Stomach medication, high prolactin, and lack of breast growth

[Steph34]

I think neither. What matters is estrogen and progesterone. And of course, that androgens are low and/or inhibited to allow for growth.

Progesterone really makes mine swell; I think I found the missing ingredient! I think of it as "feeding the girls."
Is cortisol an androgen? I know it is the stress hormone.

Saturated fat actually makes one less often hungry IF not eaten with very carby foods. People on high fat (moderately saturated), low carb diets end up eating much less.

Actually, people on low fat diets end up eating less because weight loss has less of an unfavorable impact on leptin:ghrelin ratio when fat is restricted.
http://press.endocrine.org/doi/abs/10.1210/jc.2002-021262
That study also keeps protein intake constant, unlike most studies finding 'benefits' of low carb diets that are actually due to increased protein consumption rather than carbohydrate restriction.

Also, saturated fat is less satiating than unsaturated.
http://www.sciencedirect.com/science/article/pii/S0271531710001764

I should know. Eating bacon, eggs and butter (+ macadamias) in the morning, I sometimes don't get hungry until the next day. This is one of the benefits of eating this way. It's very satiating.

A whole food, plant based diet is also very satiating, perhaps more so because the fiber stops the fat and carbs from moving through too quickly. I am able to overeat because I do not follow my own advice: I am consuming too many added oils and refined grains.

Eur J Nutr. 2013 Feb;52(1):1-24.

"The observational evidence does not support the hypothesis that dairy fat or high-fat dairy foods contribute to obesity or cardiometabolic risk, and suggests that high-fat dairy consumption within typical dietary patterns is inversely associated with obesity risk."

Observational evidence is very weak evidence and does not prove causation.

You could ask to be put on finasteride which reduces DHT levels. Even if T levels in the blood are low, DHT levels can be much higher in tissues and people like you, who are sensitive genetically, may still experience side-effects from this amount.

I am on dutasteride, which is better. Unfortunately, dutasteride may be for life if I want hair. I think dutasteride is making my skin drier and less soft because 5-alpha-reductase increases sebum production, and is suppressed by dutasteride.

If indeed estradiol raised DHEA levels and thus raised T and DHT levels, we should be observing many more cases of women experiencing hair loss during their reproductive years.

Not necessarily. Small amounts of T and DHT may be insufficient to cause hair thinning/loss in most women, especially given the benefits of E for hair. Add genetic hypersensitivity to DHT, and things change. One of my close female relatives is already suffering from hair thinning in the front and she is under 30.

Women actually experience hair thinning/loss to a far greater extent after menopause, when E levels drop.

Menopausal and post-menopausal hair thinning is caused by low E and not high DHT, since menopause actually decreases DHT levels in cis women.

How is dizziness a side-effect of hyperprolactinemia? This would be indeed quite a problem for pregnant and breastfeeding women which I don't think it is.

They often complain of queasiness, morning sickness, etc. I am not sure why dizziness would occur, but I have read of it happening in women with domperidone-induced hyperprolactinemia.

I think many, many women (trans and cis) will testify that being on estradiol for several years has not suddenly desensitized them to the mood-enhancing effects of E. There is some degree of fluctuation, especially on injections, which keeps cells responsive. In the case of pellets, levels may be indeed too steady and cause desensitization.

What about patches? I do enjoy mood enhancement on the days when I apply a new patch, but I think my levels are fairly steady overall.

I can attest to the fact that I've been on high levels for 2 yrs now (on injectables) and my mood is still perfectly fine. I see no deterioration whatsoever.

If you came down to a level of 400 (considered high by most women, cis or trans), you would probably feel horrible. Gotta stay high all the time...

I noticed bad desensitization with injections. I would feel rotten by the end of the week, despite still having a moderately high to high level of estradiol.

must admit to seeing less breast growth on injections vs pills (I was taking a high dose orally) BUT as far as the rest of me, I've found I've feminized to a far greater extent than ever before and FEEL better and look HEALTHIER.

People look healthier when they are happy so that makes sense. Looking healthier is mostly subjective, though. I find that my nipples are more often sensitive and erect on patches than they were on injections. The patches make me happier. They make my girls happier, too.

I agree but I wouldn't discount the mood-enhancing effects of hormones either. I believe hormones, by improving mood, increase the odds of the mother's survival and hence her baby's survival. From an evolutionary standpoint, it makes a whole lot of sense.

I do not see how the mother's survival would be affected much by improved mood. From an evolutionary standpoint, high hormone levels make much more sense as a mechanism to increase fertility at a time when it matters most.

It's no coincidence that progesterone, a hormone found in high concentrations in pregnant women, converts to allopregnanolone, found to have a calming effect on the organism.

I would call it a sedative.

Estradiol also positively impacts serotonin.

Maturitas. 1996 May;24(1-2):37-41.

"Serotonin, known for its beneficial action on mood and well-being, is also involved in cardiovascular functions. Thus the current work was undertaken to study the effect of hormone replacement therapy on serotonin turnover in postmenopausal women. Eighteen women received estradiol transdermally and 17 women estradiol valerate orally for 4 weeks. The serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) was determined in the urine before, and after 2 and 4 weeks' estradiol treatment. With both administration routes estradiol produced a significant increase in urinary 5-HIAA excretion, greatest with transdermal estradiol after 28 days of treatment. The enhancement of serotonin turnover may contribute not only to an improvement of mood and well-being but also to a cardioprotective effect of estradiol observed after hormone substitution in postmenopausal women."

J Clin Psychiatry. 2001 May;62(5):332-6.
Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study

"Most women recovered and did not have any depressive symptoms following treatment. There was rapid improvement in symptoms within first week and recovery thereafter. Neither psychotherapy or anti-depressants worked."

Interesting. I wonder if that is why E is 'naturally rewarding.'

Breast glands will also shrink (cell apoptosis) in response to a drop in estrogen. In order to maintain glandular tissue and firmness, a certain amount of estrogen is usually needed.

Cis women have VERY low E for part of their cycle and it never seems to do them much harm.

[KayXo]

Progesterone really makes mine swell

Same here.

Is cortisol an androgen? I know it is the stress hormone.

Cortisol is not an androgen but a corticosteroid with potent glucocorticoid effects.

Actually, people on low fat diets end up eating less because weight loss has less of an unfavorable impact on leptin:ghrelin ratio when fat is restricted.
http://press.endocrine.org/doi/abs/10.1210/jc.2002-021262
That study also keeps protein intake constant, unlike most studies finding 'benefits' of low carb diets that are actually due to increased protein consumption rather than carbohydrate restriction.

On a low carb, HIGH fat diet (protein at around 15-20%), my hunger significantly drops. I don't increase my protein, but increase my fat and reduce my carbs. This is how healthy low carb eating is done. Eating once daily suffices, sometimes twice, depending on how active I am. I have no desire to reduce fat as it is satiating, pleasurable, nutritious (fat soluble vitamins, omega 3), has not been shown (cause and effect) to adversely affect health or lead to obesity in humans (quite the contrary).

It is interesting to note in this study that the 15 % fat diet is not only lower in fat but more nutritious so other factors are also modified, not just one factor, which could have also influenced the results.

Menu for one day:
on 35% fat, for breakfast, twice as much jam as compared to the 15% fat group...jam is full of sugar
on 35% fat, for breakfast, 122 g of orange juice (full of sugar and very little nutrition) vs. 120 g of a banana which is relatively lower in overall carbs and more nutritious
on 35% fat, for snack, oreo cookies and mandarin oranges vs. non fat milk and granola bar, now it doesn't take a genius to figure which of the two is most nutritious and less sweet
Overall, you see a pattern of healthier, whole carb foods in the 15% fat group vs. in the 35% fat group which eats english muffins instead of bran flakes + whole wheat bread for breakfast and tends to eat more processed food.

Nutritious value of what each group ate should have been taken into consideration and is important. It has not and as such, this study proves to be strongly flawed. Did you even read the full study?

Anyone would feel more satiated on nutritious food versus less nutritious + more empty calorie foods.

Also, saturated fat is less satiating than unsaturated.
http://www.sciencedirect.com/science/article/pii/S0271531710001764

This study is in rats, not in human beings. We cannot generalize these findings to us. We need to replicate this in humans. 

A whole food, plant based diet is also very satiating, perhaps more so because the fiber stops the fat and carbs from moving through too quickly.

More satiating than having to only eat once daily? Ok, sure.

I am able to overeat because I do not follow my own advice: I am consuming too many added oils and refined grains.

Is it the refined grains or the added oils making you overeat? Factors must be isolated to determine cause and effect.

And when you do follow your advice, do you end up having to eat even less than once daily, say, perhaps, once every 36 hours?

Observational evidence is very weak evidence and does not prove causation.

Correct but if we don't even observe any association, this suggests that we shouldn't also find a cause and effect association. At the very least, if something causes something else, we should begin to observe an association and if we don't, this is not a path worth investigating.

I am on dutasteride, which is better. Unfortunately, dutasteride may be for life if I want hair. I think dutasteride is making my skin drier and less soft because 5-alpha-reductase increases sebum production, and is suppressed by dutasteride.

J Am Acad Dermatol. 2006 Dec;55(6):1014-23.

In this study, only a very high dose of dutasteride (unlikely to be your case) proved superior to finasteride in terms of hair counts, expert and investigator assessment while subjects' assessments of improvement were pretty much the same for both high dose dutasteride and finasteride. So, if you are on the lower dose and finasteride costs you less, you might as well take finasteride. More worthwhile for you.

Recently, I came across studies that suggest finasteride/dutasteride may cause depression in some. You should know this treatment reduces levels of allopregnanolone and tetradeoxycorticosterone which play a crucial role in mood enhancement, memory, learning, brain health. With that being said, I'm not sure I would take it at all, even if you noted no depression or anxiety, I would be worried of the impact this treatment would have on such important neurosteroids and would not want to compromise my well-being or brain health especially considering that with HRT, T is already significantly reduced anyways and hair loss will not get worse. Perhaps, you would get a slightly fuller head of hair with DHT inhibitors but at what cost? Your call...I thought you just needed to know this.

Not necessarily. Small amounts of T and DHT may be insufficient to cause hair thinning/loss in most women, especially given the benefits of E for hair.

So then who cares IF estrogen raised DHEA levels because of the protective effects of E. Take more E, higher DHEA but higher E too so what's the problem? Why even mention this?

One of my close female relatives is already suffering from hair thinning in the front and she is under 30.

A rare case. No one will argue the fact that balding is MUCH more common in men than in women. DHEA levels are also lower in women than in men, on average.

Menopausal and post-menopausal hair thinning is caused by low E and not high DHT, since menopause actually decreases DHT levels in cis women.

Exactly my point that E drops so DHEA would also drop, DHT levels drop and yet we see more thinning due to the fact that E:A ratio is reduced. Your original concern was about E raising DHEA and yet we see women do better on high levels of E so this is a non issue. Why are we still talking about this? LOL.

They often complain of queasiness, morning sickness, etc.

But who's to say this is because of high prolactin levels and not due to higher progesterone levels which slow down intestinal transit time. My prolactin levels are very high, up to 130 ng/ml and yet no dizziness, queasiness, morning sickness to speak of.

I am not sure why dizziness would occur, but I have read of it happening in women with domperidone-induced hyperprolactinemia.

Maybe it's not caused by the high prolactin levels but it's some other side-effect of the drug. Where is the cause and effect relationship between both high prolactin and dizziness? So far, you have not shown any.

What about patches? I do enjoy mood enhancement on the days when I apply a new patch, but I think my levels are fairly steady overall.

I would also be worried about patches due to too steady levels. But, this may also depend on other factors such as skin sweat, patch not staying on, etc which may make levels not as steady as they should.

If you came down to a level of 400 (considered high by most women, cis or trans), you would probably feel horrible. Gotta stay high all the time...

If you also went down to a lower level, you would feel horrible too. This applies to all of us, regardless of our current levels. I have no reason to lower my dose or levels. I will stay high. And contrary to what you say, I have not become desensitized to E.

I noticed bad desensitization with injections. I would feel rotten by the end of the week, despite still having a moderately high to high level of estradiol.

This is not due to desensitization but rather due to levels dropping too much, even if still high but significantly lower relative to higher levels earlier during the week. Some, like me, may need to inject more frequently, every 5 days. Levels fluctuate quite a bit on injections and in some, due to fast metabolism, levels can drop too fast too soon.

Looking healthier is mostly subjective, though.

In my case, it's obvious and there is a big change that can't be missed. Face looks healthier, people have also noticed and even asked me...what did you do to your hair, your face, you look great, you are glowing, etc.

I find that my nipples are more often sensitive and erect on patches than they were on injections. The patches make me happier. They make my girls happier, too.

And I am happy for you. That's the most important. Stick with what makes you feel and look good.

I do not see how the mother's survival would be affected much by improved mood. From an evolutionary standpoint, high hormone levels make much more sense as a mechanism to increase fertility at a time when it matters most.

A pregnant woman is already pregnant, she doesn't need fertility. LOL. Being in a good mood, not stressed increases the chances that a woman will not miscarry, will not have an unhealthy baby, etc. A calmer, happier body is a healthier body. This is obvious to me.

I would call it a sedative.

Yes it is but it is also an anti-depressant and an anxiolytic agent. It raises allopregnanolone levels much like some anti-depressants and antipsychotics do. As a result, general mood is improved and one is more relaxed, sleeps better...sleep makes for a happier person.

Cis women have VERY low E for part of their cycle and it never seems to do them much harm.

E levels drop but not long enough to make a significant difference in breasts. I think if you asked most women, they would tell you they would rather have higher E all the time than go through the hell of having lower E for even just one week. In some, the suffering is very significant and debilitating.

[Steph34]

I thought of one other reason I may not be developing properly: acid/food reflux. Sometimes when I have reflux, I feel like the acid or food rises into my chest and spreads throughout the breasts. That can be painful, especially when it is acid. I cannot use acid suppressors because they interfere with domperidone and therefore make me nauseous.

Cortisol is not an androgen but a corticosteroid with potent glucocorticoid effects.

I still do not see why that would be harmful to breast growth.

On a low carb, HIGH fat diet (protein at around 15-20%), my hunger significantly drops. I don't increase my protein, but increase my fat and reduce my carbs. This is how healthy low carb eating is done.

A diet composed predominately of fat cannot possibly be healthy because 1)it excludes the vast majority of nutritious foods, and 2)it would contain a low level of water-soluble vitamins.

It is interesting to note in this study that the 15 % fat diet is not only lower in fat but more nutritious so other factors are also modified, not just one factor, which could have also influenced the results.

That is a problem with nearly all studies if you really look closely; it does not invalidate the results.

Overall, you see a pattern of healthier, whole carb foods in the 15% fat group vs. in the 35% fat group which eats english muffins instead of bran flakes + whole wheat bread for breakfast and tends to eat more processed food.

Again, supporting my belief that processed food (regardless of composition) is the problem, and not total carbs. Because IF carbs were really so evil like you often suggest, the 70% carb diet would not be superior to the 50% carb diet just because it is more nutritious.

More satiating than having to only eat once daily? Ok, sure.

I only eat once a day.

Is it the refined grains or the added oils making you overeat? Factors must be isolated to determine cause and effect.

It is not possible for me to consume 5000+ calories unless I have plenty of BOTH. Either one alone is insufficient to enable such overeating.

And when you do follow your advice, do you end up having to eat even less than once daily, say, perhaps, once every 36 hours?

No; I always get grumpy if I pass 24 hours. However, when I eat more whole and less processed food, I am much less hungry before the next day's meal time.

Correct but if we don't even observe any association, this suggests that we shouldn't also find a cause and effect association. At the very least, if something causes something else, we should begin to observe an association and if we don't, this is not a path worth investigating.

Human behavior is so complex with so many confounds that we cannot assume any association will stare us in the face.

J Am Acad Dermatol. 2006 Dec;55(6):1014-23.

In this study, only a very high dose of dutasteride (unlikely to be your case) proved superior to finasteride in terms of hair counts, expert and investigator assessment while subjects' assessments of improvement were pretty much the same for both high dose dutasteride and finasteride. So, if you are on the lower dose and finasteride costs you less, you might as well take finasteride. More worthwhile for you.

I have much worse sensitivity to DHT than most people with hair loss, so the results of studies cannot be extended to me. Dutasteride has been shown to be superior to finasteride for reducing both serum and scalp levels of DHT. To imply that has no effect on hair is preposterous.

Recently, I came across studies that suggest finasteride/dutasteride may cause depression in some. You should know this treatment reduces levels of allopregnanolone and tetradeoxycorticosterone which play a crucial role in mood enhancement, memory, learning, brain health.

I really don't care about anything else if it is good for my hair.

With that being said, I'm not sure I would take it at all, even if you noted no depression or anxiety, I would be worried of the impact this treatment would have on such important neurosteroids and would not want to compromise my well-being or brain health

If you were going bald, I think you would change your mind.

especially considering that with HRT, T is already significantly reduced anyways and hair loss will not get worse.

Hair loss can worsen even during transition. Women get hair loss, too, especially in my family. The difference between male and female ranges is much smaller for DHT than it is for T. I twice tried going off my dutasteride and the loss/thinning quickly resumed, only to stop once again upon resumption of dutasteride.

Perhaps, you would get a slightly fuller head of hair with DHT inhibitors but at what cost? Your call...I thought you just needed to know this.

If living as a man and taking tons of T and steroids would save my hair, I would do it. And I love my femininity. I think that puts things in perspective. Hair is life, the catalyst for my transition in the first place.

So then who cares IF estrogen raised DHEA levels because of the protective effects of E. Take more E, higher DHEA but higher E too so what's the problem? Why even mention this?

I mention this because, for me personally, the benefit of E for hair is offset by the fact that it worsens my scalp fungus, causing excessive and unsustainable shedding.

No one will argue the fact that balding is MUCH more common in men than in women.

Not me, but some of the guys on hair loss boards are in total denial that male hormones are causing their hair loss.

DHEA levels are also lower in women than in men, on average.

True, but there is a large amount of overlap between the male and female ranges. In stark contrast to T and E, male and female levels of DHEA are fairly similar.

Your original concern was about E raising DHEA and yet we see women do better on high levels of E so this is a non issue. Why are we still talking about this?

Like I said, I do worse on high levels of E because of increased scalp fungus.

But who's to say this is because of high prolactin levels and not due to higher progesterone levels which slow down intestinal transit time. My prolactin levels are very high, up to 130 ng/ml and yet no dizziness, queasiness, morning sickness to speak of.

Your progesterone is also high. Not everyone experiences those side effects. Some people, like my mother and perhaps you, are blessed with fast stomach emptying.

I would also be worried about patches due to too steady levels. But, this may also depend on other factors such as skin sweat, patch not staying on, etc which may make levels not as steady as they should.

I use waterproof bandages to make sure the patch stays on, but I do have some strategies (temporarily wearing no patch, overlapping patches, and altering the spacing between application days) to make my levels less steady. Still, I need some semblance of a steady level in order to be emotionally stable. I am a very emotional girl and wild swings are hard for me to handle.

If you also went down to a lower level, you would feel horrible too. This applies to all of us, regardless of our current levels.

Yes; we become accustomed to a certain level of E and coming down is always hard. Now that my E level is typically 100-200, a level of 80 would feel bad. Back when I was accustomed to a level of 30-60, a level of 80 felt like getting high. On injections when my level was 400-1000, I actually felt bad when I came down to 400! That sounds like desensitization to me, but I think I have another explanation: A rising level feels good and a falling level feels bad, regardless of the actual level. I have tried topical, oral, sublingual, injections, and patches and have noticed that pattern regardless of what form I use and what my level is. That is why injections feel bad to me: the level reaches a peak fairly quickly and then spends the rest of the week declining. With patches, I enjoy a slower and steadier rise and therefore have more happy emotional days and fewer depressed days. Unlike oral and topical products when my level was too low, patches also work fairly well to give me a normal female level and have milder side effects compared to oral and injectable forms which gave me bad side effects for the digestive tract and the scalp. 

I have no reason to lower my dose or levels. I will stay high.

I am glad you found what works for you. I am a much more emotional person, though. High E levels from injections made my emotions so over-the-top that I became practically psychotic; my mother was "scared." I love being an emotional girl, but it is possible to have too much of a good thing.

And contrary to what you say, I have not become desensitized to E.

You might have become desensitized to normal levels of E; you certainly seem afraid of them. It is understandable to me that many doctors would be afraid to prescribe high-dose E because of this 'tolerance' effect. If a patient had to go completely off of E for medical reasons, extreme moodiness and physical distress would occur. It would be like menopause on steroids!

In my case, it's obvious and there is a big change that can't be missed. Face looks healthier, people have also noticed and even asked me...what did you do to your hair, your face, you look great, you are glowing, etc.

Lucky you. With that said, I have received compliments for my skin and hair which were always in very poor condition before I discovered E. No need for psychosis-inducing megadoses.

And I am happy for you. That's the most important. Stick with what makes you feel and look good.

For me, that would be the "good stuff" patches. I love them!

A pregnant woman is already pregnant, she doesn't need fertility. LOL.

I disagree. A woman who becomes pregnant demonstrates that she is able to become pregnant and it makes sense that nature would give her hormones that would help her become pregnant again later. Also, higher female hormone levels to maintain fertility would reduce the risk of miscarriage.

A calmer, happier body is a healthier body. This is obvious to me.

I am not aware of any studies showing a cause-and-effect relationship between calmness and health or between happiness and health. This is not obvious to me. After all, old people who are too calm (due to lack of social interaction) are more likely to die. Likewise, bursts of happiness can shock the heart.

Yes it is but it is also an anti-depressant and an anxiolytic agent. It raises allopregnanolone levels much like some anti-depressants and antipsychotics do. As a result, general mood is improved and one is more relaxed, sleeps better...sleep makes for a happier person.

Taking progesterone does help with sleep but I think that is due to the sedative effect of allopregnanolone rather than anything else. Progesterone itself can make my depression worse, though, because it is anti-estrogenic.

E levels drop but not long enough to make a significant difference in breasts.

A low level for even 24 hours makes a significant difference in my breasts.

I think if you asked most women, they would tell you they would rather have higher E all the time than go through the hell of having lower E for even just one week. In some, the suffering is very significant and debilitating.

I do not think most women think consciously about their E levels; they are lucky enough that they do not need to. Although mood can be correlated with E, I do not think there is usually a conscious process involved, like "I wish I did not have low E this week!"

[KayXo]

I still do not see why that would be harmful to breast growth.

Just something I personally noticed and makes sense intuitively. Perhaps not because of cortisol but because of impaired blood circulation.

A diet composed predominately of fat cannot possibly be healthy because 1)it excludes the vast majority of nutritious foods, and 2)it would contain a low level of water-soluble vitamins.

The Maasai people and the Inuit people, eating a diet predominantly composed of fat, were observed to be quite healthy, even healthier than us. They survived harsh environments for thousands of years and had their diet not been healthy, this would not have been possible. I highly recommend The Fat of the Land / Not By Bread Alone by Vilhjalmur Stefansson.

Also, as stated before,

http://www.jbc.org/content/87/3/651.full.pdf

"Two normal men volunteered to live solely on meat for one
year, which gave us an unusual opportunity of studying the
effects of this diet."

"25 per cent of the calories were derived from protein, 75 to 85 per cent from
fat, and 1 to 2 per cent from carbohydrate. Details concerning
the food eaten are presented in Table I."

In the summary and conclusions part:

"Vitamin deficiencies did not appear."

And earlier noted  "No clinical evidence of vitamin deficiency was noted."

That is a problem with nearly all studies if you really look closely; it does not invalidate the results.

It may not invalidate your "beliefs" but it invalidates results because more than one factor was changed and so causation and effect may not established. Basic science. Only change one variable at a time. Some studies do indeed change ONLY one variable at a time. They are called randomized double blind placebo controlled trials.

Again, supporting my belief that processed food (regardless of composition) is the problem, and not total carbs. Because IF carbs were really so evil like you often suggest, the 70% carb diet would not be superior to the 50% carb diet just because it is more nutritious.

Of course, it's better to eat more carbs that are more nutritious than less carbs that are mostly empty carbs BUT I take issue with eating little fat and meat which are nutritionally dense. I consider even a diet predominantly composed of nutritious whole carb foods less healthy, in my opinion (based on several well-designed studies and my understanding of the effect of insulin and sugar on the body), than a diet higher in fat and lower in carb because, over time, insulin will be overstimulated and cause metabolic problems + the fiber, so often touted as essential and healthy in a high carb whole grain diet irritates sensitive lining of digestive tract, why may form a callous over time which reduces one's ability to absorb nutrients. Fats in animals and the vitamins they contain appear to be superior to those found in vegetables (Vitamin A vs beta-carotene, DHA/EPA vs ALA, even Vitamin K) and the protein in more complete. There is no Vitamin D in the plant world and B12 is lacking.

I only eat once a day.

Not the impression I get from your messages.

I have much worse sensitivity to DHT than most people with hair loss, so the results of studies cannot be extended to me. Dutasteride has been shown to be superior to finasteride for reducing both serum and scalp levels of DHT. To imply that has no effect on hair is preposterous.

As shown, the dose of dutasteride you (probably) take, regardless of how much DHT is reduced, was equally effective to the highest dose of finasteride in terms of actual hair counts and overall assessment. What counts more: how much DHT is in your blood or scalp or actual hair results? I'm trying to help you save money while maintaining the same good results. That's all.

I really don't care about anything else if it is good for my hair.

If you were going bald, I think you would change your mind.

No because estrogen, other, safer anti-androgens will just as effectively reduce T and DHT to castrate levels, under those seen in premenopausal women who rarely go bald. Dutasteride is not the only option and can have adverse effects on the brain and mood.

Hair loss can worsen even during transition. Women get hair loss, too, especially in my family. The difference between male and female ranges is much smaller for DHT than it is for T. I twice tried going off my dutasteride and the loss/thinning quickly resumed, only to stop once again upon resumption of dutasteride.

I'm sorry this happened but you may not be on an adequate HRT regimen then. Too little E perhaps or not enough anti-androgenic action. This should be discussed with your doctor.

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81479
Range in males (after 19) is 112-955 pg/mL
In females (20-55 yrs old), 300 pg/ml or less

I consider this difference significant! Compared to males, females are MUCH, much less likely to suffer from baldness, hence why it's termed MALE pattern baldness.

Hair is life, the catalyst for my transition in the first place.

I understand but what I'm saying is that there are possibly other safer ways to go about it. Don't dismiss them so quickly. There are blockers like bicalutamide or suppressors like lhRh agonists.

On injections when my level was 400-1000, I actually felt bad when I came down to 400! That sounds like desensitization to me

Desensitization is not that but rather cells stop responding to the same level when earlier they responded. In your case, levels dropped and this is why you felt bad.

You might have become desensitized to normal levels of E; you certainly seem afraid of them.

What is normal? Ciswomen's range varies so widely and they can go through pregnancy several times during their lives. Lowest can be around 20 pg/ml, highest during pregnancy can be 75,000.

Why would pregnancy levels not be considered normal when women go through this, some several times during their lives and when traditionally, it was considered the norm, was often experienced by women who had up to ten or more children during a lifetime? I am well within "norm".

It is understandable to me that many doctors would be afraid to prescribe high-dose E because of this 'tolerance' effect.

There is no such effect. I intend to remain on high levels for my entire life. My doses need not be reduced. If I absolutely had to lower my dose because of (in my opinion) incompetent doctors, then I guess eventually, I would adapt to lower levels after going through menopausal symptoms for awhile. But, I am surrounded by several competent doctors that trust me and see eye to eye with me. My cousin's wife is also a gynecologist.

If a patient had to go completely off of E for medical reasons, extreme moodiness and physical distress would occur. It would be like menopause on steroids!

I personally see no reason to go off of E for medical reasons (based on all that I've read) unless the E is taken orally or is non bio-identical. Ciswomen have E coursing through their veins and aren't told to remove ovaries because of medical reasons unless the reason is tumor or cyst on ovaries which does not apply to us.

No need for psychosis-inducing megadoses.

For you. One study actually observed post-partum psychosis because of a drop in E levels following pregnancy so they gave these women E and it worked! Where antipsychotics didn't. The power of E.

A woman who becomes pregnant demonstrates that she is able to become pregnant

Obviously. That she is fertile, able to become pregnant.

and it makes sense that nature would give her hormones that would help her become pregnant again later.

This doesn't happen until after she enters ovulation again. Hormones produced during pregnancy, as far as I know, have no impact on the hormones that will be produced in her next cycle which may or may not be produced in sufficient amount.

Also, higher female hormone levels to maintain fertility would reduce the risk of miscarriage.

Not to maintain fertility, fertility being the ability to conceive a child (which she already did) but rather to maintain, support the fetus that is already conceived so it does not die. Not exactly the same. Slight nuance.

I am not aware of any studies showing a cause-and-effect relationship between calmness and health or between happiness and health. This is not obvious to me. After all, old people who are too calm (due to lack of social interaction) are more likely to die. Likewise, bursts of happiness can shock the heart.

You really believe happiness or being calm has no positive (or any) effect on health? Really? It's obvious to me. Oh well...will not argue where I don't see the need to.

Taking progesterone does help with sleep but I think that is due to the sedative effect of allopregnanolone rather than anything else.

Of course.

I do not think there is usually a conscious process involved, like "I wish I did not have low E this week!"

I think some women realize they feel better at a time when their E increases while others remain ignorant as to the cause. Regardless, if we could offer them E at a stable level (but not too stable so as not to desensitize) and they could experience it for themselves, I doubt they would want to go back.

[Steph34]

It may not invalidate your "beliefs" but it invalidates results because more than one factor was changed and so causation and effect may not established. Basic science. Only change one variable at a time. Some studies do indeed change ONLY one variable at a time. They are called randomized double blind placebo controlled trials.

Most of the studies you cite to support your "belief" that low carb diets are superior have similar problems: they also change protein content, vitamin levels, etc. without controls.

Fats in animals and the vitamins they contain appear to be superior to those found in vegetables (Vitamin A vs beta-carotene, DHA/EPA vs ALA, even Vitamin K) and the protein in more complete.

The difference is moot because plant forms are more than adequate for good health for the vast majority of us.

There is no Vitamin D in the plant world and B12 is lacking.

Vitamin D is not a real vitamin as it is produced endogenously in response to radiation, plus it is found in some mushrooms which are not animals. B12 is controversial but a rational vegan will supplement it just like a rational strict carnivore would supplement vitamin C. I could also argue that B12 is not necessary if one avoids B12 "killers" and/or uses unproven natural sources, but why bother?

Not the impression I get from your messages.

It is just a very long meal...

As shown, the dose of dutasteride you (probably) take, regardless of how much DHT is reduced, was equally effective to the highest dose of finasteride in terms of actual hair counts and overall assessment. What counts more: how much DHT is in your blood or scalp or actual hair results? I'm trying to help you save money while maintaining the same good results. That's all.

I care more about hair than money. I maintain my position that actual hair count would be different in me even if no pattern was seen in a study because 1) I am more sensitive to DHT than most people, and 2)I have uncontrollable scalp fungus that further interacts with DHT to cause additional hair loss. Indeed, scalp fungus is main the reason I have not regrown hair despite transitioning with dutasteride.

No because estrogen, other, safer anti-androgens will just as effectively reduce T and DHT to castrate levels, under those seen in premenopausal women who rarely go bald.

You do not seem to understand that I have genetic hypersensitivity to DHT and a female level of DHT will NOT stop my hair loss. I lose hair w/o dutasteride even when my T and free T are in the female range. Even a female relative in her 20s has some thinning in the front and on top. That is called female pattern hair loss and it does exist. Also I need to be extra vigilant due to past damage from DHT; I was actually balding on top and had little left elsewhere pre-transition.

Dutasteride is not the only option and can have adverse effects on the brain and mood.

If not relevant to my feminization, I really don't care...

I'm sorry this happened but you may not be on an adequate HRT regimen then. Too little E perhaps or not enough anti-androgenic action. This should be discussed with your doctor.

I have already had my orchiectomy so I should not need anti-androgens.

I consider this difference significant! Compared to males, females are MUCH, much less likely to suffer from baldness, hence why it's termed MALE pattern baldness.

Males are MUCH less likely than females to suffer from breast cancer, but you would not tell that to a man with breast cancer; would you?

I understand but what I'm saying is that there are possibly other safer ways to go about it. Don't dismiss them so quickly. There are blockers like bicalutamide or suppressors like lhRh agonists.

Adding more E or bicalutamide would cause very real side effects for me, much worse than dutasteride. lhrh agonists are very expensive. And none of those three methods would suppress DHT as effectively as dutasteride.

Desensitization is not that but rather cells stop responding to the same level when earlier they responded.

True. I think that happened with me, too. After my 5 months on injections, I now require higher levels to see the same benefits for my mind and body as I did beforehand. Higher levels = worse side effects.

In your case, levels dropped and this is why you felt bad.

Yes; my mood depends more on whether my level is rising or falling than on absolute levels. Injections = rapid decline for most of the week which is why my mood suffered despite high levels. Plus the high I experienced was TOO intense and my extreme emotions were crippling.

What is normal? Ciswomen's range varies so widely and they can go through pregnancy several times during their lives. Lowest can be around 20 pg/ml, highest during pregnancy can be 75,000.

Normal is the range of a menstruating cis woman.

Why would pregnancy levels not be considered normal when women go through this, some several times during their lives and when traditionally, it was considered the norm, was often experienced by women who had up to ten or more children during a lifetime? I am well within "norm".

Pregnant women's levels do not crash by 1000 or more every week. Such rapid and frequent fluctuations of such large magnitude are not within the typical female experience and I think most women would not do well emotionally with such wild changes.

I personally see no reason to go off of E for medical reasons (based on all that I've read) unless the E is taken orally or is non bio-identical.

I can think of several: extreme constipation, candidiasis, blood clots, estrogen-positive cancer...

Regardless, if we could offer them E at a stable level (but not too stable so as not to desensitize) and they could experience it for themselves, I doubt they would want to go back.

Most people do not want to mess with their hormones unless they have to for medical reasons.

[KayXo]

Most of the studies you cite to support your "belief" that low carb diets are superior have similar problems: they also change protein content, vitamin levels, etc. without controls.

It depends. On a low carb diet, protein is not really changed (low carb should be a moderate protein diet) but carb content is reduced while fat content is increased. Of course, the nutrition one gets changes, as a result and indeed it is not perfect as more than one thing changes. I agree. Some studies have a control group whereas others don't. But, at least these studies aren't simply observations where people are followed, asked what they ate and then an association is made between what they ate and heart disease or cancer rate when so many factors can differ between these two groups. These studies are much more tightly controlled with much less confounding variables. Some of the studies I provided are indeed randomized controlled trials and these are much more solid than cohort or epidemiological studies for obvious reasons that I explained many times before.

The following 24 studies are all randomized controlled trials, one of which is a systematic review:

Obes Rev. 2009 Jan;10(1):36-50. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities.
Hession M1, Rolland C, Kulkarni U, Wise A, Broom J.

Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.

Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003.

Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.

Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 2003.

Aude YW, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat. Archives of Internal Medicine, 2004.

Yancy WS Jr, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 2004.

JS Volek, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism (London), 2004.

Meckling KA, et al. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. The Journal of Clinical Endocrinology & Metabolism, 2004.

Nickols-Richardson SM, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. Journal of the American Dietetic Association, 2005.

Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes. Diabetic Medicine, 2006.

McClernon FJ, et al. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring), 2007.

Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007.

Halyburton AK, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. American Journal of Clinical Nutrition, 2007.

Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabetic Medicine, 2007.

Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrion & Metabolism (London), 2008.

Shai I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New England Journal of Medicine, 2008.

Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. American Journal of Clinical Nutrition, 2008.

Tay J, et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. Journal of The American College of Cardiology, 2008.

Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids, 2009.

Brinkworth GD, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months. American Journal of Clinical Nutrition, 2009.

Hernandez, et al. Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. American Journal of Clinical Nutrition, 2010.

Krebs NF, et al. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. Journal of Pediatrics, 2010.

Guldbrand, et al. In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia, 2012.

a rational vegan will supplement it just like a rational strict carnivore would supplement vitamin C.

I earlier showed you a study where men ate an exclusively meat diet for one full year without Vitamin C supplement and showed no symptoms of vitamin deficiencies. You choose to ignore it. I provided information on the lack of scurvy in Inuits who practically eat only meat and fat all their lives and how raw meat cured some sailors and explorers of scurvy. I also myself lived on only meat and nothing else for more than one year and developed no Vitamin deficiency. This sort of deficiency would start kicking in quite quickly and it hasn't in people following a strict carnivore regimen.

Males are MUCH less likely than females to suffer from breast cancer, but you would not tell that to a man with breast cancer; would you?

Breast cancer is indeed much less likely in men. I never said ABSENT, or that scalp hair loss in women was unheard of but LESS LIKELY.

Adding more E or bicalutamide would cause very real side effects for me, much worse than dutasteride. lhrh agonists are very expensive. And none of those three methods would suppress DHT as effectively as dutasteride.

I didn't realize you had orchiectomy so LhRh agonists are useless. I understand about the estrogen. But, have you ever tried taking bicalutamide? What were the side-effects? Bicalutamide would block DHT very effectively, it is used in men with prostate cancer with castrate levels of T.

Normal is the range of a menstruating cis woman.

You don't consider pregnancy normal? Traditionally, women became pregnant several times during their lives and spent most their reproductive years being pregnant or breastfeeding. I consider pregnancy actually more normal than fluctuating levels every month and suspect women were traditionally exposed to much higher levels of E for a longer time than they do now.

I disagree. Pregnancy is indeed VERY normal.

Pregnant women's levels do not crash by 1000 or more every week. Such rapid and frequent fluctuations of such large magnitude are not within the typical female experience and I think most women would not do well emotionally with such wild changes.

Many transwomen report feeling BETTER on injections, usually taken weekly, than on orals where levels fluctuate much less. Most women actually do fine despite these fluctuations as long as interval is kept to about a week. You are deeply mistaken in that respect. I do well, have no emotional ups and downs. Your situation is not the norm.

I can think of several: extreme constipation, candidiasis, blood clots, estrogen-positive cancer...

I have high levels of E and my clotting times have remained perfect. Pregnant women have extremely high levels (up to 75,000 pg/ml) and despite this, their risk of thrombosis remains under 0.2% (largely in women predisposed) whereas risk increases post-partum when levels crash. Studies in men with prostate cancer (aged up to 91 yrs old, average age 75) have shown high levels (up to 700 pg/ml) not to increase risk of clots and to actually protect against it. A study found no incidences in transsexual women taking very high doses of IM EV. I have several times provided the references/studies for these. Just look back through my posts.

I have never heard of either a link between estrogen and constipation and candidiasis. I have neither of those despite very high levels and have never read any such report from transwomen on high levels, expect perhaps you. Can you provide actual scientific support for this?

Cancer is very low in transsexual women despite for decades, being prescribed sometimes VERY aggressive doses of estrogen. Pregnancy, a time of very high levels of E, has been inversely associated with breast cancer in ciswomen and in randomized controlled trials, estrogen taken alone or without progestogens known to increase risk of breast cancer, has actually neither increased the rate of cancer and even reduced incidence. Even in women with prior breast cancer, studies have shown either no recurrence, low recurrence or less recurrence on estrogen. High doses of estrogen are sometimes actually prescribed to women with advanced breast cancer and one such study even found E to be better than tamoxifen, an "anti-estrogen", in terms of survival rate. Overall, it seems that estrogen is more protective than anything else. Women get breast cancer after the age of 40 and especially 50 when their estrogen levels drop.

Pathol Oncol Res. 2012 Apr;18(2):123-33.

"even a slight decrease in their circulatory estrogen levels associated with insulin resistance may increase the risk for cancers, particularly in the organs having high estrogen demand (breast, endometrium and ovary). On the other hand, postmenopausal state with profound estrogen deficiency confers high risk for cancers in different organs with either high or moderate estrogen demand. After menopause, hormone replacement therapy improves insulin sensitivity and decreases the enhanced inclination to malignancies in postmenopausal women."

Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"There is no increase in cancer prevalence or mortality due to transgender HT."

"While some guidelines for transgender medical care express concerns for elevated cancer risk with certain hormone regimes, current data suggest that the risk of cancer may not rise."

"Although studies are small, overall cancer incidence in transgender men and transgender women to-date has not been found to be different than their respective male and female controls [5]. There are no reports of change in breast cancer specific risk among transgender individuals on estrogen compared to secular trends of male breast cancer incidence.[/u] Rates are lower relative to secular trends of female breast cancer rates."

[2Wendy2]

After much research on the effects of Domperidone in conjunction with estradiol and progesterone in my case to induce lactation I have found that it works just the opposite, Estradiol and to a larger effect Progesterone will hinder the effects of Domperidone. As part of the process to induce lactation you need to run your E2 and Progesterone levels really high simulating that of a pregnant woman. Toward the end Domperidone is introduced to increase the prolactin levels. This alone does not induce lactation, lactation begins when after a period of taking all three you stop the E2 and progesterone, while continuing Domperidone, then a few days later lactation begins, in a week or two you have full flow.

I do take a micro-dose of each while lactation, but if I increased to my normal dosages, lactation stops.

Hope this helps....

[KayXo]

Yes, progesterone, especially, strongly suppresses lactation.

[Steph34]

Yes, progesterone, especially, strongly suppresses lactation.

Does this mean skipping progesterone for a day or two can make my breasts shrink by causing contents to be released, or does that only apply to women who are breastfeeding? Because I *do* feel like my breasts shrink if I skip my progesterone, and swell up almost overnight when I take a higher dose. I was wondering what could be the explanation for such noticeable short-term changes. My free T, DHT, and estradiol levels are all within female range.

With that said, in the 13 months since I added progesterone and bicalutamide, my girls have grown three sizes; they are not so little anymore like they were when I started this thread. This really took me and my family by surprise, and I will look back on this experience as one of the highlights of my life.

[KayXo]

I *do* feel like my breasts shrink if I skip my progesterone, and swell up almost overnight when I take a higher dose. I was wondering what could be the explanation for such noticeable short-term changes.

I believe the reason why they swell up so fast is because of increased water retention in the breasts as well as milk glands being enlarged. But, yea, it also increases prolactin so could be increased milk secretion that's caught up in the milk glands, very possible!

[Steph34]

But, yea, it also increases prolactin

What change in progesterone levels is it specifically that you are saying increases prolactin? The rise or the fall in progesterone levels? Because I know that a spike in my estradiol level or domperidone dosage (which are not correlated with my progesterone use) can raise prolactin.

[KayXo]

What change in progesterone levels is it specifically that you are saying increases prolactin? The rise or the fall in progesterone levels?

The rise in progesterone. Corroborated by studies and my own experience. When levels fall, expression of milk is possible as progesterone inhibits this.