Side effects of female hormones and/or anti-androgens

[Liv_J]

Hi

Someone recently made a remark to me about how hormones have dangerous side effects. I think that's most likely overly alarmist - and not taking them, if it's what you need to be happy, can also have dangerous side effects like depression, not looking after yourself well and not taking interest in life etc.

But to what extent is it true - what health issues might you want to be aware of and are there lifestyle things you can do to offset it? This person said they can affect your liver, for example? In which case, say, maybe it's especially important to avoid abusing alcohol?

Thanks for any info.

[Dena]

The same advice anybody would receive. East healthy, control your weight, limit alcohol, don't use drugs, don't smoke and get regular exercise. Very few have any issues with HRT and regular doctors visit will spot any issues long before they are a problem. I was on Premarin which may have more risks associated with it that the current treatments and I had no issues with it so you need to do the things that will keep your body healthy then prepare for a long happy life.

[Dani]

+1 on everything Dena said and many of us here really like bio-identical estradiol taken by a non-oral route. Sublingual, topical or injectable is very safe and does not have the problems associated with horse based conjugated estrogens or ethinyl estradiol.

[Liv_J]

OK thanks

[Lucy Ross]

From what I've read here - and the posters backed this up with real research, too - you do your liver much more of a disservice when you pop an acetaminophen.  No one takes those on daily basis, of course, but the research covered that as well, it just isn't a big deal, especially if you take the estradiol sublingually. 

[Kenzie4realz]

True Lucy , and God forbid we take any nsaids... whatever will our kidneys ever do?


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[KarynMcD]

side effects like depression, not looking after yourself well and not taking interest in life etc.

These things may happen if you aren't taking hormones too.
But yeah, for depression, it's probably because your hormonal balance is off. When I first started with injections, I started to get depressed by the end of the time in-between shots. My dosage was adjusted and it hasn't happened since.
Some people get depressed on Progesterone. When they stop taking it, it went away.
That's why we have doctors monitoring us. If you don't feel right, don't hesitate to tell them.

maybe it's especially important to avoid abusing alcohol?

It's never a good idea to be abusing anything.

[Dani]

True Lucy , and God forbid we take any nsaids... whatever will our kidneys ever do?

Actually Non steroid anti inflammatory drugs are very safe when taken occasionally, but daily use is another thing.

After 5 years of daily use of Nsaid and progressive worsening of the arthritis in my left hip, I finally got a new hip about 6 years ago. Titanium is wonderful for hips.

[Liv_J]

These things may happen if you aren't taking hormones too.

That's what I meant - that those things can happen if you don't get on with your transition, including hormones, when it's what you need to do

[AnonyMs]

As others have said there are forms of hrt with significant risks. Don't take those.

At the end of the day if you take hrt there's a good change you'll increase the risks to those of your target gender. Iv already had a problem like that, and i might not have had it Ive I'd stayed off hrt. Of course I'd probable gave killed myself by now, so I can't complain too much. The specialist I saw told me I should stop my diy hrt, and I refused. He didn't understand the bigger picture, just his narrow little field.

If you see a doctor and asked to take estrogen he's going to tell you how risky that is, and if you ask to take T, well that's horribly risky too. It's truly amazing cis people are alive at all.

Your going to die of something and hrt will influence what that will be, the chances of a more male or female related thing. Chances are you won't die decades early by you own hand and you'll lead a life as full as can be hoped given your circumstances.

And finally as a mtf I can hope live the extra years woman get. i guess ftm are not so lucky, but either way it's welll worth it. And none of this begins to compare to the risks of smoking, drinking, or driving, living in poverty, etc.

[KayXo]

Based on everything that I've read so far, since 2003 when my interest in hormones was sparked, in the more than ten of thousands of studies I've come across and looked at in detail, in ciswomen, cismen and transwomen, I tend to believe that taking estrogen (and even a little T) can keep us younger looking longer (I don't think genes are the only thing responsible for making me look 15 years younger than my actual age), allow us to actually live healthier and more vital lives for many more years than the average population who is not on HRT and whose hormones gradually decrease over time. I suspect many of the ailments associated with ageing are directly caused by the drop in sex hormones and that hormones can indeed prevent or postpone the onset of cardiovascular events, cancer, degenerative diseases, neurological problems. It keeps our bones and skin healthy, as well as maintains our female silhouette. The risks are small (so small as to be negligible) as long as the HRT is bio-identical and even more so, when administered non-orally (parenterally). The benefits FAR outweigh the risks. For me, there is no doubt in my mind.

The issue is with non bio-identical forms, those drugs that pharmaceutical companies LOVE so much because they cannot be patented so that the bio-identical forms sometimes don't get much attention and become confused with the non bio-identical forms.

[Perle]

+1 on everything Dena said and many of us here really like bio-identical estradiol taken by a non-oral route. Sublingual, topical or injectable is very safe and does not have the problems associated with horse based conjugated estrogens or ethinyl estradiol.

That is not entirely true. You may avoid first pass through the liver, but the risk of deep vein thrombosis and pulmonary embolism is still there with bioidenticals. There are NO benefits to bioidenticals. It's a big scam. A scam to the patients and the doctors. Stick with regular hormones. They are cheaper and transdermal routes are available.


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[KayXo]

Studies have unequivocally shown that bio-identicals are SAFER because they are metabolized faster due to their molecular structure and have a much lower hepatic impact. This is not even subject to debate, there is no scam. The evidence is there and it makes much sense.

[p]

Hi Liv,

Just a heads up, the post below & the links I put in here talk about sexual function in a very frank way and contain NSFW images that some people may not wish to view. Please skip this post if that's you! I worried a lot about side-effects, so I did a lot of research--that being said, I am not a doc & this is no substitute for medical advice.

I got a sheet from my doc on this before I started, and it laid out certain risks of estrogen HRT. I was glad to be aware of these risks when making my decision. This post from Silly Trans Woman covers pretty much the same info as the sheet my doctor gave me: http://sillytranswoman.blogspot.com/2011/03/risks-associated-with-hormone-use.html

Here are some common side effects and some lifestyle changes:

side effect: increased risk of blood clots (which can cause other problems)
lifestyle change: try not to sit for long periods of time without getting up; quit smoking(!!!); eat a healthy diet; get 90 minutes of exercise a week; inform all of your doctors about your medication so that they can help manage your other meds and help you decide if you need to stop your HRT, say, for a couple of weeks before a procedure; my doctor recommends switching to injections or patches after age 35 because some studies show that these delivery methods present less of a clotting risk than pills (I am sure KayXo could cite the studies--she is an incredibly smart person who has really done her homework on HRT!)

side effect: increased risk of developing a tumor of the pituitary gland called a prolactinoma
lifestyle change: make sure your doctor is monitoring your prolactin levels; I'm not aware of any preventive measures you can take. This one may seem scary, but it's also a side effect of certain medications for depression and psychiatric disorders, and it also occurs naturally in some people. The word "tumor" is scary, but a prolactinoma is benign tumor (aka, it's not cancerous). If you do develp a prolactinoma, it is usually treatable with medication and/or surgery.

side effect: decreased sexual functioning (loss of libido, inability to maintain an erection, decreased volume of ejaculation)
lifestyle change: make sure to get enough rest and exercise, communicate with your partner/s, set aside time to explore your body's changing erotic landscape on your own; consider sexual techniques that allow for different experiences of and relationship to your body (see this NSFW site http://early2bed.com/2014/02/05/trans-women-sex-awesome/ ); if you would like to penetrate your partner and are unable, consider using a strap-on device; avoid drugs and alcohol, which tend to impair sexual function on their own.

side effect: infertility
lifestyle change: bank sperm

side effect: decreased testicular volume, penis size
lifestyle change: if you could figure out how to reliably increase the size of the male member, you would be a billionaire!  Many trans women do not find this change distressing. If you do, explore techniques above that might help you work around self-consciousness about your genitals. You could also pursue strap-ons or other toys, or engage a therapist to help you work through these issues.

side effect: mood changes (depression, anxiety, suicidal thoughts)
lifestyle changes: start working with a therapist; keep a mood journal to track any changes (it can be as simple as a smiley face or frowny face written on a normal calendar); make sure to get plenty of rest and exercise; try to eliminate stress from your life, where possible; let your doctor and therapist know if you experience these symptoms--I know someone who developed a panic disorder on HRT, so she added an anti-depressant to her regimen, and that really helped her and she was able to continue her HRT.

side effect: possible increased risk of gall stones (this one is on Silly Trans Woman but wasn't on my doc's fact sheet)
lifestyle change: eat a sensible diet, more here http://www.webmd.com/digestive-disorders/understanding-gallstones-prevention

side effect: possible increased risk of breast cancer (this is actually a controversial one, again if you must have the studies, KayXo could probably point you toward them)
lifestyle change: follow the recommended schedule for mammograms for a woman of your age; use self-exams between mammograms to monitor your breasts, here is a guide: http://www.nationalbreastcancer.org/breast-self-exam (note that if you follow this guide, it may scare you because it warns about lumps under your nipples, and at the beginning of your HRT, you will develop some hard, painful bumps under your nipples--that is a normal development called a breast bud; your doc can examine you if you are concerned)

Most of this stuff boils down to common sense--eat a healthy diet, exercise, and pursue HRT through a doctor who can help you monitor your risk. Almost all medications have a host of common--and uncommon--side effects of various degrees of seriousness, and estrogen is no different. Medical experts agree that estrogen HRT is safe when prescribed and monitored by a doctor, so your friend is definitely being unhelpful by calling HRT "dangerous." Many people take on the risk of serious side effects to treat non-life-threatening conditions like sexual dysfunction, acne, hair loss, etc. You rightly point out that for most trans people, the benefits of HRT far outweigh the risks.

Some steps docs take to lower your risks are:
1. To screen you for conditions that could make HRT more dangerous. You should talk with your doctor about any conditions you have (circulatory, heart, liver, kidney, & mental illness come to mind) or family history that might increase these risks to you.
2. Side effects generally increase with dosage, so your doctor may try to use the lowest effective dose. You should follow the dosage prescribed by your doctor and then communicate with your doc if you feel that your progress is not sufficient. Be aware that your mileage may vary with HRT--your results won't necessarily match others', and it takes time.
3. Doctors also order bloodwork periodically while you are on HRT so that they can make sure you are not experiencing certain serious side-effects. 

Finally, if your friend says hormones are "dangerous" but "natural" methods aren't, you should know that taking a "natural supplement" that is supposed to mimic HRT is not necessarily safe at all, as most supplements are not evaluated by the FDA. Talk to your doctor about any supplements, herbal medicines, or diet changes you plan to pursue alongside or in lieu of HRT. HRT often includes a testosterone blocker as well as estrogen, which has its own side-effects depending on which medicine you are prescribed.

Hope this helps!,
Patti

[KayXo]

This post from Silly Trans Woman covers pretty much the same info as the sheet my doctor gave me: http://sillytranswoman.blogspot.com/2011/03/risks-associated-with-hormone-use.html

There are some things mentioned on that post that are incorrect. Please do not blindly accept assertions, always ask for research to support assertions and read the research FULLY, remain critical at all times. Also, double-check with your doctor/pharmacist.

side effect: increased risk of blood clots (which can cause other problems)

Small risk with bio-identical estradiol, even smaller and almost negligible non-orally, ESPECIALLY AT DOSES typically prescribed to transwomen.

lifestyle change: try not to sit for long periods of time without getting up; quit smoking(!!!); eat a healthy diet; get 90 minutes of exercise a week; inform all of your doctors about your medication so that they can help manage your other meds and help you decide if you need to stop your HRT, say, for a couple of weeks before a procedure;

I sit for long periods of time. I think we needn't be more cautious than ciswomen are, especially considering many of them are on birth control pills which raise the risk to a greater extent and some are pregnant (with estradiol levels SEVERAL fold higher than ours, in the thousands).

my doctor recommends switching to injections or patches after age 35 because some studies show that these delivery methods present less of a clotting risk than pills

Pills containing ethinyl estradiol have been found to increase risk several fold in women after the age of 35, sometimes those doses were also quite high. Ethinyl estradiol is NOT bio-identical estradiol and impacts hepatic markers to a much greater extent.

side effect: increased risk of developing a tumor of the pituitary gland called a prolactinoma

VERY rare, despite in the past, very aggressive/high doses of estrogen including non bio-identicals. Only 8 cases reported, all of them on non bio-identical estrogens and/or progestogens. If on cyproterone acetate, one must be cautious, monitor more closely, as 5 of the 8 cases were associated with this progestogen and it tends to raise prolactin levels. Pregnant women and breastfeeding women have VERY high prolactin levels, these do not CAUSE prolactinomas. It's important to realize that higher prolactin levels is perfectly natural with estradiol and progesterone but on non native forms, the effect might be more marked and this is where the problems begin.

loss of libido

High enough E in some women may mitigate this or progesterone, or even avoiding suppressing T too much.

inability to maintain an erection

I am post-op. T levels very low. I get clitoral erections and engorgement when aroused. Regardless of E and P levels.

decreased volume of ejaculation

I still have a significant amount of ejaculate post-op. I'm a very sexual being, by nature and let myself go. I don't think about it, I react.

side effect: mood changes (depression, anxiety, suicidal thoughts)

This should NOT occur, if it does, quickly find out cause: too low T, too low E, cyproterone acetate/medroxyprogesterone acetate/finasteride/dutasteride, or environmental

side effect: possible increased risk of gall stones (this one is on Silly Trans Woman but wasn't on my doc's fact sheet)

Orally, estrogen can perhaps cause this or too low sex hormones or a progestogen. The cause and effect is hard to pinpoint. Eating enough fat could perhaps prevent this from occurring as it keeps the gallbladder active and spewing bile out instead of letting it sit there and accumulate (i.e. gallstones).

side effect: possible increased risk of breast cancer (this is actually a controversial one

So far, no increase in risk has been noted in transsexual women relative to cismen despite decades of aggressive, high dose HRT. In ciswomen, high dose estrogen is used to treat advanced breast cancer and is, at least, as effective as anti-estrogens. In randomized controlled trials, estrogen alone or without medroxyprogesterone acetate, was shown not to increase the risk in ciswomen or EVEN significantly decrease the risk!

follow the recommended schedule for mammograms for a woman of your age

Mammograms involve radiation to the breasts and can slightly increase risk of cancer. This risk is worth taking in ciswomen considering their risks of breast cancer BUT in transwomen, it's not because the risk of breast cancer does not increase and mammograms may increase it, slightly. We aren't ciswomen, we weren't exposed to the same things over time, patterns are distinct from them. Sadly, many doctors overlook this. I personally never intend to take a mammogram.

To screen you for conditions that could make HRT more dangerous. You should talk with your doctor about any conditions you have (circulatory, heart, liver, kidney, & mental illness come to mind) or family history that might increase these risks to you.

Bio-identical HRT can reduce cardiovascular risks, has not been found to harm liver and can even prevent fatty liver, has no negative impact on kidneys AFAIK and improves mood in many, can prevent mental illnesses. If anything, IMHO (I'm not a doctor), but based on studies, bio-identical HRT should be indicated to reduce health risks, improve longevity and quality of life.

Anti-androgens can, however, present some risks, I agree although Spiro can reduce blood pressure.

My 2 cents. Take with a grain of salt, as always. Do your own research, have a doctor monitor you and discuss options with them. Be PROACTIVE in your treatment, understand what is going on, what you are taking.

[Liv_J]

Thanks for all the information peeps. It's nice of you, and useful. Will bear it in mind

[Charlie Nicki]

side effect: mood changes (depression, anxiety, suicidal thoughts)
lifestyle changes: start working with a therapist; keep a mood journal to track any changes (it can be as simple as a smiley face or frowny face written on a normal calendar); make sure to get plenty of rest and exercise; try to eliminate stress from your life, where possible; let your doctor and therapist know if you experience these symptoms--I know someone who developed a panic disorder on HRT, so she added an anti-depressant to her regimen, and that really helped her and she was able to continue her HRT.

Has anyone experienced this?

[KayXo]

On oral E, I had some anxiety. On injections, anxiety gone but slight depression. Better since switching to E gel and adding some T. I'm post-op. It's important, I think, to have enough of both hormones, for some people, at least, as E alone might not suffice. Progesterone may, in some, have an anti-depressant effect due to the action of its metabolites, most notably, allopregnanolone. In others, it could have the opposite effect.  Individuals vary...