A Question Re: Beginning HRT (In retrospect)

[Arielle Noemi]

This is a question for all of you lovely women who are already on the path of HRT. In retrospect knowing what you now know, what would you take if you were to start all over? Pill? patch? sublingual? injectable? Spiro yes or no? etc....

I have my Dr appt this afternoon and have my therapists letter in hand. From the research I have done I think Id like to start off with start with and will ask her for bioidentical estradiol and no anti androgens. I dont want to evern consider anti androgens until if and when my testosterone is resistant to bring controlled by estradiol.

[sid104]

From my little experience first anti androgen is important but i dont feel happy taking it except we  treat T like a enemy or intruder.only doctor could advise you both.my doctor prescribed me both E and spiro but i dont feel ok on spiro instead of knowing that E will work much better if T is suppressed but no my mind doesn't like spiro or anti androgen..so its all in our head

[becky.rw]

It is interesting in its own way, the variety of preferences and priorities people have.  Our bodies and histories are all so unique.   Personally, you'd have to fight me to the death to get the anti-androgen out of my hrt kit.  The E.. meh, whatever.        If I were starting fresh, but knew what I know now, and didn't mind the expense, I'd go with the longest duration Lupron shot I could get (anti-androgen), and get E by patch.

But the point is, we are all very different,  I'm psychologically extremely sensitive to T, and even with my base being at the bottom end of male normal, it drives me absolutely nutso; intolerably so.   OTOH, my base E production is well into Fem normal, but its hard to know what is direct production vs what is aromataze of T as a result of metabolic syndrome fat deposition/release. (I manage metsyn with a bucket ton of exercise, thus the in&out volumes can be large)  So add a patch, tada, it all works out nice; just a matter of tuning the patch amount to the body over time.   Feminization seems fine and metabolic tests come back safe and clean.

[Michelle_P]

In retrospect knowing what you now know, what would you take if you were to start all over? Pill? patch? sublingual? injectable? Spiro yes or no? etc....

It really has to be tailored to the individual, and it sounds like you want info to help you work with your endocrinologist to do just that.  Good for you!  Nothing like an informed patient!

Knowing what I now know, I'd pretty much do what my endo and I did by accident.  I went with spironolactone as the anti-androgen, and an estradiol patch.

The spiro had several properties that were favorable to me.  I had sodium-sensitive pre-hypertension, high but not yet dangerous blood pressure that I kept under control by following a very low sodium diet, about 700 mg/day.  Normal guidelines for us 60+ folks recommend 1500 mg/day max, and the overall nutritional guidelines recommend 2300 mg/day max.  Typical American diet is around 3500 mg/day.  Spiro helps me excrete sodium, lowering blood pressure. Oh, it also lowers testosterone.    My BP runs around 95/65 now (down from 135/90 without diet, 115/85 with) resting pulse 50. (I workout daily, so this is fine for resting numbers.  No dizziness or fainting.)

The estradiol is by patch.  I wanted to avoid the 'first pass' effect on my old liver, and minimize clotting risks, so I wanted bio-identical 17-beta-estradiol via a non-oral pathway.  Sublingual (micronized) estradiol wasn't in the pharmacopeia, and I don't like needles, so I started out on the patch.

Due to oddities in my blood work, I was started on just spiro, and estradiol was added 5 weeks later.
https://www.susans.org/forums/index.php/topic,210927.msg1897653.html#msg1897653

The spiro had the single biggest effect on my state of mind.  About two weeks into treatment, I started having periods of time where I experienced great mental calmness, the 'noise' of random little mental 'alarms' fading away.  I meditate regularly, and found that I could reach a state of inner calm much more rapidly in these periods than before.  The frequency of these calm periods increased, and they have persisted for longer periods of time, until at three months they are my new normal state.     My testosterone level was at the bottom of the 'normal male' range when this effect appeared.

I started estradiol patches 5 weeks later.  Those had a rather different effect.  There was both a sensation of energy, and more acuity in my senses, like a blanket I never knew was there had been removed.  For example, a really good steak dinner and side dishes that I had liked before now tasted incredible.  (I experienced what I think was a full blown female orgasm in the middle of THAT meal.  "I'll have what she's having..." Indeed.)

For me, personally, the single greatest move toward reducing dysphoria and the mental noise that had brought me long term depression and anxiety was the anti-androgen.  The estradiol put the cherry on top, brightening my world and giving me the psychological boost from knowing that real physical changes that I had craved for decades were starting.

[rtg]

I would try to just do injections if I were to start over.  Started on the patch and hated it, been on sublingual since then which has had good results and isn't bad, but taking so many pills is kind of annoying

[KayXo]

Just injections and oral bio-identical progesterone. Nothing else. That's what I would have done.

[kaitylynn]

I have had two go arounds on HRT.  On my first, I used Spiro and pill and had effect...satisfactory to me at the time not knowing what I have experienced this time around.

This time I am using Spiro/patches and WOW!  What a difference.  I have seen tremendous result.  I have also witnessed incredible results in sisters that have used most of methods available.  There is no 'single best way' that will work best for everyone.  It is well worth discussing the various options with your endocrinologist to tailor the best regimen for you.