Low dose HRT discussion

[KristinaM]

Additionally, I'd like to point out another side effect of HRT so far.








I NEED PICKLES, GIVE ME PICKLES, NOM NOM NOM.


Oh god, and Doritos.....  Sigh.......  I'm gonna gain 5 pounds this week I know it.

[janis]

    Thanks. it's nice to know

[Stochastic]

Additionally, I'd like to point out another side effect of HRT so far.





I NEED PICKLES, GIVE ME PICKLES, NOM NOM NOM.


Oh god, and Doritos.....  Sigh.......  I'm gonna gain 5 pounds this week I know it.

Green olives for me.

[RachaelAnne]

Hi all,

Well I've been following this thread and reading through all of the other Low Dose threads that I could find.
All of you girls have been a great inspiration and help as I began my journey down the low dose path.

Well now it's my turn to share so here goes...
I hit the can't take it anymore wall head-on about 2 years ago when I just couldn't take hiding the real me anymore.  From there, it still took me another half a year before I figured it out enough, gathered enough courage and then shared my gender dysphoria with my wife (married 21 years this year) in March 2014 and then began to see a gender therapist.  After a long road of working through who I truly am, we (my therapist and I) decided that I should hold off on starting HRT until my wife was ready for me to start.  I'm trying to proceed at a pace that will help me preserve my marriage.  Although I've been battling gender dysphoria for many many years (since I was about 5), she's only had months of exposure. 

Well the dysphoria continued to get so bad through the fall of 2014 that I could only get a few hours of sleep each night between progressively worsening dysphoria attacks.  Our hope was that if I started with a low dose, the physical changes may come on slow enough for her to process and hopefully help to reduce the dysphoria attacks.

In February this year my wife agreed that I should begin with a low dose...
So my endo prescribed a low dose of E and Spiro, and I have not looked back since.

I've now been on HRT for 6 months.  Here are my experiences so far:

• Emotional state: well I can't say that I've really noticed what some of the other girls on this site or in my group have experienced.  Am I calmer, do I have a female thought process now???  Well I can say that I fell better, I don't get as hot under the collar about some things.  The dysphoria attacks over night have lessended but not gone away.
• Physical changes:
• Body hair:  Well I had already started laser hair removal on my chest down to my bikini line before HRT.  In the past 6 months I can say that the dark hairs that had remained have slowly been fading away. mostly I see more vellus type hair in their place.  I've been working on beard removal for >12 months now, I would like to think that HRT has slowed facial hair growth, but since I shave every day until it's all gone I don't realy care to see it and check on the speed of growth.  My underarm hair was lasered off before HRT so nothing to talk about there. As for hair on my legs and arms, I also keep it shaved off, but have noticed slower rate of growth the past couple of months.  As for the hair on my head, I was fairly lucky there and have a good head of hair to start with (with some small amount of receding at the temples).  My last hair cut was a buzz cut like a marine (long story for a different thread maybe) now after 18 months it's about 9 inches in length!
• Breast development:  My nipples started to become sore almost 3 weeks to the day I started taking my first dose of estrogen and they have been sore ever since.  I definitely can feel subareloar nodules and what used to be clearly male pectoral muscles are slowly changing into female breasts.  I do still try to present as male (not out yet), luckily so far at 6 months my wife says I can still pass as maleish.
• Weight Gain:  Well I can say that since I started HRT it's harder for me to loose weight doing the same routine that I had before.  I try my best to watch my calory intake, exercise, etc...  But then there are those darn pickles!   Yup I have had some food cravings in the past 6 months, can't ever remember having a craving anything like this before HRT...  Anyway I've done very well so far and have only gained about 4 to 5 pounds.  I'm 5'9" 170 lbs, working toward 155 lbs someday.
• Fat distribution:  Well I can only say that I've noticed an increase in breasts, hips and bum.  How much, I'm trying not to focus on measurements otherwise I'll go crazy wanting it to go in the right places faster.
• Genitals:  OK so I hate looking at them and handle those things only as needed.  So I honestly can't give much of a report but it has become easier to tuck the testicles up into the inguinal canals in the past couple of months. I can tell you that there is no involuntary action since week 3, thank god!  Couldn't stand dealing with that anymore.

I'll end with some good news...
Got my 6 months lab results back my Estradiol is in the low female range with the Testosterone count well below the male range, but above the female range.

I would love to jump right into a full dose from here and go full speed ahead!  I do very much value my marriage and my wife's friendship, therefor I'm trying very hard to keep my inner self in check and to sit back and enjoy the HRT ride.

[Joi]

Saw my Endo Wed. Labs after 5 mos. on E  Spiro & Progesterone indicated E level was still quite low (43) T -.75. The Spiro is definitely working.  As far as the E, I haven't had much reaction.  Emotionally, yes, but physically little, which is obviously reflected in my low E level.  I was on a low dose of E with no Spiro from 1997-2002 and experienced the "2nd puberty" effects then (breast buds/tingling/sensitivity/ fat redistribution.  I was in my early 50's then.  I am now in my late 60's and I have heard that our body chemistry reacts more slowly as we age. Perhaps I'm encountering that now.  On a positive note, my Endo agreed to dbl. my dosage of E so we'll see what happens.  Is there a 3rd puberty for me?  Sure hope so.  With my new 'script, I guess I no longer fit into the low dose category. 

[Richenda]

I'd love to know what's meant by 'low,' 'medium,' or 'high' doses. The problem is the site rule, the reason for which I totally understand. I wonder if it's possible to give an indication without a breach of the above? If you go onto a site like transgendercare.com it gives ideas which I'd, personally, consider high dosing. So by that token 'low' would be something like a third of that I'm guessing? Or are we talking here really micro dosages?

Sorry mods, I'm trying to tiptoe I promise

I'm really interested because I had a lot of problems following the kind of ideas in the aforementioned: culminating in a day when I was pretty ill from, I think, spironolactone.

[Stochastic]

I'd love to know what's meant by 'low,' 'medium,' or 'high' doses. The problem is the site rule, the reason for which I totally understand. I wonder if it's possible to give an indication without a breach of the above? If you go onto a site like transgendercare.com it gives ideas which I'd, personally, consider high dosing. So by that token 'low' would be something like a third of that I'm guessing? Or are we talking here really micro dosages?

Hi Richenda. I do not believe there is a formal description for low dose. Luna Nyan proposed the following which captures the essence of a low dose application.

Low dose HRT could be defined as the administration of cross gender hormone therapy at a dosage far lower than that which would be considered optimal for transition for an individual.  This may be for therapeutic purposes (relief from gender dysphoria) or diagnostic purposes.   Dosages would be considered 1/2 or lower that which would be usually used in a transition situation.

Again, I am not aware of standard dosages; rather, it is working with your doctor to make small adjustments based on how you feel and desired level of changes.

[Joi]

IMO  The appropriate approach for admin. of cross sex hormone therapy is a starting dose that is quite conservative.  That's what I found with my Endo.  One can always adjust upward after a few months and new lab analyses. I think most of us who have embarked upon this therapy are so anxious to get these "life saving" chemicals in our bodies and want to see the results ASAP are quite impatient.  I'm guilty of this. My Endo started me off with a dose & delivery system that was commensurate with my age. After 5 mos. I had experienced very little feminization although the Spiro is doing its job well.  He has now doubled my dosage and will evaluate again in 3 mos.

[Richenda]

I completely agree with the above and wish I had followed it, but perhaps I wouldn't have listened. That's me to a tee: being impatient for quick results. I've learned, and I hope others do, that it's far, far, better to start conservatively and then gradually increase as and when your endo is satisfied. So I concur 100% with the above.

I also think that if you do google dosages and find a prominent site giving details that their suggestions are potentially dangerous as starter dosages.

Go through an Endo. My mistake and without being too melodramatic, it could've cost me my life. Lesson learnt.

[islandgirl]

I have no idea what low medium or high dosages are. I listen to the direction of my endo. She started me off with spiro (7 months) and then very low E (4 months). She wanted to see how my system adapted to the drugs. Her main concern was to keep me healthy as I go through transition. I added dutasteride three months ago. Yesterday I finally am feel the burn! Pain in nipple area! Excited and hopeful that this is not just in my head.

[lisarenee]

If you research HRT there is a range of dosages most sources seem to quote and that matches what most transwomen I know are taking. I would consider "low" to be anything below this range and "high" to be anything above it. My starting dose was half of what those sources list and of what others I know are taking, so I consider myself "low dose". My Endo uses the term "low dose" when discussing my dosage, so it seems she agrees with my description. It (low dose) seems to be working based on lab results (T halved, E up 50%).

[Richenda]

I'm guessing most of you have seen this study suggesting low doses are just as effective?
http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2013.RE.12.MON-595

'We concluded that in MtFT subjects, lower estrogen doses than the ones recommended in the guidelines are effective to keep E2 and T levels at normal premenopausal women range, avoiding the use of higher estrogen doses potentially associated with several side effects.'

Interesting.

[Melanie CT]

Hi
It,s been 3 months on a low does of estrogen.  Not much has changed since last month. My nipples are a little sore but have not changed size. That is about the only physical thing I have noticed so far.

Emotionally I still feel better than before I started but the dysphoria is starting to come back. It's following like some of you mentioned. I spoke with my endo about how some people see the dysphoria come back after a few months and she told me it could be physical or it could be that things aren't moving fast enough and there are no changes. I am not sure what is happening with me.

I think if I talk with my wife more but I find it so hard. I know a lot of you say open communication is the key but it is so hard to talk about all of my feelings. So I'm back to feeling depressed at times. I know it's affecting her.  I went to Asia about a month ago and was very depressed while gone and she told me it gave her head aches and she was very worried about me. I have to get past this. I have to live my life which I thought I was doing for the first two months on HRT but now I feel like I going backwards.

Melanie


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[islandgirl]

Our  journeys along the path are often a roller coaster ride, with highs and lows along the way. I have been on HRT for over eight months and changes seem slow at times and others arrived quickly. Emotionally, I find that not being where I expected or wanted to be affects me negatively and often I find myself being depressed. My wife also goes through the same emotional swings. I know that the unknown, what the future will look like, and the worries of how I am doing, really affects her. All we can do is be there for each other, pick the times to have discussions, and for me, don't push her to hard. I am often surprised by her - she bought me beautiful ear rings, and pink carnations for my birthday, or chose a colourful top for me to try on. Other times we are not on the same page, such as buying shoes!

Stay true to yourself. Be patient. It sounds that your relationship is a supportive one. Look for those small openings to have discussions. All the best.

[KristinaM]

I can confirm the depression while on HRT for only a couple months.  For the last 2 weeks I've had bouts of depression over being stuck in boy mode at work and not being even remotely perceived as a girl out in public.  A lot of that last part is my doing though.  Not shaving, not wearing my bra, wearing boy clothes, telling them my real name, etc...  It sucks.  But!  I took my measurements again this morning and it's another half inch here and another half inch there, so the changes are happening and I'm reassured!

Still, as happy as I am to finally be on the right path in life, it does get depressing that I'm not able to go full time yet.  Mostly because of clothes and confidence.  I don't want people to look at me at work and say, "ahm, no, you're a dude, you look like a dude," when I tell them.  That would be utterly crushing.  So I wait.  I build my wardrobe, I work on makeup skills, I hang out with my girlfriends who only see me as Kristina, and I wear girl clothes around the house almost exclusively!  That is how I cope while I wait for the hormones to do their thing and for the right timing to come out at work.

Hang in there, talk about your feelings, they're important!  Even if not with your wife, or with your therapist, find a friend, a confidante who won't get irritated about you talking about it so much. 

[KayXo]

I'm guessing most of you have seen this study suggesting low doses are just as effective?
http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2013.RE.12.MON-595

'We concluded that in MtFT subjects, lower estrogen doses than the ones recommended in the guidelines are effective to keep E2 and T levels at normal premenopausal women range, avoiding the use of higher estrogen doses potentially associated with several side effects.'

Interesting.

In this study, the worst types of estrogen were used, those most likely to induce side-effects due to the fact they are not bio-identical and hence, remain in the body for a longer time. To group all estrogens together is incorrect as several studies have shown that bio-identical estradiol, especially if taken non-orally, even in higher doses, does not lead to all the mentioned side-effects. Androcur, ethinyl estradiol, conjugated equine estrogens have a stronger effect on prolactin secretion than bio-identicals as well. Unfortunate that the distinction is not made.

Measuring estradiol levels while taking those forms of estrogen is also inaccurate as equine estrogen and ethinyl estradiol are equally active, quite potent and not measured.

There are several problems with this research and as far as I'm concerned, this kind of research and assertions are doing a disservice to our community. All estrogens are NOT equal and in today's world, most of us take bio-identicals so this does not apply to us except perhaps in some parts of the world like Brazil.

[Lucie]

1. How long have you been on low dose and reasons for choosing low dose.

I have been on low dose oestradiol for a week (vivelledot, prescribed by endocrinologist). I have also been taking low dose dutasteride for 3 months (avodart, prescribed by urologist).
Given my age (I am 64) I don't envisage going to transition. However if I were much younger I definitely would go to F.T.
I hope that low dose HRT will stabilize my mind and calm dysphoria. I hope also that it will stop BPH (prostate enlargement).

2. Describe to what extent low dose has helped with dysphoria.

It's probably too soon to tell. I will report in a few weeks.

3. Changes with low dose.

Surprisingly breast/nipples tenderness has appeared after two days only. Also I sleep somewhat better.

4. If changed to transitioning dose, explain reasons for change as well as length on low dose before change in dose.

Not applicable.

5. Other thoughts.

First of all I thank all of you ladies for your contributions to the subject of low dose HRT. They helped me a lot in deciding to go for it.

Yesterday I read from several medical sites that oestrogens might take part in BPH. I am confused with that because I never heard anything about transgender or transsexual women suffering from BPH due to HRT.
The situation is rather tricky for me as regards doctors advices: I can't ask my GP because he has shown himself to be not open at all to gender dysphoria subject. Besides that I do not trust a lot my endocrinologist: she did not know that dutasteride may be prescribed as an AA in HRT for transgender women, and also she left me choose the oestrogens dosage. And as regards the urologist I am pretty sure that he will say that as long as doubt exists I should not take oestrogens even if their implication in BPH is a mere hypothesis and has not not been proven on humans.
Needless to say that I'll appreciate a lot any feedback or advice on this subject.

Finally I apologize for my english which is not very good. I thank you for your indulgence.

[RachaelAnne]

I'm now just about 8 months down low dose hrt road.  To my wife's worst fears I've developed steadily to a full A cup.
Not having had a hair cut for 21 months my hair is now down to my shoulders.

Given those changes and a slow change in my style of clothing to a more androgynous presentation...

I was confronted this week by a coworker (familiar with the signs of transitioning) as to whether I'm transgender or not.  Two days later my wife was confronted about me by our children's pediatrician, telling her that when I brought one of our sons in for his checkup all the nurses and the doctor her self could tell.  Further, that she had more facial hair than me and that I wasn't going anyone.

Needless to say panic has set in with my wife and now is demanding that I decide if I going to continue our not.

The options she gave me were:
1 stop everything and go back to presenting clearly as male
2 continue down the transition path and divorce. With her desire to have me out of their lives forever.

They are my life, my everything.  When hit the wall and my GID was unbearable I started on the low dose path; she was fully aligned at that point.

I don't know what I'm going to do.  After 8 months my breasts are never going away.  I wouldn't want them to either.

Anyway I'm now (in very short oder this past week) faced with the decision which either way I lose.
[emoji22]

[KristinaM]

Maybe try looking at this a little more clinically.

Would you be able to live with yourself if you stopped HRT? Didn't it basically fix your brain?

Would you be able to live with yourself if your wife decides she can't be with you anymore? It's not like you're choosing to leave her...

It doesn't seem fair if she chooses to leave at this point, no, but two people are only together as long as they want to be (or have to be).

If you can't be a whole or happy person without HRT, that's a medical issue. If you can't be a whole or happy person without your wife, that's a social/mental/financial issue.

I really feel for your situation. My wife could say the same thing someday. I just hope I can take my own advice if that time ever comes, lol.

[Stochastic]

I know that many here have had difficult times as of recent. My thoughts are with you. 

I have not provided an update in a while because not much has changed. Low dose for 1.5 years. As stated previously, the physical changes have leveled off, and my measurements have remained the same in the last six months. A slight increase in spiro helped to keep male function under control, but that provided short-term relief from dysphoria.

Anxiety is still high, and it is difficult to separate the psychological from the biochemical. In other words, can HRT serve as a replacement for a transition? Is there underlying non-dysphoria related anxiety that also needs to be treated? Still trying to find the Goldilocks zone where I can manage dysphoria and have minimal impacts to my family. I will continue to tweak my treatments (meds and non-meds) and monitor the results.