GnRH blocker long term use

[Megan.]

Are there any non-op transwomen here who have or are intending to use GnRH blockers long term (i.e decades)?

I'm currently on oral E and Decapeptyl jabs which are working well for me. I'm still trying to assess my medical options now I've done my social transition.

X.

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[kelly_aus]

Can't help you with specifics on GnRH blockers, but as far as I know, long term use has not been adequately studied. Given the issues with other AA's, in consultation with my medical team, I've discontinued any AA's. T levels are low end female and E levels are stable. A moderate dose of sublingual E is all that is required - this is the same kind of dose a trans woman on spiro or cypro would take.

[Megan.]

Tnx Kelly. I can't find any data on prolonged use of these drugs. They have been used for several years in children for managing early onset puberty, but never for more than 7 or 8 years.
I guess I would at least need an orchi or have to roll the dice on having a jab every three months for maybe 30-40 years!

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[LexiDreamer]

No need for Orchi... or T blockers.
Just keep your Estradiol levels significant and steady. Your testicles will atrophy, shrink and be nothing more than an annoyance in your panties.

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[Megan.]

No need for Orchi... or T blockers.
Just keep your Estradiol levels significant and steady. Your testicles will atrophy, shrink and be nothing more than an annoyance in your panties.

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Does this mean I can just stop with the blocker at some point? I'd read cases of function returning after 2 or more years.

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[LexiDreamer]

Get your Estradiol and Testosterone levels tested.

My T level was consistently below cis-woman levels, so I cut my spironolactone dose in half. A couple of months later my T level was down to 18 on the half dose, so I cut it in half again. I'm currently on a quarter of the dose I started at with no noticeable androgenic effects returning and the negative spironolactone side effects are almost nil now.
I plan to drop it completely when my latest lab results for T get reported (stupid insurance billing issues is holding them up) and I see my levels are still below cis female.

For reference, my baseline T before starting Spironolactone was 1310! The normal male range for the test was 300-1100!

Estradiol is a very potent T supressor.

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[Megan.]

Very interesting,  thank you. X

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[LexiDreamer]

Just got my results from my blood lab taken on 11/27/17:

Total Testosterone is 14 ng/dL

That's at a quarter of the normal dose of Spiro I started with when I started my HRT a little over two years ago.

I'm finally confident I can discontinue taking Spiro! Yay!

[kelly_aus]

I'm finally confident I can discontinue taking Spiro! Yay!

And I get told off for suggesting it - because no medical professional would ever do that, it's not in WPATH's rules!

Rant over, yes, Lexi, this is the case and there is a growing amount of research that suggests there is no need for long term use of antiandrogens.

[LexiDreamer]

And I get told off for suggesting it - because no medical professional would ever do that, it's not in WPATH's rules!

Rant over, yes, Lexi, this is the case and there is a growing amount of research that suggests there is no need for long term use of antiandrogens.

Yes, I'm taking a little heat on another post for suggesting it as well.

I think some people forget that the old protocols that have been written for MTF transition might not always be the best path for transition.

Also, these same old protocols rely on the assumption all transgender women will complete a full physical transition (SRS).
Therefore they don't address the long term effects of continued anti-androgen use, nor do they investigate proper hormonal therapy involved with keeping the male genitalia intact.

Personally, I waffle between remaining pre-op, non-op or post-op.

The thought of any surgery scares the Hell out of me. But 2 years ago, I never imagined I'd be where I am right now and I don't rule out the idea that 2 years from now I might be ready to get rid of all of my male equipment.

I just look at this way... If I'm going to start cutting pieces away, I want it all gone... "going all in" as it were.

I think most of the push back is from the "old guard". The transwomen that transitioned quite a while ago and weren't presented with other options or other schools of thought. Just look at the first ones to shoot certain ideas down. I've also seen a lot of complaints on other sites about that very thing happening here.

Personally, I see this site as a wonderful resource that many newer Transwoman go to first to get information.

That's why I want the other Transwoman that come here to realize they have other options and not necessarily believe what most of the old literature has to say about MTF transition. (i.e... T blockers until surgery)

Transgender medicine is still an emerging medical field and no one has perfected it.


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[kelly_aus]

Yes, I'm taking a little heat on another post for suggesting it as well.

Indeed, I've been on the receiving end of a few heated rants myself. It's like people want to keep doing things that are bad for them.

[LexiDreamer]

Yes, I'm taking a little heat on another post for suggesting it as well.

I think some people forget that the old protocols that have been written for MTF transition might not always be the best path for transition.

Also, these same old protocols rely on the assumption all transgender women will complete a full physical transition (SRS).
Therefore they don't address the long term effects of continued anti-androgen use, nor do they investigate proper hormonal therapy involved with keeping the male genitalia intact.

Personally, I waffle between remaining pre-op, non-op or post-op.

The thought of any surgery scares the Hell out of me. But 2 years ago, I never imagined I'd be where I am right now and I don't rule out the idea that 2 years from now I might be ready to get rid of all of my male equipment.

I just look at this way... If I'm going to start cutting pieces away, I want it all gone... "going all in" as it were.

I think most of the push back is from the "old guard". The transwomen that transitioned quite a while ago and weren't presented with other options or other schools of thought. Just look at the first ones to shoot certain ideas down. I've also seen a lot of complaints on other sites about that very thing happening here.

Personally, I see this site as a wonderful resource that many newer Transwoman go to first to get information.

That's why I want the other Transwoman that come here to realize they have other options and not necessarily believe what most of the old literature has to say about MTF transition. (i.e... T blockers until surgery)

Transgender medicine is still an emerging medical field and no one has perfected it.


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Your honor,
"I rest my case"

[Megan.]

Unlike spiro, GnRH agonists are (to my understanding)  either on or off,  and prevent any option of tapering...

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[KayXo]

Unlike spiro, GnRH agonists are (to my understanding)  either on or off,  and prevent any option of tapering...

Indeed. I hope the day will soon come when they realize bio-identical estradiol is markedly different from the estrogens used in the past in transwomen as far as risks go and when taken orally and especially non-orally, higher doses can safely be prescribed and suppress androgens (i.e. testosterone) on their own. The proof is out there, in (older) men with (advanced) prostate cancer in whom it was found high doses of E were safe enough and resulted in very few complications, if any and even proved to be beneficial in some regards.

Prostate 1989;14(4):389-95

"The impact of exogenous estrogens on the liver is dependent on the route of administration and the type and dose of estrogen. Oral administration of synthetic estrogens has profound effects on liver-derived plasma proteins, coagulation factors, lipoproteins, and triglycerides, whereas parenteral administration of native estradiol has very little influence on these aspects of liver function."

"Indeed, when native estrogens are given parenterally, the effects on liver-derived plasma proteins, coagulation factors, lipoproteins, and triglycerides are very weak or completely abolished [17,18,20,28-30,431. Recent studies have demonstrated that the same principle is valid also during estrogen treatment for prostatic cancer. The native hormone estradiol-17B, when given as intramuscular injections of polyestradiol phosphate, can clearly provide a suppression of testosterone equal to that following orchidectomy [28,44,45]. In spite of this, there is only a minimal influence on liver metabolism as expressed by plasma protein synthesis [24]."

Please continue to follow your doctor's recommendations, no matter what we share here on the forum because none of us are experts. However, I believe there is no harm in sharing the info on here with doctors in hopes of perhaps further educating them on the matter and helping them give us an even better, safer, more effective treatment.

[LexiDreamer]

Unlike spiro, GnRH agonists are (to my understanding)  either on or off,  and prevent any option of tapering...

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Megan,
Since you have identified yourself as born intersexed (in a different thread), may I ask what your Testosterone levels have been?

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[Megan.]

Megan,
Since you have identified yourself as born intersexed (in a different thread), may I ask what your Testosterone levels have been?

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They were in middle male range before HRT,  and now low female after starting GnRH blockers and E.

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