Effects of cycling hormones

[A7A]

So I've been thinking about cycling. Usually it's done with estrogen as I understand it, and my doctor recommends it so that the receptors regulating estrogen don't get too used to the estrogen and stop having any effect. But when I stopped taking spiro, a weird thing happened - after a week my breasts started to grow FOR THE VERY FIRST TIME. So now I'm thinking about cycling even the antiandrogens. Do any of you have experience with this? My doctor couldn't explain why my breast didn't grow before but started growing when I stopped with the spiro, and now that I've begun again and have my T levels in the female range, the breasts stopped growing again! Frustrating to say the least.

[Dena]

I don't have a clue but I have a dumb idea. Drugs tend to work the same in most of the population but there is a small number of people who find the a drug may act different on them than others. It's possible the spiro is blocking the estrogen receptors and when you stop it, the remaining estrogen produces growth. When I transition blockers weren't used so it is very possible to transition without a blocker. Estrogen by it's self can sometimes suppress T so it might be interesting for you to stop the blockers and remain on estrogen without cycling. See how much it surpasses your t levels and if you continue to develop. We didn't cycle before surgery but we cycled after surgery so continuous HRT shouldn't be a problem for a while.

[A7A]

I took just estrogen for half a year, and have taken estrogen before that as well half a year a couple of years ago, and nothing happened to my breasts or anything else for that matter. So just the estrogen isn't very effective for me. With the spiro my T levels at least are in the female range, but I'm still stumped over the lack of breast growth.

[Dena]

I am a member of the small boob club as well. I was on estrogen alone for around 5 years before surgery and was only a AA cup size. I currently am an A+ cup size 33 years post surgical. To your advantage, it takes a woman 5 to 10 years to mature so you still have hope.
Also it would help to know the levels from your blood test to see the levels the doctor is targeting.

[Debra]

tough call. I've mostly heard about progesterone cycling more than anythiing.

[A7A]

My t levels are current around 40nmol/L. It's within the Swedish range, although a lot of trans girls have a lot less. But we're moving forward slowly. I do wish to be able to maintain an erection and I do have trouble with depression and have had trouble with deppresive reactions to low t before.

[KayXo]

It's possible the spiro is blocking the estrogen receptors

Spironolactone does not bind to estrogen receptors.

My t levels are current around 40nmol/L.

You are in the upper MALE range, even slightly above. 
From one source,
Normal levels for male are around: 9-38 nmol/L
Normal levels for female are around: 0.52-2.4 nmol/L

I'm post-op and my levels are 0.3.

I do wish to be able to maintain an erection and I do have trouble with depression and have had trouble with deppresive reactions to low t before.

It could be that you aren't taking enough estrogen to compensate for the low T. E is anti-depressive and has a positive effect on mood (i.e. serotonin). I'm post-op with VERY low T, I am taking E and have "erections" in the sense that I can feel all the blood rush to the area (engorgement) when I'm aroused and if a penis had been there, it would have surely been erect.

[KayXo]

It's possible the spiro is blocking the estrogen receptors

Because I question everything, I went and explored further this possibility. I found this study:

J Endocrinol. 1980 Mar;84(3):371-9.

"Spironolactone, when administered for 3 successive days (...) to immature female rats, increased all of the five indices of oestrogen agonistic activity. The oestrogen-antagonistic properties of the drug were evaluated by comparing the oestradiol-injected group (5 microgram) to the oestradiol + spironolactone-injected group. A decrease was noted in all indices measured except for progesterone receptors in cytosol. Spironolactone appeared to be very similar to tamoxifen in its action both as an oestrogen and as an antioestrogen."

In other words, when spiro was administered alone, it had estrogenic activity. In combination with estrogen, however, it did the opposite, had anti-estrogenic effects, blocked the estrogen. Remember, this was in rats.

[A7A]

KayXo: ->-bleeped-<- I meant 40 ng/dL! 1.4 nmol/L. And although I can get erections, I can't sustain them. I struggled to maintain my regular sex practices but have for now, without the help of viagra, given up. Although I love me them vaginas there will be no penetrating practices, and I will not try to reach orgasm anymore because it's really hard and it's not very satisfying either. I'm just gonna start pretending like my whole area down there is a very sensitive clit. That actually is more satisfying right now because when I get stimulus based on that assumption I'm still horny yet don't lose my erection which I do very fast when I try to jerk off, get blown or penetrate. Very sensitive I have become, yes.

My estrogen levels were around 160 which was low, and my endo said we should be getting them up toward 800-900. Zie also claimed that we should switch from patches to gels because we can't draw conclusions from the blood work based on my current patch regime (estrogen levels differ depending on which day I put the patch on).

[KayXo]

My estrogen levels were around 160 which was low, and my endo said we should be getting them up toward 800-900. Zie also claimed that we should switch from patches to gels because we can't draw conclusions from the blood work based on my current patch regime (estrogen levels differ depending on which day I put the patch on).

I'm assuming pmol/L. Mine have been anywhere from 5,000 to 14,000. Individuals vary in their sensitivity, there is no ideal level for everyone and higher levels are not necessarily indicative of increased health risks, as I have explained many times before. E levels vary within a day so even with gel, were you to take test in the morning vs afternoon vs evening, levels would differ, this is why I don't think measuring levels is accurate and even if they were, who cares what they are? I personally think it's best to find the dose that produces the best results, makes you feel good and doesn't increase health risks. Many doctors share this belief as well. I'm not a doctor though.

Cycling may not be a good idea as on top of being conducive to mood swings like in ciswomen, they may increase the risk of getting breast cancer due to high rates of proliferation and apotoposis increasing the likelihood of mutations.

The Lancet, Vol 379 June 23, 2012

"In 1713, Italian physician Bernadino Ramazzini1 noted that
nuns had an extremely high incidence of that "accursed pest",
breast cancer. Today, the world's 94 790 nuns still pay a terrible
price for their chastity because they have a greatly
increased risk of breast, ovarian, and uterine cancers: the
hazards of their nulliparity."

"MacMahon and colleagues3 were
the first investigators to make a formal link with parity,
showing, in 1970, that parous women had a decreased
risk of breast cancer compared with nulliparous women.
Parous women receive further protection if they have
their first child at a young age, bear more children, and
if they breastfeed. These reproductive factors are now
known also to protect against the risk of ovarian and
endometrial cancer.4"

"Nulliparous women have a higher number of ovulatory
menstrual cycles than do parous women because of the
absence of pregnancy and lactation, and an increased
number of cycles affects cancer risk."

This may be why transsexual women have a very low incidence of breast cancer. We don't cycle our hormones. Interestingly, the more babies, the lesser the risk and yet the more babies, the more pregnancies, the higher the levels of estrogen (up to 275,000 pmol/L)! Food for thought...

[A7A]

As long as moods swings doesn't mean more anxiety I am perfectly fine with feeling very sad one moment and happy the other. In fact I welcome it after years and years of mostly feeling anxiety and not very much else. But I'm just gonna have to experiment with this one I guess. Let's hope my doctor is up to it as well, for example by giving me more estrogen than is usual to see what the effect would be.

[Mariah]

I have never heard of it, but I would talk it over with your doctor since Spiro does more than Just lower T levels. Hugs
Mariah

[JLT1]

The literature on the benefits of cycling hormones is mixed.  A few belive it to be beneficial, most do not.  There has been a lack of good research in this area (emphasis on "good").

It is reasonable to beleive that cycling both estrogen and progesterone in a post orchi trans gendered woman for a period of a few years might stimulate or enhance feminization.  Cycling a testosterone blocker might be interesting but probably not a good idea as most blockers affect other systems beyond the endocrine.


Jen

[KayXo]

As long as moods swings doesn't mean more anxiety I am perfectly fine with feeling very sad one moment and happy the other. In fact I welcome it after years and years of mostly feeling anxiety and not very much else. But I'm just gonna have to experiment with this one I guess. Let's hope my doctor is up to it as well, for example by giving me more estrogen than is usual to see what the effect would be.

And the possible increase in risk of breast cancer doesn't worry you?

It is reasonable to beleive that cycling both estrogen and progesterone in a post orchi trans gendered woman for a period of a few years might stimulate or enhance feminization.  Cycling a testosterone blocker might be interesting but probably not a good idea as most blockers affect other systems beyond the endocrine.

Depending on how long one stops estrogen before restarting, one can experience breast shrinkage, tiredness, depression, horrible headaches, insomnia, hot flashes, some loss of feminization, aches and pains in the body, etc. Same with anti-androgens as androgenic features might come back making one feel bad about themselves, anxious, depressed. Some can experience significant withdrawal symptoms from stopping progesterone as it has anxiolytic effects similar to benzodiazepines. Add to that the constant cycle of cell death and proliferation which increases the chances that a cancerous cell might proliferate. In my opinion, there can be no good that comes out of this.

I think levels already fluctuate enough (excluding pellets which have shown that desensitization is possible) so that we needn't worry about cycling. This is especially the case with injectables. To illustrate, in just two days, my levels dropped from 2,500 pg/ml to 1,300 pg/ml. 2 days!! Same with progesterone, as levels peak and drop within hours to a significant degree.

[lauraf]

Hmm, Kay, if you're on injections aren't you worried about risk of breast cancer yourself? I feel like doing injections resembles cycling a bit (i'm on IM EV myself), even if you do them every 5 days levels do not stay the same all the time, you even mentioned the crazy level drop You had. Also, I don't believe having pregnant levels constantly for a really long period of time is doing anyone good. I imagine its  just a stress for the body, let alone the receptors being loaded with hormones thing (which im not sure if its real or proven). Note that I know and love the rush and antidepressant side of sky high E levels if it sounds like im against it, I'm totally not

Edit: I've only been on injectables for over a year now so these are only my guesses about the long term use. My doc doesnt provide such info. I do them every 5 days so obviously don't experience any mood changes.
KayXo How long have you been on them? And maybe you know if such dramatic but not long lasting fluctuations have any impact? Sorry couldn't find PM button.

[KayXo]

Hmm, Kay, if you're on injections aren't you worried about risk of breast cancer yourself? I feel like doing injections resembles cycling a bit (i'm on IM EV myself), even if you do them every 5 days levels do not stay the same all the time, you even mentioned the crazy level drop You had.

My levels don't drop to the extent that they do during menstrual cycles, otherwise I would be getting pre-menstrual symptoms. They fluctuate enough so as not to desensitize cells to E but not to the extent where they would be harmful for breast size (cell death/shrinkage) and mood (depression, anxiety). They stay high enough not to be a problem. If on the other hand, I did injections every 3-4 weeks, then this could, in the short-term, cause very bad PMS and in the long-term, breast cancer.

Consider the fact that in the past hundreds (probably thousands) of transsexual women were treated with intramuscular injections and yet the rate of breast cancer is very low in this population, similar to that in males not on HRT.

Also, I don't believe having pregnant levels constantly for a really long period of time is doing anyone good. I imagine its  just a stress for the body, let alone the receptors being loaded with hormones thing (which im not sure if its real or proven).

Pure speculation, beliefs based on nothing concrete (i.e. studies).

Consider that in traditional times, before the Industrial Revolution, women had on average many more kids (5-6), sometimes, in excess of 10 children in a lifetime and weren't harmed by this as otherwise they wouldn't have been able to live long enough to produce this many children. It is true that life expectancy was shorter in those times BUT mortality was not due to complications arising from DVT during pregnancy but rather from improper hygiene, infectious diseases and less effective/advanced medical intervention/procedures. Such high birth rates still persist in some countries (developing) and in certain communities without seemingly adverse effects. Remember that DVT incidence is very low during pregnancy, less than 0.02%, with most cases of DVT and pulmonary embolism occurring after pregnancy when E levels drop significantly and with those cases occurring during pregnancy being associated with advanced maternal age, obesity, smoking, the presence of concomitant thrombophilia (particularly factor V Leiden (homozygosity), prothrombin gene mutation (homozygosity), or antiphospholipid syndrome (APS)), and cesarian section, the last one not applying to us, obviously and the one before that being quite rare but being the second most prevalent factor increasing risk (first being previous occurrences of thrombosis). All the data we have so far points to the safety of high levels of E if taken non-orally. Pregnancy levels are also much higher relative to ours, with averages ranging from 1,000 to at most 5,000 in transsexual women VS. up to 75,000 in ciswomen. If such high levels are associated with such a low risk of health complications, then what are we to conclude from levels that are significantly lower in us?

Consider that an inverse association has been found between number of children and risk of breast cancer in women and that when women bore more children, breast cancer was much less prevalent whereas celibate nuns who never become pregnant end up having the highest incidence of breast cancer, regardless of the era (as far back as the 1700's). 

So far, my blood tests have shown no negative impact on my health and there is no reason to think that if health markers aren't negatively affected now, this will be in the future.

I feel better now on higher levels than I did on lower levels. My feminization is better as well. I see no reason to worry. Neither do my doctors. 

KayXo How long have you been on them?

Since March of 2014. Two years. I know women in their forties and fifties who have been on them for almost a decade without any complications.

[lauraf]

Thank You for the answer. Always impressd by your knowledge and analysis 
This is completely off topic but good to know all those things and to know of actual cases of people taking high dose of hormones long-term. Glad to know You do so well.

This is just common sense making me think that everything in excess is harmful, so why it wouldn't be the case here. Sadly everything has a dark side. Depends on an individual reaction I guess, and how long one wants to continue doing that. What I immediately think of is the withdrawal, needs to happen one day (unless it is taken until time when menopause naturally occurs), no need to mention they act like drugs on our brains, the more one takes the worse. I imagine coming off of such dosage must be mentally much harder than for a cis woman because of the non stop exposure time even when the dose is lowered slowly. Must resemble withdrawal from antidepressants and benzodiazepines at the same time. This is a hard one because I don't think there is much info about such form of treatment in trans women. There are widely known, thoroughly studied cases of pregnant genetic women who have such high levels of prolactin post partum that it's impossible to get pregnant for some time/not recommended to do so in 1-2 years and maybe that is the time when the brain recovers from the overflow of hormones (apart from body recovering from physical strain). Again, some of us are luckier and more resistant than the others

[KayXo]

This is just common sense making me think that everything in excess is harmful, so why it wouldn't be the case here. Sadly everything has a dark side.

But this is not excessive if you consider that women traditionally (and naturally) experienced pregnancy several times during their lifetime, with levels far surpassing those we achieve on injectables. Your conditioning (hard to overcome for any human being) is getting in the way as you've been used to seeing much lower levels and thinking this is normal for ciswomen. There is no dark side, no excess here. Despite my explanations, common sense, studies provided, you keep on insisting that this approach may be harmful. Conditioning is indeed powerful.

What I immediately think of is the withdrawal, needs to happen one day

It doesn't! Why? Give me one good scientific reason why. Don't speculate, don't assume. You won't find any.

I imagine coming off of such dosage must be mentally much harder than for a cis woman because of the non stop exposure time even when the dose is lowered slowly.

Some women experience post-partum depression/psychosis and studies have shown estrogen to be the most effective treatment for this.

There are widely known, thoroughly studied cases of pregnant genetic women who have such high levels of prolactin post partum that it's impossible to get pregnant for some time/not recommended to do so in 1-2 years and maybe that is the time when the brain recovers from the overflow of hormones (apart from body recovering from physical strain). Again, some of us are luckier and more resistant than the others

High prolactin (maintained by breastfeeding) keeps sex hormones low so women can't ovulate and get pregnant. This is why in some species, new males kill the young so females stop nursing and become fertile again to procreate with them.

You say high levels of sex hormones are a strain for the body when in fact they are not, they actually help the woman feel more relaxed, improve blood circulation, produce a glow, etc. The strain is carrying the fetus inside which is not our case. You are making many assumptions without any science behind it.