1st Endo Visit: Advice Needed

[JennX]

Hi all... This is my first post here, but I've been a reader for awhile... 

So I need a bit of advice... a little background first, I'm a MTF between 25-30 in good health, no medical issues, not currently on any meds, etc. So last week after getting my referral letter from my psychologist, I went to the endocrinologist my psychologist usually works with and highly recommends. In other words, her friend.

Now this endo is supposedly very experienced with MTF trans persons, and has been in practice for over 20 years and has treated over 100 MTF & FTM trans persons. After we discussed her usual treatment regimen, my expectations, what changes to expect, etc. she takes my blood for testing and gives me a prescription for E of 0.X xx (which is half the dose I've read most MTFs start on). She then says she usually keeps MTF patients on this same dosage for 6 months, with blood tests (liver enzymes, lipids, t-level- total, not free, etc) every 2 months. She says she won't prescribe S until after 6 months on the E alone, and again only at a very low dosage (half of what I've read as the usual starting dosage). Furthermore, she's not a big believer in the use of F although based on my research, this anti-androgen usually works well with and in concert with S... and I could use the benefits it provides IMHO. Also she shoots for getting the total T level down to around 50 xx/xx, where others like to get it below 40 xx/xx.

So what say you more experienced MTF members? Is she being overly-cautious or should I find another endo and get a 2nd opinion?

Any and all advice welcome.

Thanks,
Jenn 

[cynthialee]

Trust your endo. It may not be what you would do but you are not an endocrinologist.
She maybe being conservative but it is what it is.

If you are not happy with her after some time then seek a new doctor.

But give her a chance. Conservative is a good plan for the first several months.

As an aside my doc wants my T between 50-100 due to some of my curent medical conditions. I am doing rather well so far on a very lite dose of spiro and a moderate dose of E.

[lilacwoman]

I had my six monthly endo apointment today and from blood test last week my testo is practically zero and my estrogen is about 280...so we decided I'd stick with my use of Estrogel and Spiro now that I've lost both testicles.

Low dosage starts might mimic natal females?

[JennX]

Well since others maybe interested in this info, here's what I found out after consulting with 2 other Endos and a very well-known SRS surgeon:

There are 2 main approaches to MTF HRT. The first and slower, and some say "safer" route is to start the patient on a low level dose of E alone. Nothing else. This is what I mentioned above in my other post above. This is also the longer route, as it will not produce as "potent" a result as the second approach.

The second hormone regimen (and the more popular based on my consultations with 3 different Endos and a SRS surgeon) is prescribing a higher dosage of E (the standard dosage you see prescribed in most all research studies) along with the standard dosage of Spiro. Again, this approach while being faster, might not be the ideal regimen depending on a patient's age, general health or other medical issues. Finasteride seems to not be as widely used, unless there are other issues that the E and Spiro will not address alone. Also as an aside, was that all docs I spoke with unanimously advised against the use of Progestins (aka Medroxyprogesterone) as the upside was not worth the possible side effects.

Oh and as for me, I'm going for option #2. 

[Jenni P]

Hi Jenn

my present dosage of E is 4 times what it was at the start of HRT. The clinic that I attend believes in the slow and safe route. It seems to be working for me.

Jenni

[Sarah B]

Hi JennX

When I first started out I did not want to wait around with the slow regime, I wanted the fast regime.  In other words I did not want the effects of testosterone on my body effecting me any more and fortunately I got the normal standard dosage at the time.  In addition I then got to see the endocrinologist soon after I started taking the tablets and injections so that I could ensure I was taking the right amount and what else I should be doing correctly at the time.  In fact the endocrinologist wrote a letter in support of me having my surgery also mentioned that I was responsible in the taking of my hormones.

So I was 30 years old, basically, fit, young and healthy female at the time and for nearly twenty two years of taking various hormones.  I have never encountered any side effects of taking them.

Therefore, going back to your problem with the regime that the endocrinologist has prescribed and with your previous statement on the slow and fast options and in fact you have done a lot more research than I ever did and all I did was just ask for the full strength hormones as I did not want to wait around a couple of years to get to the full strength and hence delay my development.

Question that needs to be answered and that is the dosage that your current endocrinologist is prescribing according to what you said, is it half the starting dosage of the low regime or half the starting dosage of the fast regime?  Or another way to ask your self, what is the normal starting dosage of someone who is starting out?

Your endocrinologist may seem to be holding every one back and may not be up to date on current dosage regimes and is delaying the full dosage so that she can get to see you more often and hence you pay more in the long run or give credit where credit is due and she is a very cautious person.

So I concur with you on what you have decided and that is to go for option 2, take the full standard dose of hormones so that you are virtually in the average range of hormone levels a female would have and seek a second and third opinion if possible.  Then if need be one can adjust the dosage according to your body needs.

Take care and all the best for the future

Kind regards
Sarah B

[JennX]

Hi JennX

When I first started out I did not want to wait around with the slow regime, I wanted the fast regime.  In other words I did not want the effects of testosterone on my body effecting me any more and fortunately I got the normal standard dosage at the time.  In addition I then got to see the endocrinologist soon after I started taking the tablets and injections so that I could ensure I was taking the right amount and what else I should be doing correctly at the time.  In fact the endocrinologist wrote a letter in support of me having my surgery also mentioned that I was responsible in the taking of my hormones.

So I was 30 years old, basically, fit, young and healthy female at the time and for nearly twenty two years of taking various hormones.  I have never encountered any side effects of taking them.

Therefore, going back to your problem with the regime that the endocrinologist has prescribed and with your previous statement on the slow and fast options and in fact you have done a lot more research than I ever did and all I did was just ask for the full strength hormones as I did not want to wait around a couple of years to get to the full strength and hence delay my development.

Question that needs to be answered and that is the dosage that your current endocrinologist is prescribing according to what you said, is it half the starting dosage of the low regime or half the starting dosage of the fast regime?  Or another way to ask your self, what is the normal starting dosage of someone who is starting out?

Your endocrinologist may seem to be holding every one back and may not be up to date on current dosage regimes and is delaying the full dosage so that she can get to see you more often and hence you pay more in the long run or give credit where credit is due and she is a very cautious person.

So I concur with you on what you have decided and that is to go for option 2, take the full standard dose of hormones so that you are virtually in the average range of hormone levels a female would have and seek a second and third opinion if possible.  Then if need be one can adjust the dosage according to your body needs.

Take care and all the best for the future

Kind regards
Sarah B

Well, long story short I went with a different endo who prescribes to the faster, more often prescribed HRT regimen. It seems some favor the slower/ possibly safer course, but as to whether it's to the patient's benefit or that of the doctor is for the patient to decide. Basically, do your homework and research. Don't blindly accept whatever any doctor tells you as 100% correct, 100% of the time. I have a background in science, so I have a better than average understanding of the process, meds, dosages, etc so that's what caused my questioning in the first place. You need to be your own advocate, cause no one else will do it for you.