Worried about lack of changes

[jinruinooto]

Halleloo, everyone! x3

I'm trying to get a handle on the whole transition thing, and I'm getting a little worried.

I've been on HRT for about a month now, and I'm worried that I'm messing something up. I noticed the emotion change, and I'm definitely noticing a loss of strength.

But, I smoke, and I'm worried that it's interfering.

EDITED OUT MEDICATIONS LOL

I haven't noticed any new fat, my skin is still tight, but it may be softer, and I have no breast growth.

I take the Etradiol sublingually, which should bypass the smoking issue, because it gets into the bloodstream instead of going through my liver.

[Laura_7]

You might talk to your endo ... its possible they start you out with a low dose.

Because people are different the giving of exact dosages should be avoided ...
you might edit it out or a moderator will do it...
giving values for blood levels is ok ...

You might consider stopping smoking.
It should be really helpful.

You might split the daily dose in a few small doses when taking e sublingually.
Sublingually levels rise fast and drop hours later.
So to avoid spikes which might affect mood a few doses spread throughout the day can be helpful.

Since you smoke ... as said it should be preferable to quit ... some people take daily a very low dose of aspirin to prevent clotting. Smoking can make fine blood vessels shrink.

You might talk all of this through with your endo.


*hugs*

[jinruinooto]

I didn't know about the mediation thing, so I edited it out. Thanks x3

I just got back my bloodwork from 02/27, so about a week in, and I'm actually less worried. My T levels were high, but not too bad:


Estrogens, Total and Fractionated
Estradiol              = 173.0
Estrone         = 286.0
Estrogens, Total           = 459.0

Testosterone   
Testosterone, Serum   = 184.2

So, I think at this point, my T levels should be lower, and my E levels should be higher, unless that's not how it works lol.

And my endo told me about the asprin, and I'm on an asprin a day, I was just worried it was messing up my levels. But, my E levels seem in the correct place, so I should be okay lol.

[KayXo]

But, I smoke, and I'm worried that it's interfering.

I'm on Estradiol, spironolactone, and medroxyprogesterone.

I haven't noticed any new fat, my skin is still tight, but it may be softer, and I have no breast growth.

I take the Etradiol sublingually, which should bypass the smoking issue, because it gets into the bloodstream instead of going through my liver.

(doses removed because not allowed)

Sublingually, you will swallow some, it's not exactly like taking it non-orally. Smoking, on top of increasing health risks, does indeed interfere with estradiol metabolism because it is taken orally as it increases activity of CYP1A2 enzyme which increases metabolization/breakdown of estradiol as it is digested and absorbed. Studies have shown this.

N Engl J Med. 1985 Oct 17;313(16):973-5.

"To elucidate the effect of smoking on estrogen metabolism, we examined 136 postmenopausal women treated for one year with one of three different doses of combined estrogen-progestogen or placebo. The women were grouped according to smoking status, and serum levels of estrone and estradiol were measured before and after treatment. The results showed reduced levels of both estrogens in smokers as compared with nonsmokers in all three dosage groups. This reduction was most pronounced in the high-dose group..."

"Moreover, it was possible to demonstrate significant inverse correlations between the number of cigarettes smoked daily and the changes in the levels of serum estrone and estradiol, respectively, (P less than 0.001)."

Journal of Endocrinology (1999) 162, 265–270

"Comparing smokers and non-smokers, plasma levels of Oe(1), Oe(2) and Oe(1)S were all found to be 40-70% lower in smokers compared with non-smokers when ERT was given orally (Oe(1)S, P<0.05; Oe(1) and Oe(2), P<0.01 for both). Oe(2) given orally caused a higher Oe(1)S/Oe(2) ratio but also a higher Oe(1)/Oe(2) ratio compared with parenteral therapy in smokers (40.2 versus 7(.)0, P<0.01; and 3.2 versus 0.8, P<0.05 respectively). No significant differences in these parameters in the different test-situations were seen in non-smokers. Except for a lower level of Oe(1)S in smokers (non-significant), no difference in plasma oestrogen levels between smokers and non-smokers was observed during parenteral therapy. In conclusion, cigarette smoking has been shown to have major impact on plasma oestrogen levels during oral but not during parenteral Oe(2) replacement."

Spironolactone also increases activity of CYP3A4 responsible for metabolizing oral E, thus could potentially reduce concentrations even further. This is an often ignored side-effect of spiro when E is taken orally.

Finally, medroxyprogesterone acetate is not the safest progestogen because:
- it may potentially increase the risk of breast cancer as some studies have found an association
- it increases thrombus formation and thus risk of clots, together with smoking, poses greater risks
- it has negative cardiovascular effects and opposes estrogen's positive ones, together with smoking, poses greater risks
- it can, in some, worsen mood, cause depression, sometimes to suicidal levels, or make one aggressive/irritable
- slightly androgenic

In contrast to other progestogens, especially bio-identical progesterone which is safer and does not have any of these side-effects except perhaps mood deterioration in some, while, in others, mood improvement.

You could discuss with your doctor the possibility of switching to non-oral estrogen (gel, patch, injections) and also to oral bio-identical progesterone OR hydroxyprogesterone caproate injections. 

Best of luck.

[Jacqueline]

Greetings and welcome to Susan's,

Thanks for editing out that dosage information. It is against site policies. You can mention the type of prescription and method but not the actual dosage.

This site has a lot of people with multiple experiences and knowledge. So you have come to a great place to look for information. Although we encourage to talk to your doctor about dosage and effects of prescription.

I am adding some links with helpful information and policies. Please take a moment to take a look at them:

Things that you should read

Site Terms of Service & Rules to Live By	Standard Terms & Definitions	Post Ranks (including when you can upload an avatar)
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Look around, ask questions and join in.

Welcome again. I wish you love, acceptance and a smooth path.

With warmth,

Joanna

[jinruinooto]

Dang, He made it sound like it bypassed some of the liver metabolization, so I was hoping that would help.

I keep trying to quit, but it's so hard. I guess I'll need to try again lol

Thanks again for the info, it really helped x3

[KayXo]

Estrogens, Total and Fractionated
Estradiol              = 173.0
Estrone         = 286.0
Estrogens, Total           = 459.0

Testosterone   
Testosterone, Serum   = 184.2

Estradiol, when taken sublingually, will fluctuate greatly in the first few hours, from very high to low, just in 3-4 hours. How long after taking did you measure levels? Hence, no point in measuring levels and test doesn't indicate sensitivity to levels so whatever level you end up having, you don't know if it's right for you, the only way is to see how breast growth is going, feminization, etc.

T level is above female range (15-90 ng/dl) BUT spiro blocks some T AND SHBG raised by E will bind some of that T, making some unavailable. Better to measure bio-available T or free T. And even then...

So, I think at this point, my T levels should be lower, and my E levels should be higher, unless that's not how it works lol.

Not necessarily. Depends on how you feel, rate of progress, breast growth, demasculinization, etc. This should be evaluated by your doctor and discussed together with him.

[jinruinooto]

I definitely feel better. I have noticed a lot of things as far as my emotional well-being go. So, I know it's working on that point.

I'm just worried about fat redistribution and other physical changes. My body hair seems to be growing slower too.

I think I'm just being impatient. I hear a lot of girls where changes happen quickly, but I still feel like I look masculine.

But, I'm losing strength, and other changes have been noted.

[Saki]

I feel the same way. However Ive been on hormones for a year .

[Dena]

A woman takes between 5 and 10 year to fully mature. Estrogen production may start in a girl a year or two before much change takes place. At a month or two you may notice some sensitivity. The next step will be the development of the breast bud which is a hard spot under the nipple. After that, you will see some volume develop. In my case, at 5 years I was still a AA cup size and I haven't developed much beyond that.