Devastated after HRT checkup at 9 months

[JemmaK]

First time posting, after a year of lurking, but I really could use the support.  I had my 9 month HRT checkup a few days ago, and it left me devastated.  For the record, I go to Mazzoni, so these are experienced doctors. 

Little background: I started HRT February 8th - low doses at first, then over time checking levels and getting them to where they needed to be.  So I probably wasn't at desirable levels until May or so.

While I already had important HRT effects before that (sexual functioning switched to female, smooth skin, muscle loss, etc. - loved all of it), breast growth didn't start until the levels got where they needed to be.  Then I got some budding, and some significant nipple sensitivity - I had to switch to smaller breastforms because of pain, etc.

Little more background: my mom wasn't even quite an A-cup when she was 21.  She only got to a B-cup when she gained weight much later in life.  She is rail-thin, as am I.  My weight pre-HRT was typically 145, at 6' height.  And I didn't gaint weight on HRT.  Indeed, as a vegan, I maintained a weight of about 140 on HRT.

Then the big event...I convinced my insurance to cover early GCS!  Had it September 26th with Dr. Rumer.  Everything went GREAT.  But HRT?  That's the issue.  She took me off spiro (!!!) and estrogen a full month before the surgery.  Both a trans-focused endo and my Mazzoni primary care doc assured me that this wouldn't hurt my breast development - just pause it.  Went back on oral estradiol 1 week after surgery, and of course, no spiro (yay, right?).

And yet, it's almost two months later, and my breasts are where they were BEFORE HRT.

My doc at Mazzoni told me, among other things, that I have a "male chest", that I "look like I was never on HRT", and that trans guys would die to have my chest.  Keep in mind that I never missed a dose prior to the surgery.  Not one.

She's pretty freaked out at this point, and I'm devastated.  Things she's trying:
1. She's adding progesterone.  I've only been on oral estradiol before now. 
2.  She's got me dropping my veganism - I'm on whole milk and eggs every day.
3.  She wants me to gain 5 pounds minimum (and trust me, I don't starve myself - I eat a lot!).
4.  She's going to try injectible E too if needed (in about a month, if nothing happens).

But she's talking about how I might never get even an A cup, how we don't even need to get breast size - that we just need to get an aureole and nipple that are developed.  This is scary stuff!  I really don't want to get top surgery before I get ANY natural breast growth.  And I'm so worried that I've messed things up with getting GCS early.

And Item 5: Lactation (seriously):

One other last-ditch thing she's having me try (and I'm sure this will spark debate - sorry): prior to transition via HRT, I successfully researched and applied lactation induction methods that gave me some serious milk duct and nipple development.  That was about a year ago.  I stopped when I went on HRT.  Trust me, it worked - no drugs, just manual stimulation on a strict schedule (including in the middle of the night).  Lymph node pain, duct development, let down, etc. 

So my doc wants me to restart that.  Can't tell you how worrisome that is.  Lactation is HARD to start up, and hard to maintain.  And I know the changes are mostly temporary (though duct development isn't).  But she wants to try.

I could use some reassurance from the community, and any advice you might have.  Am I doomed?  I gave up everything to come out as trans and start my transition.  This is all terrible for me to hear...

[Jailyn]

Well we as trans sometimes imagine all women as having these great breasts but, in reality there are a lot of flat chested cis-women. It is only natural that some us will be too, but it may have nothing to do with your meds at all. As far as inducing lactation this is a good option to encourage them to grow a little. My ex when from a good B cup and went up to almost a D cup when she nursed. Breast growth also it dependent on fat. As you say, you are thin and not much fat. Breasts are mostly fat. You have to have fat for breasts, look at women body builders they don't have breasts. Some fat definitely helps in the breast growth. It wouldn't hurt to have a little fat, I know we all want to be thin and fit, but doesn't help breasts. I don't think you are completely doomed, patience is hard in our circumstances.

[Lady Lisandra]

It doesn't sound like it's a problem with HRT. And an early GCS should encourage breast growth. Perhaps it's because of your genetic, and even if you were born female, you wouldn't have had large breasts.

As Jailyn said, fat is important for breasts, as they are almost 100% fat. There won't be much breast developement when there is no body fat to redistribute towards your chest. Most of my growth happened when I started to gain weight. Remember that you don't have to eat tons of food to gain weight, you just have to eat the right things. It's easier eating a greasy steak than eating 15kg of lettuce...

[Laurie]

  Hi Jemma , I see that you are new here. So please let me say, Welcome To Susan's Place! Come on in and take a good look around.  Perhaps I can even get you to hop on over to the Introductions Thread and  create a post to tell us a little bit more about yourself so we can get to know you a little better and greet you properly.

  Also I'll add some links and information below that can help you get more out of our site. Please take time to become familiar with them especially the RED one as we are always getting questions that are answered there.

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[LexiDreamer]

I didn't have much in the way of changes on oral Estradiol, so your results are not uncommon.
Did they ever test your estrone levels? Some Transwomen who take oral Estradiol tend to have higher estrone levels and it will inhibit development, especially taller thin Transwomen.
Check out this link by Dr. William Powers:
https://lm.facebook.com/l.php?u=https%3A%2F%2Fdrive.google.com%2Fopen%3Fid%3D0B5GqH5rA-mckUUdtdDVmQUhnX28&h=ATP3_kxstI1b4k9jP7FgXf-Cryf7M-8xgBX3ippqKvYJXjOiRdnEuxtoN1fLnXhRUTsCj_iVJpNnBJRQOn4BNyESO2eTxMNW6eLDm4t2LHrGIVBR_kk-Jv3fEs2l-QaV&enc=AZPtrFdCyjQlIigErhVZfSxJbMzGoNEKoz79Qw2XjdwXCUo4UcF-t6f6pptnThDUic1fAiEnhc6FlyNJ9aOR9UFFW1qwENXVsMoxGmUMaGM1qTvQM6lsuEZfI4XtxhOCXS-zxcZHxD2AUdN5II-9U3JMqvvj6RTjvQ2On6i_xqjpjvUvhkbmEIYoiECWlyk03oo&s=1
(Especially starting at page 28).

I have since recently switched to Estradiol Valerate injections and almost immediately noticed my breast development started up again.
No need to despair, trans-medicine is not settled science there are still things most doctors do not know about.

I agree with your doctor taking you off the vegan diet. I don't thing Veganism is going to be conducive to puberty.

Hang in there and good luck!
-Lexi


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[Charlie Nicki]

There are girls here that had breast augmentation at the 6 month mark, and 8 month mark. So you can definitely get surgery if you want to. The way I see it, if your breasts develop more after surgery, then even better

[LShipley]

The lack of development doesn't exactly sound too surprising with your description of yourself and your mother as well as the timeline of hormones.

As you said it took until May for female levels and then you only had that for 3 months before you had to stop for surgery.

So at 9 months, with as much as you have accomplished, I think it is a little too soon to start freaking out. You had development after HRT and I am sure you will have development again if you said it has regressed in the time you have been off. It will restart and get you at least you what you felt prior to stopping the meds.

So your levels will take a bit more time to level off and get back to the right spot. It sounds like your doctor is suggesting the right things (140 at 6ft sounds a little light, I am 140 at 5'8" and constantly am told I need to eat) except for the lactation suggestion it sounds like a good plan. I said except for the lactation because I am not familiar, not because I know better.

I would focus on how much you actually did accomplish in this time, GCS is huge! I am so incredibly happy for you and jealous. That was only 2 months ago though so I am sure you are still recovering in many ways, your hormone levels among them.

I would expect you to start getting back on track shortly. You have a lot of positives going for you though and it sounds like you are doing what you can

[Dena]

Female puberty can run between 5 and 10 years with much of the development happening in the first 5 year. While my HRT wasn't up to modern standards, after 5 years I barely fill a AA cup bra. I have been on a more modern treatment with pills and I have reach a healthy B cup after almost 40 years. If you are like me and had no chest development to start with, I would suggest giving it a year or two before coming to the conclusion that you aren't developing.

[Pisces228]

weight gain will definitely help with breast growth.  I'm a 34C bra and my breasts didn't start growing until I gained weight and my breasts and butt filled out. 

[VeronicaLynn]

How many low body fat cis women are there with naturally large breasts? While I'm sure some exist, this is pretty rare...

Your options are the same as flat chested cis women, either gain some weight and hope it will go there, or seriously look at implants, or be OK with having small breasts.

[KayXo]

In my 13 yrs on HRT, I've tried everything, from patches, to injections to oral/sublingual, etc. With or without low-high dose progesterone, with even a small dose of anti-androgens post-op. There's practically nothing I did not try and YET, my breasts remain small, about an A cup, despite my weight going up and up. The one time things really took off was on a high dose of oral estradiol (under medical supervision, of course) but, emotionally, I felt awful and lost it all after I switched to injections.

Post-SRS, I also lost breast tissue and was flat as could be, also lost a lot of weight, maybe due to stopping Androcur (?). But I remained on estrogen pre-SRS and another anti-androgen.

All the women and I mean, ALL the women in my family have big breasts so despite my good genes, I ended up with very little.

To recapitulate, despite weight gain, eating plenty of healthy food, high (and low) doses of estrogen taken every which way, the addition of progesterone, the use of anti-androgens post-op and GREAT genes, I only grew an A.

My explanation: perhaps past puberty, we can only hope for so much as the growth impetus is much less. Nothing we can do. I'm now seriously considering implants.

[JemmaK]

I want to thank everyone for the support I've gotten after my post.  Just hearing the encouragement really, really helps - I'm so impressed with the community here. 

LShipley, I'm particularly glad you did the math on the months - I had wondered about that, too - it's really only been a few months that I've even had the levels where they should be. 

I'll try to stay positive, stick to all the things my doctor recommended, and wait...