Long term HRT and no SRS

[NickSister]

I'm interested in finding out if anybody here knows much about effects on health of long term hormone therapy without getting SRS.

I ask mainly because in an ideal world I world I would pursue HRT as a way of combating my crushing dysphoria - but I don't think I would ever get SRS. Having a penis has never really bothered me to the same extent as looking like a man. Though I would prefer not to have one I don't feel that preference is strong enough to warrant the costs in my case.   

Anyway, so I was wondering if this posses any particular extra health risks which I assume would come from using antiandrogens - I've looked online but the information seems a bit sparse. The assumption seems to be that anyone on HRT will get SRS eventually.

I feel odd asking because I feel guilty that the health risks are a consideration for me, I often hear that it needs to be a life and death situation to do it. Yet when I look at  not 'transitioning' in any form I just feel dead inside, like I am already on the road to dieing even if I don't actually physically die, looking down the barrel of a long life with this horrible sadness. But there is this fear that this would all be a horrible mistake. I don't think I am the only one with these fears but I still have them and they are not nice.

Any comments, or thoughts or information would be appreciated.

[Caroline]

Heya Nicksister *hugs*

Oral anti-androgens do have health risks when used for very long periods sadly.  I don't really know enough to quantify the risks, you'd really need to speak to an endo for that.  Also you often need to take a higher dose of estrogen while you have testes as oral anti-androgens aren't 100% effective for everybody, this puts extra strain on the liver.  There are the injected anti-androgens like zoladex/leuprorelin/triptorelin etc (GNRH agonists), as far as I know those are safe to use long term (the side effects being those of being chemically castrated, which is easily combated with estrogen therapy).   The downside to those though is cost, about $2000 a year...

An orchidectomy (castration) is probably the best long term solution if you don't want SRS.  It's a LOT cheaper than SRS and significantly less invasive (can be done as day surgery or with an overnight stay).


I REALLY don't agree with the 'don't transition unless it's a life or death situation' philosophy.  I think there is a lot to be gained in terms of self-confidence, self-acceptance, pride in having the strength to be who you really are and doing what you need to do in spite of the potential problems, that for the person with the right mindset can make transitioning a very validating and self-affirming experience.  Yes, there are downsides, sometimes very big ones, and if it's not 'transition or die' you need to weigh everything up carefully before making a decision, but transition is NOT second only to death in the list of worst possible things you could ever do (though some people do love to be self-pitying about it). (Internalised transphobia makes it seem rather worse for some people too). 

[Just Mandy]

I feel odd asking because I feel guilty that the health risks are a consideration for me, I often hear that it needs to be a life and death situation to do it. Yet when I look at  not 'transitioning' in any form I just feel dead inside, like I am already on the road to dieing even if I don't actually physically die, looking down the barrel of a long life with this horrible sadness. But there is this fear that this would all be a horrible mistake. I don't think I am the only one with these fears but I still have them and they are not nice.

You're not alone Nicky, (I hope thats right ) I feel much the same way.

I've read conflicting info on this. I don't have total recall but is seems like
I remember Tink may have said one time that her health had gradually declined and
her endo felt long-term HRT had contributed to that. I hope she responds because I'd
like to know more. I think others have said that Estrogen is natural and protects us from a
lot of the male problems like heart disease. I really think as you do the big problem is spiro or other
anti-androgens.

For me four or so months of HRT has given me much of what I wanted. My body looks and
feels female. My skin is soft and hairless. No I don't have hips and may never have them, but I
have everything else and it's SO calming to see. I can totally see being happy long term as I
am right now.

With that said the longer I'm on HRT the stronger the feeling I have that "he" needs to go at
some point. When I started I felt as you do that I did not need SRS, now I think it would
be pretty awesome but I don't have to do it. Tomorrow I may not be able to live without SRS.

This is a great topic that affects many of us.

Amanda

[NickSister]

With that said the longer I'm on HRT the stronger the feeling I have that "he" needs to go at
some point. When I started I felt as you do that I did not need SRS, now I think it would
be pretty awesome but I don't have to do it. Tomorrow I may not be able to live without SRS.

I actually think this would happen to me too. Not sure why, just have a feeling that would be the case. Perhaps it is a pyramid of needs thing - most urgent needs come first with other things replacing them in urgency as the top parts become resolved. Maybe it is the action of the hormones amplifying the incongruent bits?

Nicky works for me - I'm usually called everything from Nic to Nikolai, though I intend Nicole to be my legal name. Most just call me Nick.

[gina]

I'm also in this catagory, after 4+ years of HRT it did its job and I'm very pleased with the results but I know it cant stay like this too long without taking a serious toll on my health. I'm most probably go the orchidectomy route to lessen the damage within the next two years and reevaluate my situation from there.

gina

[NickSister]

Though if you get an ocrchdectomy doesn't that mean there is less material for surgens to work with if you eventually do desire SRS? You would probably still get a satisfactory result but something to think about too I guess. 

As Andra mentioned perhaps the injectibles are safer long term. If you have a good income this is probably still a viable option. Though I would need to consult with and endo about this to get the definiative answer. But in my country if you want to chat to an endo you need to wake up this whole beaurecratic minefield, full disclosure, and basically get accepted for hormone therapy at your own cost, just for a chat!. Very frustrating.

[joannatsf]

I've been taking Aldactone for 6 years and had no ill effects from it.  There is a slight cancer risk but the risk/benefit ratio is acceptable to me.  My MD that handles my hormone therapy tells me the risks are the same as for any woman on HRT:  Increased risk of breast cancer, blood clots  and some coronary risk.  If you take an injectable or transdermal estrodiol there may be little risk to your liver.  If your ALT/AST are normal there's not much to worry about.  I have End Stage Liver Disease and it hasn't prevented me from medically supervised HRT.  The vast majority of people can take HRT with few or no unintended consequences.  Listen to your doctor and don't worry about it!

[Caroline]

Though if you get an ocrchdectomy doesn't that mean there is less material for surgens to work with if you eventually do desire SRS? You would probably still get a satisfactory result but something to think about too I guess. 

There are ways of doing an orchidectomy that don't affect the amount of skin available for SRS.  You'd need to find a surgeon who knew how to do it the appropriate way though.

[joannatsf]

Though if you get an ocrchdectomy doesn't that mean there is less material for surgens to work with if you eventually do desire SRS? You would probably still get a satisfactory result but something to think about too I guess. 

There are ways of doing an orchidectomy that don't affect the amount of skin available for SRS.  You'd need to find a surgeon who knew how to do it the appropriate way though.

Why have surgery when there exists a pharmaceutical solution?  All surgeries, even relatively minor ones like an orchidectomy have risks.

[MaggieB]

Though if you get an ocrchdectomy doesn't that mean there is less material for surgens to work with if you eventually do desire SRS? You would probably still get a satisfactory result but something to think about too I guess. 

There are ways of doing an orchidectomy that don't affect the amount of skin available for SRS.  You'd need to find a surgeon who knew how to do it the appropriate way though.

Why have surgery when there exists a pharmaceutical solution?  All surgeries, even relatively minor ones like an orchidectomy have risks.

There are surgeons that will write an affidavit stipulating a gender change surgery has been performed after an orchi. This has been used to get the SSI and birth certificate changed. I plan to go this route.

Maggie

[NicholeW.]

Though if you get an ocrchdectomy doesn't that mean there is less material for surgens to work with if you eventually do desire SRS? You would probably still get a satisfactory result but something to think about too I guess. 

There are ways of doing an orchidectomy that don't affect the amount of skin available for SRS.  You'd need to find a surgeon who knew how to do it the appropriate way though.

Why have surgery when there exists a pharmaceutical solution?  All surgeries, even relatively minor ones like an orchidectomy have risks.

There are surgeons that will write an affidavit stipulating a gender change surgery has been performed after an orchi. This has been used to get the SSI and birth certificate changed. I plan to go this route.

Maggie

Re: Andra's post: Yes there are surgeons who know how to do that. This resource may be helpful for you.

I would, in regard to Maggie's post, also say this. Check the laws in your state about what exactly the courts will approve for a legal gender-change. Not all jurisdictions will do that, some require full-srs for formerly-designated males and others only require an orch. And, depending on the court in your own district you may be able to get the change made regardless. Another reason to do some research.

Nichole

[Caroline]

Why have surgery when there exists a pharmaceutical solution?  All surgeries, even relatively minor ones like an orchidectomy have risks.

As do taking oral anti-androgens for long periods (and injected ones are too damned expensive).  You might be ok after 6 years but 16 years?  30 years? 50 years?

[NicholeW.]

  You might be ok after 6 years but 16 years?  30 years? 50 years?

It's that 16 year-mark where you get to stop buying a night-light and simply bask in your own glow, Andra.

[Keira]

Things like spiro are relatively benign at normal doses
They give it to people with even messed up livers.

Alone, all anti-androgens are not good for your bones,
you need to also take estrogen in a reasonable dose.

[NickSister]

I think there is a common perception that the risks are high (I definitly had that perception). Perhaps my own fears running amok. Kind of makes you feel like you are damned if you do, damned if you don't.

Thank you Keira and Claire. You have eased my mind some. Also I look forward to glowing in the dark in a couple decades time! - thanks Nichole  .

[LynnER]

If the orchi is performed through the lower abdomen instead of cutting through the scrotal tissue it should not affect your GRS if you get it in the future

Also why go a surgical rout when theres a pharmaceutical rout?  MONEY... a surgery that averages 2k or the cost of higher E dosages and AAs for the rest of your life.... hummmmm... which sounds better to your pocket book?

And finaly, in some states, an orchi is enough to leagly allow you to change all your documentation so that in the eyes of the government/law, you are female...

[joannatsf]

I wouldn't know the cost of Aldactone since my insurance pays for it, same as it does my Climara.  If someone wants to have their balls off, more power to them.  I saw a post orchi photo of a bloody tray with 2 bloody testicles in it.  I made up my mind then and there that without a vagina to compensate for the loss, I wouldn't do it.

I consider the knife a last resort.

[LynnER]

I wouldn't know the cost of Aldactone since my insurance pays for it, same as it does my Climara.  If someone wants to have their balls off, more power to them.  I saw a post orchi photo of a bloody tray with 2 bloody testicles in it.  I made up my mind then and there that without a vagina to compensate for the loss, I wouldn't do it.

I consider the knife a last resort.

I have my orchi in less than 2 weeks.... I don't have insurance to pay for anything so its all out of pocket, consider yourself lucky... and I'm beyond happy to be getting rid of the little buggers LoL... I'm seriously considering having them preserved so I can give one to a friend that wont get it, and the other to the judge when it comes round 3 for the name and document changes....

[joannatsf]

Lynn, in the event you saw the post I just removed, my apologies.  I'm a sick twisted individual with a very dark sense of humor.     Good luck with your surgery and I hope you prevail in court.  I'd think twice about sending them a testicle, though.