Susan's Place Transgender Resources

Hi everyone,

I posted up some news a few months back about my transitioning. Basically I continued to have serious-feeling medical issues whilst on the usual suite of estradiol / spironolactone / finasteride. The first serious problem was being totally spun out with what I assume to be low bp. I was in a bad way that day and actually nearly had to attend A&E (probably should have). Gradually I tried to re-introduce some finasteride but continued to get migraines: awful flashing lights.

As some of you will know, the above were self-med, internet-sourced. Before I'm told off, I know it was stupid. But I have a lot of difficulties where I've been living in terms of being able to come out.

Now all that is to change and I'm about to move. I travel a lot on extended research for my work and I will be in Thailand in October/ November so I thought the best thing I can do is go and see a really good doctor there who knows what he / she is doing and who will take me on board with proper medical monitoring and medication. I figure that what isn't known about transgender in Thailand probably isn't worth knowing :)

So I was wondering: can anyone recommend someone suitable there?

much love,

Richenda x

Well many consider the best form of application either implants or injections.
With those forms of application one form of hrt is possible where the estro levels are driven well into the female range and the t levels are driven down into the female range as well.
No further anti androgens are needed, which have side effects.

https://www.susans.org/forums/index.php/topic,192044.msg1713877.html#msg1713877
https://www.susans.org/forums/index.php/topic,191591.msg1707924.html#msg1707924

You might look for a reputable doc and talk it all through with them.
Bioidentical progesterone is also available as implants.

There are endos in the us who use implants... if you travel a lot...
in L.A. for example...


hugs

I think there's one or two people here who would know. You could also contact a few of the surgeons there and ask if they can recommend anyone.

They have good surgeons, and anyone can buy HRT without prescription, but I'm not sure its all that great in terms of HRT expertise. I've never heard anything about Thai HRT, not that it means much. I was considering traveling to Thailand myself a year ago for HRT if I had any difficulty here in Australia, but I didn't need to so stopped investigating that line of things.

I'd at least get off the antiandrogens if I were you.

I'm using estrogen implants and spiro. I tried a progesterone implant but it was rejected.  Implants are good for a long time, maybe 6 to 12 months, if you can go back to Thailand that often.

Quote from: AnonyMs on August 03, 2015, 07:37:14 AM
I tried a progesterone implant but it was rejected.

There is literature on that... what I read is it might be rejected if used subcutaneously...
their solution was intramuscular ...
you might talk that through with your endo...


hugs

Quote from: Laura_7 on August 03, 2015, 07:51:01 AM
There is literature on that... what I read is it might be rejected if used subcutaneously...
their solution was intramuscular ...
you might talk that through with your endo...

Thanks, I will. Do you have a reference to the literature?

I think it was in pretty deep, but its worth checking.

Quote from: AnonyMs on August 03, 2015, 08:14:35 AM
Thanks, I will. Do you have a reference to the literature?

I think it was in pretty deep, but its worth checking.

They say its not uncommon it comes out.
The given solution is a trocar and cannula.

books.google.co.nz/books?id=gFc1uHEKxskC&pg=PA279&lpg=PA279&dq=progesterone+pellet+implant+intramuscular

Unfortunately in Thailand and most of Asia outside of Hong Kong and Macau there are few therapists and fewer endocrinologists serving the community. The Thai surgeons are well known and respected but they, as far as I know, do not hormonally reassign, I am unaware of any therapists in Thailand who will assist in social reassignment.

Quote from: Laura_7 on August 03, 2015, 08:19:52 AM

Quote from: AnonyMs on August 03, 2015, 08:14:35 AM
Thanks, I will. Do you have a reference to the literature?

I think it was in pretty deep, but its worth checking.

They say its not uncommon it comes out.
They use a trocar and cannula.

books.google.co.nz/books?id=gFc1uHEKxskC&pg=PA279&lpg=PA279&dq=progesterone+pellet+implant+intramuscular

I'm not in anyway going to reopen the debate on Progesterone, but I have been on E implants for many years. There is no way an implant will come out when performed by an experienced provider. My implants go into my tummy, sometimes I feel they have been put in my backbone! It would seem to be very much up to the experience of the practioner

Quote

Quote from: Cindy on August 03, 2015, 08:30:21 AM
They say its not uncommon it comes out.
They use a trocar and cannula.

books.google.co.nz/books?id=gFc1uHEKxskC&pg=PA279&lpg=PA279&dq=progesterone+pellet+implant+intramuscular

I'm not in anyway going to reopen the debate on Progesterone, but I have been on E implants for many years. There is no way an implant will come out when performed by an experienced provider. My implants go into my tummy, sometimes I feel they have been put in my backbone! It would seem to be very much up to the experience of the practioner

There seems to be an exception with progesterone.
I read a few experiences of extrusion, and the cited reference states its quite often they extrude.

A few pages further they discuss displacement in normal tissue.
It seems where muscular tissue is present the implants much more likely stay in place.


hugs

Quote from: Laura_7 on August 03, 2015, 08:19:52 AM
They say its not uncommon it comes out.
The given solution is a trocar and cannula.

books.google.co.nz/books?id=gFc1uHEKxskC&pg=PA279&lpg=PA279&dq=progesterone+pellet+implant+intramuscular

Thanks. My endo uses a trocar, and I guess a cannula is part it. That paper seems to be from 1952, so it just goes to show how old it all is.

Quote from: Cindy on August 03, 2015, 08:30:21 AM
I'm not in anyway going to reopen the debate on Progesterone, but I have been on E implants for many years. There is no way an implant will come out when performed by an experienced provider. My implants go into my tummy, sometimes I feel they have been put in my backbone! It would seem to be very much up to the experience of the practioner

Dr Hayes told me there was a risk of the progesterone implant being rejected, and the first time I asked about it he didn't want to do it. The rejection rate is around 10% if I recall correctly. He mentioned no such problems with the estrogen implant, and I've not had any. For anyone who doesn't know him, he's hugely experienced in transgender endocrinology and does a lot of implants.

Quote from: AnonyMs on August 03, 2015, 09:32:48 AM
Thanks. My endo uses a trocar, and I guess a cannula is part it. That paper seems to be from 1952, so it just goes to show how old it all is.

Pellets were a very well established form of application until pills were more widespread.
Its an application form where the least amount of applicated material is used.
And it makes for steady doses, which might be better for mood instead of spikes.

You might simply talk intramuscular application through with your endo. Maybe they have access to further literature, or to someone with experience with application. It might also be possible to ask with a compounding pharmacy, where the pellets are from.
There might be different advantageous places.

I like the reference, by the way. Its people citing practical experience.

hugs

Hi Richenda,

I went to Maximum Performance.  Their address is 245/9-10 Moo 9, Central Pattaya, Thailand 20150.  There PH # is (+66) 38-421-996.  Hormones were prescribed by an MD, after they preformed extensive blood tests.  I live in America and I email them regular prescribed blood tests for them to monitor.  We are in regular email and skype contact.  I am happy with there clinic and will continue hormone treatment with them.

Good luck

Sorry for some reason I didn't get notification of replies (must change that) and thought I was being ignored :D (jokes).

Thanks so much for these replies. That place in Pattaya sounds good.

Without crossing topics, I'm not really sure what happened to me except I started feeling pretty ill and one day woke up early with the world working like a tumble dryer and I couldn't stand up. I actually wondered if I was on the way out. It might have been chronic dehydration and / or very low bp, I don't know, but it scared me so much. Perhaps the meds from online were dodgy.

My fear with an implant would be another spell like the above with no recourse or way of getting back on track.

I basically need to get properly screened and blood tested, I know this. I figure for me it might be easier in Thailand although London's another (expensive) option.

Just another big question though. For those of you above who have said they generally only surgically reassign in Thailand, I don't quite follow that? There are loads of katoey (ts) there which is where I'd like to be at I think and presumably they must use something other than just surgical work on breasts / face don't they? They must use hormonal reassignment too?

Thanks everyone. This has been a lifetime's journey in the heart and despite a false start in my teens, it has only been possible this last year to do something about it.

Richenda xx

Quote from: Richenda on August 07, 2015, 07:42:26 AM
Sorry for some reason I didn't get notification of replies (must change that) and thought I was being ignored :D (jokes).

Thanks so much for these replies. That place in Pattaya sounds good.

Without crossing topics, I'm not really sure what happened to me except I started feeling pretty ill and one day woke up early with the world working like a tumble dryer and I couldn't stand up. I actually wondered if I was on the way out. It might have been chronic dehydration and / or very low bp, I don't know, but it scared me so much.

My fear with an implant would be another spell like the above with no recourse or way of getting back on track.

I basically need to get properly screened and blood tested, I know this. I figure for me it might be easier in Thailand although London's another (expensive) option.

Just another big question though. For those of you above who have said they generally only surgically reassign in Thailand, I don't quite follow that? There are loads of katoey (ts) there which is where I'd like to be at I think and presumably they must use something other than just surgical work on breasts / face don't they? They must use hormonal reassignment too?

Thanks everyone. This has been a lifetime's journey in the heart and despite a false start in my teens, it has only been possible this last year to do something about it.

Richenda xx

Another alternative to London might be L.A.
You might look up postings of jennygirl, there is an endo doing implants, without anti androgens.
You can talk about what your expectations are and for example start out slowly. Advantage is no meds are necessary during travel.

Well I'd presume there are people doing kind of a standard hrt in thailand...
imo a good endo can be helpful, having experience with treatments with less side effects and not so standard hrt...
and after all its not exact science but it has to be looked at how people react...
and getting educated yourself might help...


hugs

Thanks so much Laura. I think I have loads more research to do :)

L.A.'s not on my normal circuit but maybe that will change.

I guess the biggest lesson I've learned is to get seen professionally. Unfortunately, everything is available on the internet but not everything is desirable.

Hugs back x

Quote from: Laura_7 on August 03, 2015, 07:51:01 AM
There is literature on that... what I read is it might be rejected if used subcutaneously...
their solution was intramuscular ...
you might talk that through with your endo...

I asked my endo where the implants are placed and he said 2cm deep in fat. The only problem is that he was doing an estrogen implant at the time, and I didn't ask about progesterone implants.

For what its worth, when I did have a progesterone implant it was done in the same site as the estrogen. I'll try to remember better next time.

Quote from: AnonyMs on September 09, 2015, 07:13:51 AM
I asked my endo where the implants are placed and he said 2cm deep in fat. The only problem is that he was doing an estrogen implant at the time, and I didn't ask about progesterone implants.

For what its worth, when I did have a progesterone implant it was done in the same site as the estrogen. I'll try to remember better next time.

The reference also cites displacement in normal tissue. So its possible implants move a bit around.

But especially progesterone implants should be more stabilized in muscular tissue.

You might talk that through with your doc.

The reference also cites using smaller implants but higher numbers to better place them. But with a trocar a good placement should be possible.
Something to talk through with the endo, its possible they are grateful for some tips.

hugs

I was going to discuss it, but these posts where so long ago I forgot about it until I was there, and then I couldn't remember the details. I'll make a note for next time, but its 6 months away.

He does use a number of smaller implants, although this was done due to supply problems with the larger ones.

Quote from: AnonyMs on September 09, 2015, 07:42:28 AM
I was going to discuss it, but these posts where so long ago I forgot about it until I was there, and then I couldn't remember the details. I'll make a note for next time, but its 6 months away.

He does use a number of smaller implants, although this was done due to supply problems with the larger ones.

Well you might also tell them via email... its possible they want to do a little research themselves first... so you could profit from some experience until then  :)

Quote from: Laura_7 on September 09, 2015, 07:45:34 AM
Well you might also tell them via email... its possible they want to do a little research themselves first... so you could profit from some experience until then  :)

Its a good idea, but I'm not really comfortable doing it. He's so incredibly busy if feels like I'd be imposing on him, and I owe him a lot. On the other hand if there's an possibility of having a progesterone implant that doesn't get rejected again that's worth considering and I could schedule an earlier appointment.

Its quite unpleasant when its rejected, so if its even deeper and that happens its not going to be much fun.

Quote from: AnonyMs on September 09, 2015, 10:07:36 AM
Its a good idea, but I'm not really comfortable doing it. He's so incredibly busy if feels like I'd be imposing on him, and I owe him a lot. On the other hand if there's an possibility of having a progesterone implant that doesn't get rejected again that's worth considering and I could schedule an earlier appointment.

Its quite unpleasant when its rejected, so if its even deeper and that happens its not going to be much fun.

Well it could help quite a few people.
If you could mail him a summary and the reference he could look into it.

Well according to the reference an extrusion is not likely.
Since the reference cites having it tested it should work.


hugs

Quote from: Laura_7 on September 09, 2015, 10:16:01 AM
Well it could help quite a few people.
If you could mail him a summary and the reference he could look into it.

Well according to the reference an extrusion is not likely.
Since the reference cites having it tested it should work.

Ok, I'll do it.

Its likely to be in a few weeks.

Quote from: AnonyMs on September 10, 2015, 05:03:50 PM
Ok, I'll do it.

Its likely to be in a few weeks.

Taking bioidentical progesterone as implant has the advantage there are no side effects from capsule materials etc.
And there is no hassle with taking meds daily.


hugs

Quote from: Laura_7 on September 10, 2015, 05:11:43 PM
Taking bioidentical progesterone as implant has the advantage there are no side effects from capsule materials etc.
And there is no hassle with taking meds daily.

Agreed, that's what I was doing. If only it wasn't rejected. I'm back on Microgest again now, but I can't take as much as I should because it makes me too drowsy.

Quote from: AnonyMs on September 10, 2015, 05:57:15 PM
Agreed, that's what I was doing. If only it wasn't rejected. I'm back on Microgest again now, but I can't take as much as I should because it makes me too drowsy.

There are small capsules. You could take one in the morning and one in the evening.

And go to implants eventually  :)

Quote from: Laura_7 on August 03, 2015, 08:19:52 AM
They say its not uncommon it comes out.
The given solution is a trocar and cannula.

books.google.co.nz/books?id=gFc1uHEKxskC&pg=PA279&lpg=PA279&dq=progesterone+pellet+implant+intramuscular

I finally asked my endo about this today. I posted some of my discussion in the following thread, and you can see he's very experienced.

Re: Masculinization after SRS
https://www.susans.org/forums/index.php/topic,207756.msg1843224.html#msg1843224

This bit is about the progesterone implants. He implants them subcutaneously, not intramuscular. The problem with intramuscular is that due to the higher blood flow in muscle vs fat you get a very high peak blood levels and the implant doesn't last very long. Its much slower in fat (and lower peak levels of course). He also mentioned the book was very old and a small study.

Quote from: AnonyMs on April 15, 2016, 12:15:27 AM
I finally asked my endo about this today. I posted some of my discussion in the following thread, and you can see he's very experienced.

Re: Masculinization after SRS
https://www.susans.org/forums/index.php/topic,207756.msg1843224.html#msg1843224

This bit is about the progesterone implants. He implants them subcutaneously, not intramuscular. The problem with intramuscular is that due to the higher blood flow in muscle vs fat you get a very high peak blood levels and the implant doesn't last very long. Its much slower in fat (and lower peak levels of course). He also mentioned the book was very old and a small study.

This is VERY interesting.
Does he have a solution ? He agrees with the author of the book that progesterone implants are prone to extrusion, you mentioned that in another posting and I also know this from another endo.
So his solution would be deep in fat ?


*hugs*

I live in Bangkok and I can provide you with some good endocrinologist names and their hospitals plus therapists who are used to tgs and speak English. I will send you a list by pm.

Quote from: Laura_7 on April 19, 2016, 04:27:17 AM
This is VERY interesting.
Does he have a solution ? He agrees with the author of the book that progesterone implants are prone to extrusion, you mentioned that in another posting and I also know this from another endo.
So his solution would be deep in fat ?

If I remember correctly I got mine about 2cm deep (sounds like a lot of fat if its correct), and it did extrude. I don't think he's got any at the moment, so I can't try it again.