MtF HRT not doing any changes so far

[Jessica514]

So I'm 28 and I've been on HRT for 8 months (Androcur and Estrace increasing every 3 months) and apart from the usual skin softening and body hair thinning, I've seen no changes whatsoever. My endocrinologist says my levels are very good: T levels are around 0.6 and Estrogen levels around 260 and says my blood is now completely female. I have seen probably a hundred Trans timelines and I probably look more like the average MtF at 1 or 2 months HRT. And those changes were actually in the first 2-3 months, since then nothing. I think I was getting more changes on lower dosages of E, does that make sense?

I took measurements all over my body every 2 months: thigh, hips, waist, band size, bust size, shoulder width, bicep, forearm and waist to hip ratio. I haven't seen any changes in muscle, fat redistribution, facial rounding, etc. I went under my BMI before HRT to lose most of my muscles (which worked) and now am trying to gain fat through a very caloric but healthy Mediterranean diet (lots of good fats and good proteins, no chips, no candy, no ice cream, etc, just good stuff). I do cardio every day to be at my absolute healthiest and body-weight calisthenics for my thigh/hips/core to change my male body shape -I did gain muscle in those areas but no fat. My weight usually oscillates between 136 and 138 pounds on a weekly basis and I am 5'8". I must eat around 3500 to 4000 calories a day (good and natural calories!) and can't gain more weight... Actually the more I eat, the more I "go to the bathroom"... I have always been either skinny or muscular but never fat. Maybe it's genetic? Also, I use a fitness heart rate monitor and apparently I burn around 2000 calories for metabolism and 1000 for exercise, daily. Oh and my diet is very very rich in proteins: tons of black/kidney beans in everything, vegan protein shakes every morning, lots of lean meat, fish, etc. Maybe this prevents muscle loss?

So I am wondering. Am I doing something wrong? Or maybe I'm doing too much? Am I making my already fast metabolism faster (therefore worst for HRT)? Whenever I do gain weight it seems to be going back in a male pattern: all on my belly. Like if my body says: I got enough everywhere.

I'm not all about appearances, I mostly wanted to document my changes and maximize them through healthy behaviors. But I am seeing absolutely no results! Which annoys me because I am doing all this to help my HRT, not ruin it. I should at least see small changes after 8 months right? Overall I mostly need to lose shoulder width because I was a body builder... So I am temporarily trying a very unhealthy diet to see if it would help speed up muscle loss and fat gain: high calorie, low protein (minimum to survive for my weight would be my max: 49g/day), high carbs & high fat.

I know puberty takes time, YMMV, genetics sometimes suck, etc, etc. But I am trying my best to help the hormones do their work, not screw them. So if any of you could point out if I'm doing anything wrong, that would be very nice!

Thank you

[Laura_7]

Here are some hints concerning phytoestrogen, which might compete with estrogen for receptors, making for a weaker effect:
https://www.susans.org/forums/index.php/topic,190328.msg1695279.html#msg1695279

normal amounts from time to time should be ok... I'd avoid large amounts...

you might think about adding bioidentical progesterone to compliment estrogen.
It has some anti androgen effects, might help with mood, even out some side effects of estrogen and might help with breast development. Non bioidentical progesterone does not have these effects.
https://www.susans.org/forums/index.php/topic,192953.msg1733564.html#msg1733564

it helps against dht, a strong version of testosterone which might prevent some feminization...

[Eva Marie]

Hi Jessica-

If you get a chance you should edit your post and remove the dosage information. That's not allowed here.

I noticed that your diet is kind of a fitness diet and since you used to be a body builder it makes sense that you would be attracted to eating that way. The problem with a diet like that when you are trying to feminize is that you are eating lots of lean healthy items and very little fat. Simply put - your body needs fat to create feminine curves.

With your new temporary diet I think that you are closer to being on the right track and you will soon see some results. Don't fear the fat - your body will store it in the right places.

If you are still working out I hope that you have moved away from lifting and are doing more aerobic stuff. Heavy exercise works against fat accumulation and redistribution.

[Jessica514]

Thank you both for your replies!

@Laura, I don't take phytoestrogens anymore (no flax & no soy) but maybe there is still some in my diet. I had a list of phytoestrogen rich foods somewhere, I'll check that out! The vegan thread was very interesting too. I will cut back on meat and proteins in general. As for the progesterone, I will check next time I see my endocrinologist.

@Eva Marie, sorry for the dosage info, I tried to be as specific as possible! I removed them. For the fat, I already eat tons of it: olive oil, avocados, milk, etc. But I will try cutting on proteins and adding carbs to my diet. For the weight lifting, I still do but it's only 10lbs ankle weights while I do body-weights calisthenics and aerobics - nothing "heavy" like when I used to before transitioning. I hope it doesn't "halt" muscle loss?

I was also thinking, maybe it's the Estrace itself than is inefective on me? Like if I change to another brand, to injections or patch it could help?

[Laura_7]

I was also thinking, maybe it's the Estrace itself than is inefective on me? Like if I change to another brand, to injections or patch it could help?

A said you might talk with your endo about dht levels.
This might also prevent some feminization.

Some people report better results on injections or implants.

A patch could be good to keep levels steady.
It might be used together with pills.
For effective levels some people need quite a number of patches.


hugs

[Eva Marie]

I was also thinking, maybe it's the Estrace itself than is inefective on me? Like if I change to another brand, to injections or patch it could help?

It's certainly possible, but thats something to discuss with your doctor.

You said that your blood levels were in the feminine range - that means that you are playing the waiting game now - the medical part seems to be correct and the only lever you have left is diet and exercise.

Feminizing is not a race - it takes time, and it tends to be quite subtle. Some get results quickly and some take a lot longer. We are also the last ones to see changes - it took a long time before I saw a chick when I looked in the mirror even though I know that others saw changes much earlier. We have been looking at the same face in the mirror for years and it's hard to see anything else - it's imprinted on our brains.

I know it's hard but waiting is what you have to do now.

[Devlyn]

Jessica, welcome to Susan's Place! We must be long lost sisters of the F-16 metabolism. I need at least 3,000 calories a day or I start losing weight. The good news? Devyl Dogs!    See you around the site!

Hugs, Devlyn

[Jessica514]

Thank you Devlyn ^^

Apparently there are phytoestrogens in black beans (which was one of my main source of protein), so I got that out of my diet right away. For the DHT and progesterone I will have to wait until my next endo appointment which is late January. For the muscle loss, I've cut back proteins to the minimum, ditched proteins shakes, stopped any kind of exercise and this morning my muscles hurt! Like if I had trained really hard yesterday! This is a good sign I guess. For about two weeks now I started taking my E pills sublingually** and OMG I swear the skin on my face as gotten better in the last days than in the last 8 months! My "breasts" also started to hurt again like they did in my first few months of HRT (before everything stalled). It's obviously too soon to be sure of anything, but that gives me some new hope

**http://transascity.org/sublingual-versus-oral-estrogen/

[Picklehorse]

You should check with your endo about the methods used to take your medications. Oral pills are not necessarily designed to be taken sublingually - doing so may significantly effect your dosages.

[Jessica514]

Yeah that's the point. According to what I've found so far, the percentage of Estrogen that ends up in the blood is about 5% if taken orally and around 25% sublingually and is not transformed in any way by the liver. Must be why I can actually FEEL the difference. I had to spread them over 24hrs instead of taking them all at night because it was too strong otherwise (felt so tired I became lethargic and depressed for a week). But yeah I got blood test soon and she will notice, unless it's all in my head D: placebo effect is strong! loll

[KayXo]

You say your estrogen level is 260. Are you sure it's not estradiol instead of estrogen because estrogen is the sum of estradiol (the strongest estrogen) + estrone (a weaker form of estrogen)? I'm assuming it is estradiol probably and since you are from Quebec (like me!), the measure is in pmol/L, so the equivalent of 71 pg/ml (divide by 3.671) for American readers. This level is typical of early or late cycle in ciswomen but the levels can range from as low as 20 to up to 640 pg/ml. Any number within that range is female! And pregnant women have levels as high as 75,000 pg/ml (or 275,000 pmol/l). You are on the low end.

At your levels, I never experienced much change so had to increase dosages orally significantly until I switched to injections where I feel and look better. I gained lots of weight, from a low 140 lbs at 5'6-5'7 (I was too skinny, especially in my face) to up to 160-165. The increased estrogen helped, it was obvious. I look more feminine, younger, have a rounder, fuller face, a BUTT!, more areola/nipple definition, etc. It sounds to me like perhaps the lack of estrogen is responsible for lack of weight gain/fat. Estradiol increases fat deposition in thighs, butt, breast, face, etc.

My latest level was around 2,500 pg/ml (9,000 pmol/L), typical of early pregnancy levels but started seeing changes at probably much lower levels but definitely higher than 200-300 pg/ml (700-1,000 pmol/L). These levels have not been shown to increase health risks, in fact quite the opposite, confirmed by various observations and studies. I have two endocrinologists (among them, a graduate from Cambridge and the other, an author of a book on female hormones) and a family doctor who are overseeing my treatment. BUT, each of us is so different on so many levels that we will react differently to similar levels.

Armed with this information, you can go see your doctor and ask if perhaps if a higher level (hence, dosage) could produce and be tried for better results or perhaps, if you switched to injections. I'm not a doctor but based on experience alone, I speculate your levels are too low for you. You need to confirm this with your doctor and only your doctor, work together to find what regimen best works for YOU.

Carbs also increase fat deposition as well due to the fact that they increase insulin, this is well-known by endocrinologists. Too much, however, can be harmful to one's health.

Good luck!

[Jessica514]

Awesome! I was looking for a reply as specific as that! I can't tell you much about the units, all I remember was she said 260 (something) and that it was a normal mid-cycle cisfemale level. Estradiol or estrogen I can't tell, but she says my levels are spot on. But yes I read somewhere that pregnant women's levels of E can skyrocket. I'll speak with her about this.

For the fat redistribution you talk about, well, it really isn't working for me. I did gain about a pound with my new diet (full of carbs) but it went ALL in my belly... sooo disappointing... I asked my endo for injections in September but she said they're not available in Quebec (??). Maybe she meant available for refund with the RAMQ. But I'm on private insurance so it wouldn't matter (Tho I have no idea if it's covered). How did you get them? Just got a prescription and went to your drugstore?

[KayXo]

Awesome! I was looking for a response as specific as that! I can't tell you much about the units, all I remember was she said 260 (something) and that it was a normal mid-cycle cisfemale level. Estradiol or estrogen I can't tell, but she says my levels are spot on.

pmol/L is usually the units of measure in Quebec and Canada. 260 pmol/L is definitely NOT typical of mid-cycle. My lab  shows mid-cycle levels to range from 315-1828 pmol/L and other sources show

- 734 to 2200 pmol/L
- 367 to 1626 pmol/L
- up to 2382 pmol/L


The more informed you are, the better you will be armed when dealing with doctors. They can make mistakes, trust me!

For the fat redistribution you talk about, well, it really isn't working for me. I did gain about a pound with my new diet (full of carbs) but it went ALL in my belly... sooo disappointing...

Carbs will do that, especially if you are low on sex hormones, as testosterone and estradiol inhibit fat deposition in the waist area. Cyproterone acetate (Androcur) can also promote belly fat.

I asked my endo for injections in September but she said they're not available in Quebec (??). Maybe she meant available for refund with the RAMQ. But I'm on private insurance so it wouldn't matter (Tho I have no idea if it's covered). How did you get them? Just got a prescription and went to your drugstore?

Not covered by RAMQ. Can be prepared by compounding pharmacy, two in Montreal which I find too expensive and unreliable because I have experience with them so I get mine from Toronto, Ontario and even with shipping, it's still much more affordable. Not sure it's covered with private insurance, I pay 100%, well worth the money. I feel much better than on pills or patches. I get my my needles, syringes from the pharmacy. I used to go to the CLSC to get my injections done but they trained me to do my own so I'm on my own now.

[Laura_7]

My latest level was around 2,500 pg/ml (9,000 pmol/L), typical of early pregnancy levels but started seeing changes at probably much lower levels but definitely higher than 200-300 pg/ml (700-1,000 pmol/L).

Do you need anti androgens then ? Usually with internal application like implants or injections it should not be needed...

and some people additionally take bioidentical progesterone... it has some anti androgen effects, it prevents some dht conversion...


hugs

[KayXo]

I am post-op, don't take anti-androgens but you're right, with injections, she shouldn't need anti-androgens which is great because they tend to have side-effects.

Bio-identical progesterone has not been found to have a significant effect on DHT conversion, I'm afraid the source you are basing yourself on tested at an extremely potent, supraphysiological level of progesterone (in the thousand of ng/ml while the highest levels achieved during pregnancy are in the hundreds, 100-400) which achieved 97% inhibition. So, we cannot reply on this to state that progesterone inhibits DHT.

[Laura_7]

I am post-op, don't take anti-androgens but you're right, with injections, she shouldn't need anti-androgens which is great because they tend to have side-effects.

Bio-identical progesterone has not been found to have a significant effect on DHT conversion, I'm afraid the source you are basing yourself on tested at an extremely potent, supraphysiological level of progesterone (in the thousand of ng/ml while the highest levels achieved during pregnancy are in the hundreds, 100-400) which achieved 97% inhibition. So, we cannot reply on this to state that progesterone inhibits DHT.

This is a different source:
Hair Growth/Hair Loss
Finasteride (Propecia/Proscar) was found to be a major inhibitor of dihydrotestosterone (DHT) formation. Even 1 nM finasteride inhibited DHT synthesis in dermal papillae by 86% and 1 nM progesterone by 75%. Estrogens were less able to inhibit the synthesis of DHT in dermal papillae ( e.g. 100 nM 17alpha-E: 20%; 100 nM 17beta-E: 60%). Measurements were made on cultures done from scalp biopsies with high-performance liquid chromatography analysis, which is why test levels are reported in "nanometers." [ As reported in the European Journal of Dermatology. Vol. 11, Issue 3, May - June 2001: 195-8,


hugs

[KayXo]

First, this is in-vitro so not necessarily applicable in-vivo. Second, we must find out how 1 nanometer of progesterone in the tissue compares to how much progesterone is concentrated in that tissue when individuals like us take progesterone. We must be VERY cautious before making conclusions and get into details, be precise and exact. An easier way would be to measure DHT levels before and after taking progesterone but even then, DHT levels in blood do not necessarily reflect DHT levels in tissue. Also, one must find out, if DHT levels do decrease, is it because it has decreased LH levels in men and pre-op TS women or because it has reduced conversion of T to DHT. If the latter, then T levels shouldn't have changed while DHT would have. See all the work involved before making definite conclusions???

[Jessica514]

So much science! I love this :3

So I searched for Estradiol units on many medical websites from Quebec and yes, it's all in pmol/L. That would explain why I'm only seeing extremely low results: because I have low levels! I'll ask at my next Endo appointment and pay attention at the units.

I also checked my next blood test prescription and it doesn't even test for DHT(?). Here is the list (I won't translate this part in English to avoid mistakes):

-Formule sanguine complete et differentielle
-Albumine
-ALT AST
-Estradiol
-FSH
-Ions (na+K+Cl)
-LH
-Prolactine
-Testosterone totale
-TSH
-Uree

I must wait another 2 months before I can see my Endo. I hope I'm not waiting for nothing (if I need to take another blood test for DHT and another appointment after that). >_>

So if I understood well so far, my Estradiol levels are feminine but are way too low. DHT may be interfering but only blood tests and analysis will tell. Progesterone might help but I'll try to get everything else right first. Injections probably could help a lot but would be costly (could you give me an approximate cost per month? I'd like to know if I can afford them in case my insurance doesn't cover it).

Overall that's great! I'm much less scared now. I was afraid that my levels were perfect and seeing no changes meant I was one of those rare, unlucky people who don't respond at all to hormones... It could still be the case, but if it's any of the things you mentioned, then that means there's still hope!

thanks a lot

[KayXo]

So if I understood well so far, my Estradiol levels are feminine but are way too low.

Perhaps and the range is so wide in women that whatever level you end up with will be in the feminine range. LOL! I personally think it's more important to find the dose that works best for you, disregarding either T, DHT, Estradiol or FSH levels. The dose at which you feel good and have good development.

Progesterone might help but I'll try to get everything else right first.

Good idea.

Injections probably could help a lot but would be costly (could you give me an approximate cost per month? I'd like to know if I can afford them in case my insurance doesn't cover it).

96 dollars for 5 ml of 20 mg/ml, hence 100 mg for $96 (this includes shipping). Cost per month or year will depend on how much you inject. I cannot state my dosage here.

there's still hope!

thanks a lot

I believe there is, considering your levels are in the low end.