what hormone regimen is best for post-op woman?

[teresita]

Hi all, I hope you are all well.

I have a question for you. This is a dilemma. Now, I have ALREADY asked a few doctors about what I am going to ask here and I got very conflicting opinions, so, I will ask here. I know you can't give medical advice, this is just a question about YOUR experience and YOUR opinion.

I am post-op and I have stopped estrogens a few weeks ago because I was only getting the bad side effects. Since I have stopped estrogens, I feel much better, my body looks slimmer, I am less puffy, less flabby/sagging (despite working out a lot). However, what is the lowest amount of estrogen one can take post-op? To be honest with you, after evaluating the pros and cons, hormones have certainly given me a slightly better skin, but, to what price? Water retention, skin is much thinner and prone to injury, collagen fibers very weak, veins show through, much, much, much harder to lose weight. Virtually impossible to keep fit and firm, tight, despite working out 6 days a week. I tried different type of hormones (premarin, estradiol valerate). I stopped the hormones, and, bang, everything gets better: better metabolism, better ability to concentrate, body contours are firmer and nicer, less cravings. So, I am between a rock and a hard place because I am trying to figure out what is the sweet spot to avoid remasculinization and losing the very few benefits that hormones have given me. Thanks a lot

[Serenation]

post op hrt is basically to stop early onset menopause. So it would depend on your age what is appropriate levels. You don't want to mess up your bones. Your endo should be able to adjust your dosages to get you in a the lower end of an acceptable range.

Having more fragile skin and being less responsive to exercise is just part of being female.

[teresita]

Having more fragile skin and being less responsive to exercise is just part of being female.

Exactly. Too bad that women can get away with that since they have a female bone structure whereas, fragile skin and being less responsive to exercise in someone born male, with a male body structure, is not ideal. I feel as if I lost without gaining. The loss (fragile skin and being less responsive to exercise) was not counterparted by any gain (no change in the body structure, still masculine body structure.

[Jenna Marie]

You shouldn't have a problem with masculinization post-op, because you no longer have the ability to produce T at male levels. So a post-op trans woman is the same as a menopausal cis woman, in terms of needing at least a little sex hormones to keep the body working and prevent bone loss.

Personally, I was on a very very low dose pre-op and I stayed the same afterward (my dose is within the range of what's prescribed to cis women in menopause, in fact). If you're looking only for the very minimum, you probably do want to inquire about what is prescribed to a cis woman to fend off the worst effects of menopause.

[galaxy]

PostOP I have the same dosage estrogen like ppreOP and I also have to take Androcur again because my T is to high. My "masculinization-factor" was preOP better. Dont know why, but after surgery a got hairloss, very unclear skin and lots of new hair on the body. Doctor has no answers.

[AnonyMs]

I was curious and asked my endo about post-op estrogen, and he keeps the blood levels the same as pre-op.

Regarding high T, it doesn't seem to be commonly known, but Suporn's Post Op Care book says (edited)

In most cases, post-operatively there is no need to continue anti-androgens post-operatively.However, in some cases (about 5-10%) patients find that unwanted male characteristics can returnimmediately post-operative. ... The solution is simply start taking anti-androgens again at the same rate as one was taking pre-operatively for at least 3 months, and then gradually and steadily reduce the dosage of anti-androgen until at 12 months post-operatively the dosage can stop.

You can find it with google if you want.

I've seen other medical references say much the same.

[galaxy]

I know this - Suporn was my surgeon ...

I some case LH/FSH-section rises and it causes higher T. But my LH is nearly 0 and my T is in a good range. But for my defect hormone balance its to much! The paragraph from this handbook dont explain my own situation.

[Lady Smith]

Years on Premarin made my skin fragile to the point where I was getting very worried about it, but now I'm on Climara patches my skin has improved a lot. Premarin would also cause me to get into cycles of water retention and then having to constantly pee which isn't happening now I'm on patches.  I haven't had GRS, I had an orchie done, but the final effect is the same.  It's going to take some time for your body and metabolism to adjust post-op and finding the right HRT that will suit you best may take a little fine adjusting before you hit the sweet spot.

With Spiro I had to gradually adjust it down to a smaller dose post-op.  Excessively dry and flaky skin was the clue that my dose was too high and it did take some months before the right dosage to suit me was found.  After I changed to patches my Spiro needed to be adjusted again too.

[AnonyMs]

I know this - Suporn was my surgeon ...

I some case LH/FSH-section rises and it causes higher T. But my LH is nearly 0 and my T is in a good range. But for my defect hormone balance its to much! The paragraph from this handbook dont explain my own situation.

Sorry, I misread another post.

Have you tried an endocrinologist? I have one who specializes in trans medicine his expertise is very impressive. Way more knowledge than any GP I've met.

[Catherine Sarah]

Hi Teresita,

From what you've described, it probably worth the effort to be checked out by an Endocronologist. There may e a thyroid condition in the making here. You'll only ever know after a full blood lab including your T3 & T4.

You should always check with your PCP especially anything concerning side effects. They can be the precursor for other issues.

Check it out and see how you go.

Speak to you as soon as I've finished my night cap.

Huggs
Catherine

[Laura_7]

-imo estrogen should be in the normal female range. Not below, like in the menopausal range.
The neovagina reacts to estrogen like a cis vagina. Estrogen levels above the menopausal level should help avoid atrophy.
There are even reports of some women regaining depth after dilation and having sufficient estrogen levels.

-You might add bioidentical progesterone. Cis women also have bioidentical progesterone.
It has some anti androgen effects and might help with rounding of breasts, and mood, and counter some side effects of estrogen.

-its possible some glands produce testo, because a feedback mechanism reports low testo in the system. It might take some time for this to taper off. Testo should not be zero though, in cis women some testo is also present. It can help with orgasmic ability and overall drive. There are some forms of small dose testo applictions available for menopausal women for example.

[OCAnne]

Hello Everyone, post SRS my Estradiol Valerate level was at least doubled.  I no longer take Sprio, my thin, dry and flaky skin issue disappeared.  Oh and no frequent need to pee.
Urologist who preformed the surgery alongside Dr. Sinclair prescribed Finasteride to deal with possible prostrate infection.  He said I can stay on it to deal with any other T blocker needs, such as DHT.  Even though I don't have a hair loss issue.  Also back on bioidentical progesterone which I stopped taking 5 months prior to SRS.

Since SRS my development has really kicked into high gear.  Skin is much softer and pore size greatly reduced.  Breasts are growing with no weight gain.  The increase of Estradiol Valerate has amplified results.  I also feel much more frisky!

Not sure a minimum dosage approach would help me feminize or keep what I have achieved.  But I was only on HRT 9 months before SRS.  Age could also factor in.  I'm old and need all the help I can get!  As they say YMMV.
Thank you,
Anne

Added: Estradiol Valerate via injections.

[Laura_7]

Hello Everyone, post SRS my Estradiol Valerate level have at least doubled.  I no longer take Sprio, my thin, dry and flaky skin issue disappeared.

Yes, this is a hrt without anti androgens. Its only considered safe with implants and injections.
An estrogen level well in the female range can drive down testosterone into the female range as well.


hugs

[teresita]

What does it mean LH and YMVV and LHS? I am confused by all these acronyms, sorry, and it is hard to follow.

Anyway, thanks for all the responses. LIke I said numerous times, I have ALREADY checked with MORE than one doctors. I have ALREADY had my tests done, but, I still wanted to ask YOUR opinion, here on these boards, regardless of what the doctors said. So, I reiterate that I have ALREADY Checked with doctors and got conflicting opinions, that is why I am here.

LH/FSH I have no idea what that is.

One poster mentioned remasculinization. To what degree, apart from having more hair? I saw NO improvement from hormones in my facial appearance. If anything, they made my facial appearance worse (more puffiness on an already masculine skull is not an ideal situation). I had to have FFS to see some results.

Also, some Post-op women take testosterone supplementation to help with sex drive, metabolism etc.

I checked my thyroid and everything is fine. I know it's the HRT that is causing the problems.

PS: may I ask you all a favor? Can you please avoid to tell me to check with my doctor? I have ALREADY done that numerous times. I am here to hear about YOUR experiences and YOUR opinions.

[Laura_7]

One poster mentioned remasculinization. To what degree, apart from having more hair? I saw NO improvement from hormones in my facial appearance. If anything, they made my facial appearance worse (more puffiness on an already masculine skull is not an ideal situation). I had to have FFS to see some results.

Also, some Post-op women take testosterone supplementation to help with sex drive, metabolism etc.

I checked my thyroid and everything is fine. I know it's the HRT that is causing the problems.

Here is a study showing that bioidentical progesterone can have som anti androgen effects:
https://www.susans.org/forums/index.php/topic,192953.msg1733564.html#msg1733564

In summary, its a system with a few variables.

You might think about:
-estro levels high enough, well in the female range, maybe even high enough to drive down t into the female range.
-t should be in the normal female range, not above. Cis women do not have much masculinization by this.
-bioidentical progesterone could act as a support with a few effects

Imo its in the mix.
How much of each component should be tried out, people react differently.
And if after some time t levels produced drop doses can be adjusted.

There are not many people really very versed with this.
Many for example do not know all effects of bioidentical progesterone... like helping with breast form, and parts of the breast tissue...


hugs

[teresita]

Thank you.

One important thing that we have to mention here is that we do NOT have the same receptors as genetic females. So, saying that testosterone in genetic women is within a certain range, doesn't mean much in the case of someone who is XY genetically (male).

To sum up, genetic women have different receptors and respond DIFFERENTLY to estrogens. That is why so many trans-women on HRT do not get much benefit from HRT.

Also, I use this example to explain something. Our body is like a car. Our engine can be designed to work with fuel or with diesel. Even after SRS, our body (our car) is still designed to be working with the same fuel it was designed for. That is why, the SAME amount of testosterone in a genetic woman does NOT have the same effect on a neo-woman like me. It is a slippery slope and that is why I am constantly researching and it's a process of trial and error

[Jenna Marie]

Teresita : I apologize, then; you should disregard my experience above. I've been told by several doctors now that I do have the same estrogen receptors as a cis woman. (I don't see any reason why this wouldn't be true of any trans woman, but I won't argue with you about your own body and neither of us knows for sure about anyone else's.) That's why I was successful on a dose of estrogen low enough to be supplemental even for a cis woman (and no anti-androgens at all), and presumably that responsiveness means my post-op experience is not applicable to your situation.

Sorry about that.

[Laura_7]

Thank you.

One important thing that we have to mention here is that we do NOT have the same receptors as genetic females. So, saying that testosterone in genetic women is within a certain range, doesn't mean much in the case of someone who is XY genetically (male).

To sum up, genetic women have different receptors and respond DIFFERENTLY to estrogens. That is why so many trans-women on HRT do not get much benefit from HRT.

Also, I use this example to explain something. Our body is like a car. Our engine can be designed to work with fuel or with diesel. Even after SRS, our body (our car) is still designed to be working with the same fuel it was designed for. That is why, the SAME amount of testosterone in a genetic woman does NOT have the same effect on a neo-woman like me. It is a slippery slope and that is why I am constantly researching and it's a process of trial and error

Well transgender people are already a mix.

Especially the comparison with diesel was given as how transgender people react to hormones:
one person described it as a diesel engine running on gas... and finally being switched back to diesel...
thats the relief effect many transgender people feel...

and quite a few transgender people outgrow their siblings concerning boobies...
it simply takes time, cis people need 5-10 years to grow...

also quite a few docs are conservative...
when switched for example to injections or implants and the right dosage quite a few people had good results...

imo part of it is also in the mix.
Its in some way similar to vitamins.
When using vitamins from non natural sources a multiplication factor is needed. Why ? The vitamins are the same. But in fruit there are additional substances which help the body to accept the vitamins.
Same for sugar by the way. Refined sugar cannot be built down by the body soon because additional substances are missing. So it stays in the circulation for quite some time, making for an addiction like effect.

So a proper mixture of hormones which are also present in cis people, namely bioidentical estrogen, bioidentical progesterone and testosterone should be beneficial.

People are different so different mixtures hve some different effects. Someone said endocrinology is the adaption to patients reactions.


hugs

[teresita]

Laura, thank you very much. Your posts are very informative. I appreciate. If sometimes I am considering a viewpoint opposite to yours it is NOT, in any way, to confront you or anyone else. I see this exchange as an educational dialogue so, it is important to consider ALL factors and ALL circumstances, even the ones that contradict another poster's viewpoint. If it is done politely, like we are doing here, it is very beneficial.

Thansk again

Well transgender people are already a mix.

Especially the comparison with diesel was given as how transgender people react to hormones:
one person described it as a diesel engine running on gas... and finally being switched back to diesel...
thats the relief effect many transgender people feel...

and quite a few transgender people outgrow their siblings concerning boobies...
it simply takes time, cis people need 5-10 years to grow...

also quite a few docs are conservative...
when switched for example to injections or implants and the right dosage quite a few people had good results...

imo part of it is also in the mix.
Its in some way similar to vitamins.
When using vitamins from non natural sources a multiplication factor is needed. Why ? The vitamins are the same. But in fruit there are additional substances which help the body to accept the vitamins.
Same for sugar by the way. Refined sugar cannot be built down by the body soon because additional substances are missing. So it stays in the circulation for quite some time, making for an addiction like effect.

So a proper mixture of hormones which are also present in cis people, namely bioidentical estrogen, bioidentical progesterone and testosterone should be beneficial.

People are different so different mixtures hve some different effects. Someone said endocrinology is the adaption to patients reactions.


hugs

[Debra]

Having more fragile skin and being less responsive to exercise is just part of being female.

Exactly. I've also noticed estrogen makes it easier to gain fat esp in certain areas (lower belly). I just take that as being female and move on.