T congruent with hysto/menopause?

[Jameson]

Hey guys,

I'm new here although I've been reading and getting up to speed for a few weeks. I can't thank you all enough for your candid conversations, it's really been helping me settle on some plans.

I'm an older guy and would really like to hear from some of the older folks or anyone with relevant experiences. I'm in the process of sorting out a medical situation that may well lead to my having a hysto. Assuming that is the case and I can get it covered by insurance I will get that done in the next few months. I am thinking in the direction of going low dose T for my HRT following surgery. I don't intend to do a full transition right away, though I do have plans for top surgery likely in the next two years.

I have two areas I would like input on:

1) Does anyone have experiences to share about going on T congruent with a hysto or standard 'man-o-pause' with no previous T usage?

2) I am thinking that low dose T for a couple of years IF it produces changes in my ability to build muscles, that it would be good to build chest musculature prior to top surgery; thoughts?

For reference I'm 53

Thanks up front for any input.

[Tysilio]

I started T well after menopause (I'm 62, and started about a year ago), and it's going fine. You'll need to work closely with your doctor, and it would be best to find one with real experience with this stuff, if you can, because what's a low dose for one person may be a high dose for another. There's a lot of variation in how people react, and there's not much actual data on men who transition later in life. I see my doc about every three months, and she monitors my blood work very closely; more for things  like liver function, cholesterol level, and such than for the actual T level. It's hard to predict how T will affect an individual, but even on a low dose you're likely to get some permanent changes fairly early, most notably your voice; but you can stop if you find you don't want to go past a certain point. If you do stop, though, any gains in strength and muscle mass will eventually be lost.

Anecdotally, and based on my own experience, it seems that changes from T happen more slowly for older guys than for young ones.  And given that bio men tend to lose muscle mass as they age, that may be one of the harder things to change. I know I have to work out pretty hard, and very regularly, in order to see gains in that department.

[Alexthecat]

You don't have to work out your chest prior to top surgery, it just helps some surgeons see where to cut better. It is just good to be fit and the right size so you do not have weight fluctuations. One of my friends developed dog ear like things because he worked out prior to surgery then gained more weight later.

[Jameson]

I started T well after menopause (I'm 62, and started about a year ago), and it's going fine. You'll need to work closely with your doctor, and it would be best to find one with real experience with this stuff, if you can, because what's a low dose for one person may be a high dose for another. There's a lot of variation in how people react, and there's not much actual data on men who transition later in life. I see my doc about every three months, and she monitors my blood work very closely; more for things  like liver function, cholesterol level, and such than for the actual T level. It's hard to predict how T will affect an individual, but even on a low dose you're likely to get some permanent changes fairly early, most notably your voice; but you can stop if you find you don't want to go past a certain point. If you do stop, though, any gains in strength and muscle mass will eventually be lost.

Anecdotally, and based on my own experience, it seems that changes from T happen more slowly for older guys than for young ones.  And given that bio men tend to lose muscle mass as they age, that may be one of the harder things to change. I know I have to work out pretty hard, and very regularly, in order to see gains in that department.

Thanks Tysilio, I was hoping you'd be one of the ones to weigh in. I'm okay with the voice change, already told I'm fairly low. I don't want to get into things like baldness or some of the other changes right away. I would need to have a firm decision on how far I was going to go before I got into that. I know it's a genetic grab bag, but I had hoped that going slow and low, maybe start with a gel or something, would help with speed of changes.

I have found a trans friendly general practice Dr to act as a sort of project manager for this whole process and a few other unrelated catch-up items. I meet with that Dr for the first time early next month and hope she can order labs, recommend a knowledgeable endo, etc.. I have a line on a surgeon (gyno) but am hoping the Dr will be able to find out more about that person for me or recommend an alternate.

You bring up an interesting point about the muscle mass and older guys being hard gainers. I was under the impression that some older bio-guys will seek out hormone supplementation for their own "fountain of youth" (for lack of a better term) so that they can maintain younger T levels to stay in good shape, have you heard anything like that? I don't need to pick up a lot of bulk or quickly, my thinking was that of providing sort of a 'cut here' line of tissue so that the eventual top surgeon would be able to do the best job.

Thanks again for the input, exactly what I was looking for. 

[Jameson]

You don't have to work out your chest prior to top surgery, it just helps some surgeons see where to cut better. It is just good to be fit and the right size so you do not have weight fluctuations. One of my friends developed dog ear like things because he worked out prior to surgery then gained more weight later.

Thanks for the input Alexthecat. I already have dogears from losing a substantial amount of weight a few years ago. I was hoping that I could have a surgeon address that as part of the general reconstruction. I hadn't thought about weight fluctuations in the future ('cause we'll all have some) being uneven. I was supposing that after reconstruction weight gain or loss would be along the lines of what a bio guy would experience. Is it different because of the surgery?

[Tysilio]

Yeah, if you're going to use T, many surgeons like you to start six months to a year before top surgery in order to get more of a "cut here" line.

I don't want to get into things like baldness or some of the other changes right away.

Baldness can take a while, although that may be another thing that depends on how old you are when you start. My hairline is receding noticeably -- I'd hoped it wouldn't start for a couple of years, at least, but so far I'm minding it a lot less than I thought I would. That, some facial changes, and the "man voice" mean that I'm read as male nearly all the time now, and that feels wonderful.

I was supposing that after reconstruction weight gain or loss would be along the lines of what a bio guy would experience. Is it different because of the surgery?

I'd think that the scars (especially from DI) would make for unevenness in fat distribution, just because scar tissue is so much less elastic than normal skin: with weight gain, you'd tend to develop a "roll" bounded by the scar, and if you lost enough weight for skin to sag, the scar would define the "saggyness" in that area. At least the saggy skin does go away over time unless the weight loss is really fast, and massive.

[Jameson]

Yeah, if you're going to use T, many surgeons like you to start six months to a year before top surgery in order to get more of a "cut here" line.

That's good to know, I know some guys do top surgery with or without T but didn't know that there was a guideline for one way or the other.

Baldness can take a while, although that may be another thing that depends on how old you are when you start. My hairline is receding noticeably -- I'd hoped it wouldn't start for a couple of years, at least, but so far I'm minding it a lot less than I thought I would. That, some facial changes, and the "man voice" mean that I'm read as male nearly all the time now, and that feels wonderful.

Since I am planning to wait a couple of years to decide whether or not to go with a full transition the balding part of it is a major concern for me, I would be alright with it if I was fully passing. I look to my father and grandfather (no siblings) to get an idea, and both started an overall thinning in their mid-fifties. Yikes! I would like to have a classic hairline and facial changes but of course I don't get to pick and choose. Conversely, I think it would be terrific to have the male voice. I don't mind the idea of that as a permanent change and then I would be able to 'try on' passing in phone interactions.

I'd think that the scars (especially from DI) would make for unevenness in fat distribution, just because scar tissue is so much less elastic than normal skin: with weight gain, you'd tend to develop a "roll" bounded by the scar, and if you lost enough weight for skin to sag, the scar would define the "saggyness" in that area. At least the saggy skin does go away over time unless the weight loss is really fast, and massive.

That's a good point. My loss was both massive and really fast so I have experience with extra skin and will likely deal with a couple of other trouble spots along the way. I suspect that I will have an even more significant issue with the 'roll' aspect as a result of having already stretched things and possessing a more than average 'sagginess'. I know from the last couple of years I have to be extra vigilant about any fat regain.

[Tysilio]

Yeah, if you're going to use T, many surgeons like you to start six months to a year before top surgery in order to get more of a "cut here" line.

That's good to know, I know some guys do top surgery with or without T but didn't know that there was a guideline for one way or the other.

The surgeon whose work I'm most familiar with (I know several people who've gone to her for top surgery, and I have a consultation with her next month) will do it either way -- she's happy to work on people who don't intend to use T, but if someone does plan to, she likes them to start at least 6 months pre-op.