Quote from: GarryLynn on February 04, 2016, 09:24:44 AM
She says the HRT could be dangerous to me
IF it is non bio-identical HRT. Not the case with bio-identicals such as estradiol and progesterone. She's probably thinking of the large study from 2003 where Premarin (conjugated equine estrogens, CEE) and Provera (medroxyprogesterone acetate) were used or the use of oral contraceptives that contain progestins and ethinyl estradiol (EE). You shouldn't be taking these. Studies have shown significant differences between those drugs and the ones doctors usually prescribe to transwomen these days ALTHOUGH some doctors continue prescribing Provera, unfortunately.
Insist on taking Prometrium instead. More expensive but safer.
J Am Osteopath Assoc. 2011 Mar;111(3):153-64."17β-Estradiol is FDA approved for menopausal symptoms, may have cardioprotective effects, and may have fewer adverse effects on blood pressure than conjugated equine estrogens."
"Bioidentical hormones that are approved by the FDA may be preferred over standard hormone replacement because of their physiologic benefits and safety profile."
Maturitas. 2015 Mar 9."In an observational study of oral HT users, CEE was associated with a significantly higher risk of incident venous thrombosis (OR, 2.08; 95% CI, 1.02–4.27), significantly higher activated protein C resistance (OR 1.68; 95% CI, 1.24–2.28), and a nonsignificant elevation in myocardial infarction risk (OR, 1.87; 95% CI, 0.91–3.84) when compared with estradiol use [56]."
"The hemostatic profile of women taking CEE was shown to be more prothrombotic than that of women using oral estradiol, including significantly higher thrombin generation peak value and decreased total protein S (P = 0.001 and P ≤ 0.001, respectively) [57]. In an oophorectomized pig model, both estradiol and CEE reduced aggregation of platelets, but only estradiol increased platelet secretion of nitric oxide, and platelets from estradiol-treated animals caused relaxation of coronary arteries [58]. »
Minerva Med. 2013 Apr;104(2):161-7."Estradiol itself has a lower impact on estrogen-hepatic proteins, and is more readily metabolized by the liver than ethinyl estradiol, the ethinyl group on which slows down that process. The structure increases the bioavailability of ethinyl estradiol compared with E2, but may also contribute to an increased likelihood of estrogen-related adverse events.40 »
Minerva Ginecol. 2014 Feb;66(1):91-102."Micronized estradiol (E2) and its estere valerate (EV), is more easily metabolized by the liver than ethynylestradiol (EE). This causes minimal metabolic impact »
J Thromb Haemost. 2014 Mar 15."The hemostatic profile of women using CEE is more prothrombotic than that of women using E2. These findings provide further evidence for a different thrombotic risk for oral CEE and oral E2."
Biochem Pharmacol. 2013 Dec 15;86(12):1627-42. "CEE and E2 have different chemical structures, pharmacological properties, metabolic products, and ER binding affinity, selectivity, and agonistic properties [1]. Because both ER-dependent and ER-independent mechanisms play a role in mediating the cardiovascular actions of E2, CEE may not mimic the cardiovascular effects of E2."
JAMA Intern Med. 2014 Jan 1;174(1):25-31."In an observational study of oral hormone therapy users, CEEs use was associated with a higher risk of incident venous thrombosis and possibly myocardial infarction than estradiol use. This risk differential was supported by biologic data. These findings need replication and suggest that various oral estrogen drugs may be associated with different levels of cardiovascular risk."
J Clin Endocrinol Metab. 2012 Dec;97(12):4422-8."Historically, high-dose estrogen in the form
of ethinyloestradiol or conjugated equine estrogen (CEE) was
used to suppress testicular function and induce feminization.
In
view of the procoagulant nature of these older estrogens and the
inability to use plasma estradiol levels to guide treatment, this
protocol was changed in 2004 to oral estradiol valerate"
CLIMACTERIC 2005;8(Suppl 1):3–63"EE is much more active than the natural estrogens,
because the 17a-ethinyl group prevents the oxidation
of the 17b-hydroxy group and is able – after
the oxidative formation of a very reactive intermediate
– to inhibit irreversibly cytochrome P450
enzymes, which are involved in the metabolism of
steroids. The potency of conjugated equine estrogens
(CEE) is considerably higher than that of
estradiol, particularly concerning the effect on the
hepatic production of certain serum parameters,
e.g. SHBG, corticosteroid-binding globulin
(CBG), thyroxine-binding globulin (TBG) and
angiotensinogen (Table 3)12–14."
Clin Ther. 1999 Jan;21(1):41-60; discussion 1-2."the most commonly used synthetic progestins, norethisterone and medroxyprogesterone acetate, have been associated with metabolic and vascular side effects (eg, suppression of the vasodilating effect of estrogens) in both experimental and human controlled studies.All comparative studies to date conclude that the side effects of synthetic progestins can be minimized or eliminated through the use of natural progesterone"
"The results of published clinical studies show minimal or no changes in lipid profile, blood pressure, or carbohydrate metabolism during treatment with oral micronized progesterone.28 This safety profile contrasts with the reported negative effects of some synthetic progestins, including adverse effects on lipid metabolism and glucose tolerance. Several studies, including the 3-year prospective PEP1 study, 4, 28 have shown that oral micronized progesterone significantly improves metabolic tolerance compared with such progestins as MPA.52,54,58"
"Only minor adverse events have been reported in association with oral micronized progesterone therapy in clinical trials. Dizziness and sleepiness are the primary adverse reactions reported.33 However, these side effects can be suppressed by administering micronized progesterone once daily at bedtime. 29 Oral micronized progesterone is therefore an effective and well-tolerated form of progestogen replacement in premenopausal and postmenopausal women"
PLoS One. 2013 Nov 1;8(11)"This study confirms differential effects on breast cancer risk of progestagens and regimens specifically used in France. Formulation of EP therapies containing natural progesterone, frequently prescribed in France, was not associated with increased risk of breast cancer but may poorly protect against endometrial cancer."
