Hormones are complex: any thoughts on what is happening to me?

[Tamara Tilly]

Hi everyone,

Long story short, I'm a complex trans patient and I'd love to hear some thoughts.

Basically, I was male to female tx. I went through surgery and then, some years later, began to have second thoughts, largely because of parenting and peer pressures which made it really really hard for me to live female. I guess I thought that I'm non-binary gender fluid with male and female characteristics and that I could live male.

Anyway, for 12 months I took testosterone and nothing else. This is after some years of being on oestrogen.

Here's the curious bit. Two months ago I began to notice breast growth once more. Nipples, areolas, actual growth of breasts. The works: really full on growth with all the tingling etc. And with that, other 'feminine' characteristics. This is despite being on testosterone. I know dosages cannot be discussed here but the levels were high for those ten months, then dropped very slightly (15% drop) to what would be considered a standard dose.

Consultants are apparently astonished. But I'm not sure I am. I guess my question is this ... what would happen if I were to reduce the testosterone and, under an endo, introduce a small dose of oestrogen? I don't think the endo will know, but some people on here might!

I like the female developments. Very very much. I've missed them like crazy. I hate not being truly me.

[V M]

Hi Tamara 

Welcome to Susan's Place    Glad to have you here, join on in the fun

Might be residual effects of being on estrogen but you're best off to check with your physician

How about stopping by our Introductions Forum and introducing yourself so more folks can get to know you a bit better 

Here are some links to the site rules and stuff that we offer to all new members to help them along

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Hugs

V M

[Bea1968]

Seems to me that many women see an increase in bust size around menopause.  I am not sure how the hormone levels affect all that.  It is my thought that your body might be going through something like that.

Bea

[Tamara Tilly]

Thanks Bea. Interesting.

But V M,  12 months after the last estrogen intake? I stopped the last of my estrogen on 14th April 2018

Here are some blood results:

18th June 2018:

Test result   FSH+LH, E2, PROLACTIN, FREE TESTOSTERONE (CALC) Report, Abnormal, Other   
Serum follicle stimulating hormone level (XM0lx) < 1 iu/L [1.4 - 18.1]    
Serum LH level (XM0lv) < 0.5 iu/L [1.5 - 9.3]
Serum prolactin level (XaELX) 127 mu/L [45 - 375]    
Serum oestradiol level (4465.) 168 pmol/L [0 - 145]    
Serum sex hormone binding globulin level (44CD.) 35.7 nmol/L [21.6 - 113.1]       
Serum albumin level (XE2eA) 45 g/L [35 - 50]
Serum testosterone level (XE2dr) 12 nmol/L [8 - 27.4]

12th November 2018
Serum testosterone level (XE2dr) > 52 nmol/L [6.7 - 25.7]  * Possible overlap of gel & injection
Serum prolactin level (XaELX) 180 mu/L [86 - 324]    
Serum follicle stimulating hormone level (XM0lx) 0.3 iu/L [1.5 - 12.4]
Serum oestradiol level (4465.) 150 pmol/L [95 - 223]

12th April 2019
Serum testosterone level (XE2dr) 10.1 nmol/L [6.7 - 25.7]

I've come across this:

"Testosterone therapy.

Men who are treated with injectable forms of synthetic testosterone almost always make too much estrogen. In my own clinical practice, I saw firsthand that bioidentical (natural) testosterone therapy can also lead to high estrogen levels in men, especially when used in excess or used in men with obesity.

Faulty feedback.

Once a man has too much estrogen in his system, a vicious cycle can ensue in which the high estrogen levels lead to a faulty feedback system, tricking the brain into producing even less testosterone. This can lead to even higher levels of estrogen and more severe estrogen dominance, magnifying the high estrogen symptoms."

[F_P_M]

I've read that testosterone can be converted into Estrogen by bodies, hence why those who abuse it as a steroid get feminising features instead of the muscle growth they expected.

Looking at your bloods it does seem you are still producing estrogen. From my reading male levels should be under 82pg/ml

It's possible that your body is still a bit confused by the various hormones and has gotten into a bad habit of producing too little T and allowing the E to take dominance. Is that T your FREE t levels and not overall T levels?
Becuase it seems far too low for overall T which is usually I think in the hundreds for men. It still seems quite low though, especially if you're on HRT T shots which should be shooting it up into the higher ranges shouldn't they?

What is your doctor saying?

It's sad you've felt pressured into detransitioning when you say Estrogen makes you feel more genuinely you. Ultimately I think in life the best thing we can do for ourselves is strive to be our genuine selves, despite what others may say. Becuase at the end of the day, we should live for US shouldn't we?

Ultimately I think you need to chat with your endo about this and see what they suggest. Hormones ARE complicated and striking a balance is quite important, without a balance you can get a sort of domino effect that can mess a lot more than sex hormones up. Human bodies are pretty fragile like that, very much at the mercy of our hormones.

I wonder if dropping your T dose would help at all, if the problem is aromatisation into E. Some people are more sensitive to certain hormones than others and their bodies more proactive at dealing with them.
It's possible your threshold for aromatisation is lower than normal. Or they're giving you too much T for your particular biochemistry.

But i'd definitely get it checked out. You don't lose much by tweaking your dose to be fair, i'd certainly discuss that possibility.

[Dani]

Our bodies have many ways of regulating our hormone levels through bio feedback mechanisms. To make matters even more complex, not everyone has identical bio feedback qualities. These vary in intensity and quality. If you give a group of 100 men of the same age additional testosterone, some will respond much more than others. However, if all the results are quantified and graphed, you will see a curve of some shape. Some respond very little and others have extreme responses to the additional hormone.

Getting back to the OP's question about both T and E at the same time, this is the normal situation for most everybody without any added hormones. Men and women both have Testosterone and Estradiol in their blood system at all times. The differences we see as our appearance depends on how much of each hormone we have and how any individual responds to those hormones. We just lump all the complex biological responses into one thing we call genetics.

As we get older, our bodies hormone production decreases. There are low dose testosterone specifically designed for women to increase sexual libido and overall energy. Any masculinizing effects, such as increased facial hair, are called side effects and only are seen in some of these women, but not all.

Since the OP is asking if this is done, how will they respond? We cannot predict their response to taking both Testosterone and Estradiol at the same time. It really depends on how much of each hormone and their own genetic response to external hormones.

One word of caution. With external hormone use, the normal bio feedback mechanisms are not in play here. Your doctor needs to carefully monitor your blood levels and adjust your doses to get the response you desire.

[Tamara Tilly]

Hi everyone,

It has been a tricky time. I landed in A & E just after posting this thread. My symptoms have been grim and they were worried about the strain on my heart (troponin test on arrival was 7, bp through the roof despite normally being very fit). Symptoms that I've had ever since starting testosterone (tostran) with increasing intensity and frequency:

Night time apnoea
Racing heart
Feeling hot. Not just flashes but sustained spells of feeling really hot
Skin hot to the touch (nurse commented on it)
Blood pressure twice my normal (I'm physically fit and normally have a low bp)
Erratic heart rate with palpitations
Dizziness and light headedness
Unsteady and feeling out of my body most of the time
Breathlessness
Lumps on my left breast and under my armpit which they are convinced is breast growth
Nipples and areolas definitely enlarged (like when on oestrogen)
Breasts enlarged and sensitive

In the last two weeks I felt like dropping. When chest pains came on they finally acted.

So that's the biophysical.

Frankly, I've had it with testosterone. It has become poison to me both biophysically and psychologically. Since A&E I've spoken with my counsellor and gender psychotherapist and will be seeing an endocrinologist shortly.

I'm coming off testosterone and will live female again. I will gradually switch to a lose dose of oestrogen. I'm through with this testosterone which has made me feel like cr &p almost since I began taking it.

Hurrah!

[Tamara Tilly]

Re. the apnoea I would wake in the night, sometimes after just 30 mins sleep with heart rate through the roof, bp off the scale and breathless with palpitations, feeling incredibly hot (not 'just' hot flashes).

And, yes, everything else was ruled out: they tested for absolutely everything. It's the wretched testosterone. Poison to me. Filthy poison.

[Randi]

It's all about an enzyme called aromatase.  It converts testosterone to estradiol. (the reverse is biochemically impossible)

About a dozen years ago I was diagnosed as hypogonadic (low testosterone) and began T injections.  Within 6 months I my nipples were erect all the time and I started developing breasts.

I found I actually liked those effects and eventually switched to estradiol.  I still find that I need an occasional shot of testosterone to keep up my strength and energy.

Without those testosterone shots I would never have discovered the wonders of estrogen.  This simplified chart demonstrates how various steroids change to others.  https://www.ceri.com/q_v7n2q3.htm   

[Tamara Tilly]

That's incredibly helpful Randi. Thank you so so much.

Honestly, one thing that gets me is that so few medics know (any of) this stuff. That's why I can see some people on this forum almost have to guide their doctors rather than the other way around. In one way, that's good. My GP as the last resort said to me, 'right, drop your dose. Listen to your body. If you still feel bad, drop it again.' So I've taken the T down to 40% of what it was. I'd like to kick it wholly into touch but I know (right?) that might give me huge mood swings and flashes. I'm seeing my GiC consultant in 10 days and my Endo in 3 weeks. Three, blooming weeks after those symptoms described above 

I'm like you Randi. I LOVE it that my nipples have returned with vigour, that the areolas are swelling, that they tingle again and that my breasts are growing. It reminds me of what I've lost.

I'm coming back female ... 

[Tamara Tilly]

My endocrinologist has agreed with the above. He has started me back on oestrogen. I'm very happy.

[Tamara Tilly]

Hi everyone,

I wonder if you can now help advise me and my professionals? I'm in good hands with two counsellors, one of whom is transgender. I have two consultant endocrinologists and other medics.

However, none of them have dealt with someone like me before. They are reliant to an extent on how I feel and they are trying to steer a course which they have never navigated.

So any thoughts, appropriately filtered back through them of course, would be much appreciated by all concerned.

So here's the deal.

I transitioned MtF for 4 years. This included an orchidectomy in year 2 after heavy anti-androgens and estrogen. I then spent 12 months on testosterone treatment. So 4 yrs switching and 1 year back to male role. For the last few months my body began converting T to E through the aromatese (see above). Ten days ago medics told me to drop my T dosage and it's now 40% of what it was so it's a low daily dose.

The latest thinking of the endocrinologist and other professionals is that my body is by now 'conditioned' to be female. Certainly that's what I want to be.

So how would you advise me to continue the transition? For 12 months my testosterone dosage, in the form of daily gel, was a standard dose. High-ish but certainly not out of standard treatment range. I've now been put on low dose estrogen. But they are wanting me to guide them.

Assume please that I want to kick out testosterone, which to me has been poison (see above) how quickly / slowly would you complete the move to estrogene-only? Any thoughts gratefully received will be fedback (anonymously obviously) to my medics.

[Linde]

Tamara Tilly, why did you get testosterone at all if you want to be female?  That does not make any sense.  After my orchi, my estrogen level was adjusted to about the level of a natal female.  My testosterone was close to not detectable, and everything remained that way.  I now added progesterone to my hormone intake.
I think they could drop you off of testosterone, and adjust the estrogen level to a normal female range.

Prior to my orchi I was on fiansteride and spiro, those medications wer eliminated after my orchi.

[Tamara Tilly]

It's a good question. I came under pretty intense pressure from friends and family. Some of that was overt. A lot of it was passive aggressive, which was even worse. I was prevented from seeing my 10 yr old son, except under close supervision and my partner's teenage daughters were absolutely vile towards me. I nearly took my life.

Anyway, the main thing now is that I know my body is conditioned to be female. Those were the words of the endo and chimed with the medical consultant. That conditioning is both physical and emotional. I don't feel male. I feel female.

[Linde]

Anyway, the main thing now is that I know my body is conditioned to be female. Those were the words of the endo and chimed with the medical consultant. That conditioning is both physical and emotional. I don't feel male. I feel female.

This sounds pretty positive and I hope your journey from here on will be as smooth as possible!
Good luck and love
Linde

[Tamara Tilly]

Thank you so much. That's lovely and means a lot.
xx

Actually I came across this earlier which I thought was really good. Don't be put off by the title.

[F_P_M]

Oh Tamara, the way you describe T making you feel is exactly what E does to me!
So many of the symptoms you describe are what I deal with on a near daily basis.
It sucks.

I'm glad you've found appropriate help and are moving forward. We're under such pressure to "conform" to a society that refuses to see us as ourselves and that in itself is so damaging.

Ultimately though, you have to do what's right for you.

I do hope things improve for you!

[Tamara Tilly]

Thank you for such a sweet message F_P_M and everyone contributing.

I have my blood results from 1 week ago. So, to recap, this was before I began taking any estrogen again which started after the tests. The testosterone reading was at the 4 hr point and follows 10 days of reduced dosage. It would now be considered a low dose but is 40% of what I was taking when I was so unwell.

FSH 2.4 (Male reference range 1.5 - 12.4 mIU/ml

LH 0.4 (Male reference range 1.7 - 8.6 U/L)

Oestradiol 42 (Males 41.4 - 159 pmol/L)

Testosterone 3.39 (Males 6.88 to 25.70)

So looking at that would suggest that everything was low at that point?!

My endocrinologist thinks my body is 'conditioned' for estrogen. Since beginning estrogen in the form of estradiol validate once a day (low dose) last week and maintaining the low testosterone I feel STACKS better.

I have a Gender Identity Clinic consultation on Monday. I want to come off testosterone altogether to be honest. It feels to me like poison and I was so unwell on it. Everything about me feels better now.

Any thoughts gratefully received!

[pamelatransuk]

Hello Tamara

I am very sorry to read what you have suffered but glad that you are finally on the right road.

I hope that soon you may reduce and then delete T.

Clearly you are female and should continue to benefit from E.

I am also from UK  - the NW in fact - but have chosen to go private. I have great admiration for our NHS but sadly it is underfunded for transgender care.

May I ask which GIC you are attending please on Monday June 3rd and also to wish you good luck and success at your consultation there.

Hugs

Pamela 

[Tamara Tilly]

Hi Pamela,

Thanks so much.

Nottingham.

Then I'm seeing a consultant endo under the NHS on 17/6. I can't afford to go privately all the time but I totally concur with you and I was feeling so unwell. I'm going to push for a full spectrum thyroid profile as per an earlier post.

Main thing will be to drop off the T and double the E ... just a question of when? I think for good reasons they want to know how I'm feeling. That's not foolproof, but I do feel stack better. I met my ex just now who handed over my son for the weekend and she straightaway, 'wow you look so much better.' If she only knew the reason 

xx