Post surgery: hormones, crying, depression, anxiety etc.

[R R H]

Hello my lovelies,

I was wondering if any of you have experienced massive post-surgery mood dips? Following surgery, I have no testosterone left in my body so hormonally rely now solely on the little estrogen I take. I find myself having big mood swings, anxiety, crying for example. It all catches me at anytime, often though at night. The slightly scary part is that I seem to have no control over these feelings. Sometimes I go to sleep happy and then wake an hour later with anxiety bubbling to the surface. I can find myself crying at almost nothing and often do.

I've never before felt so unable to control my emotions, including anxiety and tears.

Any thoughts would be massively appreciated.

xxx

p.s. I could have posted this in any of about 4 different categories but feel it sits best here as it's specifically related to what happens after gender correction surgery.

[AnonyMs]

I'd guess your blood levels are fluctuating a lot, and the effect is now amplified post orchi.

[R R H]

Hi AnonyMs,

So it's just about my estrogen level? I'd be relieved if so.

My pnmol/L hit 577 in November before my FFS on 2/12. I came off all estrogen of course around the op time. That pre-op figure has been considered too high by my clinic so my estrogen input has been varying since then as I return to meds post-op. I'm also booked in to see a proper endocrinologist at some point fairly soon.

Is it really just hormonal though? Just wondered. If so I'm majorly relieved.

[AnonyMs]

I believe it is, but can't say I'm an expert in it. I have very stable emotions, I believe because of implants. The only time I notice anything is when I get a new one and I feel an amazing euphoria a few days later.

My estrogen is always above 800 pmol/L, and normally far above that.

[ainsley]

I noticed that after GRS that I would cry at even commercials and could not help it.  I still get the feeling to, as if much emotion is welling up, but I control it to not cry.  So, I think, for me at least, I was not used to having no testosterone and a decent amount of estrogen after GRS and was not able to handle the feeling to cry or be anxious.  I still get the feelings, but I manage them better now.  It seems that we are learning to deal with our emotions without the crutch of testosterone to suppress them for us.   It gets easier as time goes on, but I really think it is just part of the female experience.  Your body and mind will adjust.

[Dena]

With GCS I went from near normal testosterone  levels and no estrogen to nothing. For the most part I didn't notice mood changes until the second week when I was in overtime. The nurse came in to discuss how I was going to pay for the additional bill and I became very upset over it even tough there was money sitting in my saving account that would cover the bill. I was upset that I couldn't take care of it now. They required all my surgical money to be paid with a bank check but they were more than happy to wait for a personal check to be delivered after I returned home. At the time I couldn't explain the emotional outbreak but I am pretty sure it was due to my chemistry being really messed up.

[2cherry]

Wish I could hug you...

[R R H]

So sweet: thank you

It's hard at the moment.

[Sophia Sage]

I too have found that having a stable hormone regimen really helps to keep my emotions relatively stable.  And Rachel, honey, you're still recuperating from major surgery, which surely has triggered some heightened emotional swings all on its own. 

As for your estrogen levels, Rachel, they're not high at all.  In natal women during their normal cycle they can get as high as 1600 pmol/L -- and in pregnancy over ten times higher than that. 

[2cherry]

Yes...

I've had two major depressive episodes after FFS... been almost 3 months now.

I put it on the anesthesia withdrawal symptoms. They pump so much medicine/drugs into us... it's really something... I felt the anesthesia effect for 12 months after my SRS. So I expect no less from this FFS surgery.

[R R H]

I too have found that having a stable hormone regimen really helps to keep my emotions relatively stable.  And Rachel, honey, you're still recuperating from major surgery, which surely has triggered some heightened emotional swings all on its own. 

As for your estrogen levels, Rachel, they're not high at all.  In natal women during their normal cycle they can get as high as 1600 pmol/L -- and in pregnancy over ten times higher than that.

Whilst that's true Sophia that's not a range considered normal for MtF's and there are no studies that I know of to support such a level in those transitioning. The GIC therapeutic range is 400-600 pnmol/L.

xx

[R R H]

Yes...

I've had two major depressive episodes after FFS... been almost 3 months now.

I put it on the anesthesia withdrawal symptoms. They pump so much medicine/drugs into us... it's really something... I felt the anesthesia effect for 12 months after my SRS. So I expect no less from this FFS surgery.

That's a very interesting point. I recall now reading somewhere about the long term detrimental effects of General Anaesthesthia on patients. There are studies linking it to mental issues including depression, especially amongst the elderly IIRC.

xx

[KayXo]

Whilst that's true Sophia that's not a range considered normal for MtF's and there are no studies that I know of to support such a level in those transitioning. The GIC therapeutic range is 400-600 pnmol/L.

Hi Rachel,

those symptoms could be due to a number of things and not necessarily just hormones although too little estrogen, now that you produce very little sex hormones, could be the culprit. The actual recommended range in transwomen by the Endocrine society is, I believe (correct me if I'm wrong), between 100-200 pg/ml, hence 367-734 pmol/L. I don't recall reading anywhere studies that support or justify this recommendation either. This recommendation appears to be based on expert opinions and not evidence-based. It's what they deem to be the mean daily level in pre-menopausal women although there seems to be wide variation across different women and labs and it doesn't appear to take into account the high levels experienced during pregnancy, up to 275,000 pmol/L, according to one study.

Not all doctors worldwide treating transpatients follow this guideline, some preferring to ignore levels and going by their patient's well-being and overall results or aiming for higher levels, arguing higher is better. It's all subjective, it appears.

I'm not an expert, far from. But this is my understanding of it. I truly hope you feel better sooner than later.

[R R H]

Thanks Kay for such a lovely and wise post. I have an endo referral. I must say that I do feel better the last couple of days with a slight nudge up on my E.

There has been a lot going on in my life around me which has made things tough: https://www.susans.org/forums/index.php?topic=219370.new;topicseen#new


Rach
xx

[Rachel]

I am 9 weeks post-op. Week 8 I was depressed and I do not know why. It was not gender dysphoria. I felt overwhelmed and defeated. I discontinued the very low dose T I was taking but I do not think that was it. My primary care treat a lot of trans and they do not measure E. I see them 2/28 for blood work and I will discuss the week of depression with my doctor.

[KayXo]

I often wondered whether a little T post-op could help with depression regardless of how much estrogen and/or progesterone one takes. Not only depression, but with energy levels too, helping one cope more efficiently with the stresses of life, increase overall endurance and well-being. Food for thought.

Also, I think many doctors are quite conservative, are not up to date on the latest research, are not as thoroughly informed about the subject matter as they should be (we aren't a priority in their practice given how little of us there are) and may not be giving enough estrogen (or supplementing with progesterone) as a result so that this could also be the culprit.

As far as my own experience with hormones goes, I find I'm still not quite where I want to be and I am, for the first time in my life, actually considering adding a little T. I take a high amount of E and some P and although this has improved things significantly for me, there is still some room for improvement. I sometimes feel weak, lethargic, lacking motivation/initiative and my skin is quite thin.