Hypochondriac on Estrogen Looking for Reassurance

[Shell Dae]

Hello,
First off, my apologies if this is in the wrong forum.
I'd like to ask a question about HRT. Let me preface this by saying I have bad anxiety and hypochondriac tendencies. I recently started using estradiol patches, within the last week, and one of the things my doctor warned me to keep an eye out for is signs of blood clots. With the problems I mentioned earlier, I'm looking for some reassurance that this is something very rare and not likely to happen. While I do often remind myself that this is a rarity that I've never heard of from other transwomen and that I'm not showing any signs of such a problem, my nerves having been getting to me at night for the past few days. So a little reassurance from others would be appreciated rather than me running off to the hospital thinking that I'm dying, again.
Thank you.

[PrincessCrystal]

As far as I've read, it merely "elevates the risk".  I wouldn't worry about it: just make sure you keep a good diet and exercise up.  You're going to want to get your muscles toned anyway, because the estrogen is going to change the way they develop, and a few of those "workouts for women" are really gonna help with it.

In the mean time, also consider talking with your therapist about your hypochondria: it's hard to push through this gender stuff when you've got other problems...

[becky.rw]

All the medicines involved are approved for use in a variety of situations.   None will have a high risk of anything lethal.    Most medicines do however, have small risks of significant damage; my arthritis med combined with my statin COULD destroy my kidneys or liver in a weird, rare interaction.  Doc explained what to watch for, and to call if anything weird happens.   

Sometimes we can project a problem for ourselves too;  I was thinking bloodclot this afternoon, leg felt funny, but after a while, I put two and two together, and it seems I'm finally feeling the pulled hamstring now that the back pain has subsided to a dull roar.    [I'd decided it was necessary to lift and carelessly handle a large window AC unit to prove my useless masculinity.   And I got to pay for it too!  yes, I'm an idiot, quicker I get into a dress the sooner these episodes of stupidity will end.. I hope.]

[naa]

You're not alone.  I'm a massive hypochondriac too, and having read all the possible symptoms of all the bad things that can happen from my anti-androgens and Estrogen, I've been convinced I've had nearly every symptom at some point.

I follow a ton of trans women online, and the single case of DVT I've heard of, is from one woman who was taking herbal HRT  ( Natural does NOT equal safe ), and then doubled the recommended dose, then doubled it again. 

I know one trans woman who was self medicating, and when she had her first blood test she found her blood Estrogen level was massively over female levels.  Yet despite this, no DVT.   I still would not recommend doing what she did though.   She's corrected her levels now.

As far as I've read, patches are one of the safer ways to take Estrogen, because it bypasses the liver.

Having said all that, I'm not a doctor, these are just my experiences, things I've heard and read.  So listen to your doctors before you listen to random people on the internet like me

[AnxietyDisord3r]

I think it probably raises your relative risk. I guess the question is, does blood clotting run in your family, do you have a pre-existing condition, or do you have a lifestyle with high risk of blood clots? I'm guessing the answer to those questions is no or you would have mentioned it.

Blood clot is also a risk with birth control pills but I've never known anyone who had health outcomes like that from using them.

You're reducing the risk of heart conditions by taking E. Why do you think women have longer lifespans than men?

[Deborah]

My endo told me she had never seen anyone get a blood clot and for me not to worry about it.  The risk may be there but it is really small.

[JMJW]

I thought it was because men have a 3 to 4x higher suicide rate. 97% of workplace fatalities. Higher risk of violence on the street, drive more recklessly don't report illness nearly as much, join the army at a higher rate, play more contact sports and for most of the twentieth century smoke and drank at a higher rate than women.

[SadieBlake]

The DVT risk is indeed very small and is greatly minimized where you're using a patch as compared to taking pills.

The risk factors come principally from estrone which is created when the liver metabolizes estrogen and estrone is reduced by a factor of 10 using patches or injection (what I do).

[Rachel]

It is important to be under the care of a doctor and have blood tests. Also, the use of bioidentical hormones. In the past blood clots were associated with self medication (very high levels of hormones) and non-bioidentical hormones.

[JoanneB]

If you have no history nor family history of clotting or other similar venous issues and are not overdoing the E and have the target blood levels the doc is looking for, don't sweat it. If you are corned and want to be a bit proactive ask for a clotting time test to also be done at your next blood draw. Also take Vit E which is good for preventing clots.

In this day and age I suspect only if you are in at "At Risk" group, you haven't anything to worry about. In the early days of birth control hormone levels went through the roof and women were dying from blood clots. A neighbor across the hall from me did when I was a kid, 1960's. Back in the 70's the doses of E TS's were getting were vastly higher then what many are doing these days. Plus back then a lot of E was black market self meding. A lot more TG's were stroking or clotting out.  A member of my TG group did have a pulmonary embolism and the E was not directly related but she needed to go off it for a while. BTW - her veins are a mess. After a few months she was able to restart it as well as having to be on blood thinners.

I come from a family with bad veins, along with spending most of my day driving a desk, or just standing up. I've had to have several stripped a few times over the years. I get achy legs, and always had since I was a kid. Nothing new there. I try to eat all the right things, take my supplements, (try to) move about every hour or so, do walks, etc. to be proactive. I worry about DVT's as does my wife. So I do the normal things to mitigate them.

[Michelle_P]

You're using a patch, so it is almost certainly delivering bio identical 17-Beta-Estrodiol, which has a lower risk of clotting than synthetics.  Even better, you are getting a smooth, slow, constant delivery that bypasses the initial pass through the liver after digesting the oral pills, and avoids spikes in concentration.

It's about the safest form of the drug and the safest delivery method (allowing for the hassle of patches popping off...)

[kittenpower]

You should be fine, but do what you can (e.g, don't smoke, eat healthy foods, maintain a healthy weight, exercise, etc.) to minimize your risk.

[DawnOday]

Hello,
First off, my apologies if this is in the wrong forum.
I'd like to ask a question about HRT. Let me preface this by saying I have bad anxiety and hypochondriac tendencies. I recently started using estradiol patches, within the last week, and one of the things my doctor warned me to keep an eye out for is signs of blood clots. With the problems I mentioned earlier, I'm looking for some reassurance that this is something very rare and not likely to happen. While I do often remind myself that this is a rarity that I've never heard of from other transwomen and that I'm not showing any signs of such a problem, my nerves having been getting to me at night for the past few days. So a little reassurance from others would be appreciated rather than me running off to the hospital thinking that I'm dying, again.
Thank you.

I've had heart problems for 25 years and started HRT 18 days ago. I've already had a stroke in 94 so if anyone were to get a clot, it would be me. So far so good and my Doc's didn't seem too concerned. But I am also on blood thinners due to the aforementioned stroke.

[AnxietyDisord3r]

I thought it was because men have a 3 to 4x higher suicide rate. 97% of workplace fatalities. Higher risk of violence on the street, drive more recklessly don't report illness nearly as much, join the army at a higher rate, play more contact sports and for most of the twentieth century smoke and drank at a higher rate than women.

Males are more likely to die young because testosterone is a hell of a drug but I'm talking about life expectancy from middle age. Among other things, estrogen protects the heart. A male with a lot of body fat will get the same protective effect because fat elevates estrogen levels.

[JMJW]

I know scientists say that based on the gender difference in heart attack and heart failure deaths, but I wonder if they accounted for smoking deaths, by far the leading cause of heart attack. As it takes decades for smoking related death to hit so one has to go back a few decades where in Britain, men smoked about 10% more than women. I'm a bit skeptical on how scientists can know that, be aware of other potentially confounding variables, and still conclude estrogen has a cardio-protective effect.

Because I'm aware that estrogen keeps visceral fat away from the midsection as long as a certain weight threshold isn't crossed. But that might not translate into actual benefit if it has a blood thickening effect too.

Maybe that's why I gave up biochemistry, but I don't see how they get cause and effect out of it. It seems to be that their reasoning was:

-Women are dying from heart diseases less than men.
-Therefore being a woman must be cardioprotective.
-What's the difference between men and women? Hormone levels for one!
- Therefore having an estrogen based hormone profile must be protective!

Even if transwomen saw reduced risk of heart disease post HRT, how does one account for confounding variables like reduced depression/stress, reduced comorbid mental illness and taking better care of themselves in general post HRT?

[Deborah]

Even if transwomen saw reduced risk of heart disease post HRT, how does one account for confounding variables like reduced depression, reduced comorbid mental illness and taking better care of themselves in general post HRT?

i think that those thing would be very difficult, if not impossible, to quantify.  I think that all you might conclude is that an extended lifespan is likely. 

However, even if a longer life cannot be proven, a happier life is well worth it.  A long life of misery is not such a good thing.

[JMJW]

I suppose the way to look at that would be if transmen had worse cardiac outcomes post transition in numbers that are statistically signficant. If it goes both ways, that would prove it.