Susan's Place Transgender Resources

Hi everyone,

(MTF)

After being pointed towards looking at HRT implants I've been trawling through this site and the net and wondered if a dedicated new thread to this was possible? I'd also love any useful links people have to this.

Basically I had a lot of problems with side effects from sublingual estradiol + anti androgens. I'm looking to see a specialist to resume medication, which I've had to stop because of the side effects, and I'd like to ask him / her about HRT implants. To do so I need some knowledge! I've got loads of questions, among them:

If you have an implant do you still need anti-androgens?
How long do they last?
Are medical side effects thought to be greater or lesser?
Why don't more MTF's use them? Or do they?

much love and thanks in advance,

Richenda x

Hi Richenda
As someone using estrogen implants I'll try and answer this for you...

If you have an implant do you still need anti-androgens?
As long as you still have testicles producing testosterone, yeah.

How long do they last?
The effect is cumulative and your milage may vary. I get eight to nine months out of mine. Others more, others less.

Are medical side effects thought to be greater or lesser?
Generally less, especially compared to oral. Again, individual variances come into play.

Why don't more MTF's use them? Or do they?
A variety of reasons: cost, the implants need to be made by a compounding chemist as they aren't sold over the counter, they're generally seen as "old" practice (implants actually predate injections), a lot of endos straight out don't know about them, they need to be implanted (local anaesthetic, incision and a couple of stitches) not horrible but some don't like the idea of it.

Any other questions, ask away.

Just an update.

Seemingly Glaxo will be manufacturing implants shortly. But they want to close down compounding chemists to do so.  at least in Australia).

I've been on implants for a bit more than a year and I love them. One thing you might want to consider is that if you have any reaction to them they can be removed, although I don't suppose its very pleasant. My endo says he's never had to do that, and he does a lot of them.

I've had a progesterone implant as well, but that got rejected.

As Grace said you still need antiandrogen's, but I've gone without them before and its not been too bad. At least its a lot better than being off estrogen, which I would have a problem with.

There's been a number of posts on this site about implants, but I imagine you've already found them all. I post about them every opportunity I get!

QuoteIf you have an implant do you still need anti-androgens?

here is further info (also for ftm people, and there was a further thread for ftm people recently):
https://www.susans.org/forums/index.php/topic,192044.msg1713877.html#msg1713877

There is one form of hrt with implants or injections where the estro level is driven well into the female range (over 2-300pg/ml) and the t level driven down into the female range as well, without further anti androgens. You might look up postings of jennygirl, its described there.
Bioidentical progesterone implants or cream might complement that with some slight antiandrogen effects.
Progesterone might help also with breast development and mood and might even out some side effects of estrogen.
Progesterone pellets as exception seem to be more given to extrusion.
Intramuscular application might help here.
https://www.susans.org/forums/index.php/topic,193313.msg1723670.html#msg1723670

QuoteHow long do they last?

bioidentical estrogen implants usually 4-6 months, testo implants 6 months. All depending on individual metabolism.

Usually the implants dissolve on their own. So they might not be dissolved completely after say half a year. With the next implant there might be a cumulative effect, the old one still giving some estro.

QuoteAre medical side effects thought to be greater or lesser?

With bioidentical estro and progesterone lesser because of a minimum of applied material. Other forms of hrt use more material.
Its the closest to having ovaries.
Reported side effects concerning estro by the way often refer to non bioidentical materials.

QuoteWhy don't more MTF's use them? Or do they?

Well.. imo its a subject where the patient has to watch for their best interest.
Imo its one of the best forms of hrt. No hassle, steady doses with less mood swings, few applied material, etc.
Nowadays there are materials to educate docs and endos, so its up to patients to require it.

Quote from: Cindy on August 08, 2015, 05:07:37 AM
Just an update.

Seemingly ... will be manufacturing implants shortly. But they want to close down compounding chemists to do so.  at least in Australia).

Well this might point to non bioidentical materials...
bioidentical materials usually have few side effects and cannot be patented...
well people should be told...
and there are compounding pharmacies that deliver worldwide.

Thanks so much to you all for the above. That's incredibly helpful. I'm going to pursue this with whichever endo I settle upon. It means so much to me to have the support of this place. It can be a lonely journey, especially where I've been living the last year. Thank you :)

p.s. I've tried doing a search for Jennygirl's posts but it tells me I can't do that or something. I'll keep at it!

Richenda x

you can go here:
https://www.susans.org/forums/index.php?action=search;advanced;search=

and enter the user and various keywords in search for...

Thanks Laura. It's not working for me. Maybe I have reduced status or something. Probably about time I made some donations to the site anyway.

If you or the others can be bothered to post a link or two to Jennygirl's posts on this I'd be grateful but only if you have the time. I will work the status / search out.

I'm really interested in pursuing this as I've had to come off oral oestrogen. I wonder if it had to do with the non bioidenticals.

Quote from: Richenda on August 08, 2015, 03:12:20 PM
Thanks Laura. It's not working for me.

Well, it works like this:
https://www.susans.org/forums/index.php?action=search;advanced;search=

By user: *
delete the asterik and write the username you are looking for
Search for:
enter a term like implants

Here is one link:
https://www.susans.org/forums/index.php/topic,131660.msg1047340.html#msg1047340


Non bioidentical could play a role with orals.
Some people use micronized bioidentical estrogen sublingually, which is supposed to be less causing clotting factors because of going around the liver with intake.
And it might be preferable to split a daily dose in for example four small parts instead of two big ones to keep levels more steady, which might affect mood.
Yet with implants, levels are much more steady. And there is no need for daily intake.

Hi Laura,

Guess what? It works ;) I swear it wasn't before, honest :)

I had a lot of probs with a really spun-out spell (you saw my other post I think) so I definitely need to see a proper end but I like the idea of implants for that regulation of dose. I've got to start up again or I'll hit despondency.

thanks again so much x

I'm going to get pasted for this post, like I did last time, but I'll say it anyway.

Implants did not work for me, not at all. It was implanted by a doctor who was well experienced. Thorough investigation revealed no apparent reasons for the lack of efficacy. Short version, I paid the money and ended up with an E level lower than before I started.

Quote from: kelly_aus on August 08, 2015, 06:11:42 PM
I'm going to get pasted for this post, like I did last time, but I'll say it anyway.

Implants did not work for me, not at all. It was implanted by a doctor who was well experienced. Thorough investigation revealed no apparent reasons for the lack of efficacy. Short version, I paid the money and ended up with an E level lower than before I started.

Well imo its not exact science. An endo said so. Endocrinology is adapting to the reactions of patients. Thats why dosage for example might need an adjustment.

Here is an example for something a doctor found which is still useful and not widespread:
https://www.susans.org/forums/index.php/topic,193313.msg1723650.html#msg1723650
They also found that using a few small implants instead a big one can be more effective because of a bigger active surface.

Well if they tried a few things and it did not help the most important thing is there is a form of hrt now which works.

hugs

I've been on estradiol implants for something like 5 years already.

Each implant currently lasts me around a year - I'm a weird one, apparently they usually don't last that long for other people. Even after a year they still are in reasonably average female range.

I must admit it is super comfortable to not have to deal with pills/injections.

Warm welcome to Susan's Attisa

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I am looking to go implants too (soon) for the same reasons Attisa, also to give my organs a rest from orals! (12 years)

Look forward to seeing you about the site

L Katy  :-*

The pellets don't need to be taken out for surgery because they have not been demonstrated to elevate the risk of clotting that oral and injectables have. I still need to stop the antiandrogen but this was important to me to at least maintain the estrogen levels even if I have higher T from stopping the AA.

The surgeon I consulted indicated I'd need to let my implant "run out" before having SRS, that there was still a clotting risk. It would be good to get that confirmed or not. Will talk to my endo in a couple of months.

I think I had the same surgeon as Grace. My implant had to run out. I went nuts. Massive withdrawal as I was steady state.  But he was worried about clotting, to be honest it gave me something to gripe about.

The pain of childbirth is intense. The love you feel for your child overways it.

Welcome to GRS! With less pain.

Quote from: Ms Grace on August 30, 2015, 05:58:42 AM
The surgeon I consulted indicated I'd need to let my implant "run out" before having SRS, that there was still a clotting risk. It would be good to get that confirmed or not. Will talk to my endo in a couple of months.

Most studies are done on external application like oral/sublingual. And even on non bioidentical estrogen.
Internal application is supposed to be much safer.
Pregnant women have estro levels way beyond and still have surgeries.
There are studies showing that risks increase with abrupt changes in levels. Thats different from steady levels also.

They will find rarely a study showing much increased risk with implants and bioidentical estrogen.
Quite a few surgeons consent to this, saying implants are ok. Some even ok patches.


hugs

Quote from: Ms Grace on August 30, 2015, 05:58:42 AM
The surgeon I consulted indicated I'd need to let my implant "run out" before having SRS, that there was still a clotting risk. It would be good to get that confirmed or not. Will talk to my endo in a couple of months.

I don't think it matters much what the endo says, its the surgeon who's refusing. Having said that perhaps if your endo writes a letter saying you're fit for surgery with the implant, which I believe he will do, then the surgeon will be ok with it. Gets him of the hook legally.

If memory serves Dr Hayes said that you should aim to have estrogen blood levels for SRS at the point where you'd normally replace the implant, around 800pmol/L. Dr Hayes has had heaps of patients have SRS with implants in.

If you really have to run it down completely is going to takes absolutely ages, and if you don't want to suffer perhaps you could change over to another form of HRT like injections or transdermal. Its relatively easy to stop those at the last minute.

I sometimes supplement my HRT as the implant is nearing replacement, stopping a week before getting the blood test I get for the next endo appointment. I sometimes don't feel so great near the end. You might want to check with your endo before doing that though.

I have pellets implanted every 10 months.  They are more expensive than pills and shots and my endo takes care of that every . . . well, every ten months.

I switched because they (according to my Dr) are the least problematic delivery system, after implantation (takes about 15-20 minutes) is taken into account.  I have a day of mild, very localized soreness and wear a large bandage for 5 days.  I'm post-op, 11 years, and I really like the pellets. 

Hope that's helpful,

R