Susan's Place Transgender Resources

Ok so I was 1month into hrt using spiro and the patch and get a phone call a coule days ago about my first blood test results,dr had the office call me and tell me to stop hormones and to make an appointment to come see her because my liver levels were "abnormal". I asked what was abnormal and this is what they said
Alkeline Phos. was at 144  it should be between 33-115
AST was at 51 it should be between 10-30
ALT was at 120 it should be between 6-40

Im freaked! Does anyone have any ideas what these levels could indicate? I wanna get back on HRT but im afraid the dr is going to stop me from taking it.

seriously bummed out

Those levels probably indicate your liver is being worked too hard. It can be because it's fragile to begin with and HRT alone is too much work, because of a pre-existing problem that wasn't checked before (other medications, excessive use of alcohol, fat food...) or because HRT added to a pre-existing "potential problem" and made it a real threat.

At those levels, your health doesn't look like it's in critical, immediate danger (even though I'm not a doctor at all), so don't write a dying letter yet. But stopping HRT for now is wise. Sad and annoying, but wise.

If there are external controllable, known factors that can be harming your liver, you need to eliminate them as soon as possible. Alcohol, fat, smoking maybe..? Dunno about that one. Perhaps you're taking a lot of medication when a reformulation of your "pill cocktail" could make it easier on your body. I have no idea.

If really, there's no external factor or the external factor cannot be controlled, there are other options:

-Try other HRT delivery methods such as transdermal gels and injections. Perhaps they have some sort of liver advantage, I dunno. Ask about them.
-Have an orchidectomy, which will allow you to skip spiro, and thus reduce the strain on your liver.

Do you have any bad habits? Fatty foods, smoking, and alcohol can all fry your liver.

Truth be told I dont really drink much, gave that up entirely 4 months ago-sih, stopped smoking the day i started hrt, no fast food to speak of for several months.
NO other meds or drugs.
BUT In my days as a teen and young adult (now 29) I was a big druggie doing everything under the sun and getn messd up, junk food and what not too. was never into booze that much but did defanitely drink

What were your levels before you started? Any other meds can be hard on you liver. Just a few Tylenol before your labs could elevate the levels.

Well, if it was really that bad, there are chances it's permanent damage/fragilisation, and I don't think there's much you can do about that except improve your general health.

- Don't eat "not really fat". Eat well and flee fat like plague. You need to get your liver to a state as healthy as possible if you want to be allowed to continue HRT. And just after alcohol, fat is probably the worst thing for the liver. Especially those bad fats. Saturated and trans fats, found in transformed products (hydrogenated, partially hydrogenated [worst] or overheated oils] and animal products (milk, meat). Cutting on the meat and eating only the leanest meat when you do eat it is a good idea. Skim milk or plant milks, too, as the fat in milk is quite something. Anything of animal origin that contains any sizable amount of fat must be reduced to a minimum, because animal fat is very unhealthy in general. Don't eat too much cheese, and shop for it wisely, because most kinds are really fat. I get 4 % cheese, and it's the lowest I could find that had a solid texture. And 4 % is already a non-negligible amount of fat. As for unsaturated fats, get them, because they're good for you, but don't exaggerate. It's still fat, and fat equals liver, no? Get antioxidants, too, from colourful vegetables, for example.

- Try to do some cardiovascular exercise. My medical knowledge is extremely limited, but from what I know, the one of the functions of the liver is a sort of filter. Physical exercise is effective in helping your body "clean up" more easily. And being more in shape = more effective delivery for blood = beneficial for all organs.

- Look up what else is good or bad for the liver, and see what you can do. A quick Internet search should fetch you some useful tips.

You will need to make a big effort, probably. Because liver issues are serious issues, and I think many doctors would just rule HRT out completely unless your liver's health is well-assured.

Quote from: The Wagoneer on January 29, 2013, 12:17:10 AM
Truth be told I dont really drink much, gave that up entirely 4 months ago-sih, stopped smoking the day i started hrt, no fast food to speak of for several months.
NO other meds or drugs.
BUT In my days as a teen and young adult (now 29) I was a big druggie doing everything under the sun and getn messd up, junk food and what not too. was never into booze that much but did defanitely drink

Ya...

That's youth naivety i'm afraid. When you are young you don't think of the consequences its always here and now.  It's possible you caused permanent long term damage to your liver. The purpose of the liver is to filter out toxins coming into the body. Too much filtering and it slowly wears out. Our bodies are like machines, all sorts of moving parts and components and over time they get worn out or break. Doing drugs/drinking/smoking probably wore your liver down far faster than normal.

Not to get you down but something to consider. I would stop any HRT until you consult your doctor. It sucks but a liver failure is not worth it. Like A said there are ways around your liver with HRT so don't give up hope.

Quote from: The Wagoneer on January 28, 2013, 11:06:34 PM
Ok so I was 1month into hrt using spiro and the patch and get a phone call a coule days ago about my first blood test results,dr had the office call me and tell me to stop hormones and to make an appointment to come see her because my liver levels were "abnormal". I asked what was abnormal and this is what they said
Alkeline Phos. was at 144  it should be between 33-115
AST was at 51 it should be between 10-30
ALT was at 120 it should be between 6-40

Im freaked! Does anyone have any ideas what these levels could indicate? I wanna get back on HRT but im afraid the dr is going to stop me from taking it.

seriously bummed out

Wagoneer, your most reliable source of information and interpretation is your doctor.

With that said, I get these tests every three or four months.  The "normal" ranges quoted to me by Quest Diagnostics vary somewhat from the ranges you show.

Alkaline Phosphatase (ALP)

An alkaline phosphatase (ALP) test measures the amount of the enzyme ALP in the blood. ALP is made mostly in the liver and in bone with some made in the intestines and kidneys. It also is made by the placenta of a pregnant woman.

The liver makes more ALP than the other organs or the bones. Some conditions cause large amounts of ALP in the blood. These conditions include rapid bone growth (during puberty), bone disease (osteomalacia or Paget's disease), or a disease that affects how much calcium is in the blood (hyperparathyroidism), vitamin D deficiency, or damaged liver cells.

If the ALP level is high, more tests may be done to find the cause.
Why It Is Done

A test for alkaline phosphatase (ALP) is done to:

    Check for liver disease or damage to the liver. Symptoms of liver disease can include jaundice, belly pain, nausea, and vomiting. An ALP test may also be used to check the liver when medicines that can damage the liver are taken.
    Check bone problems (sometimes found on X-rays), such as rickets, osteomalacia, bone tumors, Paget's disease, or too much of the hormone that controls bone growth (parathyroid hormone). The ALP level can be used to check how well treatment for Paget's disease or a vitamin D deficiency is working.

http://www.webmd.com/digestive-disorders/alkaline-phosphatase-alp-test (http://www.webmd.com/digestive-disorders/alkaline-phosphatase-alp-test)

Aspartate Aminotransferase (AST)

An aspartate aminotransferase (AST) test measures the amount of this enzyme in the blood. AST is normally found in red blood cells, liver, heart, muscle tissue, pancreas, and kidneys. AST formerly was called serum glutamic oxaloacetic transaminase (SGOT).

Low levels of AST are normally found in the blood. When body tissue or an organ such as the heart or liver is diseased or damaged, additional AST is released into the bloodstream. The amount of AST in the blood is directly related to the extent of the tissue damage. After severe damage, AST levels rise in 6 to 10 hours and remain high for about 4 days.

The AST test may be done at the same time as a test for alanine aminotransferase, or ALT. The ratio of AST to ALT sometimes can help determine whether the liver or another organ has been damaged. Both ALT and AST levels can test for liver damage.
Why It Is Done

An aspartate aminotransferase (AST) test is done to:

    Check for liver damage.
    Help identify liver disease, especially hepatitis and cirrhosis. Liver disease may produce symptoms such as pain in the upper abdomen, nausea, vomiting, and sometimes jaundice.
    Check on the success of treatment for liver disease.
    Find out whether jaundice was caused by a blood disorder or liver disease.
    Keep track of the effects of cholesterol-lowering medicines and other medicines that can damage the liver.

http://www.webmd.com/digestive-disorders/aspartate-aminotransferase-ast (http://www.webmd.com/digestive-disorders/aspartate-aminotransferase-ast)

Alanine Aminotransferase (ALT)

An alanine aminotransferase (ALT) test measures the amount of this enzyme in the blood. ALT is found mainly in the liver, but also in smaller amounts in the kidneys, heart, muscles, and pancreas. ALT was formerly called serum glutamic pyruvic transaminase (SGPT).

ALT is measured to see if the liver is damaged or diseased. Low levels of ALT are normally found in the blood. But when the liver is damaged or diseased, it releases ALT into the bloodstream, which makes ALT levels go up. Most increases in ALT levels are caused by liver damage.

The ALT test is often done along with other tests that check for liver damage, including aspartate aminotransferase (AST), alkaline phosphatase, lactate dehydrogenase (LDH), and bilirubin. Both ALT and AST levels are reliable tests for liver damage.
Why It Is Done

The alanine aminotransferase (ALT) test is done to:

    Identify liver disease, especially cirrhosis and hepatitis caused by alcohol, drugs, or viruses.
    Help check for liver damage.
    Find out whether jaundice was caused by a blood disorder or liver disease.
    Keep track of the effects of cholesterol-lowering medicines and other medicines that can damage the liver.

http://www.webmd.com/digestive-disorders/alanine-aminotransferase-alt (http://www.webmd.com/digestive-disorders/alanine-aminotransferase-alt)

As others have noted there is good news! There are methods of delivering E that bypass the liver ;)

http://www.collegepharmacy.com/images/download/BHRTPelletFAQ.pdf (http://www.collegepharmacy.com/images/download/BHRTPelletFAQ.pdf)

Shots and creams bypass it, too!

Can I just step in.

Interpreting liver function tests is not the easiest thing in life. The are dynamic and that is what is looked at. Individual levels on a single test are just warning lights.

You are being called back in to have a bit of history and another blood test ( I suspect).

This is *exactly* what happened to my wife. She ended up needing a liver ultrasound just to be on the safe side. The doctor eventually concluded that there are a number of temporary liver inflammations that can happen totally without symptoms (and only get caught if someone runs a liver function test for other reasons!), all of which resolve themselves eventually. The numbers you have there look like hers, which is to say, the endo also said nothing was high enough to be a screaming red flag - just enough to be a warning that something was going wrong. The good news is that the patch is one of the methods with the least strain on the liver and the lowest risk factors, so there's a very good chance that you need further retesting and/or a brief break from hormones but will be fine to resume HRT in the long run.

My wife ended up off hormones for only a week while she waited for the second set of labs and the US results to come back. It wasn't a big deal at all. I hope it's the same for you!

(She also needed to - without discussing specifics - halve her dosage, because it turned out that even a low dose by patch was too much and was damaging her liver further. A reason to be grateful she wasn't self-medding; if she had been, she likely could have died. The endo said at that point one of the FIRST symptoms of a problem would be liver failure.)

Well the dr wanted me to get blood work after a few weeks off hrt and i went and got the bllodwork the other day and got my results today. all my levels are back to normal except my ALT level wich dropped from 120 down to 98 which is still higer than normal but not insane either from what i hear. faxed my results off to the dr and hopefull in the next few days shell call me and tell me to go back on my hrt YAY!

On a side note funny thing happened when i had stopped my meds, while on the meds i didnt see much physical changes at all except skin changed a bit. BUT since ive been off them my nipples puffed up and had a little real growth, WTF is that all about? maybe its like a womens cycle going up and down promotes growth?

My only advice:

Drink LOTS AND LOTS of WATER!
Seriously, water makes magic. I always have a gallon jug in my car.

That's all I've got. Hope things get better for you!

My 13 year old kid has elevated stuff in her liver panels lately. We're working on it. It's a dynamic situation and doesn't necessarily slam the door on medication you need. You may have to just stop temporarily, or make other lifestyle changes. Or whatever. I dunno. But it's not always the end of the world and you might be okay.

Quote from: Jennygirl on January 29, 2013, 03:56:34 AM
As others have noted there is good news! There are methods of delivering E that bypass the liver ;)

http://www.collegepharmacy.com/images/download/BHRTPelletFAQ.pdf (http://www.collegepharmacy.com/images/download/BHRTPelletFAQ.pdf)

Shots and creams bypass it, too!

I'm afraid that is inaccurate.

When we talk about things like injections bypassing the liver, what you really mean is bypassing the first pass effect phenomenon. Basically when you swallow a substance, it's transported to your liver and experiences what's known as the first pass effect. I don't recall the exact biology of it. What I can say, is that the first pass effect can alter the behavior of the substance in question, usually by reducing its effectiveness to some degree, other times by metabolizing it into a different substance all together. Indeed often oral medications are intended to metabolize into something else that is the effective compound.

Shots are probably easier on the liver because of this, but they still go through it.

As for the original poster, I don't normally make recommendations like this, but there's a lot of good info about milk thistle (the active constituent in most liver detox suppliments) and helping with liver damage.

I used to have liver problems, I spent a year prior to starting hormones losing weight and changing my diet to include many more healthy vegetables, eliminating most processed food, eating small frequent meals, drinking plenty of water, etc. After a year my liver enzymes returned to normal.  That was after 10 years of elevated liver enzymes. Changing your diet and losing weight can make a huge difference.

.

Quote from: Asfsd4214 on February 09, 2013, 04:03:25 AM
I'm afraid that is inaccurate.

When we talk about things like injections bypassing the liver, what you really mean is bypassing the first pass effect phenomenon. Basically when you swallow a substance, it's transported to your liver and experiences what's known as the first pass effect. I don't recall the exact biology of it. What I can say, is that the first pass effect can alter the behavior of the substance in question, usually by reducing its effectiveness to some degree, other times by metabolizing it into a different substance all together. Indeed often oral medications are intended to metabolize into something else that is the effective compound.

Shots are probably easier on the liver because of this, but they still go through it.

The biology of it is that the GI system has a special circulatory route called the Hepatic Portal Vein system. The dreaded "first pass" is ONLY a concern with orally administered medications. Basically, there are special veins that circulate the blood from the digestive organs directly to the liver before joining general circulation throughout the body. This aids in lipid digestion (one of the primary functions of the liver) along with reducing the potential toxicity of anything ingested (the liver is the primary organ responsible for metabolizing drugs and other similar chemicals.)

Anything that enters general circulation will eventually pass through the liver, including injections, patches and topical creams. In the early days, when nasty meds such as Premarin were all that was available and administered orally, the 'first pass through the liver' was a major concern. The main estrogenic compound in Premarin is estrone which is 80 times weaker than estradiol, so relatively high doses were required to produce feminization in MtF women. Unfortunately metabolization of large amounts of estrone by the liver results in metabolic byproducts that increase the risk of embolic events and other deleterious side effects. Thus, any administration method that did not involve the 'first pass' was deemed to be superior to oral administration.

At the present time, transdermal methods (patches and creams) and intramuscular injections of bio-identical estradiol have similarly low risk of deleterious side effects, especially when compared to oral, conjugated estrogens such as Premarin. In comparison, oral estradiol (such as Progynova) has an increased risk (mostly for older MtF women; there are age related metabolic changes that occur, unfortunately), but not nearly to the level of Premarin or other synthetic estrogens such as ethinyl estradiol. This is primarily because oral estradiol doses need to be higher than IM injections or transdermal methods (even with bio-identical estradiol, the liver metabolizes more on the first pass when it's administered orally) to achieve the same effects. While injections and transdermal methods are generally regarded as being "easier on the liver" since they don't involve the initial first pass, with any pre-existing liver damage this might not be true.

If it were me, I would stay off all HRT for another 6 to 8 weeks to fully allow any estradiol in your system to be metabolized and then consult with your doctor about SLOWLY ramping up to effective dosages. It may be that by slowly introducing estradiol to your system (while making dietary changes and lifestyle choices that promote liver health), your liver will be able to gradually accommodate to the extra estradiol without causing increased inflammation or disfunction of the liver.

Hope this helps.

Doesn't estradiol have a half-life of about 12 hours? In that case, it sounds like a lot to wait for over a month. Anyway. We should let the doctor handle this. But thanks for the explanation.

I actually am quite a heavy drinker, and have been for 20 out of my 35 years, and my liver function is perfect, even after/during HRT. If you are young, you would have had to really be drinking paint thinner for real severe damage so early, but I ain't no doc.

However, did anyone bring up Hepatitis?? That'll put the kibosh on your liver right there...

Hepatitis would've been seen / checked right away by the doctor if it were a possibility, I'd say. And everyone is different. Some people are fine with 600 mg a day of a med, Seroquel, taken in the morning, whilst 50 (I think) mg of it taken in the evening was all I needed to be unable to move (pretty much literally crawled up the stairs to call in sick) for almost 24 hours, and to sleep 34 hours in a period of 36.

Some people are much more sensitive than others, and it can happen to any part, so I think it's not safe to assume it can't be that just because the situation couldn't cause it. Besides, we don't know the details, and there might be another issue in the background. Hepatitis would most probably have been detected by now since it's an infection, but I'm sure there's a ton of things that can make a liver vulnerable.

Quote from: MaidofOrleans on January 28, 2013, 11:27:09 PM
Do you have any bad habits? Fatty foods, smoking, and alcohol can all fry your liver.

I didn't know smoking could fry the liver. Good thing I quit back on Dec 31st 2012!! I want to say I have had these liver levels at extremely high counts (mostly the alkphos) and the doc did the full range of liver panels, followed by an ultrasound. Everything looked good on all the tests, so we will never know why the alkphos was so high. I will be starting HRT next month (March) and the doc is sorta teetering about, trying to think about how best to go about it with me.

I wish you the best!! 

Dawn Heart: Smoking doesn't -directly- affect the liver the way alcohol and fat do, but it puts some a crapload of toxic chemicals in your system, and as far as I know, it's the liver's job to filter toxic compounds out of your body, right?

So I guess the answer is that it's much less bad for the liver than it is for other organs like the lungs, but it certainly doesn't help..? (Anyone being more sure of themself will be much appreciated here, because I seriously don't know what I'm talking about.)