What should I know now that I'm on HRT.

[rachel89]

what should I know now that I'm on HRT that doctor's don't really mention or gloss over because they probably don't have first hand experience with being on HRT for transition.

[Laura_7]

You could look here:
https://www.susans.org/forums/index.php/topic,200561.msg1783301.html#msg1783301


congratulations by the way 

[KayXo]

If you take Spiro, drink plenty of water and eat salty when cravings emerge. This will prevent cramps and other potential side-effects from occurring. Other stuff, just mention it to your doctor or post on this forum.

[Ms Grace]

Yes, drink plenty of water if you are on Spiro as it is also a diuretic.

Hopefully your doctor will have told you most of the important things and your starting dosage will be safe so they can check to make sure there are no complications before upping you.

You'll probably notice nipple tenderness plus a budding/hardness behind them... watch out for hugs, doorways, random kittens as this area will be very sore for a few months.

You may experience some mood swings, lethargy, sweating, food cravings, loss of libido... all of which will settle down once your endocrine system gets used to the new balance.

[Mariah]

Ms. Grace really well covered it, but do keep an eye on your sodium and potassium numbers. Spiro will cause you to retain potassium and well lose loads of sodium. This can also cause other health issues. So if something doesn't seem right and is beyond what we have or they have mentioned then best to check with your doctor's office at that point to be on the safe side. Hugs
Mariah

[iKate]

Watch your test results, particularly the lipid panel. Estrogen will raise your triglycerides. Your doctor should be doing that anyway but you should also look at your lab results and talk with your doctor to find out if you are where you are supposed to be health wise. Remember they are there to help you and make sure that HRT doesn't make you sick.

Glucose metabolism is another to watch for but that may be less concern if you're not a diabetic. I am but I manage mine very well (A1C is less than 6). You're looking for your fasting glucose to be less than 100mg/dL and your A1C to be less than 5.7.

Your liver is important too. Talk to your doctor about your liver and make sure that you're not harming yourself.

The lab report will usually list anything out of range and provide a list of normal ranges. Some doctor's offices have online portals now so you can look at all your results in one place. The lab may have a website or app. My insurance prefers Quest and they have an app.

If you are engaged in sexual activity be sure to get screened for STDs. Even if you're not, might be a good idea anyway. My NP says she likes to see people screened early and often.

With regard to spironolactone, you may experience some cramps. Leg cramps usually but it may happen in your arms or other places. That is related to sodium intake. You may have to up it a bit but make sure you aren't raising your blood pressure.

Speaking of blood pressure, get a blood pressure monitor and keep tabs on your blood pressure. Maybe test once a week just to make sure it's not raising. If it's consistently high your doctor will need to know. I use a Panasonic EW3109 blood pressure monitor. It is accurate and the numbers are big. It is an arm cuff so it is better than the cheap wrist cuff ones.

Get some exercise if you don't already.

Keep tabs on your emotional health too. Hormone therapy can bring about mental changes and incur mood swings. Sometimes just talking to someone can keep you on an even keel.

Good luck and enjoy the ride!

[Blush]

Most advice here so far is more scary than helpful imho.

Have patience and listen to your body.

[KayXo]

Estrogen will raise your triglycerides.

I think less when it is bio-identical and has no effect when taken non-orally. Carbs increase triglycerides significantly.

Glucose metabolism is another to watch for but that may be less concern if you're not a diabetic. I am but I manage mine very well (A1C is less than 6). You're looking for your fasting glucose to be less than 100mg/dL and your A1C to be less than 5.7.

It seems from my readings that estradiol improves insulin sensitivity and glucose but other drugs/hormones taken may have an adverse effect.

Your liver is important too. Talk to your doctor about your liver and make sure that you're not harming yourself.

The only agents adverse to the liver are high dosage cyproterone acetate and high dose non-bioidentical estrogen. AFAIK.

With regard to spironolactone, you may experience some cramps. Leg cramps usually but it may happen in your arms or other places. That is related to sodium intake. You may have to up it a bit but make sure you aren't raising your blood pressure.

In my experience, increasing sodium intake while on Spiro is very unlikely to raise blood pressure. Carbohydrates tends to increase blood pressure much more significantly.

Speaking of blood pressure, get a blood pressure monitor and keep tabs on your blood pressure. Maybe test once a week just to make sure it's not raising.

Spironolactone, bio-identical estradiol, bio-identical progesterone have a beneficial effect on blood pressure. Spiro may lower it too much if dose is too high for you and/or if not drinking and taking enough water and salt.

Hormone therapy can bring about mental changes and incur mood swings.

A good regimen should stabilize and improve mood. Mood swings will occur if levels fluctuate too much. Taking on a frequent enough basis prevents this.

[iKate]

I think less when it is bio-identical and has no effect when taken non-orally. Carbs increase triglycerides significantly.

It seems from my readings that estradiol improves insulin sensitivity and glucose but other drugs/hormones taken may have an adverse effect.

The only agents adverse to the liver are high dosage cyproterone acetate and high dose non-bioidentical estrogen. AFAIK.

In my experience, increasing sodium intake while on Spiro is very unlikely to raise blood pressure. Carbohydrates tends to increase blood pressure much more significantly.

Spironolactone, bio-identical estradiol, bio-identical progesterone have a beneficial effect on blood pressure. Spiro may lower it too much if dose is too high for you and/or if not drinking and taking enough water and salt.

A good regimen should stabilize and improve mood. Mood swings will occur if levels fluctuate too much. Taking on a frequent enough basis prevents this.

I'm relating my experience. All of these things may or may not happen. My triglycerides increased. I've been taking bio identical estradiol for over a year now. Hormones can negatively affect your glucose metabolism (hence why pregnant women can experience gestational diabetes). Mine got better because I took better care of my health. I didn't say all of these things will happen but some do and often they don't. Caution is well advised with any kind of medical treatment, especially with a big change like hormone therapy.

My main point was to watch your lab results and ask questions.

[KayXo]

I'm relating my experience. All of these things may or may not happen. My triglycerides increased. I've been taking bio identical estradiol for over a year now.

I assume you are taking it orally and this is why I said the effect is *less* relative to estrogen that is not bio-identical. If you took it non-orally, I don't think it would have any effect. Are you taking anything else, an anti-androgen, DHT inhibitor, a progestogen, supplements? You will notice that if you reduce your carbs, triglycerides will drop.

Hormones can negatively affect your glucose metabolism (hence why pregnant women can experience gestational diabetes).

I believe the reason for gestational diabetes is progesterone, VERY high levels because it apparently increases insulin secretion and can create insulin resistance over time, especially if one eats a lot of carbs. It is important to make the distinction between different sex hormones and their effects on the body. Estradiol apparently improves insulin sensitivity.

[WendyA]

I think less when it is bio-identical and has no effect when taken non-orally. Carbs increase triglycerides significantly.

Refined carbs (anything containing flour or added sugars) may increase triglycerides, whole food carbs are beneficial across the board.  One study does show the possibility of excess fruit intake raising triglycerides in biological males.  But this is a small percentage of folks.  If concerned about triglycerides then limiting processed (refined) carbs is key.

Carbohydrates tends to increase blood pressure much more significantly.

Again, whole food carbs are beneficial, don't confuse processed/refined carbs with whole food carbs.

[KayXo]

Refined carbs (anything containing flour or added sugars) may increase triglycerides, whole food carbs are beneficial across the board.

In some people quite intolerant to carbs, whole food carbs (remember that these have only been consumed by human for the last 10,000 years) can also cause some problems, increasing triglycerides. Carbs are lots of glucose, whether whole or not but at least with whole, you get some nutrition and the glucose does not hit the liver and blood all at once. Least harmful carbs for triglycerides are vegetables that grow above soil. Fruits can even cause some problems in some...today's fruits are modified and are sweeter than ever.

My triglycerides went way down when I stopped eating all carbs and just stuck to fat and protein. HDL also went up and all health markers improved. Studies also show this, at least when carbs are significantly cut and replaced by fats, including saturated.

[iKate]

I assume you are taking it orally and this is why I said the effect is *less* relative to estrogen that is not bio-identical. If you took it non-orally, I don't think it would have any effect. Are you taking anything else, an anti-androgen, DHT inhibitor, a progestogen, supplements? You will notice that if you reduce your carbs, triglycerides will drop.

I am on a calorie restricted diet due to type 2 diabetes.


I take bio identical estradiol (sublingually). I also take a statin for high cholesterol, spironolactone and bio identical progesterone, and metformin to control my blood sugar.

The triglycerides didn't spike until I started taking the E.

My doctor said the triglycerides increased because of Estrogen. She knows what she's saying. I'll take her word for it. If you're a doctor with a medical opinion, fine, but you're not my doctor so I'll take the advice of my doctor.

I believe the reason for gestational diabetes is progesterone, VERY high levels because it apparently increases insulin secretion and can create insulin resistance over time, especially if one eats a lot of carbs. It is important to make the distinction between different sex hormones and their effects on the body. Estradiol apparently improves insulin sensitivity.

As I said, my main point was to watch your labs and ask questions. No harm in doing that.

I'm not a novice at this. I've been seeing doctors for various medical conditions for the better part of 10 years now.

[KayXo]

I am on a calorie restricted diet due to type 2 diabetes.

A doctor by the name of Jay Wortman had Type 2 diabetes, he cured his diabetes by cutting carbs, eating fat/protein as much as he wanted. Carbs increase glucose and insulin. They worsen glucose control and intolerance. Low carb, without cutting calories, and eating as much fat and protein you want seems to be an effective and safe treatment for type 2 diabetes; recent studies have confirmed this. The reason why calorie restricted works is because you inevitably cut down on carbs and fat as well but you end up feeling hungry and undernourished.

You can check Peter Attia, a scientist who was close to becoming diabetic and overweight. Also Dr. Bernstein's Diabetes Solution (even though for Diabetics Type 1). Also Jeff Volek, Stephen Phinney, Eric Westman, Mary Vernon. And many more like Gary Taubes' books. Or on youtube.

I also take a statin for high cholesterol

Like I said, check out those people, I can send you links and the names of many authors/scientists who also give us a difference perspective on the whole cholesterol issue, like among them Zoe Harcombe, Uffe Ravnskov, Johnny Bowden and there is a great presentation on youtube called the cholesterol conundrum. Sally Fallon, Mary & Mike Eades, Atkins, etc are also other names. Thincs.org is also a great site!

Read as much as you can and discuss this with your doctors. You might not have to take some of these medications after all. Lots of marketing and dollars behind it. At least, I think so. You decide for yourself. Just sharing info that might help you.

The triglycerides didn't spike until I started taking the E.

Sublingually, some will inevitably be swallowed. Non-orally is best if triglycerides are a problem, it seems, from studies. Again, something to look into and discuss with your doctors.

My doctor said the triglycerides increased because of Estrogen. She knows what she's saying. I'll take her word for it.

You can look up the information on pubmed. I can send you privately studies, you can read them yourself and present them to your doctor. If you wish, of course. I'm not a doctor, no.

Estrogen includes ethinyl estradiol, premarin, etc. These tend to significantly increase triglycerides but bio to a far lesser extent and especially non-orally because liver is less passed through by estradiol, due to shorter half-life and nature of absorption.

I don't wish to create a conflict. Just to provide information which you can then decide with the experts what to make of. Experts, doctors are human too, can makes mistakes and they will admit to that. I have seen doctors around me making mistakes more than once. It's normal. Maybe I am in the wrong. But I think it's important to keep an open mind. For you, your own health and well-being. I think working together with the doctor is in the best interest of everyone, not just trusting blindly unless one is really not able to double-check, doesn't have the time or there are no other doctors around to get second opinions from. Even doctors sometimes disagree amongst themselves.

Another point important to make is that this is not about our intelligence or our egos. This is about agreeing on facts that have been brought forth by science thus far, disseminated science. Discussing about it, etc. Beliefs have no place in science. Only facts. As such, we must also keep an eye on new findings, keep an open mind.

Best of luck.