Off HRT, what to expect?

[iKate]

I'm having surgery in a couple weeks and I had to stop taking E. What's going to happen? I've been on a full dose for 6 months now.

I already feel like crap, have a bit of a headache and feel not so nice. Hot flashes are next?

[katrinaw]

Hi Kate,

I have had 2 breaks, one for about 3 weeks the other for about 6 weeks, both were well past the 3 or 4 year mark... I just felt a little snappy and a slight shrinkage in boobs on second break... nothing more than that.

L Katy 

[Starfire]

I understand that one needs to be off E for a couple of weeks prior to surgery due to increased risk of clotting.

It is pretty typical they also want you off spironolactone due to interference with vasopressors?  Would there be any issue with other medications like finasteride or dutasteride?

Hang in there Kate, I hope you feel better soon.

[Laura_7]

I'd ask the surgeon.

You might also ask about this, its from another thread :

From what I understand the stopping ... refers to orally,  if you on patch,  pellet,  or injection you can continue,  at least from my instructions ...


maybe it would be possible to switch for a few weeks to the patch, you can ask your endo and surgeon about it.


*hugs*

[Jenna Marie]

I was off for 3 weeks before and about two weeks after GRS. I had some anxiety and depression - though the impending surgery could account for that - and the "man smell" came back (ugh!!!) and my genitals regained their original size (even more ugh), but otherwise I didn't notice any significant symptoms. And the changes reversed themselves within the first week of going back on E (well, obviously I'd fixed the genitals thing permanently, heh).

Weirdest part was the hot flashes didn't start until *after* I was post-op, but even then it was only for a couple days at most.

Laura, it may depend on the surgeon, but Brassard was quite firm that even patches had to be removed. I'm not surprised; cis girls on birth control sometimes have to stop for major surgery too, and they're on relatively much lower doses than most of us. Something about E provided from outside the body, even in very low amounts and/or via the liver-safe routes like patch/injection/implant, increases clotting risks.

[KayXo]

Laura, it may depend on the surgeon, but Brassard was quite firm that even patches had to be removed. I'm not surprised; cis girls on birth control sometimes have to stop for major surgery too, and they're on relatively much lower doses than most of us. Something about E provided from outside the body, even in very low amounts and/or via the liver-safe routes like patch/injection/implant, increases clotting risks.

Birth control is not the same as patches. Birth control, firstly, is composed of an estrogen that is not bio-identical and that increases clotting to a great extent. Also, it typically contains a progestin, again NOT bio-identical that sometimes also increases clotting or has adverse effects on blood vessels. Birth control is also taken ORALLY, where a higher concentration goes through the hepatic portal vein, where clotting factors are modified.

Patches, on the other hand, contain BIO-IDENTICAL estradiol (with a much weaker effect on clotting), the same estradiol that is produced by ciswomen's bodies. They deliver estradiol right into the blood (not ORALLY, much less goes through portal vein), exactly like ciswomen. So, in essence, there is absolutely no difference between bio-identical patches or getting estrogen directly from inside the body (i.e. ovaries), in terms of delivery or type of estrogen. Everything is the same. Studies with men who had prostate cancer, whose age ranged from late 40's to up to 91 (age increases risk of clotting) were given a high dose of patches and yet no clotting complications were observed, which is not surprising. In fact, researchers asserted it might be protective.

Ciswomen can go through surgery and yet have estradiol running through their bodies. If these women aren't  told that they need to cease ovaries's production of hormones, then I wonder why transwomen are told to stop patches. I'm not a doctor but just makes no sense to me.

I continued taking estradiol and progesterone before and after surgery. No stops.

As always, verify this info with doctors and see what they have to say about it. Just expressing my opinion on the subject matter.

[Jenna Marie]

Kay : Yes, all I can say is that I trust the surgeon. No offense to you, but in general it's wiser to comply with the surgeon's requirements (if for no other reason than that they may well reject [or eject!] a patient who does not).

[KayXo]

I agree but there is no harm in discussing this matter with them and asking for reasons, explaining what I have explained and seeing what they say. They might agree with the reasoning and change their minds. It's all about being proactive in one's health under a doctor's supervision.

[FTMax]

I had to stop testosterone for surgery, and while different I'd assume it's a largely similar experience.

Personally, I didn't revert it at all. I didn't have any new gains (voice didn't deepen anymore, no new body hair, no new anything, etc.). The first week was fine, though I was anxious. The second was terrible. Couldn't focus on anything, didn't want to do anything, absolutely no motivation.

The worst was finding out the morning after surgery that I had to wait another week to resume HRT. Nothing bad happened physically, and I was riding a post-op high, so feeling a bit better, but I was still getting frustrated faster and having a lot of body-related anxiety.

[ainsley]

Laura, it may depend on the surgeon, but Brassard was quite firm that even patches had to be removed.

Jenna Marie, how did he tell you this?  I have my conf. letter, and the info packet, the contract, and everything done (payment, labs, etc.) and am all set to go in 2.5 months and they have not mentioned to me once about stopping.  I am curious if I a missing it somewhere, or if they tell you closer to you date?

[mm]

 Jenna Marie, your genitals must have wanted to have last show of how they can pro form before you have them gone forever.  My understanding once you girls were on E and AA for a few years your original equipment was hard to get working again.  When the hormone levels in our bodies changes we can get various reactions and not the same for each one of us.

[Jenna Marie]

Ainsley : It was a couple years ago now, so it's also possible that things have changed. But as I recall, the info packet basically said "no medications except what's on the following [very short] list without the doctor's explicit permission." I didn't write to them to ask for an exception - I didn't have any reason except not wanting to do it! - and the nurses confirmed that I was not allowed back on my patches until I left the residence to go home. They knew I was using patches, too.

Actually, the packet specifically said not to even *bring* hormones... I admit I did have my wife smuggle one patch along with us, but when the nurses said no, I didn't risk it.

I don't think I kept the paperwork anymore, or I'd try to look it up for you.


mm : I guess so! It was the weirdest thing. I had assumed the shrinkage was permanent, and I was not pleased to find out otherwise, even if it was basically moot by then.

[ainsley]

Argh!  I cannot find any mention of stopping meds in the info packet or anything.  I hate to rock the boat and ask them, but at the same time I better make sure because I don't want to not stop taking them and have that be a deal breaker.  What a dilemma!  I guess I will write and ask.

I did notice on Dr. Bower's website FAQ that she says it is no different than a cis woman having gyno surgery, and she doesn't requires the stoppage:

Do I need to discontinue my hormones prior to GRS?

The time-honored dogma for patients undergoing vaginoplasty is that estrogens increase the risk for blood clots and that all hormones must be discontinued. This suspension of hormones leaves patients moody, depressed, achy and overall not feeling well around the time of surgery. On the other hand, we do not stop hormones or birth control pills in natal women undergoing gynecologic surgery. My feeling is that those same rules can apply for our patient population so long as we drop doses as low as possible. Such has been our philosophy since 2003 without incident. We do not interfere with those who have already discontinued their HRT on the advice of their home physicians or specialists. Dropping the dose as low as possible 4 weeks prior to surgery is our current advice except in patients with higher risk.

Maybe the times have changed....?  I'll find out.

[iKate]

It is pretty typical they also want you off spironolactone due to interference with vasopressors?  Would there be any issue with other medications like finasteride or dutasteride?

No. They just said "female hormones" which meant E. I'm still taking spiro. This is Dr Kim in Korea for the voice surgery, not GRS.

[iKate]

Well it's clear I'm shrinking. My boobs stopped hurting. Just a few more days...

[Rachel]

Good luck and hang in there.

In an few weeks you will be back on your meds and the temporary regression will be gone.

[iKate]

Good luck and hang in there.

In an few weeks you will be back on your meds and the temporary regression will be gone.

I may be back on as soon as Friday or Saturday next week.

It's a little sacrifice now but the surgery will give me what I need (hopefully) to help me deal with the world. I keep my eye on the prize.

But oh wow, it's really hard feeling your bra feel just a wee bit looser and watching yourself shrink in the mirror.