Susan's Place Transgender Resources

Hello, frequent lurker, now forced to interact!

As mentioned in the title I have been off hormones for ~4 years and I am post-op. I thought I was doing my body a favor by weaning myself off my hormones, but, I think it is effecting my health. I have now been prescribed oral estradiol in hope of improving my symptoms.

I am 30 and exercise daily (despite fatigue) and eat an diet close to "Paleo". I avoid processed food, sugar, caffeine and alcohol at all times.

I am extremley worried that I have done permanent damage to my body. I have frequent heart palpitations (have had fits of tachycardia), Anhedonia, Weakness, Lack of Motivation, Brain Fog, Insomnia, Fatigue, Food allergies, Random pain, tingling and I think a sensitivity to sugar.

I am in the process of being tested by my doctor/endo for a number of problems, but this is taking forever to arrange appointments here in Canada.

Should I be worried? Have I done permanent Damage to my body by not having proper levels of sex hormones in my body? I am extremely worried after reading multiple sources commenting on adrenal burnout and shredding arteries and all sorts of other scary things.


I have been on my hormones again [doses not permitted under TOS] estradiol oral for 2 days. I do not feel much different, perhaps a little more tired. Will this possibly reverse my symptoms? or is it too late? I feel so stupid. Any free advice?

Thanks in advance!

Your doc can tell you that but I think damage is usually to your bones eg osteoperosis. You should be evaluated for that.

Your other symptoms could be caused by anything to be honest but only a doctor can tell you for sure.

Fatigue could be low testosterone, which is easily fixed.

I've had some very odd problems from low vitamin D, and I think its quite common. It sounds similar to some of yours. I don't get out in the sun much. Vitamin D3 supplements fixed that really fast.

Search the forums for osteoporosis as its been discussed here before. Try typing this in google (or use the forums search tool, but I never have much luck with that)

    site:susans.org osteoporosis

I'd be looking for an endocrinologist rather than a GP. Much better when you have difficulty.

You have made the mistake of not listening to the advice of a good doctor.

Do not make the same mistake again now.

The body renews itself every 7 years.

Real longterm stuff should be very rare.

You might simply eat healthy, do some moderate exercises like walking regularly and have a healthy lifestyle.

Stressing now is counterproductive.
Try to relax, and keep to a mental picture of things being all right in the future.
This helps much with healing and a feeling of well being.
Just trust it will be all right.

As an aside, eunuchs in the past were often reported to be healthy even in a higher age.

Just do what makes sense now... for example a low dose of estro...

and as someone said... there are tests for bone density...
remedies would be certain vitamins and supplements...


hugs

All the symptoms you described (including fatigue) plus others like accelerated ageing, increasing risk of coronary heart problems, increasing risk of Alzheimer's, bone loss, insulin resistance are usually a result of lack of estrogen. Some do not absorb estrogen well orally and it might reduce testosterone too much due to potent stimulation of SHBG. So, sometimes, non-oral is preferred, like gel, patches, pellets or injectables. Some need significant doses to see a difference in symptoms, some need less, it depends and this should be determined by a competent doctor, whether GP, endo or gynecologist. BTW, I live in Canada too. :)

Having no sex hormones in the body is usually harmful for the body, they do many useful things. In my opinion (I'm not a doctor) they are more beneficial than harmful as long as bio-identical hormones are used.

Best of luck. :)

Welcome to Susan's Place. What you are feeling may have many causes and are most likely was not caused by the lack of hormones. I have been off all hormones for about 10 years because of the amount of time I was on them and I haven't felt any ill effects. To avoid bone damage I take half my requirement for calcium in tablet form and drink about 2 cups of milk a day. This also requires vitamin D which you get in the milk, supplement or sun exposure. By all means, see a doctor and get a proper diagnosis but I suspect the lack of hormones are not the cause.

We issue to all new members the following links so you will best be able to use the web site.

Site Terms of Service & Rules to Live By (https://www.susans.org/forums/index.php/topic,2.0.html)	Standard Terms & Definitions (https://www.susans.org/forums/index.php/topic,54369.0.html)	Post Ranks (including when you can upload an avatar) (https://www.susans.org/forums/index.php/topic,114.0.html.)
Reputation rules (https://www.susans.org/forums/index.php/topic,18960.0.html)	News posting & quoting guidelines (https://www.susans.org/forums/index.php/topic,174951.0.html)	Photo, avatars, & signature images policy (https://www.susans.org/forums/index.php/topic,59974.msg383866.html#msg383866)

Quote from: AnonyMs on December 02, 2015, 11:43:48 AM
Fatigue could be low testosterone, which is easily fixed.

I've had some very odd problems from low vitamin D, and I think its quite common. It sounds similar to some of yours. I don't get out in the sun much. Vitamin D3 supplements fixed that really fast.

Search the forums for osteoporosis as its been discussed here before. Try typing this in google (or use the forums search tool, but I never have much luck with that)

    site:susans.org osteoporosis

I'd be looking for an endocrinologist rather than a GP. Much better when you have difficulty.

I will see about taking a low dose of testosterone when I can finally visit my endo. Thanks!

Quote from: Laura_7 on December 02, 2015, 01:17:03 PM
The body renews itself every 7 years.

Real longterm stuff should be very rare.

You might simply eat healthy, do some moderate exercises like walking regularly and have a healthy lifestyle.

Stressing now is counterproductive.
Try to relax, and keep to a mental picture of things being all right in the future.
This helps much with healing and a feeling of well being.
Just trust it will be all right.

As an aside, eunuchs in the past were often reported to be healthy even in a higher age.

Just do what makes sense now... for example a low dose of estro...

and as someone said... there are tests for bone density...
remedies would be certain vitamins and supplements...


hugs

Thanks, you have eased my mind a bit (especially with the eunuch comment). I probably do just need to chill out and just take my hormones! :)

I do already eat a super healthful diet and take vitamin D in winter.

Quote from: KayXo on December 02, 2015, 01:25:40 PM
All the symptoms you described (including fatigue) plus others like accelerated ageing, increasing risk of coronary heart problems, increasing risk of Alzheimer's, bone loss, insulin resistance are usually a result of lack of estrogen. Some do not absorb estrogen well orally and it might reduce testosterone too much due to potent stimulation of SHBG. So, sometimes, non-oral is preferred, like gel, patches, pellets or injectables. Some need significant doses to see a difference in symptoms, some need less, it depends and this should be determined by a competent doctor, whether GP, endo or gynecologist. BTW, I live in Canada too. :)

Having no sex hormones in the body is usually harmful for the body, they do many useful things. In my opinion (I'm not a doctor) they are more beneficial than harmful as long as bio-identical hormones are used.


Best of luck. :)

Now the question is, was my estrogen so low during this many year time period that I am actually suffering from these problems?

Yes it is hard to find a competent doctor in a Timely fashion in rural Canada. my family doc is the best I have and I have lost touch with my endo. I really hope she can fit me in soon!

Quote from: Dena on December 02, 2015, 02:55:45 PM
Welcome to Susan's Place. What you are feeling may have many causes and are most likely was not caused by the lack of hormones. I have been off all hormones for about 10 years because of the amount of time I was on them and I haven't felt any ill effects. To avoid bone damage I take half my requirement for calcium in tablet form and drink about 2 cups of milk a day. This also requires vitamin D which you get in the milk, supplement or sun exposure. By all means, see a doctor and get a proper diagnosis but I suspect the lack of hormones are not the cause.

We issue to all new members the following links so you will best be able to use the web site.

Things that you should read

I thought I wasn't having ill effects until my heart started flipfloping in my chest and my fatigue became debilitating :( But maybe they have to do with another issue, that is true.

So, you have no hormones and post op? So you don't even feel anhedonic? I have had such trouble feeling much satisfaction or positive emotion for the last few years.

Site Terms of Service & Rules to Live By (https://www.susans.org/forums/index.php/topic,2.0.html)	Standard Terms & Definitions (https://www.susans.org/forums/index.php/topic,54369.0.html)	Post Ranks (including when you can upload an avatar) (https://www.susans.org/forums/index.php/topic,114.0.html.)
Reputation rules (https://www.susans.org/forums/index.php/topic,18960.0.html)	News posting & quoting guidelines (https://www.susans.org/forums/index.php/topic,174951.0.html)	Photo, avatars, & signature images policy (https://www.susans.org/forums/index.php/topic,59974.msg383866.html#msg383866)

QuoteSo, you have no hormones and post op? So you don't even feel anhedonic? I have had such trouble feeling much satisfaction or positive emotion for the last few years.

You might look for an endo or gyn and have your levels adjusted...

here was a similar thread:
https://www.susans.org/forums/index.php/topic,200048.msg1778991.html#msg1778991


hugs

Emotionally I enjoy life just as much as before. If you are having motivation issues, it could be two things. The first it is could be some other health issue. The second is post surgical let down. I had a new life to live after surgery and I am still working on adding interest to my life. Sometimes people think the new life will be handed to them after surgery but it's not the case. You have to work on the new life post surgical just like you worked on the transition. One of the reason I am on this site is to add meaning to my life. I enjoy helping others and I think this is the best way to use my talents.

For you it could be charity, finding a new life partners or maybe sharing more with family and friends. What each person wants out of life is different so the question is what type of life do you want to live?

Quote from: Dena on December 02, 2015, 05:30:26 PM
Emotionally I enjoy life just as much as before. If you are having motivation issues, it could be two things. The first it is could be some other health issue. The second is post surgical let down. I had a new life to live after surgery and I am still working on adding interest to my life. Sometimes people think the new life will be handed to them after surgery but it's not the case. You have to work on the new life post surgical just like you worked on the transition. One of the reason I am on this site is to add meaning to my life. I enjoy helping others and I think this is the best way to use my talents.

For you it could be charity, finding a new life partners or maybe sharing more with family and friends. What each person wants out of life is different so the question is what type of life do you want to live?

Good points...

another one might simply be testo levels... if testo levels are quite low there might be few overall drive...
and higher estro might make for a more emotional setup...


hugs

Quote from: Turnip on December 02, 2015, 05:06:53 PM
Now the question is, was my estrogen so low during this many year time period that I am actually suffering from these problems?

Post-op, you don't have any gonads and your only source of sex hormones is adrenal glands so levels of testosterone and estradiol will be undoubtedly low.

The heart palpitations and fatigue went away in my case when I upped my hormones and actually added progesterone. But, to each their own. ;)

Quote from: Dena on December 02, 2015, 05:30:26 PM
The first it is could be some other health issue.

It could be or it could be the lack of hormones. A competent doctor will determine this. Do you dismiss entirely the importance of sex hormones and their effects on motivation, energy, emotions because it appears studies have shown their crucial role and I can attest to this, based on my own experience.

QuoteThe second is post surgical let down.

She is 4 yrs post-op. That is quite a long time.

Quotethe question is what type of life do you want to live?

I agree that there may be a psychological component to this but hormones also affect psyche so maybe a team composed of a competent doctor, psychologist may help decipher the mystery. It is important to consider (and work on) all dimensions and not dismiss any of them. Agreed. :)

Quote from: Laura_7 on December 02, 2015, 05:35:43 PM
another one might simply be testo levels... if testo levels are quite low there might be few overall drive...
and higher estro might make for a more emotional setup...

I personally would consider testosterone to be last resort as its side-effects can be devastating including lowering voice, even at 30, increasing facial/body hair, making one look more masculine, worsening scalp hair, producing acne. Some changes, such as voice lowering, are irreversible, others like facial hair might require additional investment into laser treatment and electrolysis. Acne could cause permanent scars. Each person responds differently to testosterone, some might be more sensitive...it's a BIG gamble, in my opinion.

Estrogen and possibly progesterone should first be looked into, I think...BUT, I'm not a doctor, it's up to your doctors to determine this. Just my 2 cents. :)

Sorry as a newbie I can't figure out how to add multiple quotes aside from copying and pasting the shortcode so i will reply to the specific points without :) I am glad you all care so much and appreciate your input :) You seem like lovley ladies, too bad we can't go out for coffee some time (although I can't do that anymore with my darn PVCs)

I think you are both making good points. To me it come down to 3 possibilities: Hormone, Psychological, or other issues.

Hormones seem the most likely (Kay seems to agree also). I see myself as very healthy psychologically. I have a great outlook on life and am happy with my situation. I just have been feeling emotionally blunted.

Health wise I treat my body very well (as I said plenty of exercise and paleo diet) and by all appearances I am in tip-top condition. I just feel weak and unmotivated inside. I may actually be a little bit to lean. I have lost a lot of weight in the last year (I used to have a solid muscular build) and I eat a tonne of food per day.

Anyhow, I hope you all can excuse my for talking about myself so much, but I am quite concerned. I really hope it is the hormones and not some other issues. Last night I had some PVCs, anxiety and tiredness, but i think overall I feel more calm and less brain fog since starting my estrace again.

I have been in touch with the endo too, I think I may be able to get an apointment soon.

Quote from: KayXo on December 02, 2015, 08:38:17 PM

I personally would consider testosterone to be last resort as its side-effects can be devastating including lowering voice, even at 30, increasing facial/body hair, making one look more masculine, worsening scalp hair, producing acne. Some changes, such as voice lowering, are irreversible, others like facial hair might require additional investment into laser treatment and electrolysis. Acne could cause permanent scars. Each person responds differently to testosterone, some might be more sensitive...it's a BIG gamble, in my opinion.

Estrogen and possibly progesterone should first be looked into, I think...BUT, I'm not a doctor, it's up to your doctors to determine this. Just my 2 cents. :)

I am worried about the same. I already have acne scars though... so that wouldn't make a difference to me lol. I am actually considerably less vain than I was a while ago, and while these side effects would bother me, my physical well being and motivation is more important to me now i guess. (also here is a TMI but I have 0 sexual satisfaction and I also feel T would help in that regard).

I'll talk to my endo and see what she thinks. I'm sure she will find that I have abnormally low testosterone. I will think about this long and hard though don't worry :)

Quote from: Dena on December 02, 2015, 05:30:26 PM
One of the reason I am on this site is to add meaning to my life. I enjoy helping others and I think this is the best way to use my talents.

:) You are a good person.

Ok so just talked to my old endo... I can't get in with he for another year! GAH. I have no idea what to do now. hopefully my GP can give me the necessary tests (he really does not place much importance on my hormone levels)

Americans, I have a question (and excuse my ignorance about your medical system there). Is there a way I could just pay to get immediate care from an endocrinologist in  your country? or does it still take forever to go through a referral process and all that. I know it would be expensive, but I am willing to give up a few vacations to find out what the heck is wrong with me asap.

Calcium doesn't actually increase bone density... muscle mass does. Bones have to be able to withstand your muscles without snapping. Bone density is always proportional to muscle torque. Older people don't get less dense bones because they all start neglecting calcium, they get frail bones because of muscle deterioration.

Testosterone doesn't actually increase muscle mass, per se, what it does is stimulate the release of growth hormones, which is what increases muscle mass, but estrogen also promotes the release of growth hormones, which is vital to muscle development. Without either hormone, less growth hormone is released, and muscle is lost, and by extension bone density.

Quote from: Turnip on December 03, 2015, 07:22:45 AM
I just feel weak and unmotivated inside. I may actually be a little bit to lean. I have lost a lot of weight in the last year (I used to have a solid muscular build) and I eat a tonne of food per day.

This was exactly my situation when my hormones were low. As soon as I increased dose, later added progesterone, I felt energetic, started to feel happier, gained weight (my face was quite sunken, it filled up), butt came back to life and I looked younger than ever. Skin and hair were also more shiny, less dry, digestion improved, allergies (i.e. hives) significantly decreased. Not perfect but MUCH better. :)

Quote from: Turnip on December 03, 2015, 07:34:43 AM
also here is a TMI but I have 0 sexual satisfaction and I also feel T would help in that regard).

You'd be surprised what estrogen or progesterone, depending on the person, can do to libido. It's a mental thing too. Progesterone improves libido in some women while enough estrogen in others suffices. Again, in this regards, I really think T is not necessary.

QuoteI'm sure she will find that I have abnormally low testosterone. I will think about this long and hard though don't worry :)

Like I said, try E (an adequate dose) and possibly P if libido is still inexistent...if really, things don't improve at all, T, it is! It will be quite low, usually in the lower end of female range because you only have adrenal glands for testosterone while ciswomen also have ovaries.

Quote from: Turnip on December 03, 2015, 08:13:45 AM
hopefully my GP can give me the necessary tests (he really does not place much importance on my hormone levels

My doctors also don't think hormone levels are important. I agree. Your T will be low, for sure, anyways.

You simply need to find the right dose of E (perhaps non-orally) AND maybe progesterone FOR YOU, where you feel good, motivated, energetic, positive, have libido and your body responds appropriately.

Quote from: Elsa Delyth on December 03, 2015, 08:35:46 AM
Calcium doesn't actually increase bone density... muscle mass does. Bones have to be able to withstand your muscles without snapping. Bone density is always proportional to muscle torque. Older people don't get less dense bones because they all start neglecting calcium, they get frail bones because of muscle deterioration.

Testosterone doesn't actually increase muscle mass, per se, what it does is stimulate the release of growth hormones, which is what increases muscle mass, but estrogen also promotes the release of growth hormones, which is vital to muscle development. Without either hormone, less growth hormone is released, and muscle is lost, and by extension bone density.

Estrogen prevents bone loss by inhibiting bone resorption, the process by which osteoclasts break down and contribute to bone loss. Both men and women suffer from osteoporosis (more women because their bone density is lower and their earlier decline in estrogen) because of lower estrogen; men get estrogen through aromatase, where testosterone is converted to estradiol, for instance.

Of course, working out your muscles helps with this, as well, keeping active. But, most important, is your estrogen. I have high estrogen and my muscle mass (and strength) has greatly diminished over the years.

There are also all kinds of medications for prevention of bone loss given to mostly women after menopause but they usually come with side-effects. :(

I didn't know that estrogen did that. It lowers the threshold of muscle torque to bone density proportions, so that women get higher bone density proportional to the same levels of muscle mass comparatively to men. So that, when women loss estrogen they loss the extra bone density, as the threshold proportional to muscle torque is increased.

That's interesting. Though, it just adds a dimension to what I said, rather than disagrees with it.

http://www.ncbi.nlm.nih.gov/pubmed/9437507

Quote from: KayXo on December 02, 2015, 08:38:17 PM

I personally would consider testosterone to be last resort as its side-effects can be devastating including lowering voice, even at 30, increasing facial/body hair, making one look more masculine, worsening scalp hair, producing acne. Some changes, such as voice lowering, are irreversible, others like facial hair might require additional investment into laser treatment and electrolysis. Acne could cause permanent scars. Each person responds differently to testosterone, some might be more sensitive...it's a BIG gamble, in my opinion.

Estrogen and possibly progesterone should first be looked into, I think...BUT, I'm not a doctor, it's up to your doctors to determine this. Just my 2 cents. :)

Yes of course first estrogen and progesterone...

but testo is also part of the package...
testo in the normal female range, below 60...
cis women usually don't have big effects of masculinization from this, apart from possibly thicker hair...


hugs

You know what else increases bone density? Kitten purrs. It's true! You could always just get fifty fur babies and roll in them!

Quote from: Elsa Delyth on December 03, 2015, 02:48:42 PM
You know what else increases bone density? Kitten purrs. It's true! You could always just get fifty fur babies and roll in them!

Their purr has healing properties...
and its very relaxing  :)


hugs

Quote from: Elsa Delyth on December 03, 2015, 08:35:46 AM
Calcium doesn't actually increase bone density... muscle mass does. Bones have to be able to withstand your muscles without snapping. Bone density is always proportional to muscle torque. Older people don't get less dense bones because they all start neglecting calcium, they get frail bones because of muscle deterioration.

Testosterone doesn't actually increase muscle mass, per se, what it does is stimulate the release of growth hormones, which is what increases muscle mass, but estrogen also promotes the release of growth hormones, which is vital to muscle development. Without either hormone, less growth hormone is released, and muscle is lost, and by extension bone density.

I agree that calcium may not increase bone density but it can prevent the loss of bone density. There are teens with frail bone because they live on soft drinks and get little sun exposure. The body need calcium and if there isn't enough, it will withdraw it from the bank of bones. I take sufficient calcium in my diet so my body doesn't need to draw it from my bones and I move around enough to hopefully maintain bone density.

Quote from: Laura_7 on December 03, 2015, 02:29:06 PM
but testo is also part of the package...
testo in the normal female range, below 60...
cis women usually don't have big effects of masculinization from this, apart from possibly thicker hair...

but ciswomen weren't exposed to high levels of testosterone for several years like us and didn't develop as men physically, our situation is quite different. It will depend on the person as well, their sensitivity but we are especially vulnerable to any sign of virilization and imagine for a moment, that our voice deepens...I personally wouldn't take that risk. Blending in with the rest of the population is important for me and there is no voice surgery at the present time to reverse this (i.e. resonance) succesfully and without risks. Too much of a gamble. Imagine suddenly losing head hair, having acne that leaves scars, being suddenly perceived as male by others after several years of passing as a woman, seeing yourself look more masculine, having to manage hair growth more intensively...anyways, personally, LAST RESORT.

Quote from: Dena on December 03, 2015, 10:00:35 PM
I agree that calcium may not increase bone density but it can prevent the loss of bone density. There are teens with frail bone because they live on soft drinks and get little sun exposure. The body need calcium and if there isn't enough, it will withdraw it from the bank of bones. I take sufficient calcium in my diet so my body doesn't need to draw it from my bones and I move around enough to hopefully maintain bone density.

But you are already losing calcium from your bones due to lack of estrogen inhibiting bone loss so increased calcium is being broken down and transferred to blood. So really, by taking additonal calcium, you are essentially overdosing your body on this mineral and this may cause damage to other tissues in the long-term. I personally don't think it's wise. There is really nothing that can substitute the loss of estrogen.

Quote from: Turnip on December 03, 2015, 08:13:45 AM
Ok so just talked to my old endo... I can't get in with he for another year! GAH. I have no idea what to do now. hopefully my GP can give me the necessary tests (he really does not place much importance on my hormone levels)

Americans, I have a question (and excuse my ignorance about your medical system there). Is there a way I could just pay to get immediate care from an endocrinologist in  your country? or does it still take forever to go through a referral process and all that. I know it would be expensive, but I am willing to give up a few vacations to find out what the heck is wrong with me asap.

People who come to the United States are pretty common. Often people will come down from Canada because the time to get care is longer than they want to wait. The Phoenix area has several world class hospitals if you wish to escape the cold weather but the east cost hospitals are equally able to address your needs.

Quote from: KayXo on December 03, 2015, 10:11:43 PM
But you are already losing calcium from your bones due to lack of estrogen inhibiting bone loss so increased calcium is being broken down and transferred to blood. In essence, by taking calcium, you are overdosing your body on calcium and this may cause damage to other tissues in the long-term. I personally don't think it's wise. There is really nothing that can substitute the loss of estrogen.

Consider what you said. Children who haven't hit puberty are incapable of building bones because they lack the sex hormones to do so. Every menopause woman will have bone failure because they no longer produce estrogen.

I am not overdosing because with all diet sources included, my intake would be 1.5 to 2 time the minimum dose. I make sure I get at least the minimum intake of calcium and the rest comes from the part of my diet I don't count.

There is a trade off with estrogen where the risk of breast cancer goes up with long term exposure. I started estrogen at age 26 so that meant about age 50-55 I hit the normal feminine exposure. I need to be very careful with estrogen from now on because would rather not have to deal with cancer.

Quote from: Dena on December 03, 2015, 10:22:09 PM
Consider what you said. Children who haven't hit puberty are incapable of building bones because they lack the sex hormones to do so.

In children and adolescents, growth hormone levels are very high and they grow. Children build bone, form new bone, get bone growth, that is why they grow.

QuoteEvery menopause woman will have bone failure because they no longer produce estrogen.

The loss of estrogen after menopause increases the risk of osteporosis and this can sometimes have fatal consequences for them.

QuoteThere is a trade off with estrogen where the risk of breast cancer goes up with long term exposure.

Consider the following:

- breast cancer most often occurs in older women after the age of 40 and mostly after 50, when estrogen levels DROP
- in the WHI trial (randomized controlled) and a long-term Danish study (randomized controlled trial), estrogen alone, whether bio-identical or not reduced significantly and not significantly breast cancer. In both cases, a reduction, not an increase in breast cancers.
- it has been observed in ciswomen that the more births, the less risk of breast cancer. More births mean more time spent in pregnancy when estradiol levels are VERY high. In contrast to nuns who traditionally have a higher risk and never become pregnant.
- breast cancer risk has been deemed by one of the leading transgender experts (Gooren, Netherlands) to be insignificant in transsexual women and equal to that of men not ever exposed to exogenous estradiol. He has studied several thousands of transsexuals over the years (decades) and only observed a couple of cases recently. Only a handful of cases reported in the literature in the transsexual population since the treatment began. Thus, this risk is extremely rare in our population.
- Harry Benjamin, in his book, noted no breast cancer occurrences in his transsexual patients despite VERY aggressive doses, unheard of today. Also, his colleage, a urologist, treated several thousand men with prostate cancer with even more aggressive doses and never noted breast cancer.

So, it seems to me, from all this, that the risk is extremely low, insignificant and that estrogen could in fact be protective. Studies have been even undertaken to see whether women with past breast cancer taking estrogen would have increased recurrence as compared to those not taking anything and it was found that this was NOT the case.

The only times HRT was found to increase breast cancer risk was when Provera was prescribed, possibly because of its effects on insulin-growth hormone.

Taking estrogen, considering all this, seems more beneficial than harmful.

QuoteI started estrogen at age 26 so that meant about age 50-55 I hit the normal feminine exposure. I need to be very careful with estrogen from now on because would rather not have to deal with cancer.

This is the time when women have the highest risk of breast cancer, when estrogen ceases so I would be worried instead of being relieved...I wouldn't want to replicate ciswomens' situation, instead it seems transsexual women, despite the fact of being exposed to estrogen for a lifetime, have a VERY low incidence.

Quote from: KayXo on December 03, 2015, 10:11:43 PM
but ciswomen weren't exposed to high levels of testosterone for several years like us and didn't develop as men physically, our situation is quite different. It will depend on the person as well, their sensitivity but we are especially vulnerable to any sign of virilization and imagine for a moment, that our voice deepens...I personally wouldn't take that risk. Blending in with the rest of the population is important for me and there is no voice surgery at the present time to reverse this (i.e. resonance) succesfully and without risks. Too much of a gamble. Imagine suddenly losing head hair, having acne that leaves scars, being suddenly perceived as male by others after several years of passing as a woman, seeing yourself look more masculine, having to manage hair growth more intensively...anyways, personally, LAST RESORT.

TOTAL TESTOSTERONE LEVELS
                  ng/dl     ng/ml
  Females  6 - 86  0.1 - 1.2
  Males  270 - 1100  2.4 - 12

Imo this is also a matter of having a look at the whole package.
If estrogen levels are well in the female range and bioidentical progesterone is present which has some anti androgen properties and the level of t is well in the female range, below 60, there should be few side effects. If there are any doses might be lowered.
Its simply a fact that cis women also have a certain level of testosterone and that it has effects on orgasmic abilities and overall drive.
The female range should be wide enough to find a good compromise.
Having levels of nearly zero are not really beneficial imo.

Quote
Taking estrogen, considering all this, seems more beneficial than harmful.

I would like to add that additional risks come imo from bras.
There are studies showing that bras can have a negative effect on breast health.
Supporting tissue gets weaker, and blood flow might be restricted. Its like wearing tight jeans which also is not recommended.

Remedies could be getting rid of a bra as soon as being home, wearing alternatives like not too tight tube bras or a few tops and regular breast massage, maybe twice a day, to help with blood flow.
There are trans people who tried the breast massage and also said it helped with growth on forums. Possibly by stimulating blood flow and estro receptors. There was a vid on youtube where a trans women showed some massage techniques, it very obviously helped in her case.
In Asia its a well known recipe for adolescent women.


hugs

Quote from: Laura_7 on December 04, 2015, 05:28:25 AM
bioidentical progesterone is present which has some anti androgen properties

The study you provided to show that progesterone inhibits DHT is far from conclusive, for the reasons I explained.

Quoteand the level of t is well in the female range, below 60, there should be few side effects.

"should be" BUT what if voice suddenly lowers and you are stuck with that? Would it really be worth it?

QuoteIf there are any doses might be lowered.

Too late in the case of voice lowering or even facial hair growth that now has to be treated. Even if the odds are low, I wouldn't do it.

QuoteIts simply a fact that cis women also have a certain level of testosterone and that it has effects on orgasmic abilities and overall drive.

I am only on estrogen and progesterone. I definitely have orgasmic abilities and have actually always had them, regardless if I was taking progesterone or not or whether my estrogen was high or low. The only difference is when my hormones got higher, the inside of my vagina was more elastic and not dry anymore. :) As to overall drive, I certainly don't lack that. I'm sure plenty of post-op women can attest to this as well without the need for testosterone. My T levels are around 20 ng/dl, quite low.

In the end, it's a personal choice dictated also by one's doctor's position on the matter. I wouldn't but to each their own.

Quote from: Turnip on December 03, 2015, 08:13:45 AM
Americans, I have a question (and excuse my ignorance about your medical system there). Is there a way I could just pay to get immediate care from an endocrinologist in  your country? or does it still take forever to go through a referral process and all that. I know it would be expensive, but I am willing to give up a few vacations to find out what the heck is wrong with me asap.

Not at all. We don't have a nationalized healthcare system (except if you're elderly or a military veteran) so there really is no long waiting list for care.

You do have to pay out of pocket if you don't have medical insurance though.

If you're coming to New York there are a few places that deal in trans specific care. Appointments are about a month out though. There are also "urgent care" places that can see you the same day but they may not be properly trained in how to deal with trans patients with regard to our hormone needs.

Wow this sounds like an option. I can actually drive to NY in less than a day if I drove all in one chunk! I will look in to this. :) thanks

I don't mind the out of pocket thing as long as it's not out of my price range.

Quote from: KayXo on December 04, 2015, 09:49:38 AM
The study you provided to show that progesterone inhibits DHT is far from conclusive, for the reasons I explained.

"should be" BUT what if voice suddenly lowers and you are stuck with that? Would it really be worth it?

Too late in the case of voice lowering or even facial hair growth that now has to be treated. Even if the odds are low, I wouldn't do it.

I am only on estrogen and progesterone. I definitely have orgasmic abilities and have actually always had them, regardless if I was taking progesterone or not or whether my estrogen was high or low. The only difference is when my hormones got higher, the inside of my vagina was more elastic and not dry anymore. :) As to overall drive, I certainly don't lack that. I'm sure plenty of post-op women can attest to this as well without the need for testosterone. My T levels are around 20 ng/dl, quite low.

In the end, it's a personal choice dictated also by one's doctor's position on the matter. I wouldn't but to each their own.

I think I have noticed a small improvement in my sexual anhedonia with this estradiol. I am generally getting more satisfaction out of everything in life for the last 2 days...Maybe this is a placebo effect though. I did chores that I have been putting off and I seem to be more patient and have a greater attention span.

Maybe going to an estradiol patch would help.

Quote from: KayXo on December 04, 2015, 09:49:38 AM
The study you provided to show that progesterone inhibits DHT is far from conclusive, for the reasons I explained.

Its not only studies. Its also endocrinologists experiences.
If a few people report it there should be something to it.

Quote
"should be" BUT what if voice suddenly lowers and you are stuck with that? Would it really be worth it?

I'd see this much more relaxed. Nature is usually analogous. There usually are no quick side effects with lower doses. If there should be a gradual deepening doses might be adjusted.

Quote
Too late in the case of voice lowering or even facial hair growth that now has to be treated. Even if the odds are low, I wouldn't do it.

Well with levels below 60 there should be no large side effects. Body hair might grow thicker. If it becomes a hassle doses might be adjusted. A new triggering of beard growth should be unlikely imo. As said cis women with a natural level of that sort do not experience a triggering of beard hair. Changes to already present hair yes.

Quote
I am only on estrogen and progesterone. I definitely have orgasmic abilities and have actually always had them, regardless if I was taking progesterone or not or whether my estrogen was high or low.  As to overall drive, I certainly don't lack that. I'm sure plenty of post-op women can attest to this as well without the need for testosterone. My T levels are around 20 ng/dl, quite low.

Levels between 20 and 60 should be preferable...
it was also meant as hint for some people to have a look at testo levels as well.
It simply is necessary in cis women also.

Quote
In the end, it's a personal choice dictated also by one's doctor's position on the matter. I wouldn't but to each their own.

Well if you feel good that is the most important thing.
It was meant as a hint that testo might help with some ailments.
Often people post srs have a low in mood and other ailments which might be attributed to too low estrogen and testo.

Quote
The only difference is when my hormones got higher, the inside of my vagina was more elastic and not dry anymore. :)

Yes.. if lestrogen evels are too low its menopausal atrophy.
Higher levels can help. Some people even report regain of depth after dilation, some used estrogen cream from time to time.


hugs

Quote from: Laura_7 on December 04, 2015, 10:30:14 AM
Its not only studies. Its also endocrinologists experiences.
If a few people report it there should be something to it.

I'd see this much more relaxed. Nature is usually analogous. There usually are no quick side effects with lower doses. If there should be a gradual deepening doses might be adjusted.

Well with levels below 60 there should be no large side effects. Body hair might grow thicker. If it becomes a hassle doses might be adjusted. A new triggering of beard growth should be unlikely imo. As said cis women with a natural level of that sort do not experience a triggering of beard hair. Changes to already present hair yes.

Levels between 20 and 60 should be preferable...
it was also meant as hint for some people to have a look at testo levels as well.
It simply is necessary in cis women also.

Well if you feel good that is the most important thing.
It was meant as a hint that testo might help with some ailments.
Often people post srs have a low in mood and other ailments which might be attributed to too low estrogen and testo.

Yes.. if lestrogen evels are too low its menopausal atrophy.
Higher levels can help. Some people even report regain of depth after dilation, some used estrogen cream from time to time.


hugs

I was just thinking that maybe you know of any standard HRT regimines involving estrogen, progesterone and testosterone...

or just estrogen and progesterone.

I can't seem to find anything official.

The reason is... I would like to be able to help my GP be more comfortable prescribing these things. I want to know what blood tests I would need etc. I was prescribed progesterone once, but never took it due to concerns with side effects.. so he might at least be comfortable putting me on that since my endo was ok with it at one time.

I have read about many benefits about having bioidentical HRT, but nothing solid.

Quote from: Turnip on December 04, 2015, 10:36:17 AM
I was just thinking that maybe you know of any standard HRT regimines involving estrogen, progesterone and testosterone...

or just estrogen and progesterone.

I can't seem to find anything official.

The reason is... I would like to be able to help my GP be more comfortable prescribing these things. I want to know what blood tests I would need etc. I was prescribed progesterone once, but never took it due to concerns with side effects.. so he might at least be comfortable putting me on that since my endo was ok with it at one time.

I have read about many benefits about having bioidentical HRT, but nothing solid.

Much of this comes down to endos experiences.
Its not really exact science.

For a good feminization many say:
estrogen levels above 200-300 pg/ml
and testo in the range of 60 or below.

Levels of estrogen of well over 700 occur during pregnancy.
Many endos consider this safe if reached by internal application, implants and injections.
With other applications for example oral/sublingual there might be side effects like clotting and liver strain at this level. 
Thats why usually anti androgens are used then.

For progesterone there is kind of a standard dose which should not be too hard to find.
Some people get sleepy from it and thus take two small doses, one in the morning and one in the evening.

Well... and there go the diferences...
oral/sublingual application, gels or patches, and often anti androgens...

implants and injections where its possible to do without anti androgens.

Many endos also do not give much value to serum levels. There are well known clinics who say so. Because its only free levels tested and not absorbed rate.
"Treat the patient not the lab"

Its important how people feel and if rate of feminization is ok.
It takes time in any case.

Overall health and possibly organ function should be monitored.


hugs

Quote from: Turnip on December 04, 2015, 10:19:24 AM
Wow this sounds like an option. I can actually drive to NY in less than a day if I drove all in one chunk! I will look in to this. :) thanks

I don't mind the out of pocket thing as long as it's not out of my price range.

Cash price for my first visit would have been about $250USD plus the cost of lab work which may be a couple hundred more.

I go to Mt Sinai Beth Israel, phone 212-604-1800. There is also Callen-Lorde which is popular with a lot of transfolk. If you don't have insurance, I know that Callen-Lorde will work with you and probably bill sliding scale. I am not sure if that applies to foreign patients who are not resident in the USA and just visiting. Doesn't hurt to ask. Google "Callen-Lorde" and they should come up as I don't know if I can post a link here.

Quote from: Laura_7 on December 04, 2015, 10:30:14 AM
Its not only studies. Its also endocrinologists experiences.
If a few people report it there should be something to it.

Nothing conclusive, purely anecdotal. Like I said, if the addition of progesterone in post-op women results in additional DHT reduction, if blood tests show this, then we can start saying this more conclusively.

QuoteThere usually are no quick side effects with lower doses.

What is a low dose? A low dose for one person may be a strong dose for another. Sensitivity between individuals varies. It's very tricky and is still a gamble. For me. To each their own. I wouldn't personally take a chance and do fine without testosterone. :) I think the issue may be more an inadequate prescription of female hormones resulting in low drive, mood and low libido, the latter being also very much a mental thing so hormones aren't absolutely essential for that, in my opinion.

Quote from: KayXo on December 04, 2015, 03:09:52 PM
What is a low dose? A low dose for one person may be a strong dose for another. Sensitivity between individuals varies. It's very tricky and is still a gamble. For me. To each their own. I wouldn't personally take a chance and do fine without testosterone. :) I think the issue may be more an inadequate prescription of female hormones resulting in low drive, mood and low libido, the latter being also very much a mental thing so hormones aren't absolutely essential for that, in my opinion.

Many people start out with gel.
So a low dose can be tried and upped if necessary. And its possible to stop from one day to the next.

Its really a mix where testo also plays a role.
In your case a level of 20 is sufficient.
There are others who have levels of almost zero, where an upping of the level helped.
Its also a well known effect for menopausal women.
There are even small dose testosterone implants specifically for menopausal women.


hugs

powermd.com/wp-content/uploads/2014/05/Testosterone-Patch-increases-Sexual-Desire-in-Menopausal-Women.pdf

Conclusions: The 300-µg/d testosterone patch in-
creased sexual desire and frequency of satisfying sexual
activity and was well tolerated in women who devel-
oped hypoactive sexual desire disorder after surgical
menopause.

But perhaps just prescribing estrogen to these women could have achieved the same results without the potential side-(masculinizing) effects  from testosterone.

This one interesting study on rhesus macaques, primates like us, showed that giving testosterone or estrone to females increased 2 out of 3 proceptive (courting) or sexual behaviors while estradiol given in a much lower dose increased all 3!!! DHT did nothing, nada! Also, not surprisingly, DHT and T did not affect male contact or mounting on females but both estrone and estradiol DID. So, estradiol not only increased female flirting and sexual play but made them more attractive sexually to males in contrast to T and especially DHT.

Also, very funny, is that both T and DHT increased yawning in females...hahahaha! while neither estrone nor estradiol did that.

I would say that estradiol is the clear winner, wouldn't you? :)

Quote from: KayXo on December 05, 2015, 10:21:45 PM
But perhaps just prescribing estrogen to these women could have achieved the same results without the potential side-(masculinizing) effects  from testosterone.

This one interesting study on rhesus macaques, primates like us, showed that giving testosterone or estrone to females increased 2 out of 3 proceptive (courting) or sexual behaviors while estradiol given in a much lower dose increased all 3!!! DHT did nothing, nada! Also, not surprisingly, DHT and T did not affect male contact or mounting on females but both estrone and estradiol DID. So, estradiol not only increased female flirting and sexual play but made them more attractive sexually to males in contrast to T and especially DHT.

Also, very funny, is that both T and DHT increased yawning in females...hahahaha! while neither estrone nor estradiol did that.

I would say that estradiol is the clear winner, wouldn't you? :)

As said its a mix.

Levels of estrogen and bioidentical progesterone imo should be high enough, well in the female range. Above the menopausal range.

Often people are in the menopausal range.

If there are issues then still, testo might be added imo.

Yep, very funny  :)


hugs

FYI, forgot to mention ...yawning in males is intended to intimidate, threaten so could have been a result of increased aggression in females due to testosterone and DHT.