Stopping Hormones prior to GCS

[kat69]

Tomorrow is my last day taking hormones prior to my surgery on 30 April.  Any advice from those who have been through this pre-op process on coping?

[Gail20]

Most women here report all sorts of issues but I was on HRT for 17 years prior to surgery last August and I had no issues at all . . .

[BillieC]

I'm at the point where I have two weeks left before I go on my 30 day pre-op, no hormone regimen. I'm not crazy about it and expect some hot flash type issues. I've been on Estradiol and Spiro for the past couple of years. I'm currently down to 1/4 of my regular dose and no major changes yet. Next week down to 1/8 normal and then off to zero for a month. I hope things have worked out well for you. I'm thinking I'll start a thread on my journey through the next 6 weeks.
All the best!

[Doreen]

Tomorrow is my last day taking hormones prior to my surgery on 30 April.  Any advice from those who have been through this pre-op process on coping?

Honestly I think most the issues are self inflicted.  This too shall pass.. its NOT the end of the world.  Personally I've been off & on HRT so many times my head spins.  Do I notice a difference?  Well.... yes? no?  I mean I'm a terrible example, but maybe hot flashes are more frequent off.   On, I'm more emotionally labile. Other than that?  My boobs hurt & ... other issues physically happen whether I'm on or off

[120716]

I am on injectable Estrogen and Progesterone. I did not stop HRT, I also did not tell the surgeon I did not stop. One of the floor nurses figured I did not stop, long funny story. I had zero issues and healed quite well, my blood pressure was normal, had minimal swelling. It was my choice not to stop. I would never ever recommend going counter to doctors orders, however, I did what was best for me.

[Dani]

The reason for stopping estrogens is the possibility of blood clots post surgery. If you do not lower your estrogen blood levels pre-surgery you increase your risk. Yes some of us will get away with not stopping the estrogens, but not all of us.

If your estrogen is injectable Estradiol valerate, the long half life means that it will take a full month to lower your estrogen blood levels. If you are taking sublingual Estradiol, the short half life means that your blood levels will be almost nothing in just a few days. I have never heard of a surgeon differentiating between which route of administration for the  recommended withdrawal period. 

This applies to all types of surgery. Smoking tobacco is another risk factor for blood clots.

If you lie to your surgeon, you take your chances post op.

[LizK]

I have a 6 week no E rule with my surgeon but I am not impressed at all. Why would I be any more prone to clots than what any cis woman would be? They have plenty of E onboard when they have surgery and I would bet that their levels are not even checked. It never has made any sense to me and I would even doubt if they check it. I will, under real protest follow my surgeons request but I think its unnecessary. Maybe I am wrong on medical grounds and will happily defer to those with more knowledge. I would also not recommend going against your Drs request to stop. Personally I have made no decision either way.

[Mendi]

I´m thankful, that I only need to be off from HRT for 10 days prior to surgery and 5 days after it.

It is just surprising, that there is such varioation how many days and weeks you need to be off. Guess it comes down to how long they want to keep you stationary at bed.

[Dani]

I have a 6 week no E rule with my surgeon but I am not impressed at all. Why would I be any more prone to clots than what any cis woman would be? They have plenty of E onboard when they have surgery and I would bet that their levels are not even checked. It never has made any sense to me ...

Holding Estradiol for a few days is an easy way to limit our risk factor for blood clots. Cis-women cannot stop their Estradiol production at will. They will have to wait until menopause sets in. In fact, post menopausal women on Estradiol are asked to hold their hormones for a few days before any scheduled surgeries.

Also, depending on the individuals Estradiol dose, blood levels are much higher in women with a TG history.

[Ellement_of_Freedom]

30 days? 6 weeks?! Anything more than 1 week prior to surgery seems ridiculous. I won't be stopping for any longer than that should any of my surgeons ask. And I'm going to have an E implant well and truly active at the time of my FFS, already approved by my endo who is transgender too. In my opinion the pros of continuing to have a supply of sex hormone in the body throughout the surgery period outweigh the cons. I don't want to go back to crying all the time and breaking out in hot sweats in the middle of the night.

[Rachel]

I think I was 4 weeks before and 2 weeks after for a total of 6 weeks. GCS is very invasive and you are on your back for 3 days. Then the recovery and it is slow. I had a complication and I was on bed rest for 3 weeks. I had my catheter for 2 weeks and had a procedure to finish my GCS 1 week after the initial procedure.

I did not have hot flashes but I felt out of it. That most likely was from the experiences I went through. You can have a complication and the standard GCS can turn into a more complicated series of events. If you fly you will have a difference in pressure to contend with too.

I highly recommend you follow your doctors recommendations.

[josie76]

A great deal of the concern dates back to the use of horse estrogens. Human estradiol has been shown not to influence clotting factor however the other forms of estrogen such as estriol and estrone/estrone sulfates do. Metabolites of progesterone actually help to negate the clotting factor effect.
Funny how nature does it all on it own.

I recently had spine surgery and an orchiectomy. Neither the orthopedic surgeon or the urologist had any problems with me taking my hormones. The back surgery was pretty invasive also and I was chair bound for several days except I could still go use the bathroom. Both disc and bone were cut out.

[Mendi]

It would be interesting to know, to which scientific fact such a long pauses are based on...if to any.

Because the half time of estrogen is quite fast and definitely doesn´t on that basis require such a pause.

Cyproteronacetat does accumulate into body an the half time is much much longer, but still not six weeks.

[DanaDane]

I'm one week post op as of today and my surgeon had me stop 4 weeks prior and 2 weeks after.  When I had my previous two procedures (Rhino and BA), neither surgeon had required me to stop. 

I haven't been on Spiro for over a year and my E levels have always been pretty high.  I didn't had hot flashes, but the hair shedding post has been significant. 

Looking forward to going back on E next week.

[Doreen]

I think if you are going to be at bedrest recovering and not moving your extremities obviously your risk of blood clots is going to increase.. even more so if you have high blood pressure.  Take all this into account as you plan for surgery folks.

If, on the other hand, you get up an hour after the surgery, move in the bed a lot, and everything is hunky dory and your B/P is 120/60 and pulse 65 you probably have absolutely nothing to worry about.  Which ironically was my case hehe.   I wasn't the most mobile person but my cardiac functioning has always been great.

Just my thoughts I still wouldn't recommend going against what the doc wants.. but then again I've never been entirely compliant with them anyways.  Frankly I know a LOT more about my condition than most docs I've run into.  They refer me to a specialist who refers me to another specialist ....... 

[kat69]

Hey, everyone.  Just so you know I had my GCS with Dr Brassard on 30 April 2018 and have restarted my estrogen over a week ago.  Please feel free to continue the thread to assist others.

Kat

[AnonyMs]

One of the advantages of estrogen implants is that you don't have to stop for surgery.

[Devlyn]

I've been off estrogen twice, your skin and hair gets oily, and you get a little cranky. It's not the end of the world.

Given the choice of possible blood clots or possible pimples, it's kind of easy to make the decision. For me, anyway. Your decision making ability may vary. 

Hugs, Devlyn

[SadieBlake]

We had someone here reporting just in the last couple of weeks that they nearly died as a result of post-op blood clotting. There was no particular mention of whether she'd followed surgeon's instructions wrt HRT.

Incidence of venous thromboembolism post surgeries generally is around 1% and the ACS has been taking measures to reduce that number. 1% is the same fraction of GCS patients who will see a fistula connecting the colon to the neovagina. Nobody in their right minds wants either of these outcomes and ignoring your surgeon's instructions seems to me as incredibly short sighted.

@josie76 I wouldn't call a spinal procedure anywhere near as invasive as GCS, bone, and ligament tissues don't have anywhere near the degree of vascular perfusion as the work done in GCS.

I consider myself to have been at an extremely low objective risk, I take a tiny dose of IM estradiol valerate and I did discuss this with Dr Wittenberg. She told me to stick to protocol and I did. I'm glad of it, I was immobilized considerably longer than I'd expected post-op and my recovery was also harder than expected. I'm glad I didn't have a DVT to add to that.

[AnonyMs]

Incidence of venous thromboembolism post surgeries generally is around 1% and the ACS has been taking measures to reduce that number. 1% is the same fraction of GCS patients who will see a fistula connecting the colon to the neovagina.

Where did you get 1% rate for fistula from? It seems very high.