Intresting talk with my endo

[tori319]

My therapist sent an email to my endo giving me the go ahead. My appointment was for yesterday. This is my second meeting with him and he was very friendly. He asked me if I had name that I wanted to be called, and I said no. He then asked me if I preferred that he use female pronouns and I said no I'm fine with male pronouns. We then went over my blood test results, and he told me that my testosterone levels were unusually high and that my there was something odd about my kidneys. He asked me if I smoke, drink, or do drugs, and I said no. He told me that he wanted a urine sample and another blood test before he would prescribe me anything. He told me that he wants to lower my testosterone before I get on estrogen. I told him that the only blocker I had heard of was spiro but he said that spiro is a weak blocker and that Provera progesterone would be stronger and better. he also said that the pills aren't hard on the liver. He said after I've been on it for a month or two he might start me on estradiol and spiro. What do you guys think? Is this a good plan?

[VeronikaFTH]

Not being doctors, most of us can't (and shouldn't!) tell you what you should and shouldn't be taking.... and I am not a doctor... but I can tell you that there are various kinds of progesterone, some act as anti-androgens, but not all of them.  If he says that one works, he's probably right.

I think the reason people use Spironolactone as an androgen blocker is because it's well tolerated and available generically. But there are some other more effective options, but some are incredibly expensive, something to be concerned about if you are paying out of pocket.

It sounds like your doctor is being cautious at first, and that's not a bad thing...

[spacial]

tori

Sounds like your Dr is being quite considerate and attentive.

Really pleased for you.

In your shoes, I'd go along with him completely. If things don't work out, in a few months, then you should ask some questions.

Believe me, we know how you are feeling. But it seems silly to make any waves at this stage.

Again, so pleased for you pet.

[regan]

I had "routine bloodwork" done one time that showed some elevated liver enzymes.  It was enough for the doctor to order additional blood test and send me for an ultrasound.  In the end everything turned out normal.  But it's worth being thorough.  People have died because they ignored minor symptoms that turned out to be major problems and had they sought treatment early on it would have been easily treated.  So yeah its not necessarily what you want to hear, but its the safest thing for you.

Actually, after my second round of tests, my doc sat me down and said "we need talk about your drinking".  I told him the last blood test was two days after NYE, "understood"  and that was the end of it. 

[Bird]

I'd go with your doc, as everyone said. Careful doctors are good for you.

[Asfsd4214]

I will say two things.

1. Is that the claim that all doctors, even the significant of majority of doctors, are worthy of our blind trust in our treatment, is complete rubbish.

The transgender community, including this forum, is littered with countless examples of doctor incompetence, and it seems clear to me the only reason people make this assertion is to discourage self medication out of a paranoid fear of legal reprecussions.

Now, having said that, a lot of doctors ARE competent, a lot of forum posts are completely incompetent, and I will be the first to say I for one am not competent enough to judge if provera is a more powerful anti-androgen than spironolactone. I can absolutely say that it is used for exactly that goal in chemical castration (which is basically a massive suppression of testosterone).

I can also say it's usage for this purpose is uncommon, and that spironolactone and cyproterone acetate are more the norm.

I can say that unlike more typical and specific androgen antagonists, I can't find much information in a quick google about how provera works at being an anti-androgen.

EDIT: One other thing, as far as I'm aware, none of the estrogen replacement pills are unusually hard on the liver, neither is spironolactone. Cyprotone on the other hand is.

Disclaimer: This post should not be taken to be an avocation that people ignore their doctors advice, I believe everyone should arm themselves with as much knowledge as possible and base their choices on that.

[sarahla]

Oral drugs are hard on the liver and kidneys and have less absorption.

[marissak]

I think you have a good endo, in the sense that he is careful and respectful.

[Melody Maia]

My Endo has taken the same approach as marissak with the exception that we are using ethinyl estradiol capsules made by a compoundic pharmacy. We started with a very low dose and my T level actually went up from 269 to 446 with normal male range from 200-1200. However, my free androgen index went from 31 to 17 with normal male range being 14.8-94.8. We doubled the small dose and I just got my blood work today. T is now at 114.7 and free androgen index dropped all the way to 2.2. I am now on triple the small dose I started at and my Endo feels that will be very close to my final dose. Blood work to come shortly after the new year to confirm.

[Randi]

I know we all have different reactions to different meds. My T levels took a sharp nose-dive when I started taking Spironolactone so it worked well for me. Follow your doctors advice and get your base levels established.
Randi

[VeronikaFTH]

I will say two things.

1. Is that the claim that all doctors, even the significant of majority of doctors, are worthy of our blind trust in our treatment, is complete rubbish.

The transgender community, including this forum, is littered with countless examples of doctor incompetence, and it seems clear to me the only reason people make this assertion is to discourage self medication out of a paranoid fear of legal reprecussions.

Now, having said that, a lot of doctors ARE competent, a lot of forum posts are completely incompetent, and I will be the first to say I for one am not competent enough to judge if provera is a more powerful anti-androgen than spironolactone. I can absolutely say that it is used for exactly that goal in chemical castration (which is basically a massive suppression of testosterone).

I can also say it's usage for this purpose is uncommon, and that spironolactone and cyproterone acetate are more the norm.

I can say that unlike more typical and specific androgen antagonists, I can't find much information in a quick google about how provera works at being an anti-androgen.

EDIT: One other thing, as far as I'm aware, none of the estrogen replacement pills are unusually hard on the liver, neither is spironolactone. Cyprotone on the other hand is.

Disclaimer: This post should not be taken to be an avocation that people ignore their doctors advice, I believe everyone should arm themselves with as much knowledge as possible and base their choices on that.

You're correct, doctors don't know everything, although some seem to think they do. I never encourage blind trust of doctors... I hope I didn't give that impression. I just said that her endo is probably right, because I know that Provera is an anti-androgen, and if he suggests that it's a better anti-androgen than Spiro, I'm going to assume that as a specialist (depending on how long he's been practicing), he is drawing on some personal experience leading him to that conclusion. I could be wrong, but in my experience, specialists know what they're doing more often than not.

But, I also encourage people to do their own research, and don't be afraid to question your doctors. Ask, ask, ask...

[lisanicholeb]

I would agree with you on most of your writing, with one exception, Oral estrogens ARE hard on you liver, they may pass thur your liver up to 4 times to be broken down, that is much more work than should be. Liver lipids and enzymes therefore
very important to monitor. transdermal estrogens would be the best as it is absorbed into your body in a more natural way like a
natal female does.
As for progesterone or progestogens, I had success with them establishing more female development in my breast area
and fat redistribution, that was not overnight nor in a few months but in about 3 years time.
I have had endless discussions with my endo and his staff about "me" and while he does not think progesterones are really necessary, in his opinion they can harm you in more ways than help...So I stopped.
I did do Spiro and had noticeable affects that suited me and my case. you body is different than mine it is why a good
doctor is necessary for properly read blood work and your physiology. Endo's seem to be most qualified eh?