Third Year Of HRT Changes

[Gina P]

When I started HRT, I was 5'10". Now 5'8" I have heard its due to the pelvic tilt, others say its just aging(61) anyway I take it as a win/win. My shoe size has dropped a half size as well.

[NancyDrew1930]

I am not on HRT I can not comment on this topic. But I have a few questions, and I am prob a bit uneducated. My questions would be for those individuals who have been on hormones for a long time. Prob 5+ years.

I know bone and skeleton does not change, but I know soft tissue and cartilage does. Has anyone noticed that their height has changed, or hands have gotten smaller, maybe even dropped a half and shoe size or so.

Also has anyone noticed their eye color change. Maybe more vibrant or completely changed color while on HRT.

Just wondering.

Just recently I've found that my fingers have shifted towards a feminine appearance, so while the bones haven't changed, I would say that the fat has moved around and I have also allowed my nails to grow out and I have been putting clear nail polish on them.

With my eyes, my color has gotten lighter on the inside but I have developed a deeper colored blue limbal ring that also seems to be a little thicker. Also my irises used to be, in my left eye, a greenish-brown, and in my right eye a more bluish green.  Now they still have some brown, but they are more green and lighter.

So far I haven't noticed anything with my feet, they are still pretty big.  And my height has decreased.  But my skin is paler, and when I put the sunscreen on before my makeup, I notice that the sunscreen gives, not just a white pale to my skin (I have had people ask me if I was feeling alright, because to them the sunscreen makes me look like "death warmed over".  And since Covid I have found that if you even have a slight hint of a cold or the flu, people recoil and do not want to be around you out of fear.  So I tell people that I need to wear make-up in order to give me some color, because I was getting tired of, with just the sunscreen, people constantly telling me that I looked like death---also lately the sunscreen has been giving me a bluish cast as well as the white paleness.) 

But I am also finding that, even though I am a bigger person, I am getting that hourglass shape between my breasts and stomach, and my breasts are becoming more rounded, so tighter shirts are giving me that look.  Also I'm finding that my hips are getting wider as the fat moves to them.  But on HRT my hair also seems to be growing faster, and every time that I get a haircut, my stylist can't believe how fast my hair has grown or even how thick it's become.  This last time she even commented on how the texture of my hair has changed, even with getting highlights in my hair.  Of course I started HRT when I was 38, so compared to those in their 60's, HRT is having more effect because I was not on my natural testosterone as long as those who didn't start until their late-50's or 60's.  Also, when I was starting I had the choice between Spiro or Cypro since I'm in Canada, and I went with Cypro because it is a progestin, and I wanted to have that as part of my HRT (in a few weeks I'll be asking my doctor's to put me on actual progesterone, besides being on just Cypro and Estradial---I had asked them to put me on when I had only been on HRT for six months, but they didn't want to do it at that time, they wanted to wait for the year, but then I forgot to ask about it last year, but from what I hear progesterone will help even more at 2 years or more).  So I think that, even though Cypro is a progestin (not natural progesterone), that progestin has helped with the feminization that I have undergone over these last two years, even though I have been taking it at a very low level.   

[NancyDrew1930]

So I just had my appointment with the clinic today.  They didn't want to increase my estrogen, since they said according to the guidelines I was already at the maximum and my bloodwork was showing that I was in normal cis female ranges, so it would be risky going up even one pill more a day.  They suggested that if I wanted to try injectable I could try that, however, at this time, I'm sticking with the pills.

They did agree to a three month trial of progesterone.  So I'll be starting that.  I don't know the brand I'll be on, but it is micronized bioidentical progesterone pill that I'll take sublingually at night (as I write this, they have sent it to the pharmacy, but the pharmacy hasn't input it into their system so I can't see on the app what it is or when I can pick it up).  In three months I'll have to get bloodwork and that done just to make sure everything is okay, since they noticed that my in my bloodwork for this check up, my prolactin was a little high---however that could be because the day I had the test done, because the lab kind of got backed up, I was a little stressed that I would miss another appointment, even though I had gone early enough.  The clinic is also cutting my Cypro down from every day to every other day, even though I've been on a very low dose of Cypro.

Also recently I've been noticing that my breasts are still growing.  I've been getting every so often little annoying itches in my breasts (not pain, just itchiness).

[NancyDrew1930]

So my pharmacy's app just updated and its Prometrium that the clinic is putting me on, which I believe from seeing on these boards, most of the other girls here on progesterone are on it too.

[NancyDrew1930]

So I just picked up my progesterone today, so I'll be starting it tonight.

[Lori Dee]

Prometrium is the best choice. Since it is micronized and bioidentical it has all the benefits of ovarian progesterone with fewer risks. You may notice it makes you drowsy and maybe dizzy, so they recommend taking it before bed. I don't have those side effects anymore, so I take mine three times a day but at half the dose. I hope you have great results!

The reason I take mine throughout the day is because previous studies showed the elimination half-life of oral progesterone was about 18 hours. Since it takes 18 hours for your body to eliminate it, once-a-day dosing would seem appropriate. However, a newer study using a more modern type of assay found that it is eliminated from the body as quickly as 3 hours.

I told my doctor that would mean I take a dose before bed, and even if I wake up in the middle of the night and take another dose, my body will have eliminated it by the time I get up in the morning and I should be getting another dose. But I have to wait until bedtime.

She reviewed the literature I sent her and she agreed to try it my way. I am not suggesting that is what you should do. But be informed and if things do not seem to be working for you, have a discussion with your prescriber.

For reference, here is the discussion about the elimination half-life. Yes, it is Wikipedia but it lists its references.

Pharmacology of Progesterone

[Faith]

Prometrium, hmm, well .. my breast growth had stalled so I had nothing to lose. 2 yrs ago I had it added (all my Drs said optional so didn't care if I did or didn't). I'm at 6yr 4mo at the moment and have recently stopped it - no more gain seen and it's expensive.

Results: slight increase in size, rounded and fuller, over the 2yrs. My guy friends aren't afraid to tell me that they like how they look. They profess "honest feedback" as the reason. I think it's because they are guys.

I am not on any type of blocker for some time now, my T levels are too low to measure
My E level are just shy of 200pg/ml. I am trying to convince my Dr to keep it there. He refuses to allow over 200 citing 'normal women of my age' (Um, except I'm not and this is a comfortable level for me) and he would prefer that I was lower.

[Lori Dee]

I had similar discussions with my doctors when they couldn't get my levels consistently above 100. They wanted to target "my age" and I explained that they were looking at 66-year-old me as post-menopausal but I'm still trying to get through puberty!

I convinced her that after 4, almost five years now, oral doesn't get it done and patches didn't do it either. I understand the concepts of "lowest effective dose" and "first, do no harm". But I was tired of them slowly increasing my dose over the years without any benefit. I told her to put it in my records that I am giving informed consent and that if I suffer any ill effects, it is on me. She documented my request and switched me from patches to injections. It has only been a couple of weeks (3 injections so far) and I feel much better.

Many doctors rely on the prescribing protocol set out by the Endocrine Society. As @Allie Jayne pointed out, they have not been studied in transgender people. They know what the medicines do in cis-gender women and they hope there will be similar effects in transgender women. As pointed out, they are being used off-label to accomplish this. Spironolactone is a diuretic. But it has the interesting side effect of affecting the 5a reductase enzyme which converts testosterone into DHT which is the more potent version responsible for male-pattern baldness, facial hair, etc. Finasteride works in the same way but is stronger than Spiro.

The problem is that the 5a reductase enzyme affects all hormones: estradiol, testosterone, progesterone, pregnenolone, etc. When my Endocrinologist was trying to figure out why my levels were consistently low, she stopped the Spiro, and the Finasteride and went with Eligard injections every three months, and oral Bicalutimide (Casodex) tablets daily. Eligard (leuprolide) blocks testosterone production. Casodex blocks the androgen receptors without affecting the 5a reductase. It and its metabolites have no hormonal activity at all.

It pays to do your research, be informed, and inform your doctors. There have been very few studies on transgender women, so most doctors are not up on the latest studies and treatment protocols. Don't be afraid to ask them about these things. By showing them the information you can help yourself and every other patient that provider has in the future.

[NancyDrew1930]

Prometrium is the best choice. Since it is micronized and bioidentical it has all the benefits of ovarian progesterone with fewer risks. You may notice it makes you drowsy and maybe dizzy, so they recommend taking it before bed. I don't have those side effects anymore, so I take mine three times a day but at half the dose. I hope you have great results!

The reason I take mine throughout the day is because previous studies showed the elimination half-life of oral progesterone was about 18 hours. Since it takes 18 hours for your body to eliminate it, once-a-day dosing would seem appropriate. However, a newer study using a more modern type of assay found that it is eliminated from the body as quickly as 3 hours.

I told my doctor that would mean I take a dose before bed, and even if I wake up in the middle of the night and take another dose, my body will have eliminated it by the time I get up in the morning and I should be getting another dose. But I have to wait until bedtime.

She reviewed the literature I sent her and she agreed to try it my way. I am not suggesting that is what you should do. But be informed and if things do not seem to be working for you, have a discussion with your prescriber.

For reference, here is the discussion about the elimination half-life. Yes, it is Wikipedia but it lists its references.

Pharmacology of Progesterone

I'm taking Prometrium.  Right now I'll be taking 1 tablet sublingually before bed.  If I'm reading that page right it looks like sublingual gives a 6-7 hour half life.

[Lori Dee]

I'm taking Prometrium.  Right now I'll be taking 1 tablet sublingually before bed.  If I'm reading that page right it looks like sublingual gives a 6-7 hour half life.

True, and also says that at those doses it is normally taken three times a day. The intent is the same: to try to maintain an even serum level so it can do its work and make us rounder and fuller up top. 
 

[NancyDrew1930]

So over the past week have my breasts ever been itchy around the aerola and nipple.  I don't seem to have pain when my breasts are growing, just itchiness. 

And from what I've read, you don't really see any growth from progesterone until you have been on it six months.  Or I wonder if because I'm on Cyproterone if my body is already used to some form of progestin/progesterone, if the effects will start sooner.

[Lori Dee]

I have been on progesterone for a few years now without much effect. I read an article that discussed dosage frequency. Under the old assay method, progesterone was believed to have an elimination half-life of 18.5 hours. Thus, the prescriptions given were for a single dose before bedtime. The thinking is that once every 24 hours should keep levels where they need to be, and the side effects some people have are dizziness and drowsiness. You can't get dizzy and drowsy while sleeping in your bed, so take the dose before bed.

However, the new assay method shows that the elimination half-life was way off. It is closer to three hours. I discussed this with my doctor. If the half-life is three hours, that means I take a dose before bed, and even if I wake up and take another in the middle of the night, it is out of my system by morning and I need another dose.

She reviewed the report and agreed to try a lower dose but three times a day. The results are that this is working much better. I, too, feel like my breasts are now growing. There is no measurable increase in bustline measurement, but they are filling out (volume) and feel more firm.

This is because of how these hormones affect the body. Estrogen redistributes fat (breast, hips, and butt) and develops the infrastructure of the breast (the ducts that connect to the nipple). This causes the breasts to grow out to project more from the body. Progesterone develops the alveoli which is the gland tissue that would eventually produce milk. As the glands develop, the breasts increase in volume.

In my case, now that I am injecting the estradiol weekly, my labs show my level at 244 where it has rarely been over 100 in almost 5 years. Taking the progesterone three times a day keeps my levels steady so the hormone can work. And I can feel the results.

I think that every transgender woman who is taking hormones and progesterone needs to have this discussion with their doctor. Surveys have found that a majority of trans women are not satisfied with their breast growth and end up opting for surgery. I think if prescribers would stay up to date on the latest information about hormones and how they function, many surgeries could be avoided.

For those interested in the reports, the summary is on Wikipedia with footnotes to the source references. Pharmokinetics of Progesterone

I hope this information is helpful.

[ChrissyRyan]

It is past year three for me.  I have not measured or noticed any pelvic tilt.
I have nice round boobs though and a more feminine face for sure.  Strange as it may seem, I look more in the face feminine than some female world class athletes, but that is my opinion only.

But I am no outward beauty either.


Chrissy

[NancyDrew1930]

It's been 2.5 months since I started Prometrium for my Progesterone.  I had and still am on Cyproterone.  Prometrium is a bio identical progesterone that is identical to the progesterone that Cis girls make.  Cyproterone is a progestin, or artificial progesterone, and it's weak and is primarily used as a testosterone blocker.  I've been on Cyproterone for about 2.25 years now at a lower than recommended daily dose.  And back in July I was cut to every two days.  So while I have been getting some progestin advantage over the last 2 years, it's been weak.

Over the last week and a half, I've been noticing that I'm eating a little bit more, and everything seems to be going to my breasts.  They feel a little heavier and my nipples seem to be forming up and pushing out.  There had been some development on my nipples since I started estrogen and Cyproterone a few years ago, however they were still soft on the inner part and were only starting to stick out. 

My NP did extend my prescription through next July, so it'll be interesting to see what happens over the next nine and a half months.

[darilee]

It's been 3-1/2 years since I had my orchiectomy and been injecting estradiol valerate once a week. I go for blood work every 6 months and my levels have been holding at 140.

As of lately I only feel minor breast discomfort, they're quite generous in size and I now have to wears a sports bra. For something I didn't want at all, it turns out that I love having them.
 
My body fat has been distributed to my waistline, I'm not sure how I appear outwardly since I still present as male, but I feel quite different. I do feel like I get quite a few stares, but I don't know if it's just me thinking that.

My hair has thinned and takes longer to grow back after shaving. the results have been very satisfying, one of the things I've found tricky is going to the beach I lay out topless but wear a shirt when walking the beach, I'm about a C cup with large areolas It's just another one of the things I didn't realize before beginning my transition.

I'm 67 Years old and married for 36 years I don't have a desire to do anything else regarding my transition.

[NancyDrew1930]

So I've been noticing that my breasts have been really itchy over the last few weeks, especially around the aeorolas.  Plus I think I've experienced some pelvic tilt, since went to turn off the outside water tap for winter and the shut off is in the ceiling and I wasn't able to get the grip on it to turn it like I used too, so I had to get a stepladder. (The ceilings are 8 feet high., also I have more body fat than some at that area, so it doesn't look like thinner bodies there where you can notice.)

[NancyDrew1930]

This morning I noticed in the mirror that I'm starting to see that "S" curve where my breasts and rear are giving that feminine look.  Of course I put a bra on today, so that was helping with my breasts (48DD, I tried a 52DD the other day but it kept going over my breasts when I raised my arms, so I use a bra extender to increase the bust size).

[ChrissyRyan]

This morning I noticed in the mirror that I'm starting to see that "S" curve where my breasts and rear are giving that feminine look.  Of course I put a bra on today, so that was helping with my breasts (48DD, I tried a 52DD the other day but it kept going over my breasts when I raised my arms, so I use a bra extender to increase the bust size).

Good luck to you on developing the curves.  I still have seen not much growth in my hips.
Breasts, yes.  Slightly slimmer waist, yes. 

Voice, not really feminine in my opinion.  All well.

Chrissy

[NancyDrew1930]

Good luck to you on developing the curves.  I still have seen not much growth in my hips.
Breasts, yes.  Slightly slimmer waist, yes. 

Voice, not really feminine in my opinion.  All well.

Chrissy

I'm one of those bigger people, so it's been difficult seeing the curves.  However I have seen my breasts grow, but today was the first time from the side I saw the "S".

[ChrissyRyan]

I'm one of those bigger people, so it's been difficult seeing the curves.  However I have seen my breasts grow, but today was the first time from the side I saw the "S".

Yay!