Quote from: ferencmerenda on December 04, 2016, 11:37:36 AMRetinal artery thrombosis from hypercoagulable state from E2
QuoteCerebrovascular event from hypercoagulable state (TIA or CVA)
Less likely due to E2 if E2 is bio-identical and especially, if taken non-orally. Please, let's keep things in perspective, we don't even know how much or what exactly she is taking. Instilling panic is not reassuring or constructive. At least, that is how I see things.
Biochem Pharmacol. 2013 Dec 15;86(12):1627-42.
Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease."There was no increase in VTE risk with the use of transdermal estrogen, even in patients with pre-existing thrombophilia [15]."
Climacteric. 2012 Apr;15 Suppl 1:11-7."There is a wealth of evidence to suggest that, unlike oral estrogens,
transdermal estradiol does not increase the risk of venous thromboembolism, probably due to its lack of effect on the coagulation cascade, including thrombin generation and resistance to activated protein C, and does not increase the risk of stroke."
Here, oral estrogens refer to no bio-identical forms such as conjugated equine estrogens and ethinyl estradiol.
Rev Prat. 1993 Dec 15;43(20):2631-7."there is no known theoretical risk when oestradiol is given parenterally(...). This type of replacement therapy with oestradiol should be more often prescribed to subjects with atherogenic hyperlipidaemia, arterial hypertension or ischaemic coronary disease:
not only it is not contraindicated, but it should soon become an indication."
Int J Pharm Compd. 2013 Jan-Feb;17(1):74-85."Administration of compounded transdermal bioidentical hormone therapy in doses targeted to physiologic reference ranges administered in a daily dose significantly relieved menopausal symptoms in peri/postmenopausal women. Cardiovascular biomarkers, inflammatory factors, immune signaling factors, and health outcomes were favorably impacted, despite very high life stress, and home and work strain in study subjects.
The therapy did not adversely alter the net prothrombotic potential, and there were no associated adverse events."
Maturitas. 2008 Jul-Aug;60(3-4):185-201."Non-orally administered estrogens, minimizing the hepatic induction of clotting factors and others proteins associated with the first-pass effect, are associated with potential advantages on the cardiovascular system. In particular,
the risk of developing deep vein thrombosis or pulmonary thromboembolism is negligible in comparison to that associated with oral estrogens."
Oral estrogens = non bio-identical
Prostate 1989;14(4):389-95"Oral administration of
synthetic estrogens has profound effects on
liver-derived plasma proteins, coagulation factors, lipoproteins, and
triglycerides, whereas
parenteral administration of native estradiol
has very little influence on these aspects of liver function."
J Sex Med. 2016 Nov;13(11):1773-1777."CSHT in the United States typically includes estradiol with the antiandrogen spironolactone"
"A retrospective chart review of transgender women who had been prescribed oral estradiol at a District of Columbia community health center was performed."
"The primary outcomes of interest were deep vein thrombosis or pulmonary emboli."
"From January 1, 2008 through March 31, 2016, 676 transgender women received oral estradiol-based CSHT for a total of 1,286 years of hormone treatment and a mean of 1.9 years of CSHT per patient.
Only one individual, or 0.15% of the population, sustained a VTE, for an incidence of 7.8 events per 10,000 person-years."
Most were taking bio-identical estradiol.
Obstet Gynecol. 2015 Mar;125(3):605-10."In transgender women, estrogen therapy, with or without antiandrogen therapy, was associated with lower BP."
"All transgender women had estradiol levels at least in the physiologic female – range at 6 months, with 3/16 (19%) having supraphysiologic levels > 1000pg/dl (including the one transgender woman using intramuscular estradiol valerate)."
pg/dl should read pg/ml
Only bio-identical estradiol was prescribed.
Hypertension. 1999 May;33(5):1190-4."Fifteen healthy postmenopausal women were studied in each of 3 conditions: on placebo, after 8 weeks of transdermal estradiol (...) twice per week, and again 2 weeks after addition of intravaginal progesterone"
"Levels of estrogen and progesterone similar to those in premenopausal women were achieved. On estradiol, nocturnal systolic BP (110+/-3 mm Hg), diastolic BP (63+/-2 mm Hg), and mean BP (77+/-2 mm Hg) fell significantly (P<0.02) compared with placebo systolic BP (116+/-2 mm Hg), diastolic BP (68+/-2 mm Hg), and mean BP (82+/-2 mm Hg). Daytime BP followed the same trend but was significantly lower only for mean BP. There was no activation of the RAAS. The addition of progesterone resulted in no further fall in BP but a significant activation of the RAAS. Thus, contrary to what is often assumed,
administration of estradiol with or without progesterone not only did not raise BP but rather substantially lowered BP. This BP-lowering effect may be responsible for the lower incidence of hypertension in premenopausal than in postmenopausal women."
QuoteRetinal detachment (may or may not be related to HRT)
IF HRT is bio-identical such that hormones are identical to that produced in ciswomen, then we should ask do women who take no birth control pills (only rely on their endogenous hormones) get retinal detachment to a greater degree than men during reproductive years? If so, can cause and effect be established?
QuoteOptic chiasma compression from prolactinoma
Prolactinoma is rare in transwomen, only 8 cases reported. Also never been reported with the use of exclusively bio-identical hormones. Visions problems typically include loss of peripheral vision and double vision.
Quoteseek help, ideally professional help
Agreed. Go see someone!
Quote from: Jane Emily on December 04, 2016, 11:55:11 AMI have out of range prolactin levels.
How high are they? What does your HRT consist of? Just curious, not trying to diagnose or anything as I'm not a doctor. Mine are 80-130 ng/ml but my estradiol levels are also high so those numbers are perfectly normal.
