(MTF) HRT - Balancing Estrogen & T

[Vervain]

Hiya!

I'm asking a question on behalf of my fiancee Thorne, who is very stressed with work (call center + mandatory OT likely through the holiday season, ouch). She has recently come out to me and our polyfamily as a trans woman. Initially, she said she didn't want anybody outside family to know. But the last couple days she's been talking about how many she can bring it up in some way with her parents in which they won't explode (I'm still trying to figure that one out), and she also said it was weird for her to go from home, where she is called by her female name and pronouns, to work, where she is called by her male name and male pronouns.

She also made a couple comments that lead me to suspect we will be having a conversation about HRT soon. First up: All of us within our polyfamily, chosen family, and close, trusted friends circle are absolutely supportive of whatever she chooses. Period. No if's, and's, or but's.

Here is the issue, though. She is on a small dose of T (I don't know the exact, and I understand we aren't supposed to talk about that here anyway) for erectile dysfunction she was unhappy with. She doesn't have dysphoria around that and has said flat-out she doesn't want bottom surgery. The fact that she brought that up is what makes me suspect we'll have an HRT discussion not too far in the future.

I read some posts in the forums here that didn't go into much detail but said that it was possible to be on both estrogen and T without the effects of one canceling the other out. Does anybody have personal experience they would be okay with sharing? General knowledge is good too. I truthfully didn't even know it was possible to balance estrogen and T together until I saw a couple comments saying as much here. Since Thorne is unlikely to do much research herself -- out of both time limitations, and I think a bit of fear -- I'm asking so I can either give her the info verbally or link her here.

Also, how to bring this up with an endo would be good too! I know she has one but I don't know how trans-familiar she is. Unfortunately, my fiancee Thorne is limited by state insurance coverage which means only a certain number of specialists take hers. There are a few other insurance options she could switch to; is this something that would likely require a VERY trans knowledgeable (almost specializing?) endo, or should any endo be able to address this?

Thanks SO VERY MUCH everyone who takes the time to read and reply. Love and cookies (of choice)! <3

[Randi]

All healthy individuals have both T and E in their systems.  It's only the ratio that varies between the sexes.

My mother took DES when carrying me, and I believe this resulted in hypogonadism (Low T) when I was in my mid-fifties.  I was prescribed testosterone injections.  One of the side effects was the action of the enzyme aromatase, which converts excess testosterone to estradiol.  This resulted in the paradoxical effect of feminization and budding breasts.

Well, that opened the gateway into realizing that I was some variety of trans*.  I greatly reduced the testosterone and began a combination of Estrogel and Estradiol Valterate injections.

Blood tests showed that when I don't take T, my T levels fall below measurable levels.  My original complaint of lack of energy, and falling asleep when watching TV or sitting down, even though I had had adequate sleep the night before, resurfaced.

My physician and I decided that zero T, was not healthy.  E and T are not polar opposites, and healthy people should have some of each.  It's easy to Google up normal levels for both sexes. 

Many MTF's struggle to keep their T levels down, but my body doesn't seem to make any.  I've been on HRT or one variety or the other for nearly 10 years. I still have testicles, but they seem to be purely decorative at this point. 

[Artesia]

I am the same way, but just started so don't have any information for you so will be watching this thread intently.


Side question:
Where did you get that top in your picture/avatar?  I really like it, and would like to find one for myself.

[Vervain]

Side question:
Where did you get that top in your picture/avatar?  I really like it, and would like to find one for myself.

In fact, my dear Thorne made it! She does amazing chainmail work, and I asked her if she would make me a rainbow pride bikini for Worldcon, which is a science fiction con I went to last year. When we have the money, she will be acquiring the links to make the miniskirt bottom I want. She was very dubious about that and said I would likely have to be hooked into it by someone with pliers, but I pointed out that I expected it to ride low on the hips, and... well. I'll just say there is at least one advantage to having joint hypermobility disorder. I can get things to fit that others often can't. >_>

I came back home with stories of the chainmail sellers in the con vendor room who stopped me to ask if I was cold or had discomfort because the bikini top is unlined. I said no, it was quite warm once the links adjusted to my body temperature, and Thorne is extremely finicky about making sure the links are tightly closed, because pinching in certain areas would be painful!

I know she does still make them on commission. I'll toss you a PM for more info along those lines, since I don't think it would be appropriate to discuss publicly.

[Vervain]

All healthy individuals have both T and E in their systems.  It's only the ratio that varies between the sexes.

I should have clarified I am aware of this. I personally was told by my endo that it would be a very, very, very bad idea for me to go off birth control because my T levels without estrogen/progestin are in cis male levels. Low cis male, but still. My natural, non-medicated endocrine system produces over twice the T that Thorne's endo decided to put her on Androgel for. (Well. They tried shots first, but Thorne is, um, very needle-phobic. Mom, who is a nurse, came over bi-weekly to do the injections, but Thorne was still having massive issues. That was enough to get the freaking insurance to cover the gel form, FINALLY.)

She's not had any of the usual side effects from the Androgel except for sorting out the issue she was unhappy with, and last I knew, her levels were still very low for an AMAB individual. But, since said issue is taken care of, she is perfectly happy leaving that.

I suppose my question is potentially even more general, which is, where does an endo decide to balance it at? If the dosage of T she is currently on is sufficient for addressing the erectile issues she was unhappy with, would adding estrogen into the mix work against that? Would this result in a likely medication merry-go-round until the correct balance is found? (Considering it took me seven medications to find the one that would both control my T levels AND address the issues I had from them, I wince at the thought of my poor dear going through that.)

Many MTF's struggle to keep their T levels down, but my body doesn't seem to make any.  I've been on HRT or one variety or the other for nearly 10 years. I still have testicles, but they seem to be purely decorative at this point.

I don't think that keeping T levels down is likely to be the issue for Thorne either, although there are, I'm pretty sure, different reasons for why. I think she would be more concerned about keeping them at a ratio where she would not deal with a sexual side effect she would not care for. She has been firm about that.

So, I suppose, what I'm trying to ask if anybody else has an experience of being on T/Androgel for that issue while also starting estrogen, and how difficult was it to adjust so both were at appropriate doses? Also, I have a related question because I know more about spironolactone from my direction; I am prescribed it for facial hair growth. Thorne loves her beard, and her waist-length strawberry blonde hair (seriously, it's envy-worthy gorgeous), but she would probably like to ditch the body hair without shaving every day or two. If someone has a very, hm, extensive? beard (hers has been compared favorably to a dwarven beard), would spiro have a significantly negative effect?

I know from my own experience it didn't thin much, but I was on a low dose. Also, I'm assuming spiro would not completely "ruin" it (as she would perceive it), since most trans women I know personally on HRT and spiro still are looking into laser hair removal (...as am I, it's just that I don't have the money... a woe I'm sure is familiar to all here).

Basically, if anybody would be able to help answer these questions, or even just point me at a thread I've missed or suggest search terms (I, um, failed pretty badly at Google earlier), I would be very much appreciative. Thorne has found that, between her time limitations, and also her own anxiety and fear, it's easier for her to ask me these things instead of ask herself or search or etc. But, she's known me for over a decade, she knows my own gender identity issues, she knows a not insignificant number of my romantic partners have been under the trans* spectrum somewhere, and so she tells me it feels safer to ask me.

Problem being, I don't always know the answers... so, I hope that explained a little better without rambling too much.

Thanks!

[Randi]

Dr. John O'dea of Marina Del Rey claims to be able to be able to deliver just about any desired result, but he's not cheap.