yes. having Bipolar while transitioning is a genuine pain, but it should not be a barrier, per se... just a little tlc and some understanding that you will not conform to either Bipolar or trans boxes. It just makes things... more interesting.
regarding medications, keep in mind that everything we put in acts on various receptors.
Obviously, ERT is rather obvious, however, it is important to keep in mind that Estradiol has a slight qt-prolongation effect (this takes place in ciswomen, but is balanced by qt shortening effects of Progesterone). A LOT, most, if not all, medications that are used for Bipolar WILL prolong the qt interval, especially Lithium and the antipsychotics. In and of itself, having a med that does this is not usually problematic, indeed generic stuff like over the counter benadryl will do it slightly. The problem is only when several medications are combined that have this effect... so say, taking Estradiol alone, plus say Risperdal, plus say an antibiotic... that could be a problem in people who are prone to drug induced long qt prolongation.
Another issue to keep in mind is that many Bipolar medications act in ways contradictory to Estrogen. For example, Lamictal is an awesome mood stabilizer that will, as an effect, reduce the amount of Estrogen in the blood stream. So, if Lamictal is used with Estrogen, it will take more Estrogen to have the same effect. Also with Lamictal, it makes your skin more sensitive, so using a transdermal estrogen with Lamictal may make the skin more irritated. This being the case, Lamictal is otherwise one of the most forgiving and best meds for Bipolar.
My experience with Depakote and Estrogen is that the feminizing effects were almost completely canceled out AND I gained a huge amount of weight, it put me to around 207IB and when I stopped Depakote I dropped to around 183IB almost right away. Also, with Depakote and Estradiol the water retention was awful and I couldn't stop eating sugar or drinking water.
Combining Lithium and Estradiol had a negative impact on my Thyroid function. Apparently either can do this to some extent, so if Lithium and Estradiol are combined, I would recommend getting a thyroid test.
As for the antipsychotics - a LOT of antipsychotics actually work by INCREASING estrogen levels, and, as you noted, estrogen has an antipsychotic effect (it seems that women have a built in defense against psychosis that men do not have for the sake of protecting children). For some, like Risperdal, this effect is so noted that it can cause men who identify as men to begin lactating milk. So, in this case, less estradiol may have the same effect. As a personal note, when I combined high doses of oral estradiol with high doses of risperdal, my breasts became huge and painful and I had to be re fitted and could not wear any cute bras.
One of the things is that a lot of HRT prescribers have a mindset that MTFs get _blank_ amount of Estradiol before and then _blank_ amount after surgery and likewise a lot of psychiatrists have a mindset that people diagnosed with Bipolar need _blank_ amount of an antipsychotic along with _blank_ amount of a mood stabilizer.
After going through many doctors and psychiatrists who seemed upset with me for not being fully compliant with both, I have someone who listens and realizes and accepts that my experience with the two will be unique, there are not that many of us, but there is no reason why the two conditions can't coexist and be treated at the same time. What is needed is patience to find the right mix and doctors who are willing to listen. For example, by raising Estrogen levels, a Bipolar pattern may be somewhat treated and need less of other medications - but its important to note that the Bipolar is still there underneath lurking - be careful - because _some_ will try to discount the notion that the two coexist and will try to chalk up both to being Borderline PD (in this sense, Estrogen limiting a psychotic incident is both helpful and harmful).
With all of these, its important to start off with smaller doses and go up slowly.
This is all my own experience having these together & constitute ideas to talk to your Dr. about and is not medical advice.
