Susan's Place Transgender Resources

Hi everyone,

I had an Orchie a couple of years ago. They brought my E down to half.  Since then, I've always been very tired, and sluggish.  When we checked my E levels, I was at 60.  Which is pretty low. 

So, they up'd my E by a little to help that out.  My Doctor thought that I should have it higher than that, and said it might help with the Heat Flashes and sluggishness. 

Does anyone have any thoughts on that?  I don't want to over do the E (and risks associated with it), but I don't want to under do it either. My Doc is not a Trans doc. I use to go to the LGBT center but the wait is many months to see anyone, so my doc took over to help me out.  He's been very cautious with me, but after seeing my results, thought that I should experiment a bit with the dosage and slowly (check it every two months) up it if need be.

I pass pretty well, and HRT has been good to me, but I'd like to get my libido up and just feel over all better. I'm very low on energy.

I'd love to hear from those of you that might have had something similar happen.

Levels of estro at 60 are menopausal levels. Transgender people are not menopausal women.

Many endos as rule of thumb strive for levels of 200 pg/ml or above. Its well in the female range.
Cis females have levels of many thousand when pregnant, without bad effects.

Most studies reporting bad effects were done on non bioidentical estrogen and oral application.

Thus with patches, implants or injections the risks should be negligible.
And with sublingual dissolving instead of swallowing the risk should be strongly reduced because it bypasses the liver with intake.

And its a mix.
Cis people also have bioidentical progesterone and testosterone in the female range.
Especially a small dose of testosterone, with levels below 60, can help with orgasm abilities and diminishing of fatigue.

You might take that to your doc, they should immediately see the facts.


hugs

Quote from: KarmaGirl on February 15, 2016, 01:04:09 PM
Hi everyone,

I had an Orchie a couple of years ago. They brought my E down to half.  Since then, I've always been very tired, and sluggish.  When we checked my E levels, I was at 60.  Which is pretty low. 

So, they up'd my E by a little to help that out.  My Doctor thought that I should have it higher than that, and said it might help with the Heat Flashes and sluggishness. 

Does anyone have any thoughts on that?  I don't want to over do the E (and risks associated with it), but I don't want to under do it either. My Doc is not a Trans doc. I use to go to the LGBT center but the wait is many months to see anyone, so my doc took over to help me out.  He's been very cautious with me, but after seeing my results, thought that I should experiment a bit with the dosage and slowly (check it every two months) up it if need be.

I pass pretty well, and HRT has been good to me, but I'd like to get my libido up and just feel over all better. I'm very low on energy.

I'd love to hear from those of you that might have had something similar happen.

I'm afraid you're being underprescribed E for reasons that are not justified by science and as a result, you are suffering. Bio-identical estradiol, taken orally or non-orally is quite safe in contrast to non bio-identical estrogens which your doctor is basing their fears on. One needs to understand the differences between several forms of estrogen, this is a prerequisite, I think, for anyone prescribing sex hormones to women, whether cis or trans.

I'll sum it up for you, you can share this with your doctor. If they need additional papers, etc., let me know.

1) Cardiovascular (3) and clotting risks (4)

. Ciswomen are reported to be much less affected than men by cardiovascular complications despite pregnancy levels of estradiol and levels of up to 650 pg/ml every menstrual cycle. Their risks increase post-menopause when estrogen levels DROP. Studies have strongly suggested a protective role for estrogen. I can provide these studies as well.

. Randomized controlled trials, the Danish and WHI (Women's Health Initiative, 2003) studies have shown estrogen taken alone or without medroxyprogesterone acetate (known to have deleterious effects on cardiovascular markers and oppose estrogen's beneficial effects on cardiovascular health) to DECREASE cardiovascular complications significantly while having no incidence on risk of stroke.

. Studies in men with prostate cancer (ages 49-91) have shown that levels up to 700 pg/ml were safe. There were no cardiovascular complications or incidences of thrombosis. In fact, researchers stated high levels could be PROTECTIVE. They were treated with high dose injectable or transdermal (patches) estradiol. I can provide you those studies. 

. Pregnant women have levels that go as high as 75,000 pg/ml and yet the risk of having a DVT or pulmonary embolism is less than 0.02 % with thromboembolism being 5 times as more likely post-partum (when levels drop) and pulmonary embolism being extremely rare during pregnancy and more common post-partum (when levels drop). I can provide you the evidence as well.

. Am J Obstet Gynecol. 1993 Dec;169(6):1549-53.

"As serum estradiol levels increased throughout each phase (maximum mean estradiol 739.8 pg/ml)"

"Down-regulation of the fibrinolytic system was observed as estradiol levels increased. However, thrombin formation did not change, thus suggesting that elevated circulating estradiol alone does not predispose to a thromboembolic event."

. Arch Sex Behav. 1998 Oct;27(5):475-92. In this study, transsexual women were given high dose intramuscular and low to high dose oral E. Despite 41 people being on this regimen, there was not one incidence of thrombosis (or prolactinoma).

"None of our patients developed deep vein thrombosis or embolism during cross-gender hormone therapy performed in our clinic."

"we detected no prolactinoma as described by other authors (Asscheman et al., 1988, 1989; Kovacs et al., 1994; Gooren et al., 1980)."

2) Breast cancer risk (7)

. In transsexual women, breast cancer incidence is very low, equal to that of men not on HRT (as per Dr. Gooren and his team, leading specialists of HRT treatment in transwomen). Only 10 cases reported since 1968 despite decades of very aggressive, high doses of oral estrogens and non-oral estrogens (intramuscular). Only one case reported in Holland among Gooren's patients in decades of treatment, despite high doses of E for several years. Studies to support this.

. In men with prostate cancer treated with high dose estrogen over the years, since the 1960's, breast cancer is extremely rare. Supporting evidence.

. High dose estrogen has actually been used to treat ciswomen afflicted with breast cancer.

. Randomized controlled trials (the strongest form of study) showed estrogen to be either protective of breast cancer incidence or have no effect, even in women who had had breast cancer, when MPA (medroxyprogesterone acetate, linked to breast cancer) was NOT used or sparingly. I can provide studies.

. The more childbirths a woman (hence, the more pregnancies when levels of E are sky high), the lower the risk of breast cancer. On the other hand, celibate nuns are historically known to have a higher incidence of breast cancer risk.

. Breast cancer risk is highest in women over the age of 40 and especially 50, when estrogen levels drop.

3) Uterine cancer risk

. YOU HAVE NO UTERUS

4) Prolactinoma (2)

. Ciswomen have very high levels of prolactin, up to 210 ng/ml, during pregnancy and continue to have high levels during breastfeeding which can sometimes last a few years. As far as I know, prolactinoma is not more prevalent in women because of this and this has never been called into question by doctors asking mothers to stop breastfeeding their children or not become pregnant again due to risk of prolactinoma.

. In my extensive search through incidences of prolactinoma in transsexual women (and ciswomen), the only incidences reported were found to be in those women who took non bio-identical forms of estrogen orally (especially or exclusively ethinyl estradiol) with or without cyproterone acetate, known to abnormally elevate prolactin levels. Incidences in women taking bio-identical estradiol without the above mentioned agents taken simultaneously have NEVER been reported to date.

You can ask doctor to provide studies (not statements made by an association) that they base their fears on. 

I'm on a high dose of intramuscular E. Supervised by three doctors who approve, one of whom is an author of a book on female hormones, another a trans-specialist endocrinologist from the University of Cambridge. My blood tests results show no change in clotting factors, or liver enzymes, or lipids, insulin, glucose, c-reactive protein. Nothing is out of range given my high levels of E2, which are in the range of 1,000-4,000 pg/ml. I've also been on high doses of oral bio-identical estradiol for several years. I started HRT in 2004.

Thank you girls for this info.
And YES! The more I have info on the better!

No wonder I've been EH, for a while.  I may look into getting an endo in the future. My Doctor is a great and smart man, but I think (as you stated) he is basing things are CIS-Females and I'm losing out.  I had spoken with another tgirl and she said that her levels went down lower after her orchiectomy and so they bumped her back up to what her E was before the orchie.

AGAIN, THANKS SO MUCH! I really appreciate everyone chiming in on this.

HUGS!

Quote from: KarmaGirl on February 15, 2016, 06:08:52 PM
I had spoken with another tgirl and she said that her levels went down lower after her orchiectomy and so they bumped her back up to what her E was before the orchie.

An important thing to consider is that T is reduced to castrate levels pre-orchie or pre-SRS, on top of often being blocked as well. So before and after op, T levels (action) remain about the same. Hence, there being no reason to cut down estrogen. This practice comes from when, in the 1960's-80's, only estrogen was taken to feminize and shut down T, so that post-op, T now being naturally low, less E was needed. This is the problem with some doctors, they keep continuing to do what was done in the past without stopping and realizing things have changed, without taking a look at why things were done a certain way and how this does not apply today.

Well, some of you were right!

I was recently up'd with a little more Estrogen, and it's made a HUGE difference! A little= A lot!

I'm not having any weird hot flashes like I was before. It was starting to get really annoying. It felt like an IRON on the back of my head! Yuck!

AND I've also noticed my libido is getting better as well!

My doctor has really been trying hard to learn even more about stuff, and he thinks he wants to keep me on this change for a bit more to see where it goes.  Then he'll do tests and see if I need more or not.

I'm happy.

AGAIN, thanks to all of you that posted and wrote to me. You all made a difference.

Quote from: KarmaGirl on March 15, 2016, 08:28:29 PMAND I've also noticed my libido is getting better as well!

Goes to show you that estrogen also improves libido, that testosterone is not necessary for this. This has been confirmed by others as well as giving more energy. Great news! :)

Quote from: KayXo on March 16, 2016, 10:34:44 AM
Goes to show you that estrogen also improves libido, that testosterone is not necessary for this. This has been confirmed by others as well as giving more energy. Great news! :)

I can support your statement due to first person experience.
Mid January my E level was still in the male range with 40pg/ml and T was 0.1 ng/ml, we doubled E dosage and now two weeks ago E was 284 pg/ml and T the same as before.

In January my libido was gone and my mood was somewhat below normal, since increasing E I feel incredible and my libido is coming back and I totally enjoy it.  :D

Quote from: Thessa on March 16, 2016, 11:20:01 AM
I can support your statement due to first person experience.
Mid January my E level was still in the male range with 40pg/ml and T was 0.1 ng/ml, we doubled E dosage and now two weeks ago E was 284 pg/ml and T the same as before.

In January my libido was gone and my mood was somewhat below normal, since increasing E I feel incredible and my libido is coming back and I totally enjoy it.  :D

So glad to hear you are also experiencing good things with your new e Levels. 

I will be gradually going up little by little until we get to a point where we (my doctor and I ) are happy medically and mentally. 
Cheers!