Where is the leading edge of HRT technology? (MTF)

[Christina308]

I thought i would ask this question as my Endo has given me a pretty routine prescription of Spiro and oral Estrogen once a day. As I live in Canada, I'm concerned about the potential for second rate medical advice. If there is a better combination of medications, or delivery methods, i'd like to know about it. Better results would be worth some extra effort or money in my opinion.

[Ms Grace]

That is a fairly standard starting regimen. They are almost always going to start you off slow so your body has time to change hormonal gears.

[SophieD]

You're getting the same advice I'm getting in Washington, DC, from a clinic that specializes in care for LGBT folks and which routinely manages HRT.

[AnonyMs]

Once you're over the beginning bit look into estrogen implants.

Kind of leading and trailing edge at the same time, they have been around for decades and are still the best.

[KayXo]

They don't offer implants in Canada BUT you can get injections from compounding pharmacies. I did better on injections vs oral. Be sure to drink plenty of water and eat enough salt on Spiro, limiting overall potassium intake. I'm from Canada as well.

[AnonyMs]

They don't offer implants in Canada BUT you can get injections from compounding pharmacies.

No implants at all, not even for cis-women?

[KayXo]

No. Not my knowledge, at least.

[AnonyMs]

I'd be pretty upset if I couldn't get implants. Not sure what I'd do.

There's a supplier in the USA of implants. Maybe they have customers in Canada and could put you in touch with them (or vice-versa)?

[KayXo]

I wouldn't want implants for three reasons:

1) I'm doing so well with injections and it's convenient, barely any hassle. Why fix if it ain't broken?
2) Too steady levels from implants may cause desensitization as suggested by one study
3) I don't heal well and I don't want another scar from implant insertion. I also hate any kind of anesthesia, local or otherwise.

Let Christina know by PM but I'm personally not interested. Thanks though.

[Christina308]

What's a compounding Pharmacy, and how does one get them to provide injectables? Prescription?

[KayXo]

A compounding pharmacy is a pharmacy that compounds hormones or medications suited to your specific needs. You need a prescription from a doctor. I will send you the link.

[Laura_7]

I'd be pretty upset if I couldn't get implants. Not sure what I'd do.

There's a supplier in the USA of implants. Maybe they have customers in Canada and could put you in touch with them (or vice-versa)?

Here is complete information for a doc or endo to start implants:
https://www.susans.org/forums/index.php/topic,200276.msg1780555.html#msg1780555

There are compounding pharmacies in the us which deliver worldwide. A source is included in the link.

There are strategies with implants and injections to drive estrogen well into the female range which all by itself, via a feedback loop, can lower testo to female levels. So no anti androgens are needed.

Many people have good results on injections. Using a weekly insead of a biweekly cycle makes for less ups and downs in levels and could help keep mood more steady.

Concerning desensitisation by very high and stable levels with implants there might be strategies ...
some endos use bioidentical progesterone or Proluton-Depot shots to compliment estrogen.
Another might be to avoid too high levels .


*hugs*

[KayXo]

Another might be to avoid too high levels .

The problem is not high levels but rather the steadiness of levels. Otherwise, pregnant women would become desensitized (clearly not the case) to hormones as they are VERY high during pregnancy. And besides, what would be the point of the body producing such high levels if cells stopped responding?

[Laura_7]

The problem is not high levels but rather the steadiness of levels. Otherwise, pregnant women would become desensitized (clearly not the case) to hormones as they are VERY high during pregnancy. And besides, what would be the point of the body producing such high levels if cells stopped responding?

Someone reported from their endo they do no further implants above a certain level of estrogen.
So there seems to be a threshhold for the effect.

Well it seems nobody is really sure about desensitisation. It seems it occurs when many receptors are permanently occupied by the same molecules. A change in levels would result in at least a small change in molecules. Also if levels are not really high. There should be an amount of come and go.

Additionally bioidentical progesterone might play a role, maybe by replacing some of the molecules on receptors.
It is present in cis women.
So the threshhold for desensitisation would be higher, higher levels of estrogen would be needed for desensitisation.
Some endos use high levels of estrogen with implants together with bioidentical progesterone and without anti androgen.

So ... maybe its possible to switch to implants if:
-the dose is not too high
-bioidentical progesterone is added
-or the dose is high and the levels are jiggled from time to time.
Flaxseed have a certain amount of phytoestrogen. It also stays in the body for a while but makes for a weaker effect than estrogen.
Introducing for example some freshly blended flaxseed (don't overdo amounts... if in doubt ask your doc) from time to time might be a remedy.
It should make for some replacement on receptors, with a falling effect over some time.

Just talk it through with your doc.


*hugs*

[KayXo]

Someone reported from their endo they do no further implants above a certain level of estrogen.
So there seems to be a threshhold for the effect.

Is this the reason why endo didn't want levels above a certain threshold? And if so, is endo's statements true? supported by studies? by observations? Does not seem like it.

My levels go up to 4,000 pg/ml, pregnant women's up to 75,000 pg/ml. There is no desensitization.

Steadiness of levels is more likely to be the culprit.

[Laura_7]

Is this the reason why endo didn't want levels above a certain threshold? And if so, is endo's statements true? supported by studies? by observations? Does not seem like it.

My levels go up to 4,000 pg/ml, pregnant women's up to 75,000 pg/ml. There is no desensitization.

Steadiness of levels is more likely to be the culprit.

Studies often are conducted when there is enough of a market presumed.
So in the absence of studies observations and comments of experienced endos can be regarded.

One endo has made the experience that above 1000pmol with steady levels from implants there might be a higher probability of desensitisation. He uses implants on clients with a low probability below that level regularly.
So there is a treshhold. The study you cited also mentions levels above that with those persons who had symptoms. With all other persons there were no symptoms.


*hugs*

[KayXo]

Studies often are conducted when there is enough of a market presumed.
So in the absence of studies observations and comments of experienced endos can be regarded.

But there are studies on women who are on implants. Endo's assertions are only opinions, speculations. They can be wrong.

One endo has made the experience that above 1000pmol with steady levels from implants there might be a higher probability of desensitisation. He uses implants on clients with a low probability below that level regularly.

Blindly trusting is not something I do, sorry. If indeed levels above 1,000 pmol/L caused desensitization, then please explain why in pregnant women or in women like myself who are on injectables or even men with prostate cancer with levels far exceeding 1,000 pmol/L on patches (steadier levels but still less steady than pellets) do not experience any desensitization.

So there is a treshhold. The study you cited also mentions levels above that with those persons who had symptoms. With all other persons there were no symptoms.

Earlier, you said in the absence of studies but now you yourself admit there is a study. In that study, there was no other group, just that group with high levels. No such thing as "with all other persons, there were no symptoms".

[Laura_7]

But there are studies on women who are on implants. Endo's assertions are only opinions, speculations. They can be wrong.

There are no studies concerning higher levels and desensitisation concerning bioidentical estrogen implants.
Even the study you provided speaks of presumably desensitisation.

Concerning studies its very important to exactly read what they say.
Some endos presume adverse effects from higher levels of estrogen. But studies concern non bioidentical estrogen and oral intake.
Cis people have higher levels without adverse effects.

Same with Progesterone. There is bioidentical progesterone and other forms which have different effects.

Blindly trusting is not something I do, sorry. If indeed levels above 1,000 pmol/L caused desensitization, then please explain why in pregnant women or in women like myself who are on injectables or even men with prostate cancer with levels up to 2,500 pmol/L on patches (steadier levels but still less steady than pellets) do not experience any desensitization.

Its a AND connection. Higher levels AND very stable levels. Otherwise EVERY person with implants would have this effect.
The study you provided cites affected persons only with high levels.
Levels in pregnant woman vary to a degree also with time of day and levels from patches fall off during a few days until they need to be replaced.

Earlier, you said in the absence of studies but now you yourself admit there is a study. In that study, there was no other group, just that group with high levels. No such thing as "with all other persons, there were no symptoms".

The study you provided was not conducted to look at desensitisation. They even speak of presumed desensitisation.
The majority of people had no adverse effects.
Those who had adverse effects had raised levels.


*hugs*

[KayXo]

There are no studies concerning higher levels and desensitisation concerning bioidentical estrogen implants.
Even the study you provided speaks of presumably desensitisation.

The study in question...

CLIMACTERIC 2005;8(Suppl 1):3–63

"There are reports on recurrence of hot flushes within 3–16 weeks after implantation of (...) estradiol, although (or because?) the estradiol levels were measured in these women to be extremely high (between 400 and 1000 pg/ml)149. The underlying mechanism is unknown; perhaps the symptoms are due to a desensitization phenomenon by extremely high estrogen levels causing the recurrence of estrogen deficiency symptoms."

These are high levels, in excess of 1,000 pmol/L and desensitization is reported, more than once. Authors admit they don't know why this happens and suggest a reason why but that is far from certainty. One could just as well speculate that it is because of steady levels because the same thing doesn't occur in pregnancy or in individuals who are on injectables/patches with very high levels but with less steady levels.

From study:

"In contrast to the transdermal treatment with estradiol which showed large intra- and interindividual variations, the administration of estradiol pellets was associated with relatively small fluctuations during the 6 months after implantation"

Concerning studies its very important to exactly read what they say.

Indeed and I have done just that.

Its a AND connection. Higher levels AND very stable levels. Otherwise EVERY person with implants would have this effect.
The study you provided cites affected persons only with high levels.
Levels in pregnant woman vary to a degree and levels from patches fall of during a few days until they need to be replaced.

In all cases, there are high levels but in the case of pellets where desensitization is noted, levels are more stable. By simple deduction, one can conclude that steadiness is the problem, not high levels.

[Laura_7]

In all cases, there are high levels but in the case of pellets where desensitization is noted, levels are more stable. By simple deduction, one can conclude that steadiness is the problem, not high levels.

It needs to be both otherwise there would be a high incidence of people with symptoms with less higher levels.
This is not the case.
Most people have no adverse symptoms.
They even speak of bioidentical estrogen implants very favourably.
Bioidentical estrogen implants simply would not be around if it would lead to a desensitisation on a large scale.


*hugs*