Serum Levels At Two Months

[Steph34]

If you've had the surgery does your T level zero out or do you still produce low levels (like a ciswoman)?

My understanding is the adrenal gland still produces some T, but it is less than the amount a cis woman would typically have, because a cis woman also produces some T in other places, primarily the ovaries.

[KayXo]

My comparison was to the average cis female level over the course of a typical month; I am well aware that it varies.

No such thing as an average level in ciswomen since it constantly varies. Anyways, what is the point of comparing us to ciswomen? They had their development at quite a different time in their lives, when younger and when their GROWTH hormone levels were WAYYY higher.

T has been linked to heart attacks and strokes

And yet, strokes most often occur in older men (and women) who have less T (and E) than their younger counterparts.

while E may be good in moderation, it could still be dangerous at excessive levels.

And yet pregnant women with "excessive" levels seem to do quite well. Some go through pregnancy several times during their lives.

Even at a relatively modest level (near 60), my skin became drier and more sensitive to sunlight, and I saw a couple of new flat moles. It is hard to see how having 20 times as much would be good for skin, when having even this much has caused my skin to deteriorate in every way except softness.

In my personal experience, the significant increase in E improved markedly my skin condition, making it more elastic, softer and younger looking. On lower levels, it was dry and just not in very good condition.

Well of course, high doses of E will be protective in men because they suppress androgens; this probably signifies the harmful effects of T more so than the protective benefits of E.

Doctors are often concerned about high levels of E because of the risk of thrombosis and as this study suggests in prostate cancer patients, high levels of E (non-oral bio-identical E) were actually protective.

The informed consent form I signed for HRT required me to acknowledge that it could induce breast cancer. The legal experts seem concerned.

And yet, have we seen direct evidence between bio-identical estradiol and an increase in breast cancer risk? I think it's important to question. Pregnant women experience VERY high levels and yet pregnancy seems to be protective of breast cancer. Most women get breast cancer as they age, mostly after 40-50 when their estradiol (and progesterone) levels DECLINE. Not at a young age, when they are HIGHER or during pregnancy.

Interestingly, breast cancer is quite rare and rarely reported in transwomen despite sometimes quite high levels or doses given, especially in the past. It is a much rarer occurrence in us vs. ciswomen. A study from the Netherlands concluded after decades of treatment of transsexuals, that breast cancer was VERY rare in this population and that the rate was comparable to that of men who weren't treated. Not my conclusion but the conclusion of a team that has extensive experience treating TS women for several decades.

However, if most doctors are unwilling to prescribe it at such high levels, and their professional associations warn against doing so, then they are obviously concerned about serious risks, and such concern among medical professionals does not arise without good scientific evidence.

Sadly, this can happen even without strong scientific evidence. Through my research, this is what I've sometimes concluded about certain things. You want to give them the benefit of the doubt and assume they've done their work but dig a little into papers and such and you will see for yourself.

The Endocrine Society does not seem to think bio-identical hormones are any safer, and there seems to be a lack of large-scale studies to prove otherwise.

There have been countless studies showing the difference between bio-identical estradiol and other estrogens in terms of their effects on coagulation, blood pressure and such. The evidence is quite strong and clear. Also, there was a large scale controlled study in Denmark over 6 yrs+ consisting of bio-identical estradiol which showed those women given estrogen alone actually suffered less breast cancer and did as well on other markers or better.

Anti-androgens like cyproterone and spironolactone also can cause dehydration, which reduces energy.

I never heard of cyproterone causing dehydration, instead it tends to increase water retention and on it, my skin was quite soft and never dry or dehydrated.

There are plenty of people who feel good without much T.

I'm fine with very low levels post-op, the little that is left that is being produced by my adrenal glands. I have less than most women since they still produce some from their ovaries, at least before menopause strikes.

[Steph34]

No such thing as an average level in ciswomen since it constantly varies.

Constant variation does not preclude the calculation of an average.

Anyways, what is the point of comparing us to ciswomen? They had their development at quite a different time in their lives, when younger and when their GROWTH hormone levels were WAYYY higher.

I think you have a point there. It could, in some cases, require much more E to feminize a masculine form than an undeveloped form, especially with low growth hormone levels. I personally want my E and T levels to be based on my own needs, not what a ciswoman would have, and my doctor does not seem to understand that. It has always been my assumption that cis females seem to do fine on a certain level, and therefore we should too, but now I am realizing it is not that simple. However, it stands to reason that there may be health risks to exceeding the typical cisfemale level. The Endocrine Society and even the WPATH seem to think so... What about liver damage? My doctor seems very concerned about that as a possible side effect of estradiol, and one person on here even reported liver damage at a low dose.

And yet, strokes most often occur in older men (and women) who have less T (and E) than their younger counterparts.

Yes, age is the primary risk factor for strokes because of circulatory damage that occurs over time, like atherosclerosis and arteriosclerosis. Also, men with lower T may have more health problems because the health problems themselves (including aging itself) can reduce T levels, not the other way around. Likewise, poor circulation can both increase stroke risk and reduce T levels. Since male HRT (ie. exogenous T) has been found to increase the rate of not only strokes, but also heart attacks, and men tend to have more health problems, it stands to reason that any causative effects of T are bad. A similar effect has been found for strokes in postmenopausal women who use E long-term. This occurs because of age, but HRT certainly does not help matters.

And yet pregnant women with "excessive" levels seem to do quite well.

In what way? They do tend to have higher mortality rates, weight gain, cellulite, lethargy...

In my personal experience, the significant increase in E improved markedly my skin condition, making it more elastic, softer and younger looking. On lower levels, it was dry and just not in very good condition.

I feel like my skin has aged at least 5 years in my 3 months on a small amount of E - wrinkling, splitting, cracking, crusting, drying, spotting, burning, itching - the list goes on. If raising my E level to 63 did that much damage, I would probably look like my grandmother if I had 1000+. Indeed, skin concerns are the main reason I am reluctant to raise my E level any further, because while I want to look feminine, I do not want to look older than my mother. I am glad you found what works for you, but I obviously have a very different skin type.

Doctors are often concerned about high levels of E because of the risk of thrombosis and as this study suggests in prostate cancer patients, high levels of E (non-oral bio-identical E) were actually protective.

Like I said, the E could simply pose a lower risk than the T it replaced. That is especially true for prostate cancer patients, who may be hypersensitive to the risks of T because it promotes cancer growth.

And yet, have we seen direct evidence between bio-identical estradiol and an increase in breast cancer risk? I think it's important to question.

My doctor and I prefer bio-identical estradiol because it is the same as what the body produces naturally, but safer? There seems to be no consensus on that.

Pregnant women experience VERY high levels and yet pregnancy seems to be protective of breast cancer.

Pregnancy affects many other hormones, too. The overall protective effect does not preclude a weak carcinogenic effect of any one of those hormonal changes in other contexts.

Most women get breast cancer as they age, mostly after 40-50 when their estradiol (and progesterone) levels DECLINE. Not at a young age, when they are HIGHER or during pregnancy.

As with stroke, aging is a much stronger risk factor than hormones, so that overall risk increases greatly even as one weak risk factor declines. Some evidence suggests that even just a replacement dose of E increases their breast cancer risk.

Interestingly, breast cancer is quite rare and rarely reported in transwomen despite sometimes quite high levels or doses given, especially in the past. It is a much rarer occurrence in us vs. ciswomen. A study from the Netherlands concluded after decades of treatment of transsexuals, that breast cancer was VERY rare in this population and that the rate was comparable to that of men who weren't treated. Not my conclusion but the conclusion of a team that has extensive experience treating TS women for several decades.

So why then was I required to sign paperwork acknowledging that E could induce breast cancer? Why did my doctor try to make me scared of it by telling me, "If you have a stroke, that can't be reversed"? It kind of makes me wonder if there is a hidden agenda to prevent me from feminizing. It would not be the first time. Even the WPATH seems to recommend low levels, discouraging 'maximum feminization' in favor of feminizing 'only to the extent necessary to [relieve dysphoria]' - clear hypocrisy to someone like me who wants nothing more than to look fully female someday. Is there no one I can trust anymore? 

Sadly, this can happen even without strong scientific evidence. Through my research, this is what I've sometimes concluded about certain things. You want to give them the benefit of the doubt and assume they've done their work but dig a little into papers and such and you will see for yourself.

I know this is so true. It has made me very skeptical and misanthropic, feeling like most of the 'common knowledge' is so distorted as to bear no relation to the science that allegedly shapes it. Whenever I hear a health claim nowadays, my first thought is, "Where's the evidence?" Still, this is one thing I thought I could trust my endocrinologist about. Two therapists have told me that I have one of the best endocrinologists out there, with extensive experience treating transgender patients. It never occurred to me that such a well-respected doctor would offer only limited treatment options as a result of weak or misinterpreted science. The overemphasis on 'safety' belies the fact that nothing is more hazardous to my health than being too masculine.

There have been countless studies showing the difference between bio-identical estradiol and other estrogens in terms of their effects on coagulation, blood pressure and such. The evidence is quite strong and clear.

Hmm, so maybe my doctor is behind the times and ignorant?

I never heard of cyproterone causing dehydration, instead it tends to increase water retention and on it, my skin was quite soft and never dry or dehydrated.

My mistake. Unfortunately, it is not available in the USA and the closest related substance, spironolactone causes dehydration and skin dryness. As such, I was given something else altogether to suppress T production, and it really does not work so well.

I'm fine with very low levels post-op, the little that is left that is being produced by my adrenal glands. I have less than most women since they still produce some from their ovaries, at least before menopause strikes.

I really want to know how that feels! Every day I suffer through with an unwanted organ still producing some endogenous T (albeit at reduced levels) is a day I almost wish I would just die already.

[KayXo]

However, it stands to reason that there may be health risks to exceeding the typical cisfemale level. The Endocrine Society and even the WPATH seem to think so... What about liver damage? My doctor seems very concerned about that as a possible side effect of estradiol, and one person on here even reported liver damage at a low dose.

1) What about pregnant women whose levels go up to 75,000 pg/ml? What about women who have 4-5 kids during their lifetimes, especially in undeveloped countries and who survive through them with no apparent complications? We don't even come close to these levels, even on injectables, my levels are typical of first trimester levels only and so far, my liver is PERFECTLY FINE! My doctors are not concerned.
2) What are they basing themselves to say there is a risk with non-oral bio-identical estradiol? Have you investigated further into what their assertions are based on? Have you asked them? It is VERY important to question.
3) In prostate cancer patients, high levels were attained with unconventional high doses of injectables, in hundreds of patients, spanning up to 12 months of treatment. Liver was not affected, thrombosis neither and actually researchers concluded high levels might have a PROTECTIVE effect!

My feeling (and research) has led me to believe that their assertions are based on the old non bio-identical forms of estrogen, that when high doses were given, complications arose BUT there are significant differences between ethinyl estradiol, conjugated equine estrogens and bio-identical estrogen. There are SEVERAL papers showing this quite unequivocally, you just need to take the time to research which I have done in my 10 yrs +. Thankfully, for my well-being. Do doctors really take the time to do the research in depth, do they truly really care about us to take the time? Food for thought...one hopes so but is it really the case for most?

Yes, age is the primary risk factor for strokes because of circulatory damage that occurs over time, like atherosclerosis and arteriosclerosis.

The risk of strokes is lower in women vs men and suddenly after menopause, when estrogen levels drop, their risk increases, almost up to the same degree as men and I think, eventually is higher. Coincidence? Several studies have observed the beneficial effect of estradiol on arteries, blood circulation, etc. It's when non bio-identical estrogen and progestins (not bio-identical progesterone) are used, that results begin to differ.

Also, men with lower T may have more health problems because the health problems themselves (including aging itself) can reduce T levels, not the other way around. Likewise, poor circulation can both increase stroke risk and reduce T levels. Since male HRT (ie. exogenous T) has been found to increase the rate of not only strokes, but also heart attacks, and men tend to have more health problems, it stands to reason that any causative effects of T are bad. A similar effect has been found for strokes in postmenopausal women who use E long-term.

I honestly haven't researched much about men and men's health risks with age or as they relate to T but I'm still not personally convinced by what you say or most authorities. If Indeed high T was a risk factor and high levels of T are present in young men, then why aren't stroke and all the other health risks occurring with more frequency in them? You might say young age is protective but how so? This needs to explained in detail.

Regarding the association between stroke and long term use of E, it's only been observed with E that was NOT bio-identical and often with also the use of a progestin (not same as bio-identical progesterone). The two long term studies (up to 6 years) I've read saw no increase in strokes with the use of bio-identical estrogen taken alone or with bio-identical progesterone. Interestingly also, in one of those studies and another one, the use of estrogen alone without a progestin was associated with a significant DECREASE in breast cancer risk.

I feel like my skin has aged at least 5 years in my 3 months on a small amount of E - wrinkling, splitting, cracking, crusting, drying, spotting, burning, itching - the list goes on. If raising my E level to 63 did that much damage, I would probably look like my grandmother if I had 1000+.

I think you have it all wrong. When I raised my E and added P, my skin IMPROVED and I looked markedly younger now than before. I have pics to prove it, people around have noticed it. The reason you may have all these symptoms is because...your E is TOO LOW! I had those same symptoms when my E was low, similar to yours and if I had used the same logic as you, I would have done myself more harm than good and stayed where I was. Not only did my skin improve since the changes, but I feel better too. Not 100% but 85% and that's a lot better than before, trust me! Girls in puberty and in their twenties experience higher levels on E, on average, they ain't looking bad and aging quickly, are they?

That is especially true for prostate cancer patients, who may be hypersensitive to the risks of T because it promotes cancer growth.

This, I personally question again and I'm certainly no doctor BUT if indeed T promoted prostate cancer growth, then why do young men with high levels of T get this cancer much less than their older counterparts who have much less T. Something doesn't fit for me...this is just my take on it and opinion.

My doctor and I prefer bio-identical estradiol because it is the same as what the body produces naturally, but safer? There seems to be no consensus on that.

There is consensus. Plenty of research on this and I could (personally) send you all the links and studies.

So why then was I required to sign paperwork acknowledging that E could induce breast cancer? Why did my doctor try to make me scared of it by telling me, "If you have a stroke, that can't be reversed"? It kind of makes me wonder if there is a hidden agenda to prevent me from feminizing. It would not be the first time. Even the WPATH seems to recommend low levels, discouraging 'maximum feminization' in favor of feminizing 'only to the extent necessary to [relieve dysphoria]' - clear hypocrisy to someone like me who wants nothing more than to look fully female someday. Is there no one I can trust anymore? 

You are questioning and that's good. Be smart about it, read up, talk to many doctors, see if what they say stands up to research and science, check the science, etc. It takes time, lots of time but eventually, you will begin to sense what is right and what is wrong.

[Steph34]

1) What about pregnant women whose levels go up to 75,000 pg/ml? What about women who have 4-5 kids during their lifetimes, especially in undeveloped countries and who survive through them with no apparent complications? We don't even come close to these levels, even on injectables, my levels are typical of first trimester levels only and so far, my liver is PERFECTLY FINE! My doctors are not concerned.

Pregnancy increases the risk of thrombosis and one reason for that is thought to be the extremely high E level.
http://www.everydayhealth.com/news/facts-about-blood-clot-dangers-of-pregnancy-and-dvt/

2) What are they basing themselves to say there is a risk with non-oral bio-identical estradiol? Have you investigated further into what their assertions are based on? Have you asked them? It is VERY important to question.

Well, on Monday my doctor gave me a prescription for oral estradiol because injections are too strong and the topical products were too weak. (Even my conservative doctor was forced to admit that after I rejected a prescription for another worthless topical product, explaining that such products cannot possibly produce a satisfactory level.) My doctor seems to think that risk of liver damage is enhanced by the oral pathway, which takes it through the liver. Also, my doctor is not open to questioning. Whenever I ask for details, I am ignored.

3) In prostate cancer patients, high levels were attained with unconventional high doses of injectables, in hundreds of patients, spanning up to 12 months of treatment. Liver was not affected, thrombosis neither and actually researchers concluded high levels might have a PROTECTIVE effect!

Damage to an organ such as the liver could occur over decades, even if no change is evident in one year.

My feeling (and research) has led me to believe that their assertions are based on the old non bio-identical forms of estrogen, that when high doses were given, complications arose BUT there are significant differences between ethinyl estradiol, conjugated equine estrogens and bio-identical estrogen. There are SEVERAL papers showing this quite unequivocally, you just need to take the time to research which I have done in my 10 yrs +.

I would hope that is the case, but I am having a hard time finding evidence. This one study seems to show they are safer, but most others conclude there is insufficient evidence to say that.
https://www.hoffmancentre.com/assets/files/pdf/articles/A_Comprehensive_Review_of_the_Safety_and_Efficacy_of_Bioidentical_Hormones.pdf

Do doctors really take the time to do the research in depth, do they truly really care about us to take the time? Food for thought...one hopes so but is it really the case for most?

Like most people, doctors seem to care only about money, not patients. I would have thought that a good background on the scientific evidence would be necessary for a doctor to keep patients (and thus income), because most people prefer to see someone who is knowledgeable. My father is a doctor and he always reads the latest scientific journals to stay up to date in his field, but I recall him saying something recently about how most younger doctors "can't be bothered." If that is the case, it is a disturbing trend. I am beginning to see that just because a doctor has an answer to every question, that does not mean the doctor is always right.

You might say young age is protective but how so? This needs to explained in detail.

It is not necessary to know why these problems are rare in younger adults to accept that T is risky in older people. I would think it has something to do with age-related circulatory changes, or perhaps oxidative damage.

The two long term studies (up to 6 years) I've read saw no increase in strokes with the use of bio-identical estrogen taken alone or with bio-identical progesterone.

I would like to see those studies.

I think you have it all wrong. When I raised my E and added P, my skin IMPROVED and I looked markedly younger now than before. I have pics to prove it, people around have noticed it. The reason you may have all these symptoms is because...your E is TOO LOW! I had those same symptoms when my E was low, similar to yours and if I had used the same logic as you, I would have done myself more harm than good and stayed where I was. Not only did my skin improve since the changes, but I feel better too. Not 100% but 85% and that's a lot better than before, trust me!

I used the overly simplistic assumption that "E causes dry skin, and I have dry skin, so it must be caused by the E." I should have known better. My own re-thinking of the evidence led me to conclude after seeing my blood results on Monday, long before logging on here, that I was indeed wrong. My E actually declined back into the MALE range! Yet my skin was awful. Then it occurred to me that I had a dry skin problem during the colder season last year, too, and it was caused by the cold weather; I was totally pre-transition then. I always had bad skin in the wrong body, except on my face where I use a multi-purpose product. I received a slightly stronger estradiol prescription on Tuesday, with the goal of raising my level to 100, and so far the only changes I have noticed are increased energy, improved mood and decreased sensitivity to masculinizing triggers. Indeed, I felt like I was high after my first dose. My doctor has implied that this is the highest I can go, since that would be a typical 'female' level. I would like to see how I do on this product before seeking another doctor. All I can say is that if my E level goes so low again, my doctor will lose a patient.

Girls in puberty and in their twenties experience higher levels on E, on average, they ain't looking bad and aging quickly, are they?

Of course not, but aging occurs over time. A 19-year-old can get a severe sunburn and be beautiful again in 2 weeks, but no one would suggest that sunburn is good for skin.

This, I personally question again and I'm certainly no doctor BUT if indeed T promoted prostate cancer growth, then why do young men with high levels of T get this cancer much less than their older counterparts who have much less T.

First, carcinogenesis is not the same as growth. T can be conducive to growth without necessarily initiating the cancer. It is widely acknowledged that prostate cancer feeds on T and DHT. Indeed, all prostate cells do. Some men with prostate cancer even take T blockers that bring their T down to the female level. They hate it, and do it only because their life depends on it. Cancer is an age-related disease. Susceptibility is due to environmental exposures and oxidative damage over time, as well as genetics and other risk factors. Without the predisposition brought on by aging, exposure to carcinogens is unlikely to cause cancer at normal levels of exposure.

You are questioning and that's good. Be smart about it, read up, talk to many doctors, see if what they say stands up to research and science, check the science, etc. It takes time, lots of time but eventually, you will begin to sense what is right and what is wrong.

I am really not sure what to think right now, but my experiences in other matters suggest that 'everything in moderation' are the words to live by. The 'more is better' mentality seems to make people happy only until something tragic happens. I see no reason to believe that hormones are fundamentally different from anything else, so as to alter that basic premise.

[KayXo]

Pregnancy increases the risk of thrombosis and one reason for that is thought to be the extremely high E level.

And, as I explained before, billions of women experience pregnancy, sometimes more than once and up to several times during their lives...and yet the woman's population doesn't seem to be dwindling away or the overall population in the world due to declining birth rate. What matters most is what is seen in reality and reality shows us that pregnancy, when high levels of E are attained (higher on average than we will EVER attain), is not such a significant health risk to women; otherwise, we should observe many more women having complications, dying, giving less births, etc. Up to 75,000 pg/ml during pregnancy compared to our 1,000-5,000 when injecting E is quite the difference!

My doctor seems to think that risk of liver damage is enhanced by the oral pathway, which takes it through the liver.

It is also important to make the distinction between different forms of estrogens taken orally. It has been proven quite clearly that birth control pills and Premarin taken orally have a greater impact on clotting and liver than bio-identical estradiol. To base oneself on the risks observed with other forms of estrogen is inaccurate. Bio estradiol is quite different.

Damage to an organ such as the liver could occur over decades, even if no change is evident in one year.

I'm not a doctor but based on everything I've read, seen, experienced, I'm not worried about liver damage from taking bio-identical estradiol orally at typical doses prescribed for us. Doctors in my area prescribe quite high doses (if needed) to their transgendered patients because they have understood/concluded, over the years, that it is quite safe, in contrast to birth control pills or Premarin.

It's quite alright to be cautious but overcautioness is not justified.

I would hope that is the case, but I am having a hard time finding evidence.

You can write to me privately and I will provide all the evidence that I have accumulated over the years, with pleasure.

I would like to see those studies.

http://www.ncbi.nlm.nih.gov/pubmed/23048011
BMJ. 2012 Oct 9;345:e6409. doi: 10.1136/bmj.e6409.
Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial.

http://www.ncbi.nlm.nih.gov/pubmed/15011717
Climacteric. 2003 Dec;6(4):293-301.
Progestins initiate adverse events of menopausal estrogen therapy.

and many other interesting studies that I could message you privately.

I received a slightly stronger estradiol prescription on Tuesday, with the goal of raising my level to 100, and so far the only changes I have noticed are increased energy, improved mood and decreased sensitivity to masculinizing triggers. Indeed, I felt like I was high after my first dose. My doctor has implied that this is the highest I can go, since that would be a typical 'female' level.

There is no such thing as typical female level as it constantly fluctuates, from low to very high. Progesterone sometimes help with dry skin, by the way.

I'm enjoying our discussions, Steph. You seem like a pretty sound and rational person. You have interesting tidbits to share.

[Steph34]

And, as I explained before, billions of women experience pregnancy, sometimes more than once and up to several times during their lives...and yet the woman's population doesn't seem to be dwindling away or the overall population in the world due to declining birth rate. What matters most is what is seen in reality and reality shows us that pregnancy, when high levels of E are attained (higher on average than we will EVER attain), is not such a significant health risk to women; otherwise, we should observe many more women having complications, dying, giving less births, etc.

Given the many factors influencing women's choices (including maternal instinct), this risk is a minor influence, too small to have much of an effect on population through either mortality or prevention of pregnancy. With that said, that does not mean it is trivial, that no one dies from it or that it is irrelevant. In most places, murder is too rare to have a significant effect on population, but no one would argue that we should not take it seriously or just let it happen.

Up to 75,000 pg/ml during pregnancy compared to our 1,000-5,000 when injecting E is quite the difference!

Those incredibly high levels are only attained for a relatively short duration at any one time, while the high E levels from injections can persist for years continuously. The risks from hormones come not only from the level attained, but also from the duration for which one has such a level.

It is also important to make the distinction between different forms of estrogens taken orally.

I would only use bio-identical estradiol because 1) it is the precise substance I was deficient in, so using other estrogens would make me feel 'fake' ; 2) it does not come from animals (ewwww); 3) there may be greater health risks from other estrogens.

It has been proven quite clearly that birth control pills and Premarin taken orally have a greater impact on clotting and liver than bio-identical estradiol.

But that does not mean there is no risk from bio-identical estradiol.

To base oneself on the risks observed with other forms of estrogen is inaccurate.

I agree, but there seems to be an assumption floating around that all forms of estrogen have the same effects. Sometimes I wonder if that assumption is perpetuated by people who have a financial stake in the continued use of equine estrogens or birth control pills.

I'm not a doctor but based on everything I've read, seen, experienced, I'm not worried about liver damage from taking bio-identical estradiol orally at typical doses prescribed for us. Doctors in my area prescribe quite high doses (if needed) to their transgendered patients because they have understood/concluded, over the years, that it is quite safe, in contrast to birth control pills or Premarin.

For me, the risk of side effects is a minor concern relative to living in the wrong body. With that said, it does affect the willingness of many doctors in my area to prescribe these hormones. If I were to explain to my current doctor why I need to raise my level over 200 through the use of oral estradiol, he would probably refuse to write a new prescription due to concerns about liver damage. Indeed, he has even told patients with levels in the mid-100s to reduce their dosage! It does make me wonder what to think, if one of the 'best' doctors for transgender care is unwilling to prescribe doses that may be necessary for feminization, due to a relatively modest risk of liver damage. What does this reflect: a) negative perception toward transgender individuals in society, b) negative perception of hormones due to over-hyped health risks, or c) the ignorance or indifference of medical professionals. I do wonder which of the above is true, perhaps more than one.

There is no such thing as typical female level as it constantly fluctuates, from low to very high.

That technicality does not stop a 'typical female level' from being defined for the purposes of transgender care. It can be defined as 1) an average level over the course of the menstrual cycle (and this seems to be the most common interpretation), or 2) a level that a menstruating woman is likely to have during a particular portion of the cycle. Based on the most common interpretation, my doctor's characterization of 100 as a 'typical female level' seems reasonable. That does not mean that it is an ideal level, and I think it is important to make that distinction. An ideal level for someone using exogenous estradiol should be the lowest level necessary to attain the desired result, and depending on one's individual needs and sensitivity, that could be lower or higher than a 'typical female level.'

Progesterone sometimes help with dry skin, by the way.

I have read that progesterone 'opposes' or reduces the 'dominance' of estradiol, and also that it can raise T levels by being "partially broken down into testosterone." Indeed, multiple people on this site have reported increased T levels from using P. While possibly irrelevant to someone who is injecting E and has an E level of 1000+, those would be serious concerns for me given my lower E level. Since E is the most important feminizing agent, I do not want to oppose it, and since I still struggle with high T levels, more T is the last thing I would ever need. There are other options for dry skin; moisturizers would seem to be the standard treatment for that; I do not think I would use hormones to improve my skin. Some people seem to think P is beneficial to hair, but E is also beneficial to hair and it is not clear to me how P would do anything for hair that E is not already doing. P is not part of standard transgender care in my area, so I would prefer not to request it unless I am certain that the benefits would outweigh the drawbacks.

I'm enjoying our discussions, Steph. You seem like a pretty sound and rational person. You have interesting tidbits to share.

Thank you; same here.

[KayXo]

Those incredibly high levels are only attained for a relatively short duration at any one time, while the high E levels from injections can persist for years continuously.

Yes but on injections, we don't even come close to those levels. Highest would be 4,000-5,000 at most.

In the old times, women would have 5-15 children in a lifetime and in poor undeveloped countries, have many children so spend a good deal of time with high levels of both hormones. If, indeed, pregnancy would be harmful due to high levels, they wouldn't have lived to make all these children...they did. And still do.

If I were to explain to my current doctor why I need to raise my level over 200 through the use of oral estradiol, he would probably refuse to write a new prescription due to concerns about liver damage.

Ok. So propose the following to him...have your liver regularly tested on higher levels and see if it does anything. If it doesn't, then he is wrong and there is no reason to deny you higher levels. If liver enzymes increase, then switch to non-oral and retest a month later. And so on...propose this experiment to him. I think it's fair enough, don't you?

Since E is the most important feminizing agent

I question this based on my own experience and that of others.

There are other options for dry skin; moisturizers would seem to be the standard treatment for that; I do not think I would use hormones to improve my skin.

Higher levels of E and P have done WONDERS for my skin and hair and nails. My skin is incredibly soft and young looking, hair is soft, shiny, thicker and nails very strong and grow fast. Hormones are, by far, a better moisturizer as they work from the inside out whereas those creams are mostly a marketing tool to extract money from women who have a hormonal imbalance due to unnatural menstrual cycles all the time with highs and lows and sometimes they even make skin worst as they interfere with water retention in the important layers in the skin.

I suspect without P, my skin and hair might be drier. Many transwomen have reported the addition of P to enhance skin, hair and nails.

Try it first with your doctors consent, if possible at all and THEN make your own conclusion.

[Steph34]

In the old times, women would have 5-15 children in a lifetime and in poor undeveloped countries, have many children so spend a good deal of time with high levels of both hormones. If, indeed, pregnancy would be harmful due to high levels, they wouldn't have lived to make all these children...they did. And still do.

Sadly, many do not. Life expectancy is still much lower in places with high birth rates, and that was even truer in the old times. Enough survived to cause runaway population growth, yes, but that does not mean that death rates were insignificant or that there was no risk.

Ok. So propose the following to him...have your liver regularly tested on higher levels and see if it does anything. If it doesn't, then he is wrong and there is no reason to deny you higher levels. If liver enzymes increase, then switch to non-oral and retest a month later. And so on...propose this experiment to him. I think it's fair enough, don't you?

I like that idea; shall do. It is hard for me to see a reasonable person rejecting it, but then again I question my doctor's reasonableness sometimes. If he does, then I am sure I can find someone else.

I question this based on my own experience and that of others.

Yet, most doctors only prescribe E and never even consider P. If P is really so important for feminization, how come the transgender community does not object to this bias? It would seem to me that it is because the benefits of E are proven and reliable, while the benefits of P are largely anecdotal and unpredictable. Like I said, there is even some evidence that P can interfere with E or raise T levels. It is understandable that many doctors would be uninterested in that if they care about their patients, especially if the patient is on a rather low dose of E as I am.

Higher levels of E and P have done WONDERS for my skin and hair and nails. My skin is incredibly soft and young looking, hair is soft, shiny, thicker and nails very strong and grow fast.

That is inspiring, and I do believe in the benefits of E. I obtained just a small increase 2 weeks ago, and for the first time in 5 years, my hair shines sometimes and my nails are actually growing a little. I do however need to lose weight before going too high, or else I could forever be stuck with my large waist due to the bone-strengthening effects of E. Transwomen seem to report better improvement to body shape when starting from a lower weight. I must make that a priority in 2015 because my hair is still falling out; I really need to move on. Without hair, nothing else matters; I will have nothing left to live for.

With that said, I am very skeptical of P. I would not be interested in requesting it unless I knew 1) Does P actually improve hair, body shape, skin, or nails, and through what mechanism? 2) Is there any scientific evidence suggesting that P itself produces these benefits in humans, or could the improvement some transwomen see on P be due largely to confounding influences, such as the likelihood that doctors who are interested in prescribing P would also be willing to prescribe more potent forms of E? I think those are important questions.

Many transwomen have reported the addition of P to enhance skin, hair and nails.

Most also do not use dutasteride to reduce DHT formation and I do. Their hair improvements from progesterone could be due to its inhibition of DHT formation, which would be less relevant for me given what I am on. Without knowing a clear mechanism of action, I can't help thinking there might be a placebo effect going on here. If we think it is going to help, it probably will.

Hormones are, by far, a better moisturizer as they work from the inside out

There seems to be no consensus with regard to the effect of hormones on skin quality. With regard to P in particular, some people find that it causes oily skin while others report drier skin while using it.

Try it first with your doctors consent, if possible at all and THEN make your own conclusion.

I would be worried about trying it because of the risks I mentioned, namely increased T and decreased efficacy of E. I am open to the idea, but only if I can be sure that it will improve my feminization, or at least my hair.

[KayXo]

Life expectancy is still much lower in places with high birth rates, and that was even truer in the old times

Due to other reasons not because of pregnancy...because in those times or places, proper hygiene, care and diet were /are less likely. I think that's quite obvious.

Enough survived to cause runaway population growth, yes, but that does not mean that death rates were insignificant or that there was no risk.

Given the growth of the population, I consider the risk to be minimal.

If P is really so important for feminization, how come the transgender community does not object to this bias? It would seem to me that it is because the benefits of E are proven and reliable, while the benefits of P are largely anecdotal and unpredictable

Proven and reliable? I often come across transwomen not getting optimal breast growth, complaining about skin dryness, brittle nails, not enough curves, etc and often this is helped with P. The evidence is largely anecdotal because so few doctors prescribe it and usually, I consider the dose quite low. There is still much to be learned in the treatment of transwomen, I think.

Like I said, there is even some evidence that P can interfere with E or raise T levels.

But, in breast tissue, for example, the effect is additive to E. And I take a high dose and my T levels have remained low, I'm post-op. No androgenic side-effects, in fact, quite the opposite. Pregnant women have very high levels and if it were androgenic, then both the women and female fetuses would be in harm's way which is not the case. I have never come across a transwoman (perhaps one) complaining from androgenic effects due to P.

Does P actually improve hair, body shape, skin, or nails, and through what mechanism?

Many transwomen have reported this, in my experience. I also notice this with P.

Is there any scientific evidence suggesting that P itself produces these benefits in humans, or could the improvement some transwomen see on P be due largely to confounding influences, such as the likelihood that doctors who are interested in prescribing P would also be willing to prescribe more potent forms of E?

Those benefits were seen and observed ONLY after the addition of P and sometimes, even a reduction of E at the same time!!! This is from my reading of 10,000+ posts in my 10 yrs +.

Their hair improvements from progesterone could be due to its inhibition of DHT formation

No. Hair is shinier, softer, not thicker or sheds less. Progesterone, at the levels tested to inhibit DHT significantly enough, was EXTREMELY high, supraphysiological.

Without knowing a clear mechanism of action, I can't help thinking there might be a placebo effect going on here.

A placebo effect in dozens, if not more women...I doubt it!

If we think it is going to help, it probably will.

LOL. There is only so much the mind can do. It can't grow breasts! or make skin softer or give more curves. Common' let's be serious here and rational.

With regard to P in particular, some people find that it causes oily skin while others report drier skin while using it.

It seems P slightly increases sebum production while E reduces it so that they complement each other.

[Steph34]

Due to other reasons not because of pregnancy...because in those times or places, proper hygiene, care and diet were /are less likely. I think that's quite obvious.

Pregnancy itself poses numerous health risks when modern medical care is/was unavailable. Women died in childbirth all the time.

Given the growth of the population, I consider the risk to be minimal.

When birth rates are at least double the replacement rate (as is/was the case in rapidly growing populations), even a serious health risk would not prevent runaway population growth.

Proven and reliable? I often come across transwomen not getting optimal breast growth, complaining about skin dryness, brittle nails, not enough curves, etc

I have read of those complaints numerous times. Indeed, I have many of those problems myself. They can almost always be attributed to insufficient E levels, and consistently improve when switching to more potent forms of E.

The evidence is largely anecdotal because so few doctors prescribe it and usually, I consider the dose quite low.

Yet, many transwomen have excellent feminization anyway.

There is still much to be learned in the treatment of transwomen, I think.

Yes, definitely, but the evidence to support prescribing P at all (let alone in high doses) is really weak IMO.

But, in breast tissue, for example, the effect is additive to E.

So why not just use more E?

And I take a high dose and my T levels have remained low, I'm post-op.

Well I am not post-op, and it is doubtful that those who reported increased T from using P were. If E suppresses T, then maybe the reason some transwomen have reported increased T from using P is because P interferes with E.

No androgenic side-effects, in fact, quite the opposite.

It is typically used together with a high dose of E. If I were to use it at a lower E level, my experience could differ.

Pregnant women have very high levels and if it were androgenic, then both the women and female fetuses would be in harm's way which is not the case.

I never suggested that P itself was androgenic, but rather that it can interfere with feminization through other mechanisms, such as reducing the efficacy of E or raising T levels. Pregnant women and transwomen on strong injections have very high E levels, which would likely render those effects irrelevant.

I have never come across a transwoman (perhaps one) complaining from androgenic effects due to P.

I could be the one, though.

Many transwomen have reported this, in my experience. I also notice this with P.

Without knowing WHY it works, I can't help being skeptical. There are so many frauds out there that people say have wonderful effects, but once studied scientifically it becomes clear that they do nothing.

Those benefits were seen and observed ONLY after the addition of P and sometimes, even a reduction of E at the same time!!!

Yet, plenty of people have reported those benefits solely from increasing their E levels.

No. Hair is shinier, softer, not thicker or sheds less.

E makes hair softer and shinier too, and unlike P, also thickens and slows loss.

A placebo effect in dozens, if not more women...I doubt it!

I would not doubt it. When I take my E, I feel more feminine and think better of my progress within minutes. I even think my skin and hair are softer. My thoughts totally change after 4 hours or so.

LOL. There is only so much the mind can do. It can't grow breasts! or make skin softer or give more curves.

No, but it can change perception of features, so one reports better progress. E does that to my mind.

[ImagineKate]

Liver tests seem to me to be standard. Every time I get my blood tested they test liver levels. However I take 4 additional oral medications.

[KayXo]

Pregnancy itself poses numerous health risks when modern medical care is/was unavailable. Women died in childbirth all the time.

But, that's not because of high hormone levels. We're the only animal on this earth who needs assistance during childbirth, all other animals do quite well thank you and this has not jeopardized their population growth, other things may have but not childbirth.

Interestingly, I came across this...
http://www.ncbi.nlm.nih.gov/pubmed/25304605

"Venous thromboembolism is, in the developed world, a major cause of maternal morbidity and mortality during pregnancy or early after delivery, with a reported incidence ranging from 0.49 to 2.0 events per 1000 deliveries"

This is often the most feared side-effect of high levels of estrogen but despite levels going extremely high, beyond what we could ever reach, the risk of DVT is only 0.05-0.2 %. Quite low, don't you think? And if one investigates further, one will notice that DVT most often occurs in women who are either obese, have a genetic predisposition or who smoke.

[Steph34]

But, that's not because of high hormone levels.

Most of it is not, but extreme hormone levels are a likely explanation for the weight gain that occurs during pregnancy. The increased body fat would indeed raise the risk of heart attacks after pregnancy, after the protective effect of the estradiol has worn off. Many women struggle to ever lose "baby weight." Indeed, my mother gained a lot of weight during her second pregnancy and never lost it.

We're the only animal on this earth who needs assistance during childbirth, all other animals do quite well thank you and this has not jeopardized their population growth, other things may have but not childbirth.

I am not so sure about that. Do we really know enough about animal life to draw that conclusion?

Interestingly, I came across this...
http://www.ncbi.nlm.nih.gov/pubmed/25304605

"Venous thromboembolism is, in the developed world, a major cause of maternal morbidity and mortality during pregnancy or early after delivery, with a reported incidence ranging from 0.49 to 2.0 events per 1000 deliveries"

This is often the most feared side-effect of high levels of estrogen but despite levels going extremely high, beyond what we could ever reach, the risk of DVT is only 0.05-0.2 %. Quite low, don't you think? And if one investigates further, one will notice that DVT most often occurs in women who are either obese, have a genetic predisposition or who smoke.

There are also trans women who have those risk factors. Also, like I said before, the risk increases the longer levels remain elevated, and trans women on strong injections can have a supra-physiological level (by non-pregnancy standards) for far longer than pregnant women. If I felt I needed a very high dose of estradiol, I would not let that risk influence my decision, but I do think it is important for people to be aware of it so they can make informed choices. Unfortunately, in today's world of defensive medicine, many doctors may look at that and feel unwilling to put their patients in such a "risky" place, leaving many trans women without a full range of treatment options.

[Jennygirl]

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Time to take a break my lovelies