need the answer for; is why the progestin for 10 days only out of the month?

I hope they have a well researched and convincing answer.

Huggs
Catherine

Progesterone seems to be the biggest controversy here in regards to HRT as evidenced by the thread here. They didn't explain their rationale behind the 10 days a month on the site.

[Leila]

Progesterone seems to be the biggest controversy here in regards to HRT as evidenced by the thread here. They didn't explain their rationale behind the 10 days a month on the site.

Please don't confuse progesterone with progestin.

One is plant derived and chemically the same as found in humans, the other is a synthetic chemical quite dissimilar to the compound found in humans with properties similar to progesterone and also a number of nasty side effects thrown in for free.

[Wynternight]

Please don't confuse progesterone with progestin.

One is plant derived and chemically the same as found in humans, the other is a synthetic chemical quite dissimilar to the compound found in humans with properties similar to progesterone and also a number of nasty side effects thrown in for free.

I'm not confusing anything and am quite aware of the difference between synthetic Progestin and Progesterone.

[Leila]

I'm not confusing anything and am quite aware of the difference between synthetic Progestin and Progesterone.

Hey no worries. I'm sorry if you think i was teaching you to suck eggs. Just looking out for you at the end of the day in case you didn't.

Not all peeps out there know the difference and scarily from anecdotal evidence includes also some from the medical profession who should ought to.

[Wynternight]

Hey no worries. I'm sorry if you think i was teaching you to suck eggs. Just looking out for you at the end of the day in case you didn't.

Not all peeps out there know the difference and scarily from anecdotal evidence includes also some from the medical profession who should ought to.

No worries. It really is a controversial topic. The thread here is up to what, six pages? Endo and other specialists are debating the use of progesterone in HRT but those on it swear by its efficacy. If I do go on it I'm definitely avoiding the progestin and going on micronised progesterone (itself fraught with controversy) but that's if the NP I'm seeing agrees with me going on it at all.