High DHEA sulfate and poor feminization

[Steph34]

I have been trying to figure out why my feminization has been poor.

DHEA sulfate is associated with low femininity in women. My level of DHEA sulfate has consistently been high, within the middle to upper part of male range and above female range. My doctor has not been helpful in identifying a cause, but I think I figured it out.

Domperidone (which I must take due to gastroparesis, a stomach ailment) raises prolactin levels, and prolactin raises DHEA sulfate. Elevated levels of the adrenal androgen are a known side effect of drugs that raise prolactin levels. Hence, domperidone and prolactin actually are impeding my transition. Because DHEA sulfate is more prevalent in blood than testosterone, it exerts significant androgenic activity despite being a "weak" androgen. It can also be converted to testosterone; as a result, my doctor says my T level is "unusual" (read: high) for someone who has had an orchiectomy. Perhaps this is why my breasts tend to grow overnight, when domperidone levels drop.

I also can't help wondering if stress, exercise, or high calorie intake is raising my DHEA sulfate level.

Does anyone else have this problem (high DHEA sulfate) and have any ideas for reducing levels?

[KayXo]

I have very high prolactin levels (80-130 ng/ml) and my DHEA-S levels are in the lower female range. I sometimes deal with lots of stress too. Since I eat a lot of fat, my caloric intake is high.

[Steph34]

I have very high prolactin levels (80-130 ng/ml) and my DHEA-S levels are in the lower female range. I sometimes deal with lots of stress too. Since I eat a lot of fat, my caloric intake is high.

Unlike me, you have very high estradiol levels which suppress all androgenic production. Prolactin is less likely to raise DHEA-S if your E is also high. My DHEA-S has consistently been in the mid to upper male range and above female range. Nothing I can do seems to change that. I fear that my DHEA-S (and consequently T) will go even higher now that I no longer take leuprolide acetate. My FSH will therefore be rebounding quite soon.

I also have low esterone. My E1 has been much lower on patches than it was on pills or injections. My doctor says E1 is important for its intra-cellular effects. Could my low E1 level also be holding back my feminization?

And is there anything I can do, short of begging doctors for bicalutamide, to control my DHEA-S?

[2cherry]

I think that there is too much emphasis om testosterone, not only here, but also in the general population. Many seem to think that testosterone is some kind of power hormone, but it's actually the weakest, and does the least. DHT is our main culprit, DHT is also responsible for the growth of our reproductive system, balding, etc. Yes, DHT is produced from T, but DHT is ten times more powerful in expression, which means that with a tiny, tiny, tiny bit of T, DHT can unleash havoc. But, DHT is also independently produced in the skin, adrenal gland, prostate and there are probably more organs involved which are yet to be correlated, since no-one actually knows for sure. Cortisol is involved as well, especially with terminal hairs and sebum production.

Since no-one knows for sure which hormones are exactly involved, they prescribe us an anti-androgen: a medication that prevents all androgens from expressing/attaching. Kinda like a hail-shot. So if you want to know, then you have to find out what works for you. Takes a lot of time I guess, lot of blood tests, elimination of foods, etc. It probably would pay of to try a large range of anti-androgens, and see what they do. And don't forget the simple DHT blockers, sometimes that's enough. For others they don't work. Bicalutamide is worth a try.

[Lucie]

But, DHT is also independently produced in the skin, adrenal gland, prostate and there are probably more organs involved which are yet to be correlated, since no-one actually knows for sure.

Are you sure that in human body DHT can be produced independently of testosterone ?

[Steph34]

I think that there is too much emphasis om testosterone, not only here, but also in the general population. Many seem to think that testosterone is some kind of power hormone, but it's actually the weakest, and does the least. DHT is our main culprit, DHT is also responsible for the growth of our reproductive system, balding, etc.
Yes, DHT is produced from T, but DHT is ten times more powerful in expression, which means that with a tiny, tiny, tiny bit of T, DHT can unleash havoc.

DHT is the primary cause of hair loss and thinning (low E also plays a role). That is why I still take dutasteride, even though my primary source of testosterone has been removed. However, do you really believe that testosterone is almost worthless without DHT? If that were true, then men who take dutasteride (which almost completely suppresses DHT, but slightly raises T) would complain of muscle loss, fatigue, impotence, etc., which is clearly not the case. The large majority of men who take dutasteride have no side effects. Yes, DHT is a much stronger androgen than testosterone, but because it is present in much lower quantities in the blood, it is no more important as an androgen. DHT suppressors like finasteride and dutasteride are also ineffective for feminization, because testosterone is still abundant and doing its damage.

But, DHT is also independently produced in the skin, adrenal gland, prostate and there are probably more organs involved which are yet to be correlated, since no-one actually knows for sure.

I have also heard of DHT being produced in abdominal fat, which is perhaps why so many obese women seem to have thinning hair.

Since no-one knows for sure which hormones are exactly involved, they prescribe us an anti-androgen: a medication that prevents all androgens from expressing/attaching. Kinda like a hail-shot. So if you want to know, then you have to find out what works for you. Takes a lot of time I guess, lot of blood tests, elimination of foods, etc. It probably would pay of to try a large range of anti-androgens, and see what they do. And don't forget the simple DHT blockers, sometimes that's enough. For others they don't work.

I have tried flutamide, spironolactone, MPA, and progesterone. All of them just made my problems worse in various ways. Cyproterone is not available in my area, and my doctor thinks I would not like it anyway if I did not like the other steroidal anti-androgens. Dutasteride has almost completely stopped the progression of my hair thinning/loss, but otherwise it has done nothing for me. I do not see how food would affect my hormone levels at this point. Some people say that animal protein raises DHEA sulfate, but I don't eat that anyway.

Bicalutamide is worth a try.

But doesn't bicalutamide raise testosterone and DHT? My current doctor also refuses to give me non-steroidal anti-androgens because she thinks they would definitely make me anemic. Yet, looking through the scientific evidence, I see no reason to believe that non-steroidal anti-androgens would cause anemia in women. Any blockage or suppression of androgens will reduce hemoglobin levels in men since the male range is higher due to the action of testosterone. Those findings are not relevant to me because, with my testosterone already reduced to a female level, my hemoglobin has already dropped accordingly. Maybe I need a new doctor?

[Lucie]

My current doctor also refuses to give me non-steroidal anti-androgens because she thinks they would definitely make me anemic. Yet, looking through the scientific evidence, I see no reason to believe that non-steroidal anti-androgens would cause anemia in women.
[...]
Maybe I need a new doctor?

I think so.

[Steph34]

Are you sure that in human body DHT can be produced independently of testosterone ?

I doubt it. There are many places in the body where 5-alpha-reductase, the enzyme that converts testosterone to DHT, is present. But, that enzyme can only produce the devastating DHT if there is already testosterone for it to act on. That is why DHT levels tend to track together with testosterone levels. As such, reducing testosterone will also reduce the severity of DHT-induced ailments, such as MPB and BPH.

I think so.

I have three ideas:
1) I can beg my doctor for bicalutamide. Even though she has refused in the past, I did once get her to prescribe something else over her objections.
2) I can make another appointment with my surgeon, who is familiar with bicalutamide and may be willing to prescribe it after I say that I have tried everything else. The downside is that he is pricey and not covered by insurance, and there is no guarantee he would give me the medication over my primary hormone doctor's irrational objection.
3) I can get another doctor's name from my therapist, but that would take time.
4) I can make an appointment with a random endocrinologist and hope for the best.

I am really desperate and upset that it will probably take all summer to obtain the medication I need NOW.

Flutamide worked well for the 6 hours or so until it wore off. Breasts grew, face softened, distribution of body weight improved, mood improved, emotions enhanced. All of that happened with just three 6-hour doses. After it wore off, though, there was an androgenic flare or rebound effect that caused rapid hair loss, worsening of facial and body shape, agitation, and even some facial hair growth, making it far worse overall than taking nothing. I think bicalutamide, a similar medication with a longer half-life, could provide the benefits without the flare.

[Lucie]

I doubt it. There are many places in the body where 5-alpha-reductase, the enzyme that converts testosterone to DHT, is present. But, that enzyme can only produce the devastating DHT if there is already testosterone for it to act on. That is why DHT levels tend to track together with testosterone levels. As such, reducing testosterone will also reduce the severity of DHT-induced ailments, such as MPB and BPH.

That's what I meant.

I have three ideas:
1) I can beg my doctor for bicalutamide. Even though she has refused in the past, I did once get her to prescribe something else over her objections.

You could tell her that if she refuses you will have to order from Internet vendors which is not without risk.
Also you can ask her that she prescribes a (very) low dose at first.

[Steph34]

That's what I meant.

I agree and was just elaborating for clarity.

You could tell her that if she refuses you will have to order from Internet vendors which is not without risk.
Also you can ask her that she prescribes a (very) low dose at first.

I cannot lie and I would not try to order a medication illegally (I don't even know how, nor do I want to). Low-dose can be worse than nothing for anti-androgens due to the risk of a flare or rebound effect if the medication leaves the system. In any case, I begged my HRT doctor for bicalutamide, to no avail. I also saw the surgeon who performed my orchiectomy to beg for bicalutamide, again to no avail. It is remarkable that the doctors who are allegedly helping me transition are refusing to give me the medication I need in order to block the adrenal poison and finally feminize! It just demonstrates the unfortunate state of transgender medical care. My DHEA-S is over 400; my doctors acknowledge that is a problem, but they refuse to help! It almost makes me want to surrender and just go back to binge eating and hiding from reality.

I did, however, make another doctor's appointment with someone new for this Thursday, and yet another for two weeks later. Given my lack of success so far, however, I am not optimistic. I think there are also medications that can suppress the adrenal gland, and I should look into those, too.

[Lucie]

In any case, I begged my HRT doctor for bicalutamide, to no avail. I also saw the surgeon who performed my orchiectomy to beg for bicalutamide, again to no avail. It is remarkable that the doctors who are allegedly helping me transition are refusing to give me the medication I need in order to block the adrenal poison and finally feminize! It just demonstrates the unfortunate state of transgender medical care. My DHEA-S is over 400; my doctors acknowledge that is a problem, but they refuse to help! It almost makes me want to surrender and just go back to binge eating and hiding from reality.

What reason(s) did your doctor invoke for refusing to give you bicalutamide ?

[Steph34]

What reason(s) did your doctor invoke for refusing to give you bicalutamide ?

The HRT doctor said it is a medication she does not usually use and does not want to write for something she is unfamiliar with.
The surgeon said that he doesn't like to write prescriptions ( ) and wanted me to see an endocrinologist to determine the cause of the high DHEA-S. Really, there are only two possible causes: genetics and domperidone. Either way, bicalutamide would help! Their refusal to help is astounding given its horrific implications for my appearance.

I saw an endocrinologist last week. He ordered a blood test and told me to come back next week to beg for the medicine. I am also seeing another endo next week. Maybe someone will help? This is so frustrating, really. It sure would be nice if all I had to do was take my estradiol...

[Lucie]

The HRT doctor said it is a medication she does not usually use and does not want to write for something she is unfamiliar with.
The surgeon said that he doesn't like to write prescriptions ( ) and wanted me to see an endocrinologist to determine the cause of the high DHEA-S. Really, there are only two possible causes: genetics and domperidone. Either way, bicalutamide would help! Their refusal to help is astounding given its horrific implications for my appearance.

I saw an endocrinologist last week. He ordered a blood test and told me to come back next week to beg for the medicine. I am also seeing another endo next week. Maybe someone will help? This is so frustrating, really. It sure would be nice if all I had to do was take my estradiol...

Did you show the wikipedia page about bicalutamide to the doctors ?
My endo did not want to prescribe it for the same reason as yours, but I convinced her to read the description of bicalutamide I had printed from the wikipedia page. Seeing that pros far exceed cons she changed her mind and finally accepted to prescribe it (starting at half dose). She requested that I have a full blood test for liver check to be done before starting bicalutamide and then an other one to be done three months later.

I think that more and more doctors understand the benefits of this anti-androgen for trans women. What I note is that the bicalutamide wikipedia page is frequently updated and that it gives more and more details about its usage for trans women.

[galaxy]

I also have too high DHEAS postop. People said the adrenal overdrive goes back after a few month but not in my case. First i tried CPA but with it my prolactin goes up to high. Than i tried dustasteride but it has no effect on my DHT levels. Now I'm taking bicalutamide. Hairloss goes back a bit. My acne is still there and the body hair. Maybe ive to wait some more weeks or month to reach my preop status again. Virilization after SRS is not usual. Thats the problem. No doctor could use a well known solution for this. Most girls get more feminization with SRS. I think that is the goal.

[Lucie]

I also have too high DHEAS postop. People said the adrenal overdrive goes back after a few month but not in my case. First i tried CPA but with it my prolactin goes up to high. Than i tried dustasteride but it has no effect on my DHT levels. Now I'm taking bicalutamide. Hairloss goes back a bit. My acne is still there and the body hair. Maybe ive to wait some more weeks or month to reach my preop status again. Virilization after SRS is not usual. Thats the problem. No doctor could use a well known solution for this. Most girls get more feminization with SRS. I think that is the goal.

For how long time have you been taking bicalutamide ?
The wikipedia page says that "bicalutamide requires 4 to 12 weeks of administration to reach steady-state (maximal) levels".

[galaxy]

4 weeks now

[Lucie]

It might be that after 4 weeks it's still too soon to see and feel the effects of bicalutamide. Are you at full dose ?

[galaxy]

As far as i know we shouldnt post any dosage here. But its good to know that it takes a minimum of 4 weeks for have a steady state.

[Lucie]

As far as i know we shouldnt post any dosage here.

AFAIK no numerical dosage has been posted.
I just asked if you were at full dose or at low dose (as I am)...

[galaxy]

Low full dosage as it mentioned for transsexual treatment. Half dosage is too less in my eyes. I also look forward for my acne development. Generally its a good indicator for any effect.