Susan's Place Transgender Resources

So I just returned from my endo visit and I am freaking out with what he said.

He says according to my reports, his best judgement is that I need a much lower E dosage (to about 2/3rds my current levels), change my T block from AA to the GnRH method, and introduce progesterone (the good part, about which I am not freaking about)

Now I am really scared about the GnRH, I was doing fine on AA - why change the method now? The endo says my T levels are still a bit high and he is not comfortable with my current E dosage level as it affecting my liver :'( .

So girls please could you help me understand...

1) What is difference between AA and GnRH methods for T blocking?
2) How does GnRH make E more effective that a third of my original dose would be as effective?
3) Will the new method slow my transition or does YMMV matter here as well?
4) Please recount your experiences with GnRH, if you have had that?
5) Should I change my endo? he is really really nice person and highly recognized in the field..

Thank you sooo much .. I am going to keep refreshing this page for answers ... I am so freaking out at this point.. 

1) What is difference between AA and GnRH methods for T blocking?

AA either binds with anrdogen receptors or makes the body believe there is plenty of it. GnRH tells the gonads (either LH or FSH) basically "nothing to see here, move along" and effectively stops their function. GnRH is more effective/safe but a lot more expensive and not all androgen production is blocked (nor conversion of the remaining testosterone to hair killing DHT).

2) How does GnRH make E more effective that a third of my original dose would be as effective?

It would depend on blood levels and gut feel as to how current amounts are working.

3) Will the new method slow my transition or does YMMV matter here as well?

YMMV. a lot of hormone therapy is psychological expectations *because* the changes takes months and the increment often isn't seen by self.

4) Please recount your experiences with GnRH, if you have had that?

I'm at a blank on this one (sorry).

5) Should I change my endo? he is really really nice person and highly recognized in the field..

This would have to be a personal choice. It seems that he wants to put your health first but simply saying that estrogen is affecting liver without (blood) labs numbers (indicating a level of dysfunction) isn't really saying much.

If he is highly recognised in his field that should be a good sign he at least knows what he is talking about. If you're concerned it doesn't hurt to get a second medical opinion, no need to bail on him until then.

Quote from: ssneha23 on October 03, 2014, 09:24:18 PM
he is not comfortable with my current E dosage level as it affecting my liver :'( .

Have your liver values been checked out and are they above normal values? I'm assuming you are taking bio-identical estradiol and if so, you can ask why your doctor is so concerned about your liver if pregnant women experience levels up to 75,000 pg/ml (up to 640 during menstrual cycle) and yet do not seem do have an increased incidence of liver complications. Liver complications are more typically observed with non bio-identical forms of estrogen. If you really want to remain on the safe side, it's best usually to take estradiol non-orally. Discussion with your doctor about these matters is imperative. You need to be on the same page, otherwise find someone else.

QuoteWhat is difference between AA and GnRH methods for T blocking?

Some AAs only block androgen from binding to receptors, others block AND reduce production of androgen while GnRh only reduce production of androgen from testicles. GnRh also tend to increase production of androgen for the first 2-3 weeks after which production ceases.

QuoteHow does GnRH make E more effective that a third of my original dose would be as effective?

If androgen is more strongly inhibited by GnRh as compared to the AA you were taking and even then, who knows if really 1/3 of E dose would be as effective? Time would reveal the answer.

QuoteWill the new method slow my transition or does YMMV matter here as well?

Time will tell.

p.s. : regarding progesterone, be sure that bio-identical progesterone is prescribed and not any other form, especially medroxyprogesterone acetate (Provera, Depo-Provera) as this tends to be associated with negative side-effects not observed or observed to a much lesser extent with bio-identical progesterone.

Good luck. :) I'm not a doctor but you can bring up these issues with your doctor and see what they say.

Quote from: Flan on October 03, 2014, 09:51:22 PM
AA either binds with anrdogen receptors or makes the body believe there is plenty of it.

Pure androgen blockers such as flutamide or bicalutamide actually tend to make the body think not enough androgen is being produced and, as a result, androgen production is INCREASED. Since androgen is blocked though, the excess androgen is converted to estrogen increasing levels of estrogen and feminization. These blockers, by binding to androgen receptors, prevent actual androgen from binding to androgen receptors. :)

Quote
GnRH tells the gonads (either LH or FSH) basically "nothing to see here, move along" and effectively stops their function.

GnRh overstimulates pituitary gland so that LH and FSH are increased initially but this overstimulation eventually leads to desensitization where LH and FSH production end up being abolished, leading to a marked decreased in testicular production of androgen and sperm.

Quote
GnRH is more effective/safe but a lot more expensive and not all androgen production is blocked (nor conversion of the remaining testosterone to hair killing DHT).

GnRh only reduces testicular production of androgen. Adrenal production of androgen, although weak and quite insignificant persists.

I presume I am on GnHR as I'm on injectable anti androgen called prostap
Basically my gender therapist told me it's safer, less harmful than lets say spironolactone which is a generic tst blocker, it stops the t production at its very beginning

How do I feel? Calmer, sex drive very low, less erections but still some, acne seems to be going away, I just feel calmer and less sex-driven :)

Quote from: ssneha23 on October 03, 2014, 09:24:18 PM
So I just returned from my endo visit and I am freaking out with what he said.

He says according to my reports, his best judgement is that I need a much lower E dosage (to about 2/3rds my current levels), change my T block from AA to the GnRH method, and introduce progesterone (the good part, about which I am not freaking about)

Now I am really scared about the GnRH, I was doing fine on AA - why change the method now? The endo says my T levels are still a bit high and he is not comfortable with my current E dosage level as it affecting my liver :'( .

So girls please could you help me understand...

1) What is difference between AA and GnRH methods for T blocking?
2) How does GnRH make E more effective that a third of my original dose would be as effective?
3) Will the new method slow my transition or does YMMV matter here as well?
4) Please recount your experiences with GnRH, if you have had that?
5) Should I change my endo? he is really really nice person and highly recognized in the field..

Thank you sooo much .. I am going to keep refreshing this page for answers ... I am so freaking out at this point..

GnRH is quiet effective but always used in conjunction with AA and E. GnRH is not widely used because it is expensive (~400 $ a month) and it dosage has to be monitored more closely.

I f your health insurances covers it or if your pocket can afford it I will take in a beat

Do not freak out ! enjoy the the journey

Thank you so much for your replies. So here is an update. I had a word with my endo and got my blood work result for LFT and kidneys. Both my organs are doing perfect.

So on the GnRH.. I so cannot afford it right now and I mentioned that to my doctor. He was very understanding and reluctantly agreed that I could continue Spiro for AA. He did reduce my E dose by about a third - Given my progress I am fine with that lower dose. However, the doctor did add progesterone to the mix to compensate for the lower E dose. For progesterone he prescribed a low dose of the naturalized version to be taken daily. I asked my doctor if I needed to cycle P. He said he had bad experiences with cycling and mentioned that a daily low dose would produce the same effect as a cycled high dose.

I have been with the doctor for like 2 years now and I  trust him. Its just his sudden decision to change prescriptions caught me off guard.

And one last thing, my endo did ask me to consider getting my orchi done. I am not sure I want that yet....

Orchi can affect your SRS outcome, keep that in mind, good luck!