Taking estrogen with history of strokr

[Russngrl]

Hi ladies,

I was wondering if anybody knew of any source of information on safely taking estrogen if you have a history of stroke.  A referance or article that I could read myself.

This thing has me in quite the tizzy.  I was taking low dose estradiol for nine months, then I had a small stroke.  That was 3 months ago!  I'm about 98% recovered, just some balance issues when I get really tired when working out.  BUT, my docs say no more estradiol!!!!   They have me only on a low dose of spiro.   I'm hoping that, plus my age, 67, keeps me from losing too much of the gains from the estradiol.

Any thoughts or similar experience?

[Dena]

My thoughts include are you on an anticoagulant? if you are, it's possible that you might be able to take estradiol in a non pill form. Consider that CIS women have strokes and DVTs but continue to produce estradiol afterward. Pills do have a higher risk of issues however most people can take them safely. This is something you will have to explore with your doctor because it may be possible for you to return to hormones with the proper treatment plan.

[luckygirl]

I would imagine the cause of your stroke would dictate your answer. If it was a clot, regardless of thinners I would think no. I know a few women that had strokes on E and were forced to quit E. Didn't stop them from living in their chosen genders, though. Personal opinion alert. E does so little over 60 that I can't see it being worth the risk. Most of the Cis women I know that are over 50 don't take any, either.

[Russngrl]

I have thought of that, Dena, and have read some medical reports suggesting it might be possible.   Not yet, the stroke is too fresh in my mind.  But it's a dance with my wife as to staying married and what I do..   I pass well as of now and volunteer at a non-profit and a local museum, (I believe stealth)so I'm going to take the spiro alone for a while.

It's my understanding it's not the estrogen being in the body that's the risk factor, it's the process whereby it gets into the body.  I'm thinking eventually low dose patch and heavy anticoagulation.   I'd want a second trans-experienced opinion.

Luckygirl, it was an ischemic stroke very tiny, wasn't seen on the initial scans.  So it was likely a very small clot.

My doc did suggest social transition.  The LOW dose E I was onfor 8 months gave me decent butt and hips and 38A bust.  I could probably pass in a one piece swim suit (but with a small bust).

Thanks for your answers!

[Dani]

I am 69 years old and I am taking Estradiol sublingual. My Endocrinologist really prefers to give Estradiol in a patch form for older women. It seems to be the safest way if any type of blood clots are mentioned in your medical history. She gave me a pass on that because I am heavily involved in water sports and the patches are not an option.

I know the risk and I mitigate that risk by taking low dose aspirin.

Most of the problems with blood clots were with Ethinyl Estradiol which were common in birth control pills. Today, we have Micronized Estradiol, Estradiol topical or Estradiol Valerate injection. All of these are much safer than Ethinyl Estradiol, but the common opinion still persists that any type of Estradiol may cause a blood clot.

[Joanne ONeal]

Lucky Girl, Your personal opinion is not fair to the many over 60 trans women. It is worth the small risk for me!!! Comment not appreciated! 

[luckygirl]

Lucky Girl, Your personal opinion is not fair to the many over 60 trans women. It is worth the small risk for me!!! Comment not appreciated!

My opinion was that I didn't feel it was worth the risk for her after throwing a clot and having a stroke. How does any of this affect you?

[Janes Groove]

Personal opinion alert. E does so little over 60 that I can't see it being worth the risk. Most of the Cis women I know that are over 50 don't take any, either.

So it's strictly an opinion based on a single case, anecdotal incident, that may have been caused by anything?  I'm curious if you can cite any peer-reviewed, science-based, longitudinal studies that support this opinion.

A lot of people read this site to get good information on whether or not they should pursue HRT to alleviate lifelong, many times quite crippling, gender dysphoria conditions.  That's why it matters what you post here.

[luckygirl]

So it's strictly an opinion based on a single case, anecdotal incident, that may have been caused by anything?  I'm curious if you can cite any peer-reviewed, science-based, longitudinal studies that support this opinion.

A lot of people read this site to get good information on whether or not they should pursue HRT to alleviate lifelong, many times quite crippling, gender dysphoria conditions.  That's why it matters what you post here.

Hi Jane. I certainly appreciate your concern and it is in no way my intention to be contentious or incur anyone's ire.
My original post was out of concern for the OP and was intended to help her justify her physician's decision to stop her estrogen protocol based on her health incident. FWIW, you may notice

Personal opinion alert

in the body of my message. I'm well aware that words have power. I hope that helps clarify things.

[Russngrl]

Please pay attention to this.

Do NOT take my experience to mean you should not take estrogen.   It turns out that my age (67), and family history (my mother died from a stroke) are risk factors INDEPENDENT of the estrogen.  The estrogen may not have had anything to do with it!

The risk of thromboses is actually very low, 2.5 cases out of 1,000 or .25%. Compare this to the HUGE risk of attempted suicide in our population - 41%. 

Estrogen can be LIFESAVING when taken responsibly.  I haven't ruled it out for me in the future, maybe a patch with heavy anticoagulation.

So, don't be afraid of it, just respectful

[luckygirl]

I'm sorry, but for the sake of every woman's health:

There are links that are easily googled to help with an informed decision.  Every woman must weigh her options, but to say that there is little to no risk is uniformed at the minimum. Please be careful with your precious bodies, guys. If HRT is right for you, your primary care physician is best informed to make that decision.




<links removed by moderator>

[Russngrl]

Yes,I agree.  Be careful with your bodies.  The risk is small but it's still there.  Don't be afraid but respect the danger.  I used to do neuroscience research and some of the research tools we used were extremely lethal toxins.  Same thing - don't be afraid BUT take precautions and seriously respect the stuff.

I haven't ruled it out for the future - heavy anticoagulation meds with low dose patch?  But only if I read the research literature and am convinced it's safe

[Joanne ONeal]

Lucky girl, your comment was "E does so little over 60 that I can't see it being worth the risk". I am a changed person because of my low dose E. Suicide is no longer an option for my life long dysphoria. All of my health care professionals are on board with my HRT plan. I'm 66 and HRT saved my life! 

[luckygirl]

You, however do not have blood clots and for you it was obviously worth the risk given your circumstance.
      I'm very glad that hrt gave you the relief that you sought. Unfortunately, it can be deadly for some individuals.

[NatalieRene]

You, however do not have blood clots and for you it was obviously worth the risk given your circumstance.
      I'm very glad that hrt gave you the relief that you sought. Unfortunately, it can be deadly for some individuals.

In my opinion it is worth the risk. Even if I don't die old in my bed I know I won't die with regret of allowing fear to rob me of what little time I had to at least get a fleeting glance at what a normal life is. Looking back and thinking if I had spent the last decade fearing death from estrogen I might have simply found another way to kill myself but instead of having lived my life I would have squandered it.

If the person knowing the risks accepts the risks I say let them take the dosage. Obviously I agree that I would mitigate the risk as much as possible but I think it's important to note that for some the dysphoroia is higher risk then the estrodile.

[Russngrl]

Luckygirl, I looked at all three of the links.  Are you aware of any research reports on the topics. These were more like summaries or news reports.  I'd like to read the original research with the reported data, odds ratios, confidence intervals, all that stuff.  That way I can judge the magnitude of the risk and the validity of the study myself.

[Devlyn]

I would imagine the cause of your stroke would dictate your answer. If it was a clot, regardless of thinners I would think no. I know a few women that had strokes on E and were forced to quit E. Didn't stop them from living in their chosen genders, though. Personal opinion alert. E does so little over 60 that I can't see it being worth the risk. Most of the Cis women I know that are over 50 don't take any, either.

I can't say I'm onboard with that, because...

I am 69 years old and I am taking Estradiol sublingual. My Endocrinologist really prefers to give Estradiol in a patch form for older women. It seems to be the safest way if any type of blood clots are mentioned in your medical history. She gave me a pass on that because I am heavily involved in water sports and the patches are not an option.

I know the risk and I mitigate that risk by taking low dose aspirin.

Most of the problems with blood clots were with Ethinyl Estradiol which were common in birth control pills. Today, we have Micronized Estradiol, Estradiol topical or Estradiol Valerate injection. All of these are much safer than Ethinyl Estradiol, but the common opinion still persists that any type of Estradiol may cause a blood clot.

... I'm 57, and like Dani, I'm on sublingual estradiol and a daily aspirin to counter the stroke risk indicated by my family history. Risks can be clinically managed.

Hugs, Devlyn

[PurplePelican]

I can't say I'm onboard with that, because...

... I'm 57, and like Dani, I'm on sublingual estradiol and a daily aspirin to counter the stroke risk indicated by my family history. Risks can be clinically managed.

Hugs, Devlyn

In addition to proper management, recent studies have shown that the stroke risk for trans women is not actually as high as the stats say it should be - the model is wrong. The general gist if the results was that trans women taking estradiol had a very minor increase in risk over cis men and a much lower risk than cis women on estradiol.

As other have mentioned, delivery method is also important, with all methods but swallowing being essentially no additional risk. Swallowing pills also has another undesirable effect, much of it ends up as estrone - this leaves you with an undesirable E1:E2 ratio. Estrone binds better and acts more weakly, if at all.

[luckygirl]

I never was referring to transwomen that hadn't previously had a stroke already while on any form of estrogen. My point was for women that have already had a stroke of any magnitude. If the discussion goes on, I would like to suggest that focus revolve around professional opinion of those individuals. I personally know zero women that have had strokes while on any form of estrogen where their Doctors continued them on an estrogen protocol or were willing to reintroduce it later and I have personally known two. I have also read of others plight but never met them and they found themselves in the same position which was the original issue became a deal breaker for estrogen administation.
So I would think these individuals are the ones you want to focus on and not the general population or trans population at large.

   That's my final thoughts on the issue and I wish you all luck in your ongoing struggles with your dysphoria and your abilites to mitigate the problem through whatever means you deem necessary.


<edit by moderator>

[christinej78]

Hi All,                        08 January 2019

I recently experienced a DVT in my left leg the day after Thanksgiving. Went to the Emergency Department at our local Baylor Scott and White Hospital. They did an ultrasound of my leg and found two DVT's (clots) in the calf muscle.

They prescribed Xarelto rather than admitting me to the hospital. Fortunately, that drug is available, has been since 2011. I could see a difference about four hours after I took the first dose (15mg pill), the only option available.

I'll be on it for approximately 6 months as that's the standard treatment protocol. I have an appointment with a vascular surgeon on the 21st of this month. I am off the estradiol as of the day I developed the DVT. My personal opinion, which is worth exactly what it cost, is that the estradiol was not the culprit. I had noticed what I thought was Petechiae around the ankles of my legs for a couple of years every time I mowed the pasture with a walk-behind mower. It was most pronounced on the left side.

When using the walk-behind mower I walk about 7 or 8 miles in two to three hours. The odd part was the Petechiae would clear up within a day or so. Went to the doctor several times about it. Problem was, by the time I got to the doc it had cleared up. I'm only talking a day or two at the most.

A vascular surgeon is going to ultrasound both legs on the 21st so I should know more then. I'll remain off the Estradiol until my endocrinologist gives me the OK to restart. I see her on the 11th of February.

If anyone thinks DVT's are minor, they need to understand they can kill you or disable you in ways you don't even want to contemplate. If you think you have a DVT, get to a real hospital emergency department and not the "Doc-In-A-Box" variety, unless that's the only thing available.

My symptoms were swelling of my left leg, very red and hot to the touch. I only noticed it when I went to scratch an itch. As soon as I touched it I decided to take a look at it. It was red and swollen and felt hot enough to light a match on. Fortunately, the Love of my Life and I were Skyping and I showed her my leg. She told me to get my buns to a real hospital emergency department ASAP. I did and am happy she sent me on my way. They found the clots in the calf muscle and prescribed Xarelto. Oh, who is she? She is Our Dena; she saved my life and health.

Yes, I miss the Estradiol, I feel, sleep and pee better, my boobs grow and my hair seems to be filling in the empty spaces when I'm on it. I'm not going to restart it until I have the OK from my doctors.

I hope my experience will be of some help to our community. Take good care of yourselves, it's your health, the only health you have, keep it well.

In case you don't know, I am 78 years young and have many more years of living I want to do.

Best Always, Love
Christine