Stopping HRT prior to surgery?

[Amari_293]

Hello there!
I am a 33yo mtf transgender. I'm taking hormones since 5 months now and my breast is growing pretty nice and I love the new feminine features on my face. The thing that is bugging me at the moment is the fact I have a feminization surgery in March and my endocrinologist advised me to stop the HRT a month prior to the date of surgery. I am afraid this will have my breast shrink and that other testosterone related features will get back. I had my laser therapy also finished so I would hate to see body hair come back.. Has any of you also had to stop the HRT because of surgery? My surgeon told me they will ask me to stop the HRT 1 day prior to the surgery and they will use all the precautions to avoid thrombosis effects etc. I dont know, I wanna follow my endocrinologist advice but 1 month out of hormones.. After only a total of almost 6 months that I am in therapy.. What do you think? Thanks for your time reading this.

Julia

[Denise]

Your breasts are yours to keep.  They won't, or shouldn't, shrink due to lower E levels.  They may think a little as you will probably not be eating a lot after surgery and you'll lose some body fat.

Again in the body hair, you shouldn't notice anything.

I assume you are on a blocker like spironolactone or finasteride.  Ask you Dr if you can stay on those.  I could for breast augmentation surgery all but the day off the surgery.

As always Your Milage May Vary.

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[KathyLauren]

Hi, Amari!

Welcome to Susan's.

Stopping HRT prior to surgery is pretty normal.  It is really only the estrogen that is a risk factor for surgery, so you should be able to stay on blockers.  But follow your doctors' advice.

You won't experience significant breast shrinkage in a month.  Some fluctuation in overall breast size is normal in response to fat deposition and consumption.  But the breast tissue itself is permanent.  You don't have to worry about it going away.

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[Colleen_definitely]

Stopping estradiol is quite common.  The last thing a surgeon needs to worry about is you throwing a clot and turning a routine plastic surgery procedure into a code blue.

Now how big of a risk is it?  Not very, but physicians tend to be cautious and I really can't blame them in this case. 

You aren't going to lose all of the physical changes.  You are likely to get emotional though.

All of the docs I've talked to did not want me to stop taking my antiandrogens prior to surgery, so I won't have to worry about testosterone production picking up again.  Even if your surgeon asks you to stop taking your AA, your testosterone production is not going to immediately come back up to pre HRT levels. 

[Amari_293]

Thank you all for your advice. You're very helpful! I will ask my doctor if I can atleast keep taking the Tblockers. It's called Androcur from Bayern, while my estrogens are Progynova from Bayern as well.

[KayXo]

I continued taking some estrogen throughout the surgery, also bicalutamide wasn't stopped, neither was finasteride. Cyproterone acetate, discontinued several weeks before. BUT that was me, everyone is different. Dr. Bowers, as far as I know, allows for a little E to continue to be taken before SRS but maybe she changed her recommendation now. Not sure. As always, **absolutely follow your doctor's orders** but you can perhaps show them a recent review that concluded that transdermal estrogen does not increase the risk of DVT (I can pm you the link) and also have them explain and ask what is the case for ciswomen who undergo extensive surgery as their ovaries produce estrogen so that if nothing is done in their case, why should we, if we take the same estrogen (estradiol) non-orally, have to stop? This is a question I would personally would have brought up and found out what they say but to each their own. Nothing wrong with questioning things and discussing with the experts, I think.

Keep us posted and be safe.

[Pisces228]

I have an orchi scheduled for march 8th and my Dr said it was not necessary to stop hrt before that.

[Dani]

Stopping Estrogen one month before surgery really depends on the half-life of the estrogen you are taking. If you are taking an injectable form of estrogen every 2 weeks, then stopping one full month before surgery is reasonable. However, if you are taking a sublingual estrogen 2 or 3 times a day, then the estrogen will be completely out of your blood in 3 or 4 days after you stop taking the tablets.

The real issue here is responsibility for adverse events post op. In the US, your surgeon has that responsibility for your well being, so we do what our surgeons tell us to do.

[rmaddy]

My FFS surgeon requested that I discontinue.  I did.  My GCS surgeon states that I don't need to.

On one side, the argument is "why not improve the odds if you can?"

On the other, the argument is "why potentially diminish pre-operative patient wellbeing when the known risks are low and cis-gender females don't "discontinue estrogen".

They are both good arguments, honestly.  I don't think this is one with a right answer.  I recommend discussing the issue openly with your surgeon.  If they want you to discontinue, I would recommend doing so.  As always, YMMV.

[Amari_293]

I asked my endocrinologist and she said that stopping the tablets for hormones and keep taking the T-blockers tablets will make me feel extremely tired. So she advised me to stop taking both things. I will have to follow those instructions I am afraid. Also, I am getting so worried about the food eat. I am avoid anything with animal fat (hamburgers, heavy cheese, butter, etc.), I heard that once in a while it is ok but I am almost avoiding anything like that for the blood cloth danger. I am basically becoming a vegetarian :p

[KayXo]

I eat high fat (including butter, bacon, fatty rib steaks, etc.), studies haven't shown ever a *causal* relationship between fats, saturated fats and health risks. I used to believe that until I checked it out for myself... Studies have even shown an improvement in health in individuals consuming low-carb with high fat, weight loss, etc. So, yea, as far as I'm concerned, I'm not worried but that's just me.

[Pisces228]

I eat high fat (including butter, bacon, fatty rib steaks, etc.), studies haven't shown ever a *causal* relationship between fats, saturated fats and health risks. I used to believe that until I checked it out for myself... Studies have even shown an improvement in health in individuals consuming low-carb with high fat, weight loss, etc. So, yea, as far as I'm concerned, I'm not worried but that's just me.

I've eaten a high fat diet for years and my bloodwork is fine

[Dani]

I've eaten a high fat diet for years and my bloodwork is fine

And if I ate high fat, I would be back up to over 300 pounds in no time at all.

If you can eat high fat and not gain unwanted weight, then you can have my desert anytime.

Just pass me the vegetables, please. 

[KayXo]

And if I ate high fat, I would be back up to over 300 pounds in no time at all.

There is only so much fat one can eat, after a while, nausea sets in. You might well be the exception to the rule as the vast majority lose weight on a high fat LOW carb diet and it's often prescribed to people who wish to lose weight. It's also a great appetite suppressant.

I believe this is on-topic as this was also a concern for Amari...

[epvanbeveren]

I have had my GRS 4 months ago and my Dr. allowed me to continue HRT. She did make me walk the first day after surgery and I did have some kind of massage pumps on my legs that kept the blood flowing trough my legs I guess?

Walking daily was  a mandatory thing I had to do, little by little at home and after the catheter was removed, I had to start walking outside daily.

[AnneK]

I eat high fat (including butter, bacon, fatty rib steaks, etc.), studies haven't shown ever a *causal* relationship between fats, saturated fats and health risks. I used to believe that until I checked it out for myself... Studies have even shown an improvement in health in individuals consuming low-carb with high fat, weight loss, etc. So, yea, as far as I'm concerned, I'm not worried but that's just me.

According to something in the news not too long ago, many of the problems attributed to fat came from the sugar industry trying to divert blame from the problems sugar causes.

http://www.cbc.ca/news/health/sugar-harvard-conspiracy-1.3759582