My clinic blood results: heeeeeelp?!

[April_TO]

As a suggestion being an ex-spiro user, can you look into Cyproterone Acetate as your AA since it's a lot more potent in reducing T. It actually stops your body from producing LH which in turn signals your body to stop producing T if I have read that correctly.

I was on spiro for 1yr and half with very bad side effects. I have switched to CPA/Adrocur and never looked back. I recently had my blood work done and I was at 1800 pm/ol estradiol and 1.4 ng/dl T with 4 as my free T.

Yes, the estradiol was super high since I just took my E sublingually a few hours before my blood test.

With regular monitoring from a health professional, side effects will be managed.

Hope this helps and Good luck.

[KayXo]

And just as an aside, I've been studying all the blood results carefully: there are pages of them. I've been flagged for low:

Haemoglobin
Hemacrit

Both of these naturally reduce due to HRT and are lower in females. Are you in female range or is male range still used?

Sodium

Spiro?

Oh, re injections: it's not difficult to get them done in Thailand if I really wanted. I'll await my next GiC clinic before any radical steps like that.

Injection is a radical step?

I'm lactating.

Are you stimulating your breasts? Otherwise, lactation would concern me. Did you check prolactin levels? It is sometimes a symptom of prolactinoma, a pituitary tumor, that has been associated with non bio-identical estrogen and cyproterone acetate.

Although administered sublingually the half-life of estradiol valerate is actually 3-4 hours and the 12 hour figure is 1/8th of peak concentration. Conclusion of the study:

'Conclusion:

Sublingual administration of micronized 17β-estradiol results in a rapid, burst-like absorption into the systemic circulation, yielding high E2 levels that fall rapidly over the first 6 hours.'

http://www.sciencedirect.com/science/article/pii/S0029784496005133

I thought you were taking it orally. The figures I provided were for oral intake.

I'm going to look into either flutamide or bacilutamide

So, Flutamide or Bacilutamide. Any thoughts anyone?

Better is bicalutamide as there is no hepatoxicity, less side-effects and you only need to take bicalutamide once daily due to much longer half-life.

Urology. 1996 Jan;47(1A Suppl):70-9; discussion 80-4.

"Bicalutamide is a new antiandrogen that offers the convenience of once-daily administration, demonstrated activity in prostate cancer, and an excellent safety profile. Because it is effective and offers better tolerability than flutamide, bicalutamide represents a valid first choice for antiandrogen therapy"

Arch Ital Urol Androl. 1999 Dec;71(5):293-302.

"As regard as pure antiandrogens clinically important adverse events including gastrointestinal events, particularly diarrhea and occasional disturbances of liver function related to flutamide treatment and antabuse effect, problems with light-dark adaptation and rare interstitial pneumonitis related to nilutamide indicates the bicalutamide, due to its better tolerability profile, together with its once-daily oral administration regimen, could be considered the antiandrogen of first choice"

Fertil Steril. 2012 Oct;98(4):1047-52.

"Hepatotoxicity is a rare but possible event using low- and ultralow-dose regimens of flutamide."

As a suggestion being an ex-spiro user, can you look into Cyproterone Acetate as your AA since it's a lot more potent in reducing T. It actually stops your body from producing LH which in turn signals your body to stop producing T if I have read that correctly.

Cyproterone acetate can cause depression in some, has been associated with prolactinomas and meningiomas, interferes with adrenal steroidogenesis and can adversely affect coagulation. In some, it can also cause too much weight gain and extreme tiredness. At high doses, it can be hepatotoxic. Based on all the studies and reports I read, I personally don't consider this anti-androgen to be the best out there and there are better, safer alternatives like bicalutamide, lhrh agonists and E injections.

My 2 cents...but I'm not a doctor. You need to research this and discuss this with a doctor.

[Richenda]

Wow thanks for such detailed replies April and KayXo.

First up Cyproterone Acetate. Yep I'm not keen. I took it briefly whilst out here last year and did not enjoy the effects of it. Lots of Thai kathoey use it either in the unmentionable form or alone with separate androcur. I've got to say, I'm not a fan and do think the side effects are worrying.

Interesting about the lower Haemoglobin & Hemacrit from HRT. I didn't know that. The low sodium: I haven't taken spiro for over a year. It's probably sweating in the Thai heatwave.

Injections: yes I do think it's quite radical, especially if unsupervised.

Breasts: confession, yes I stimulate them. Actually I use a breast pump 2 x day so I guess that's why?

Estradiol valerate: I do indeed take it sublingually.

I am really interested in bicalutamide. I've got to say that I'm leaning 90% that way.

I like the way KayXo you said I need to research and discuss with a doctor. My own 2 cents is that's often how we do it. A lot of doctors won't have trained in transgender care and may even have less background knowledge than we do. When I saw my GP she was great and dialogued with me: she asked me what I knew about certain regimes and we negotiated. She was really impressed that I took the oestrogen sublingually (protecting the liver). My view is that doctors are at their best for us in the realm of endocrinology i.e. monitoring levels of all the key indicators. They work with us not dictating to us and that's important. My biggest gripe is the way the UK set up works. I'm in the GiC system but they won't yet prescribe the meds. To me that's craaaaaazy. How many of us are left to self-med as a result? That's the reality and we can tell people off, place as many caveats as we like, but the fact is that lots of us do self-med. The key thing I've learned is that, if we do have to be in that situation, we should be monitored.

All of this is temporary though. I want GRS and that's my primary focus now: https://www.susans.org/forums/index.php?topic=209474.new;topicseen#new

xx

[KayXo]

Injections: yes I do think it's quite radical, especially if unsupervised.

Plenty of girls (including myself) do them (supervised though), nothing uncommon or radical about it.

Breasts: confession, yes I stimulate them. Actually I use a breast pump 2 x day so I guess that's why?

Most probably, yes.

She was really impressed that I took the oestrogen sublingually (protecting the liver).

Bio-identical estrogen will likely NOT harm your liver, alcohol or acetaminophen is significantly more harmful to your liver, so is sugar. Clotting may slightly be less affected but a different matter.

Studies have shown high doses of non bio-identical estrogen to affect liver function.

[Laura_7]

Injections: yes I do think it's quite radical

It may look that way first.

But its one stab per week, compared to daily intake of pills.

And it can make for anti androgens to fall away, which have side effects and also need to be taken.

There are multidose vials so it may not look too uncommon if crossing borders.

And it may be relatively cheap.

You may talk it through with the clinic. It may be possible you have well feminized until the NHS even starts .

hugs

[Richenda]

The clinic don't use them Laura (they use gel) and I'm not travelling 160kms and paying $260 a month just for the privilege of asking how to stick a needle in. That's not feisty back, promise, just the reality of the situation.

They're intra muscular, right?

I just have no experience with them so the most 'radical' part for me is the fairly inevitable self-med and self-administration it would require out here in Thailand. I'm not sure if the NHS in the UK use them so that's another possibility.

What happens if you have a reaction? Or the dosage levels are haywire? Many questions.

[Laura_7]

The clinic don't use them Laura (they use gel) and I'm not travelling 160kms and paying $260 a month just for the privilege of asking how to stick a needle in. That's not feisty back, promise, just the reality of the situation.

They're intra muscular, right?

Have you asked them if they would oversee injections without anti androgens, keeping testo levels in the female range ? They might be interested, it may be a niche for them. Imo there are advantages they could offer other people too.

Its intramuscular but quite common, maybe a doctor from the clinic or a nurse could show you how it is done.

I personally would definetly ask the clinic about it. The same about implants, if they are available locally.

If they do gel this may be the reason they are more pricey. Its possible its not easy to come by there and considered premium.


hugs

[Richenda]

That clinic is a business, primarily aimed at male body building which operates a flat rate non-negotiable $260 a month (I asked). It's 120 miles or 4 hours from my home which is admittedly less far than flying 5000 miles to Australia. The nurses seemed lovely people but for reasons already set out the clinic's not the right choice for me.

For those recommending injections, I'm guessing you mean as opposed to implants, which were also mentioned earlier, right? Can you be really specific without going into dosages? Exactly what are you recommending? Which brand are we talking about? As an aid to answering there are three injections currently available in the UK: http://www.nhsdirect.wales.nhs.uk/encyclopaedia/c/article/contraceptiveimplantsandinjections/

The reason I'm asking for specifics is based on how things work in Thailand and possibly when I see the UK GiC too. There's a sort of two-way process about this akin to what KayXo you were hinting. If I go to a doctor or nurse in Bangkok forearmed with some ideas, they will be able to talk it through with me and assist with the injection if necessary.

As for the anti androgen I'm going to give bicalutamide a go and will keep on with my finasteride. Yes.

[Richenda]

Interesting thread on injections: https://www.susans.org/forums/index.php/topic,97015.100.html

[Laura_7]

If I go to a doctor in Bangkok

There are basically two forms of injectable estrogen, one is estradiol valerate which may be of advantage because it tends to stay longer in the body (less faster metabolized).
One brand name would be progynon depot.
Additionally there are different forms of suspension oil, cotton seed oil, sesame oil, etc. If there should be adverse reactions a different form might be tried.
There are resources on the internet showing the injection process for trans people. As said the first time a doctor or nurse should be able to show you.
Warlockmaker and I have given you hints to transgender clinics in Bangkok. Telling them exactly what you want should help them start you out. Again I also would consider implants as you say they are also available there. You might ask for quality products if possible, not the cheapest ones because they might make for a more stable release.
A good clinic or doctor should be able to help you. Just talk to them imo.

hugs

[Richenda]

That's really helpful Laura: thank you. I'm back to Bangkok tomorrow. I'll wait and see if anyone adds to yours then go and seek out a medic to do the deed.

Brilliant

[AnonyMs]

Kind of off topic, but have you been to visit the various SRS surgeons while you are there?

[Richenda]

Hi not yet but I have been in touch by email. If I can go ahead this autumn then I'll do my homework though I know there are some justifiable favourites with forum members here.

[Richenda]

Wow I've found a great clinic in Bangkok. They will do me regular tests and the prices are excellent.

The drug regime is interesting. The prescription for the IM hormone injection is two vials. One is estradiol valerate Progynon Depot 10mg/1ml

The other vial is Proluton Depot (hydroxyprogesterone).

Would you advise taking both or just the estradiol?! That kind of finer detail is outside their expertise: the prescription comes with both vials.

[Laura_7]

Wow I've found a great clinic in Bangkok. They will do me regular tests and the prices are excellent.

The drug regime is interesting. The prescription for the IM hormone injection is two vials. One is estradiol valerate Progynon Depot 10mg/1ml

The other vial is Proluton Depot (hydroxyprogesterone).

Would you advise taking both or just the estradiol?! That kind of finer detail is outside their expertise: the prescription comes with both vials.

Imo bioidentical progesterone as capsules and proluton depot are forms of progesterone that may be considered.

There are studies showing for fully developed breast tissue progesterone may be necessary. It may also help with mood.
I personally would use it. Its present in the hormone setup of cis females.


hugs

[Richenda]

That's fab: thank you so much Laura x

[AnonyMs]

Wow I've found a great clinic in Bangkok. They will do me regular tests and the prices are excellent.

Would you mind posting the name/address of this clinic, or pm it to me. You never know when it might be useful. Others may benefit as well.

[Richenda]

Hi, yes of course. This is the clinic: http://www.brianet.com/en/

It's close to Lad Prao which is on the MRT line. Prices are extremely competitive as can be seen from the table of comparison: http://biohacked.net/getting-blood-tests-in-bangkok-private-labs-vs-hospitals/

[AnonyMs]

Thanks

[KayXo]

Both the estrogen and progestogen appear to be good choices. 7-10 days interval between injections for both seems to be optimal, based on studies and anecdotal evidence. Some may do ok with even greater interval for Proluton.

Too much Proluton (progestogen) relative to Progynon (estrogen) may result in oily skin, less than optimal breast development as progestogens have some anti-estrogenic effect so watch out for those and also headaches, irritability, pms symptoms, less than optimal feminization.

Best of luck. And discuss with health professionals so that all may be safe.