Quote from: AlyssaJ on May 04, 2017, 12:50:05 PMShe said she starts at a low dose of Estradiol for two reasons. First, in her experience, it helps avoid Tuberous Breast growth (which can only be corrected with plastic surgery).
Any science, studies to back up that claim?
QuoteSecond, and her bigger concern is the risk of blood clots.
Not a good reason, in my opinion. Bio-identical estradiol is a relatively safe estrogen (I hope she can distinguish between this and other forms of estrogen like Premarin and birth control pills) and there are several studies supporting the use of higher doses of ESTRADIOL (in transgendered women) and even VERY high doses (used for advanced breast/prostate cancer) with little risk ("that do give rise to major concerns"), sometimes in much older women (and men), up to 92 yrs old. Studies estimate (I can provide the studies by PM for anyone interested, you can show doctor) the potency of birth control pills to be the equivalent of anywhere between 10 mg and 50 mg oral estradiol. And older birth control pills containing more, just a decade ago or so, to be the equivalent of 15 mg and 75 mg oral estradiol. The risks of blood clots associated with older birth control pills in absolute numbers was 0.03%, now probably lower with birth control pills containing the equivalent of 10-50 mg oral estradiol. Birth control pills are prescribed to millions of premenopausal women, sometimes without even checking for predisposition to clots. Why be so cautious with oral estradiol when it comes to transgendered women when the same is not true for premenopausal women? Something is not right...
The problem is some doctors are unaware of the above information and have fears regarding estrogen or oral estrogen because of large studies using other forms of estrogen combined with non bio-identical progestogens in post-menopausal women without understanding the intricacies of the studies, the differences between estrogens.
The dose she prescribed to you is far far smaller than all the above and you are still young. Her explanations do not justify her actions, I think. I'm not the expert though. I base my opinion on information I've come across in studies in journals and statistics provided by reputable sources.
QuoteShe admitted she and likely other OB/GYN's are probably more conservative about this than an Endo would be given that they work with pregnant women who are at a much higher risk of blood clots.
Still not a good reason, in my opinion. Pregnant women have levels as high as 75,000 pg/ml, typical levels around 1,000-40,000 during the course of pregnancy. The ABSOLUTE risk of deep vein thrombosis is 0.1%, the ABSOLUTE risk of pulmonary embolism is 0.01%. Your levels are probably under 100 pg/ml, more than 10 to 75 times lower. Calculate your risks...draw your own conclusions.
QuoteSo in the end, she's more conservative than an Endo, I'm ok with that.
I wouldn't be satisfied with her answer given what I know. If you want, I can send you those studies privately and you share these with her. Your call. But, it is our job and responsibility, I think, to also educate our doctors about a subject matter that is far from extensively studied and taught in medical schools and for which several misconceptions continue to circulate. We need to start somewhere and WE can make a difference.
Quote from: Laurie on May 04, 2017, 01:00:28 PMOne of them posed an inquiry about increasing my estradiol. In his reply hes indicated at my next regular meeting with him on the 22nd (4 months from last when he prescribed my HRT) he will order more labs and see hows my hormone levels are then decide what to do.
Levels of estradiol in men with prostate cancer around 300-600 pg/ml, aged 49-91. No increase in risks but decreased risk of DVT and cardiovascular risk improved. Levels seen in women during menstrual cycle, from less than 100 to up to 650 pg/ml. During pregnancy, read reply above. My own levels, from around 1,000 to 4,000 pg/ml, I'm neither very young, nor old. Clotting factors remain normal, everything is fine according to my three doctors. Studies with high levels in post-menopausal women (older than 45) with levels anywhere from 100 to 3,000 pg/ml showed no complications.
Why do doctors keep on relying on levels to determine risks? It has no bearing on breast cancer risk as pregnant women actually seem to have a decreased risk of breast cancer incidence in the long-term (breast cancer risk also does not increase in transgendered women) while prolactinoma is very rare in transwomen despite decades of aggressive doses of estrogen and the few times they were present, bio-identical estradiol was not taken exclusively.
QuoteIn answering another question about adding progesterone he said that will not happen until I am on a "Full" dose of estradiol.
Why not? What are his reasons?
I apologize for bringing this up, again and again but I can't just say nothing knowing what I know. I've personally taken the time (because I can, I realize not everyone has the luxury) to research this matter because I didn't want doctors making the wrong decisions, I wanted to understand what I was putting in my body, the benefits and risks, I wanted to play an active role in my treatment and not blindly follow with potential harm being done to me. I'm not a doctor, nor a health professional. But thanks to the knowledge I gather, the doctors that treat me can't just do as they please, we have a discussion and sometimes, their opinions are changed. I also have the luxury of choosing my doctors.
