Susan's Place Transgender Resources

So this is sort of a shout out as well as a question.

I pulled the old switcheroo today with my hormones. I know I've been talking about asking my endo why he chose Premarin and did so at my 6 month appointment today. He basically said that he chose it because it's predicable and it works but immediately offered to put me on Estradiol.

I havn't had a problem with the Premarin but all the hate I hear towards it and the cost I figured what the hell and said yes. He wrote me out a years worth of refills of Estradiol so i'm set for a while. He also asked me when I was going full time and offered to write up the paperwork to have my drivers license changed and have it ready for me.

Has anyone done the switch from Premarin to Estradiol oral and had any side effects? Positive or Negative changes? He told me if I feel i'm not changing enough to see him and he will work with me to try something else.

My endo is Jeffrey Sandler MD. I would seriously recommend this endo to any girls in the southern California area, especially San Diego for obvious reasons. MY experiences so far working with him have been nothing but positive and he is super compassionate with trans poeple.

I think me and you are on a tiny boat with just the two of us
I suspect

Yesterday morning I already had my 3 month supply of estradiol
And dumped all my premarin...today is first day. .

I feel the same so far...I think lol
But I'll wait a week to post how a transition from premarin to Estrace
Goes.

I wish I lived in San Diego. :( Outdoor swimming on Christmas must be the best.

Oh yea side effects
Forgot to write that...

I had a long conversation with a pharmD the other morning
And I addressed all my concerns due to clotting ...

He informed me that Estrace will have less clotting factor than
Premarin...but still do not smoke...

Maybe hit a doctor and get a blood req for clotting factor
Of blood?

There are lots of problems with Premarin, not the least of which is it is derived from pregnant mare urine.  These are similar mammalian (horse) hormones, but not human.  It is a "conjugated estrogen" (that is to say, a mixture of estrogens.)

The composition of horse estrogen is vastly different from human estrogen.

The metabolic breakdown products of Premarin are biologically stronger and more active than the original equine estrogens. Various studies have shown that these breakdown products can produce DNA damage that is cancer-causing. So, for example, the incidence of breast cancer increases when women take Premarin.

Premarin, like all conventional HRT, is prescribed in standard dosages and not tailored to individual requirements. This usually means women are often taking more "estrogen" that they need.

It takes about eight weeks to clear Premarin out of the body. In contrast, natural hormones are completely metabolized and cleared in 6-12 hours.

Premarin can easily, and usually does, throw a woman into Estrogen Dominance.

It causes an excessive increase in Sex Hormone Binding Globulin(SHBG), which in turn blocks thyroid hormone function.

http://www.womenlivingnaturally.com/articlepage.php?id=17 (http://www.womenlivingnaturally.com/articlepage.php?id=17)

By way of analogy, from the 1920s to the 1980s, insulin for diabetics was made primarily from porcine and bovine pancreases.  These differed from human insulin by several amino acids.  With the advent of biosynthetic technology, many insulins in common use today are bio-identical.  That lessens the chances of any reaction to foreign proteins.

I was put on oestrogen implants for just the reason Jamie mentioned. My E level was just going up and up and at 4000 my endo was not happy, so I had to come off and when it dropped I was put on implants which are great, level is now about 400 and I get a new implant every 4-6 months, easy beezie.

I'll try and answer your question as applies to me.

I was on P for fourteen-ish years and after 8 years off I'm now 9 months into E. I'll try and use a 0-5 scale where 5 is very good (minus is bad). I take no AA.

Hair P 0, E much regrowth 4
Skin softness P 1, E 4
Skin collagen P -1, E 3
Waistline P -3, E 0
Hips P4, E3
Boobs P A/B cup, E C cup
Feet P 0, E lost 1 shoe size
Ankles + wrists P 0, E lost about 1/2 to 3/4 of an inch
hands maybe slightly smaller on E, hard to say.
Erections P steady decline over 10 years but never went away. E gone in a month.

Personally  I found 90% of the change with both happened very rapidly <3 months

Thanks for the info girls.

Sounds like the switch was a good idea anyways.

Day one on Estrace from premarin...
No psychologicql changes..
But
My breasts really hurt more

Newbie here... trying to determine what the accumulated wisdom is.  After reading the FAQ, wiki and many articles, i am leaning toward estrace to start off with.

My first consultation with a doctor isn't until late May, so i still have a few weeks to determine, based on the experience of others here, what the best course is.

FYI both my parents had strokes, so i'm frankly terrified what they'll tell me my risk factor is.  Is there a chance i'll be turned down?

Sorry to jump onto your thread, MaidOfOrleans, should i start a new one?  Will be watching this one closely, regardless...

Quote from: XchristineX on April 24, 2013, 12:05:16 AM
...He informed me that Estrace will have less clotting factor than
Premarin...but still do not smoke...

Quote from: karla.allen on April 24, 2013, 05:36:55 AM
Newbie here... trying to determine what the accumulated wisdom is.  After reading the FAQ, wiki and many articles, i am leaning toward estrace to start off with.

My first consultation with a doctor isn't until late May, so i still have a few weeks to determine, based on the experience of others here, what the best course is.

FYI both my parents had strokes, so i'm frankly terrified what they'll tell me my risk factor is.  Is there a chance i'll be turned down?

Sorry to jump onto your thread, MaidOfOrleans, should i start a new one?  Will be watching this one closely, regardless...

I don't mind if you hijack it.  ;D

Why did that have strokes? Do you have any clues a to lifestyle choices, etc? The best way to counter the increased risk is to lower other risk factors. My family history includes a lot of heart disease but it didn't phase my doctor simply because I lead a healthy lifestyle opposite to what my grandparents did. I don't smoke, I don't drink, I'm not overweight. Things like that can help a lot in lowering risk.

Quote from: MaidofOrleans on April 24, 2013, 01:31:29 PM
I don't mind if you hijack it.  ;D

Why did that have strokes? Do you have any clues a to lifestyle choices, etc? The best way to counter the increased risk is to lower other risk factors. My family history includes a lot of heart disease but it didn't phase my doctor simply because I lead a healthy lifestyle opposite to what my grandparents did. I don't smoke, I don't drink, I'm not overweight. Things like that can help a lot in lowering risk.

R
Totally 100 percent what she said.   
Risk reduction....in all areas of life.
No smoking.  Very little alcohol.  No illicit drugs..
Learn to get rid of things that stress and depress you
Don't eat sugars or fatty foods.  Lots of veggies and fruits
Exercise like yoga for improving flow of blood through legs

Than all will be fine.   Seems like a lot of work but the
Pay offs is tremendous

Lifestyle choices played a large part... sedentary, cigarettes... and i'm totally with you and christine on the right choices.  Even moved to a place where we do a lot of gardening, woodcutting... out in the countryside, there's no end to the exercise, fresh organic food...!  :)

What i'm really afraid of is having my parents medical records to explain away.... fear of being turned down for hrt/surgery.  I have bad memories of a quack of a therapist; who, in his professional arrogance, deigned to try cure me (on my nickel). 

I fear 'standards of care' that haven't evolved much since Christine Jorgensen, in which mental health 'professionals' get to act as our gatekeepers.  Makes me feel like a woman's word isn't worth much at all... much less a woman who would want to give up that wonderful life of male privilege and power.

Sorry.  my rant for the day.  When i start hrt will i rant less?  ;)

Quote from: MaidofOrleans on April 24, 2013, 01:31:29 PM
Why did that have strokes? Do you have any clues a to lifestyle choices, etc? The best way to counter the increased risk is to lower other risk factors.

That's good for you. Funnily, this topic makes a good contary to my old thread, "My endo is a stubborn cow." :p

Day two on Estrace.....
I think my personality is getting softer and more
Passive....

Yes Estrace is good

No clue why anyone... especially in the US would still prescribe Premarin? It's old and outdated. Estrace, Estradiol, Estrofem are usually what is prescribed as they are 17-beta-estradiol which are "bioidentical" forms of naturally occuring estrogen. The key word here is bioidentical. If you look at the molecules and molecular structure of Estrace it is the same as that produced by the ovaries. This is much safer and will stress your organs much less. And who doesn't want the real sutff.
;D

So, is there any functional difference between estrace and estradiol, in terms of effectiveness?

Quote from: ZoeM on April 25, 2013, 10:03:01 AM
So, is there any functional difference between estrace and estradiol, in terms of effectiveness?

No. Estrace is the prescription brand (from Warner/Chilcott) and Estradiol is the generic (from Teva, and other manufacturers)... both contain 17-beta-estradiol.

I read somewhere the reasoning for writing premarin is this

There is scientific evidence with use  of premarin
No trials done with 17b.   

It sounds like maybe conservative doctors don't want ro
Get in trouble or something like that

The article did not state a conclusion. .its just that's what
I undrrstood

Quote from: MaidofOrleans on April 24, 2013, 01:31:29 PM
... I don't smoke, I don't drink, I'm not overweight.

Que lástima! ¿Tienes cualquier diversión?

Quote from: XchristineX on April 25, 2013, 10:41:05 AM
I read somewhere the reasoning for writing premarin is this

There is scientific evidence with use  of premarin
No trials done with 17b.   

It sounds like maybe conservative doctors don't want ro
Get in trouble or something like that

The article did not state a conclusion. .its just that's what
I undrrstood

There is probably some truth to that.

 I think premarin also messed up my ability to umm take
Myself to completion....

Tonight day three Estrace I was fantasizing and I got ummm

Estrace returned ability to enjoy sex a little more...

Should I be taking the Estradiol under my tongue or just swallowing it? I've heard under the tongue but i've never done that before with a medication and i'm afraid to screw it up! :P

You can't go wrong by taking it under your tongue. Worst case, the medication isn't made for being taken there and won't be absorbed through your skin. Which just means it'll go down to be swallowed eventually, just as if you'd swallowed the pill whole. Usually though, estradiol can be taken under the tongue.

I swallow.
Haha I met the Estrace.. .works well so far...I originally wanted
Estradiol injections...but ill settle for Estrace

Hmmm well I tried it and it turned into a blue blob under my tongue. Had to swish some saliva around to break it up. Now i'm all freaking out that I screwed up.

I think i'm extra nervous about it because I switched from another estrogen that was working well and I don't know if it's still working or working better.
Ugh i'm such a wreck with this.

Don't stress. Don't worry. No matter what you do, as long as you don't spit it out, the medication has been taken. This is not like an injection. Unless you do obviously irrational things like spitting it out, putting it in the wrong hole or trying to dissolve it in some chemical, you just can't go wrong.

For putting it under your tongue, you need to wait for a while. it takes time for it to be "squished" and absorbed. It's normal for it to turn into that kind of thing. It takes up to half an hour. Also, it's not the end of the world if you mess up and end up swallowing it. It just means you've taken it part sublingual, part swallowed it. Still better than just swalloing it.

And yeah, if you're taking Estrace, then you can take it sublingually, guaranteed.

So is sublingual better and why?
How long does it take to break down

I always take my E sublingually.  This allows it to go straight into the blood stream, rather than having to digest and metabolize it first.  In theory, you can do with a lesser dosage that way, or else get more effectiveness out of the dosage you are on.  It is also easier on your liver.

Peace,
Kristi

What she said, pretty much. As to how long it takes to break down... Do you mean physically, in your mouth? It depends on how much saliva it comes in contact with. More saliva increases speed but also increases the risk of some or all of the product being dissolved in it and sweeped away into the rest of the mouth and/or swallowed. So personally I try to leave it relatively dry under my tongue. Then it takes up to 40 minutes, but in average maybe 25 minutes.

If you mean inside the body, as in, how long it takes to disappear from the blood, its half-life is 12 hours, I think, meaning that after 12 hours, the blood level should be half what it was at its peak, which is why taking HRT 2 or 3 times a day makes sense. Personally I take it twice a day, and I definitely feel the up-and-down effect, some days. So when I get a decent dose (which should coincidentally be divisible by 3), I'll split my daily doses in 3, so I can have something more stable.

Quote from: MaidofOrleans on April 29, 2013, 07:02:37 AM
Hmmm well I tried it and it turned into a blue blob under my tongue. Had to swish some saliva around to break it up. Now i'm all freaking out that I screwed up.

I think i'm extra nervous about it because I switched from another estrogen that was working well and I don't know if it's still working or working better.
Ugh i'm such a wreck with this.

Sloshing it defeats the purpose of sublingual administration. You just have to keep it under the tongue for about 10 minutes. It does turn blobby quick but it does get  in the blood without swallowing it at all.

Quote from: karla.allen on April 25, 2013, 06:08:33 AM
Lifestyle choices played a large part... sedentary, cigarettes... and i'm totally with you and christine on the right choices.  Even moved to a place where we do a lot of gardening, woodcutting... out in the countryside, there's no end to the exercise, fresh organic food...!  :)

What i'm really afraid of is having my parents medical records to explain away.... fear of being turned down for hrt/surgery.  I have bad memories of a quack of a therapist; who, in his professional arrogance, deigned to try cure me (on my nickel). 

I fear 'standards of care' that haven't evolved much since Christine Jorgensen, in which mental health 'professionals' get to act as our gatekeepers.  Makes me feel like a woman's word isn't worth much at all... much less a woman who would want to give up that wonderful life of male privilege and power.

Sorry.  my rant for the day.  When i start hrt will i rant less?  ;)

The absolute contraindications for HRT are cancers that feed on estrogens (unlikely in a MtF person, other than breast cancer) and severe liver damage.

If you have coronary artery disease, or if you have had some sort of thrombosis (blood clot), you may have to have additional drug therapy, such as aspirin or Plavix.