Post-Op off all hormones for 4 years, Now worried about my health

[KayXo]

I just feel weak and unmotivated inside. I may actually be a little bit to lean. I have lost a lot of weight in the last year (I used to have a solid muscular build) and I eat a tonne of food per day.

This was exactly my situation when my hormones were low. As soon as I increased dose, later added progesterone, I felt energetic, started to feel happier, gained weight (my face was quite sunken, it filled up), butt came back to life and I looked younger than ever. Skin and hair were also more shiny, less dry, digestion improved, allergies (i.e. hives) significantly decreased. Not perfect but MUCH better.

also here is a TMI but I have 0 sexual satisfaction and I also feel T would help in that regard).

You'd be surprised what estrogen or progesterone, depending on the person, can do to libido. It's a mental thing too. Progesterone improves libido in some women while enough estrogen in others suffices. Again, in this regards, I really think T is not necessary.

I'm sure she will find that I have abnormally low testosterone. I will think about this long and hard though don't worry

Like I said, try E (an adequate dose) and possibly P if libido is still inexistent...if really, things don't improve at all, T, it is! It will be quite low, usually in the lower end of female range because you only have adrenal glands for testosterone while ciswomen also have ovaries.

hopefully my GP can give me the necessary tests (he really does not place much importance on my hormone levels

My doctors also don't think hormone levels are important. I agree. Your T will be low, for sure, anyways.

You simply need to find the right dose of E (perhaps non-orally) AND maybe progesterone FOR YOU, where you feel good, motivated, energetic, positive, have libido and your body responds appropriately.

Calcium doesn't actually increase bone density... muscle mass does. Bones have to be able to withstand your muscles without snapping. Bone density is always proportional to muscle torque. Older people don't get less dense bones because they all start neglecting calcium, they get frail bones because of muscle deterioration.

Testosterone doesn't actually increase muscle mass, per se, what it does is stimulate the release of growth hormones, which is what increases muscle mass, but estrogen also promotes the release of growth hormones, which is vital to muscle development. Without either hormone, less growth hormone is released, and muscle is lost, and by extension bone density.

Estrogen prevents bone loss by inhibiting bone resorption, the process by which osteoclasts break down and contribute to bone loss. Both men and women suffer from osteoporosis (more women because their bone density is lower and their earlier decline in estrogen) because of lower estrogen; men get estrogen through aromatase, where testosterone is converted to estradiol, for instance.

Of course, working out your muscles helps with this, as well, keeping active. But, most important, is your estrogen. I have high estrogen and my muscle mass (and strength) has greatly diminished over the years.

There are also all kinds of medications for prevention of bone loss given to mostly women after menopause but they usually come with side-effects.

[Elsa Delyth]

I didn't know that estrogen did that. It lowers the threshold of muscle torque to bone density proportions, so that women get higher bone density proportional to the same levels of muscle mass comparatively to men. So that, when women loss estrogen they loss the extra bone density, as the threshold proportional to muscle torque is increased.

That's interesting. Though, it just adds a dimension to what I said, rather than disagrees with it.

http://www.ncbi.nlm.nih.gov/pubmed/9437507

[Laura_7]

I personally would consider testosterone to be last resort as its side-effects can be devastating including lowering voice, even at 30, increasing facial/body hair, making one look more masculine, worsening scalp hair, producing acne. Some changes, such as voice lowering, are irreversible, others like facial hair might require additional investment into laser treatment and electrolysis. Acne could cause permanent scars. Each person responds differently to testosterone, some might be more sensitive...it's a BIG gamble, in my opinion.

Estrogen and possibly progesterone should first be looked into, I think...BUT, I'm not a doctor, it's up to your doctors to determine this. Just my 2 cents.

Yes of course first estrogen and progesterone...

but testo is also part of the package...
testo in the normal female range, below 60...
cis women usually don't have big effects of masculinization from this, apart from possibly thicker hair...


hugs

[Elsa Delyth]

You know what else increases bone density? Kitten purrs. It's true! You could always just get fifty fur babies and roll in them!

[Laura_7]

You know what else increases bone density? Kitten purrs. It's true! You could always just get fifty fur babies and roll in them!

Their purr has healing properties...
and its very relaxing 


hugs

[Dena]

Calcium doesn't actually increase bone density... muscle mass does. Bones have to be able to withstand your muscles without snapping. Bone density is always proportional to muscle torque. Older people don't get less dense bones because they all start neglecting calcium, they get frail bones because of muscle deterioration.

Testosterone doesn't actually increase muscle mass, per se, what it does is stimulate the release of growth hormones, which is what increases muscle mass, but estrogen also promotes the release of growth hormones, which is vital to muscle development. Without either hormone, less growth hormone is released, and muscle is lost, and by extension bone density.

I agree that calcium may not increase bone density but it can prevent the loss of bone density. There are teens with frail bone because they live on soft drinks and get little sun exposure. The body need calcium and if there isn't enough, it will withdraw it from the bank of bones. I take sufficient calcium in my diet so my body doesn't need to draw it from my bones and I move around enough to hopefully maintain bone density.

[KayXo]

but testo is also part of the package...
testo in the normal female range, below 60...
cis women usually don't have big effects of masculinization from this, apart from possibly thicker hair...

but ciswomen weren't exposed to high levels of testosterone for several years like us and didn't develop as men physically, our situation is quite different. It will depend on the person as well, their sensitivity but we are especially vulnerable to any sign of virilization and imagine for a moment, that our voice deepens...I personally wouldn't take that risk. Blending in with the rest of the population is important for me and there is no voice surgery at the present time to reverse this (i.e. resonance) succesfully and without risks. Too much of a gamble. Imagine suddenly losing head hair, having acne that leaves scars, being suddenly perceived as male by others after several years of passing as a woman, seeing yourself look more masculine, having to manage hair growth more intensively...anyways, personally, LAST RESORT.

I agree that calcium may not increase bone density but it can prevent the loss of bone density. There are teens with frail bone because they live on soft drinks and get little sun exposure. The body need calcium and if there isn't enough, it will withdraw it from the bank of bones. I take sufficient calcium in my diet so my body doesn't need to draw it from my bones and I move around enough to hopefully maintain bone density.

But you are already losing calcium from your bones due to lack of estrogen inhibiting bone loss so increased calcium is being broken down and transferred to blood. So really, by taking additonal calcium, you are essentially overdosing your body on this mineral and this may cause damage to other tissues in the long-term. I personally don't think it's wise. There is really nothing that can substitute the loss of estrogen.

[Dena]

Ok so just talked to my old endo... I can't get in with he for another year! GAH. I have no idea what to do now. hopefully my GP can give me the necessary tests (he really does not place much importance on my hormone levels)

Americans, I have a question (and excuse my ignorance about your medical system there). Is there a way I could just pay to get immediate care from an endocrinologist in  your country? or does it still take forever to go through a referral process and all that. I know it would be expensive, but I am willing to give up a few vacations to find out what the heck is wrong with me asap.

People who come to the United States are pretty common. Often people will come down from Canada because the time to get care is longer than they want to wait. The Phoenix area has several world class hospitals if you wish to escape the cold weather but the east cost hospitals are equally able to address your needs.

[Dena]

But you are already losing calcium from your bones due to lack of estrogen inhibiting bone loss so increased calcium is being broken down and transferred to blood. In essence, by taking calcium, you are overdosing your body on calcium and this may cause damage to other tissues in the long-term. I personally don't think it's wise. There is really nothing that can substitute the loss of estrogen.

Consider what you said. Children who haven't hit puberty are incapable of building bones because they lack the sex hormones to do so. Every menopause woman will have bone failure because they no longer produce estrogen.

I am not overdosing because with all diet sources included, my intake would be 1.5 to 2 time the minimum dose. I make sure I get at least the minimum intake of calcium and the rest comes from the part of my diet I don't count.

There is a trade off with estrogen where the risk of breast cancer goes up with long term exposure. I started estrogen at age 26 so that meant about age 50-55 I hit the normal feminine exposure. I need to be very careful with estrogen from now on because would rather not have to deal with cancer.

[KayXo]

Consider what you said. Children who haven't hit puberty are incapable of building bones because they lack the sex hormones to do so.

In children and adolescents, growth hormone levels are very high and they grow. Children build bone, form new bone, get bone growth, that is why they grow.

Every menopause woman will have bone failure because they no longer produce estrogen.

The loss of estrogen after menopause increases the risk of osteporosis and this can sometimes have fatal consequences for them.

There is a trade off with estrogen where the risk of breast cancer goes up with long term exposure.

Consider the following:

- breast cancer most often occurs in older women after the age of 40 and mostly after 50, when estrogen levels DROP
- in the WHI trial (randomized controlled) and a long-term Danish study (randomized controlled trial), estrogen alone, whether bio-identical or not reduced significantly and not significantly breast cancer. In both cases, a reduction, not an increase in breast cancers.
- it has been observed in ciswomen that the more births, the less risk of breast cancer. More births mean more time spent in pregnancy when estradiol levels are VERY high. In contrast to nuns who traditionally have a higher risk and never become pregnant.
- breast cancer risk has been deemed by one of the leading transgender experts (Gooren, Netherlands) to be insignificant in transsexual women and equal to that of men not ever exposed to exogenous estradiol. He has studied several thousands of transsexuals over the years (decades) and only observed a couple of cases recently. Only a handful of cases reported in the literature in the transsexual population since the treatment began. Thus, this risk is extremely rare in our population.
- Harry Benjamin, in his book, noted no breast cancer occurrences in his transsexual patients despite VERY aggressive doses, unheard of today. Also, his colleage, a urologist, treated several thousand men with prostate cancer with even more aggressive doses and never noted breast cancer.

So, it seems to me, from all this, that the risk is extremely low, insignificant and that estrogen could in fact be protective. Studies have been even undertaken to see whether women with past breast cancer taking estrogen would have increased recurrence as compared to those not taking anything and it was found that this was NOT the case.

The only times HRT was found to increase breast cancer risk was when Provera was prescribed, possibly because of its effects on insulin-growth hormone.

Taking estrogen, considering all this, seems more beneficial than harmful.

I started estrogen at age 26 so that meant about age 50-55 I hit the normal feminine exposure. I need to be very careful with estrogen from now on because would rather not have to deal with cancer.

This is the time when women have the highest risk of breast cancer, when estrogen ceases so I would be worried instead of being relieved...I wouldn't want to replicate ciswomens' situation, instead it seems transsexual women, despite the fact of being exposed to estrogen for a lifetime, have a VERY low incidence.

[Laura_7]

but ciswomen weren't exposed to high levels of testosterone for several years like us and didn't develop as men physically, our situation is quite different. It will depend on the person as well, their sensitivity but we are especially vulnerable to any sign of virilization and imagine for a moment, that our voice deepens...I personally wouldn't take that risk. Blending in with the rest of the population is important for me and there is no voice surgery at the present time to reverse this (i.e. resonance) succesfully and without risks. Too much of a gamble. Imagine suddenly losing head hair, having acne that leaves scars, being suddenly perceived as male by others after several years of passing as a woman, seeing yourself look more masculine, having to manage hair growth more intensively...anyways, personally, LAST RESORT.

TOTAL TESTOSTERONE LEVELS
                  ng/dl     ng/ml
  Females  6 - 86  0.1 - 1.2
  Males  270 - 1100  2.4 - 12

Imo this is also a matter of having a look at the whole package.
If estrogen levels are well in the female range and bioidentical progesterone is present which has some anti androgen properties and the level of t is well in the female range, below 60, there should be few side effects. If there are any doses might be lowered.
Its simply a fact that cis women also have a certain level of testosterone and that it has effects on orgasmic abilities and overall drive.
The female range should be wide enough to find a good compromise.
Having levels of nearly zero are not really beneficial imo.

Taking estrogen, considering all this, seems more beneficial than harmful.

I would like to add that additional risks come imo from bras.
There are studies showing that bras can have a negative effect on breast health.
Supporting tissue gets weaker, and blood flow might be restricted. Its like wearing tight jeans which also is not recommended.

Remedies could be getting rid of a bra as soon as being home, wearing alternatives like not too tight tube bras or a few tops and regular breast massage, maybe twice a day, to help with blood flow.
There are trans people who tried the breast massage and also said it helped with growth on forums. Possibly by stimulating blood flow and estro receptors. There was a vid on youtube where a trans women showed some massage techniques, it very obviously helped in her case.
In Asia its a well known recipe for adolescent women.


hugs

[KayXo]

bioidentical progesterone is present which has some anti androgen properties

The study you provided to show that progesterone inhibits DHT is far from conclusive, for the reasons I explained.

and the level of t is well in the female range, below 60, there should be few side effects.

"should be" BUT what if voice suddenly lowers and you are stuck with that? Would it really be worth it?

If there are any doses might be lowered.

Too late in the case of voice lowering or even facial hair growth that now has to be treated. Even if the odds are low, I wouldn't do it.

Its simply a fact that cis women also have a certain level of testosterone and that it has effects on orgasmic abilities and overall drive.

I am only on estrogen and progesterone. I definitely have orgasmic abilities and have actually always had them, regardless if I was taking progesterone or not or whether my estrogen was high or low. The only difference is when my hormones got higher, the inside of my vagina was more elastic and not dry anymore. As to overall drive, I certainly don't lack that. I'm sure plenty of post-op women can attest to this as well without the need for testosterone. My T levels are around 20 ng/dl, quite low.

In the end, it's a personal choice dictated also by one's doctor's position on the matter. I wouldn't but to each their own.

[iKate]

Americans, I have a question (and excuse my ignorance about your medical system there). Is there a way I could just pay to get immediate care from an endocrinologist in  your country? or does it still take forever to go through a referral process and all that. I know it would be expensive, but I am willing to give up a few vacations to find out what the heck is wrong with me asap.

Not at all. We don't have a nationalized healthcare system (except if you're elderly or a military veteran) so there really is no long waiting list for care.

You do have to pay out of pocket if you don't have medical insurance though.

If you're coming to New York there are a few places that deal in trans specific care. Appointments are about a month out though. There are also "urgent care" places that can see you the same day but they may not be properly trained in how to deal with trans patients with regard to our hormone needs.

[Turnip]

Wow this sounds like an option. I can actually drive to NY in less than a day if I drove all in one chunk! I will look in to this. thanks

I don't mind the out of pocket thing as long as it's not out of my price range.

[Turnip]

The study you provided to show that progesterone inhibits DHT is far from conclusive, for the reasons I explained.

"should be" BUT what if voice suddenly lowers and you are stuck with that? Would it really be worth it?

Too late in the case of voice lowering or even facial hair growth that now has to be treated. Even if the odds are low, I wouldn't do it.

I am only on estrogen and progesterone. I definitely have orgasmic abilities and have actually always had them, regardless if I was taking progesterone or not or whether my estrogen was high or low. The only difference is when my hormones got higher, the inside of my vagina was more elastic and not dry anymore. As to overall drive, I certainly don't lack that. I'm sure plenty of post-op women can attest to this as well without the need for testosterone. My T levels are around 20 ng/dl, quite low.

In the end, it's a personal choice dictated also by one's doctor's position on the matter. I wouldn't but to each their own.

I think I have noticed a small improvement in my sexual anhedonia with this estradiol. I am generally getting more satisfaction out of everything in life for the last 2 days...Maybe this is a placebo effect though. I did chores that I have been putting off and I seem to be more patient and have a greater attention span.

Maybe going to an estradiol patch would help.

[Laura_7]

The study you provided to show that progesterone inhibits DHT is far from conclusive, for the reasons I explained.

Its not only studies. Its also endocrinologists experiences.
If a few people report it there should be something to it.

"should be" BUT what if voice suddenly lowers and you are stuck with that? Would it really be worth it?

I'd see this much more relaxed. Nature is usually analogous. There usually are no quick side effects with lower doses. If there should be a gradual deepening doses might be adjusted.

Too late in the case of voice lowering or even facial hair growth that now has to be treated. Even if the odds are low, I wouldn't do it.

Well with levels below 60 there should be no large side effects. Body hair might grow thicker. If it becomes a hassle doses might be adjusted. A new triggering of beard growth should be unlikely imo. As said cis women with a natural level of that sort do not experience a triggering of beard hair. Changes to already present hair yes.

I am only on estrogen and progesterone. I definitely have orgasmic abilities and have actually always had them, regardless if I was taking progesterone or not or whether my estrogen was high or low.  As to overall drive, I certainly don't lack that. I'm sure plenty of post-op women can attest to this as well without the need for testosterone. My T levels are around 20 ng/dl, quite low.

Levels between 20 and 60 should be preferable...
it was also meant as hint for some people to have a look at testo levels as well.
It simply is necessary in cis women also.

In the end, it's a personal choice dictated also by one's doctor's position on the matter. I wouldn't but to each their own.

Well if you feel good that is the most important thing.
It was meant as a hint that testo might help with some ailments.
Often people post srs have a low in mood and other ailments which might be attributed to too low estrogen and testo.

The only difference is when my hormones got higher, the inside of my vagina was more elastic and not dry anymore.

Yes.. if lestrogen evels are too low its menopausal atrophy.
Higher levels can help. Some people even report regain of depth after dilation, some used estrogen cream from time to time.


hugs

[Turnip]

Its not only studies. Its also endocrinologists experiences.
If a few people report it there should be something to it.

I'd see this much more relaxed. Nature is usually analogous. There usually are no quick side effects with lower doses. If there should be a gradual deepening doses might be adjusted.

Well with levels below 60 there should be no large side effects. Body hair might grow thicker. If it becomes a hassle doses might be adjusted. A new triggering of beard growth should be unlikely imo. As said cis women with a natural level of that sort do not experience a triggering of beard hair. Changes to already present hair yes.

Levels between 20 and 60 should be preferable...
it was also meant as hint for some people to have a look at testo levels as well.
It simply is necessary in cis women also.

Well if you feel good that is the most important thing.
It was meant as a hint that testo might help with some ailments.
Often people post srs have a low in mood and other ailments which might be attributed to too low estrogen and testo.

Yes.. if lestrogen evels are too low its menopausal atrophy.
Higher levels can help. Some people even report regain of depth after dilation, some used estrogen cream from time to time.


hugs

I was just thinking that maybe you know of any standard HRT regimines involving estrogen, progesterone and testosterone...

or just estrogen and progesterone.

I can't seem to find anything official.

The reason is... I would like to be able to help my GP be more comfortable prescribing these things. I want to know what blood tests I would need etc. I was prescribed progesterone once, but never took it due to concerns with side effects.. so he might at least be comfortable putting me on that since my endo was ok with it at one time.

I have read about many benefits about having bioidentical HRT, but nothing solid.

[Laura_7]

I was just thinking that maybe you know of any standard HRT regimines involving estrogen, progesterone and testosterone...

or just estrogen and progesterone.

I can't seem to find anything official.

The reason is... I would like to be able to help my GP be more comfortable prescribing these things. I want to know what blood tests I would need etc. I was prescribed progesterone once, but never took it due to concerns with side effects.. so he might at least be comfortable putting me on that since my endo was ok with it at one time.

I have read about many benefits about having bioidentical HRT, but nothing solid.

Much of this comes down to endos experiences.
Its not really exact science.

For a good feminization many say:
estrogen levels above 200-300 pg/ml
and testo in the range of 60 or below.

Levels of estrogen of well over 700 occur during pregnancy.
Many endos consider this safe if reached by internal application, implants and injections.
With other applications for example oral/sublingual there might be side effects like clotting and liver strain at this level. 
Thats why usually anti androgens are used then.

For progesterone there is kind of a standard dose which should not be too hard to find.
Some people get sleepy from it and thus take two small doses, one in the morning and one in the evening.

Well... and there go the diferences...
oral/sublingual application, gels or patches, and often anti androgens...

implants and injections where its possible to do without anti androgens.

Many endos also do not give much value to serum levels. There are well known clinics who say so. Because its only free levels tested and not absorbed rate.
"Treat the patient not the lab"

Its important how people feel and if rate of feminization is ok.
It takes time in any case.

Overall health and possibly organ function should be monitored.


hugs

[iKate]

Wow this sounds like an option. I can actually drive to NY in less than a day if I drove all in one chunk! I will look in to this. thanks

I don't mind the out of pocket thing as long as it's not out of my price range.

Cash price for my first visit would have been about $250USD plus the cost of lab work which may be a couple hundred more.

I go to Mt Sinai Beth Israel, phone 212-604-1800. There is also Callen-Lorde which is popular with a lot of transfolk. If you don't have insurance, I know that Callen-Lorde will work with you and probably bill sliding scale. I am not sure if that applies to foreign patients who are not resident in the USA and just visiting. Doesn't hurt to ask. Google "Callen-Lorde" and they should come up as I don't know if I can post a link here.

[KayXo]

Its not only studies. Its also endocrinologists experiences.
If a few people report it there should be something to it.

Nothing conclusive, purely anecdotal. Like I said, if the addition of progesterone in post-op women results in additional DHT reduction, if blood tests show this, then we can start saying this more conclusively.

There usually are no quick side effects with lower doses.

What is a low dose? A low dose for one person may be a strong dose for another. Sensitivity between individuals varies. It's very tricky and is still a gamble. For me. To each their own. I wouldn't personally take a chance and do fine without testosterone. I think the issue may be more an inadequate prescription of female hormones resulting in low drive, mood and low libido, the latter being also very much a mental thing so hormones aren't absolutely essential for that, in my opinion.