Susan's Place Transgender Resources

I have been on estradiol for 17 months and have seen no breast growth after the first 4 months. I can't even consider wearing a bra because I have like nothing there. I have tried so many different dosages and types of estradiol, to no avail. I have even tried progesterone, with only temporary swelling. I have sensitivity and soreness frequently, so I know there is developing tissue in there, but they just won't grow! My mother and sister both have big breasts, so I know my problem is not genetic.

So, I was wondering if this lack of progress could be explained by my stomach medication, domperidone. I have been on domperidone for almost 10 years due to gastroparesis. Without it, I suffer from severe nausea and vomiting because my stomach muscles do not contract properly. However, domperidone together with estradiol creates a very high prolactin level, so high that my doctor is afraid I might have a prolactinoma. Could this be impeding the growth of my two little ones? I do get the sense that they shrink when I take a higher dosage of domperidone for my stomach. They also shrink when I exercise; they bounce out of place and disappear!

Could domperidone be stunting their growth?
Would they do better if I wore something to hold them up when they swell and sag?

Help! I really want to grow healthy breasts and would never consider covering them up with shapely plastic.

Interesting question because that drug does cause an increase in lactation apparently, likely related to the prolactin thing. If your doc does not know, i'd ask around to other docs. Is your doc an endo specialist?

Has your weight changed much on HRT?

I asked my endo about using domperidone to help with breast growth. He didn't say it would do any harm, and I'm pretty sure he would have if it did.

Regarding lack of development have you been doing blood tests and checking the results. Not every doctor knows what they are doing. And is this genetic? Do your female relatives have small breasts?

De Groot LJ, Beck-Peccoz P, Chrousos G, et al., editors.
South Dartmouth (MA): MDText.com, Inc.; 2000-.

"Prolactin is another anterior pituitary hormone integral to breast development. Prolactin is not only secreted by the pituitary gland but may be produced in normal mammary tissue epithelial cells and breast tumors (14, 15). Prolactin stimulates epithelial cell proliferation only in the presence of estrogen and enhances lobulo-alveolar differentiation only with concomitant progesterone."

so, if anything, prolactin is a good thing...but on domperidone, yes, I think it's wise to check prolactin levels regularly, check for milk letdown, symptoms associated with prolactinoma.

Side effects of domperidone include gynecomastia, a GOOD thing!

Domperidone appears to also INHIBIT CYP1A2 and CYP3A4 enzymes responsible for metabolism of estradiol, hence increasing bioavailability and concentration and half-life of estradiol. Again, more a positive than a negative thing.

Perhaps lack of body fat as you need enough fat to support and help with breast growth. Malnutrition due to malabsorption or not enough nutrients in diet, stress? Stress can strongly affect and negate development.

Have you checked your levels of vitamins, especially B12, fat-soluble vitamins and levels of omega3 relative to omega6? What about your general health? Thyroid, adrenal health? I'm assuming doctors have verified all this.

I'm not a doctor but these are all I can come up with. Perhaps, get the opinions of several doctors on this and something might pop up. Who knows?!

Best of luck. :)

High prolactin to the point of worrying about a prolactinoma...

The issue is that estrogen in combination with high prolactin would in almost anyone mean breast growth that is probably more than average because you would be developing your milk ducts and a system in the breasts that would further develop them so I would be focusing on wether or not you are underweight which is often a problem for breast development in all women..

Quote from: RobynD on February 25, 2016, 10:25:44 AM
Is your doc an endo specialist?

Has your weight changed much on HRT?

My doctor is not an endocrinologist but she is much more knowledgeable about transgender medicine than my previous endocrinologist, who made poor decisions to the point of malpractice.

My weight has fluctuated a little, but overall no real change since starting HRT.

Quote from: AnonyMs on February 25, 2016, 10:58:55 AM
I asked my endo about using domperidone to help with breast growth. He didn't say it would do any harm, and I'm pretty sure he would have if it did.

I do wonder because they swell up overnight when my domperidone levels are lower, and seem to shrink when I take too high a dosage. Like I said, I used this medication for my stomach for almost a decade, so I wonder if it caused some kind of desensitization or something.

QuoteRegarding lack of development have you been doing blood tests and checking the results. Not every doctor knows what they are doing.

I had monthly blood tests up until November. My estradiol levels have been consistently good and testosterone in the female range.

QuoteAnd is this genetic? Do your female relatives have small breasts?

Like I said, my mother and sister have big ones. My sister said that is one of only two parts of her body that she actually likes. I wish I knew what it felt like to walk around with them on my chest! :(

Quote from: KayXo on February 25, 2016, 08:30:44 PM
De Groot LJ, Beck-Peccoz P, Chrousos G, et al., editors.
South Dartmouth (MA): MDText.com, Inc.; 2000-.

"Prolactin is another anterior pituitary hormone integral to breast development. Prolactin is not only secreted by the pituitary gland but may be produced in normal mammary tissue epithelial cells and breast tumors (14, 15). Prolactin stimulates epithelial cell proliferation only in the presence of estrogen and enhances lobulo-alveolar differentiation only with concomitant progesterone."

Even if prolactin is good at normal female levels, that does not preclude the possibility that a high level, disproportionately high relative to E and P, could be bad because it stimulates something resembling lactation, in which breast contents go away.

Quoteso, if anything, prolactin is a good thing...but on domperidone, yes, I think it's wise to check prolactin levels regularly, check for milk letdown, symptoms associated with prolactinoma.

My doctor checks the level routinely, though I have not had symptoms.

QuotePerhaps lack of body fat as you need enough fat to support and help with breast growth.

I think I have enough fat in unwanted places...

QuoteMalnutrition due to malabsorption or not enough nutrients in diet, stress? Stress can strongly affect and negate development.

Why would stress matter?

QuoteHave you checked your levels of vitamins, especially B12, fat-soluble vitamins and levels of omega3 relative to omega6? What about your general health? Thyroid, adrenal health? I'm assuming doctors have verified all this.

B12 deficiency causes anemia so my doctors see no reason to check for that as long as my RBC and hemoglobin remain in the normal female range. My thyroid and adrenal function are normal. I take provitamin A and consume adequate vitamin E so I doubt any deficiency exists. Levels of omega 3 vs. 6 mean nothing as long as there is no deficiency; I consume enough of both.

Quote from: calicarly on February 26, 2016, 12:29:05 PM
The issue is that estrogen in combination with high prolactin would in almost anyone mean breast growth that is probably more than average because you would be developing your milk ducts and a system in the breasts that would further develop them so I would be focusing on wether or not you are underweight which is often a problem for breast development in all women..

My BMI is about 21, which is very normal and no one really thinks I am big-boned. I have adequate fat in MALE places like my abdomen, along the waistline... HRT has made little difference, sadly. And my female relatives do not have that problem; only my father does, which makes sense given his obvious lack of E.  I enjoy frequent swelling, itchiness, sensitivity, sometimes pain, but never any lasting growth. :(

Quote from: Steph34 on February 28, 2016, 08:46:57 AMEven if prolactin is good at normal female levels, that does not preclude the possibility that a high level, disproportionately high relative to E and P, could be bad because it stimulates something resembling lactation, in which breast contents go away.

When women breastfeed/lactate and their prolactin levels are disproportionately high relative to E and P which are very low, their breasts are HUGE, sore and engorged. Ask any ciswoman!

QuoteI think I have enough fat in unwanted places...

Cortisol (stress hormone) and insulin tend to stimulate abdominal fat deposition.

QuoteWhy would stress matter?

Poor blood circulation, cortisol may affect development. I noticed this as when I am under stress, my feminization and especially breast growth suffers vs. when I am more relaxed, calm, breasts suddenly begin to grow again. 10 yrs + taking hormones and I've noticed this pattern consistently. I do not have a full explanation as to why this occurs but it just makes sense to me that a stressed body would respond less optimally than a healthy one.

QuoteLevels of omega 3 vs. 6 mean nothing as long as there is no deficiency

It seems that too much omega 6 relative to omega 3 can cause inflammation in the body. Omega 6 is inflammatory, omega 3 is anti-inflammatory. They need to be in balance.

QuoteI have adequate fat in MALE places like my abdomen, along the waistline... HRT has made little difference, sadly. And my female relatives do not have that problem; only my father does, which makes sense given his obvious lack of E.

His lack of T; males aren't supposed to have significant levels of E. In females, it is lack of E, especially.

Maturitas. 2012 Mar;71(3):248-56.

"Estradiol stimulates the activity of lipoprotein lipase
(LPL) in femoral adipocytes and lipolysis in abdominal adipocytes
[35], thereby promoting accumulation of gluteo-femoral fat. On
the other hand, estrogen deficiency is associated with enhanced
accumulation of abdominal fat [35]."

"Larger depots of abdominal fat in men are
associated with lower testosterone levels because gonadotropin
secretion is reduced [63], while upon weight loss testosterone levels
and insulin sensitivity return to normal. Furthermore, long-term
treatment of obese men with testosterone causes them to burn fat
and enhances lean body mass [63]. "

The first sentence (second paragraph) may actually clarify one of the recent discussions we had about why T reduces in men who are more obese...GONADOTROPIN SECRETION reduces! And as you see, as weight loss occurs, not only does T increase but INSULIN sensitivity improves. 

Quote from: KayXo on February 25, 2016, 08:30:44 PM
Side effects of domperidone include gynecomastia, a GOOD thing!

Presumably, that occurs mostly in obese patients who are more prone to it to begin with. I was never one of the lucky ones while on domperidone in my pre-transition years. (though they probably feel differently about the 'lucky' part). I did, however, have an occasional stabbing pain in either breast. Such pains are random and more likely to occur when I overeat. They have continued while on HRT. I am not sure if this is good or bad.

QuoteDomperidone appears to also INHIBIT CYP1A2 and CYP3A4 enzymes responsible for metabolism of estradiol, hence increasing bioavailability and concentration and half-life of estradiol. Again, more a positive than a negative thing.

I guess that could explain why I have so little trouble maintaining a healthy E level. Still, not really a good thing as I simply adjust my dosage accordingly, and have a harder time coming down when I need to. High E levels, and eating too much while on E, can cause severe scalp fungal flares and resultant hair loss for me.

Quote from: AnonyMs on February 25, 2016, 10:58:55 AM
I asked my endo about using domperidone to help with breast growth. He didn't say it would do any harm, and I'm pretty sure he would have if it did.

It seems to be harmful for my breasts, though. After controlling for food intake, they swell when I take less and shrink when I take more. I wonder if the domperidone is causing breast contents to be diverted to the stomach and digested. It is also a very risky drug because it can cause cardiac arrythmia (QT prolongation), which can be deadly. That is why it is not FDA-approved in the USA. I used to suffer from irregular heartbeats pre-transition. Suppression of T and addition of E have largely eliminated my heart problem and my EKG is normal now.

Quote from: KayXo on February 28, 2016, 10:26:06 AM
Cortisol (stress hormone) and insulin tend to stimulate abdominal fat deposition.

I just had my insulin tested and it was so low as to be undetectable, so clearly that is not the culprit. Cortisol is a different matter...

QuotePoor blood circulation, cortisol may affect development. I noticed this as when I am under stress, my feminization and especially breast growth suffers vs. when I am more relaxed, calm, breasts suddenly begin to grow again. 10 yrs + taking hormones and I've noticed this pattern consistently. I do not have a full explanation as to why this occurs but it just makes sense to me that a stressed body would respond less optimally than a healthy one.

Is there any way to suppress cortisol production? My level has consistently been rather high, though still normal, clearly not optimal. Reducing sources of stress in my life does not seem to work as I just stress out more over little problems when I do not focus on big problems.

QuoteHis lack of T; males aren't supposed to have significant levels of E. In females, it is lack of E, especially.

Does this mean my body still thinks it is 'male' and is accumulating abdominal fat due to lack of T? I have sufficient E. Furthermore, high E due to injections tended to make my abdominal fat problem worse.

The lack of a clear explanation for my lack of growth further contributes to my suspicion that someone in my family is giving me something to inhibit feminization. >:(

Quote from: Steph34 on March 06, 2016, 08:23:16 AM
I wonder if the domperidone is causing breast contents to be diverted to the stomach and digested.

Contents of the breast digested? What? When breasts shrink, there is simply cellular apoptosis (cells die) of the glandular and adipose tissue.

QuoteIt is also a very risky drug because it can cause cardiac arrythmia (QT prolongation), which can be deadly. That is why it is not FDA-approved in the USA.

From motilium monograph

"The QT prolongation observed in this study when domperidone was administered according to the recommended dosing is not clinically relevant."

"This lack of clinical relevance is corroborated by pharmacokinetics and QTc interval data from two older
studies"

"It was therefore concluded that concentrations of domperidone (...) daily had no clinically significant effect on QTc in healthy subjects."

"Co-administration with potent CYP3A4 inhibitors has been shown to increase domperidone
concentrations to the point where QT interval prolongation may occur."

"Examples of potent CYP3A4 inhibitors include some azole antifungals (eg, intraconazole, voriconazole,
posaconzazole), some macrolide antibiotics (eg, clarithromycin, telithromycin), and some
protease inhibitors (ritonavir, saquinavir, telaprevir)."

"Use of MOTILIUM and other drugs which prolong QTc intervals requires that caution be exercised in
patients who have existing prolongation of cardiac conduction intervals, particularly QTc, patients
with significant electrolyte disturbances or underlying cardiac diseases such as congestive heart
failure. Other risk factors for sudden cardiac arrest include a family history of coronary artery
disease, high blood pressure, high blood cholesterol, obesity, diabetes, smoking and excessive
alcohol consumption. It is desirable to optimise electrolyte levels prior to starting domperidone."

"Caution should be exercised when domperidone is co-administered with drugs which have been
shown to cause QT interval prolongation"

"Very rare case reports of QTc prolongation, ventricular arrhythmia, and sudden death have occurred
with domperidone use. Although most reported cases have occurred in patients receiving the
intravenous form of domperidone, or in patients with other risk factors, an association with oral
domperidone cannot be completely ruled out. Therefore, domperidone should be used with caution
in patients with other risk factors for QTc prolongation including hypokalaemia, severe
hypomagnesaemia, structural heart disease, the concomitant administration of QTc prolonging
medicines, or an underlying genetic predisposition."

In summary, it seems the risk is very low if taken alone at normal doses, in a person without medical or genetic predispositions without other drugs that increase its concentrations or have an effect on QT prolongation. I would exercise caution if Spiro were also taken as it affects electrolytes.

QuoteI just had my insulin tested and it was so low as to be undetectable, so clearly that is not the culprit.

Good news! :) I'm happy for you.

QuoteThe lack of a clear explanation for my lack of growth further contributes to my suspicion that someone in my family is giving me something to inhibit feminization. >:(

LOL. I doubt it.

Quote from: KayXo on February 28, 2016, 10:26:06 AM
When women breastfeed/lactate and their prolactin levels are disproportionately high relative to E and P which are very low, their breasts are HUGE, sore and engorged. Ask any ciswoman!

Cis women breastfeed after going through pregnancy, a 9-month period when their E and P are extremely high. It makes sense that they would have bigger breasts after exposure to such high levels of E and P during pregnancy. Again, this does not mean that high prolactin is good or even necessarily harmless.

QuoteCortisol (stress hormone) and insulin tend to stimulate abdominal fat deposition.

I was wondering if my higher than ideal cortisol level could be due to my long walks, sometimes 5 hours or 10 miles. Walking alone *is* a little stressful, after all. I do get the sense that my breasts shrink when I walk. Then when I have dinner and relax, they swell again. ???

Quote from: KayXo on March 06, 2016, 10:32:29 AM
Contents of the breast digested? What? When breasts shrink, there is simply cellular apoptosis (cells die) of the glandular and adipose tissue.

And why would my cells be dying? I am only in my second year of HRT; my breasts should still be growing!

Quote"The QT prolongation observed in this study when domperidone was administered according to the recommended dosing is not clinically relevant."

Therein lies the catch. When I overeat (and even when I do not, albeit to a lesser extent), I usually exceed the recommended dosage for reasons of efficacy.

QuoteIn summary, it seems the risk is very low if taken alone at normal doses, in a person without medical or genetic predispositions without other drugs that increase its concentrations or have an effect on QT prolongation. I would exercise caution if Spiro were also taken as it affects electrolytes.

I did have some bad irregularity when I used spironolactone, but thankfully I got off of it before it did too much harm to any part of me other than my skin. I am careful to avoid those other medications. When I had an infected finger, they wanted to put me on ciprofloxacin, but I declined because my stomach doctor told me the combination could lead to "sudden death" from QT prolongation. Still, I must quote my stomach doctor who told me, "Either drug (domperidone or ciprofloxacin) alone is risky. Together they are deadly." So I am inclined to believe my stomach doctor about it being a risky medication that I need to watch my usage of.

QuoteLOL. I doubt it.

I wouldn't rule it out. Twice in my adult life, I was given a steroid without my consent. The first time was done directly by my father after he got angry at me and I lacked the will to resist because I was scared of him and misled to believe the drug had a legitimate medical purpose. The second time, I stood up for myself BUT it was done through my mother after my father made angry threats and again lied by claiming medical necessity. I did not find out until my mother confessed several years later after I came out as trans. So, it has happened before. How can I ever trust my parents again after that? And yes, I still live with them for reasons of finances and companionship.

Quote from: Steph34 on March 09, 2016, 10:23:20 AM
Cis women breastfeed after going through pregnancy, a 9-month period when their E and P are extremely high. It makes sense that they would have bigger breasts after exposure to such high levels of E and P during pregnancy

Despite E and P levels dropping after pregnancy, their breasts remain big and can even become more so due to engorgement of milk as a result of high prolactin levels. It is only after prolactin levels drop for good, that breasts finally shrink and sag. Prolactin is an important hormone involved in the etiology of breast growth.

QuoteI was wondering if my higher than ideal cortisol level could be due to my long walks, sometimes 5 hours or 10 miles. Walking alone *is* a little stressful, after all. I do get the sense that my breasts shrink when I walk. Then when I have dinner and relax, they swell again. ???

Exercise may be good up to a certain point and it depends on the individual. Too much exercise may actually stress the body and for some people who are already stressed, this threshold is reduced. I think it's best to not do more than you can. Know your limits.

QuoteAnd why would my cells be dying? I am only in my second year of HRT; my breasts should still be growing!

Cell death could be due to a drop in E levels, perhaps an increase in stress leading to other hormonal changes, it could be due to weight/fat loss, etc.

QuoteI did have some bad irregularity when I used spironolactone, but thankfully I got off of it before it did too much harm to any part of me other than my skin.

Dehydration due to sodium/water loss.

QuoteStill, I must quote my stomach doctor who told me, "Either drug (domperidone or ciprofloxacin) alone is risky. Together they are deadly." So I am inclined to believe my stomach doctor about it being a risky medication that I need to watch my usage of.

It's important to be proactive in one's treatment and read the actual studies, data as sometimes doctors are not familiar with them fully. Doctors are not infallible. I should know. ;)

Hi Steph,

My blood work also showed a high (33) Prolactin level pre-HRT and I will have to do another test after 1 month on HRT. He wants to make sure my prolactin doesn't boost over 100 with added estrogen.

After doing some reading I found out that a high protein diet can boost your prolactin and since I'm on the slow carb diet for almost a year it could explain this.

Are u on a similar diet?

Cheers
-J


Sent from my iPad using Tapatalk

Quote from: JessicaSondelli on March 12, 2016, 08:11:56 AM
My blood work also showed a high (33) Prolactin level pre-HRT and I will have to do another test after 1 month on HRT. He wants to make sure my prolactin doesn't boost over 100 with added estrogen.

He is afraid that a prolactinoma, a tumor of the pituitary will develop. High prolactin levels alone aren't proof that there is a prolactinoma.

My prolactin levels are between 87 and 130 ng/ml. This is perfectly normal given my E values, which range from 1,000-4,000 pg/ml. My doctors aren't concerned. Prolactin levels in pregnant women can go up to 350 while they remain quite high during breastfeeding. The incidence of prolactinoma in women is 0.1%. E naturally stimulates prolactin synthesis and has not been found to cause prolactinomas in humans.

Consider the following:

1)

Journal of Endocrinological Investigation
June 1995, Volume 18, Issue 6, pp 450-455

"Observations that a high proportion of patients with prolactinoma had previously used estrogen containing oral contraceptives"

"A large multicenter controlled case study found no evidence suggesting that estrogen containing oral contraceptive users were more likely to develop a prolactinoma (4) than non-users. Another study (5) did not find an increased risk of prolactinomas in users of estrogen containing oral contraceptives for the purpose of birth control. However, the latter study did find that women who had taken estrogen containing oral contraceptives or non contraceptive estrogens (as conjugated estrogen or ethinyl estradiol) for menstrual regulation had approximately an 8 and 16 fold greater likelihood respectively of developing a prolactinoma."

J Clin Endocrinol Metab. 2007 Aug;92( 8 ):2861-5.

"autopsies of patients treated with pharmacological doses of estrogen do not show an increased number of prolactinomas (15), and case control studies have not demonstrated an association between estrogen use and prolactinoma formation (16)."

Hence, so far, causation has not been established between the use of non-bio-identical estrogens (which you are likely NOT taking) and prolactinoma.

2) There only have been 8 cases reported in transsexual women in the literature, despite decades of sometimes aggressive dosages of E. Of these 8 cases, all were taking some form of non-bio-estrogen with sometimes a non-bio-identical progestogen. There has not been one report of transsexual woman developing a prolactinoma under treatment with exclusively bio-identical hormones.

Andrologia. 2015 Aug;47(6):680-4.

"Prolactinomas in oestrogen-treated MtoF persons are
rare."

"Even though the majority of subjects followed at our
clinic have used extremely high doses of oestrogen during
several years, the frequency of prolactinomas in our
group was very low. This was also the case in the Amsterdam
gender clinic in subjects who had used very high doses of
oestrogens."


3) Even those with hyperprolactinemia or a small prolactinoma rarely, if ever, show a deterioration of the condition when treated with non-bio-identical estrogens or during pregnancy (when E levels go up to 75,000). Pregnancy has even shown to have a favorable effect on pre-existing prolactinomas. Hence, pregnancy and HRT use is NOT contraindicated in women with high prolactin levels or small pituitary tumors as they rarely, if ever, make things worse.

J Clin Endocrinol Metab. 2007 Aug;92(8):2861-5.

"no evidence of tumor growth was seen in premenopausal women with microadenomas or women with idiopathic hyperprolactinemia treated with conjugated estrogen or oral contraceptives for 2–6 yr (14, 17, 18). Additional information supporting the safety of estrogen in women with prolactinomas is the observation that microprolactinomas rarely increase in size during pregnancy (10)."

"observational studies have shown that pregnancy has a favorable effect on the natural history of preexisting prolactinomas. Prolactin levels are lower after delivery than before conception and complete remission of hyperprolactinemia has been reported in 17–37% of women after pregnancy (19, 20). Changes in tumor vasculature resulting in pituitary necrosis, microinfarction, or hemorrhage have been suggested as potential mechanisms to explain how pregnancy might lead to normalization of prolactin (21)."

Ann Endocrinol (Paris). 2007 Jun;68(2-3):106-12.

"In women with microadenomas, pregnancy generally has little impact on their adenoma, delivery is normal and breast-feeding is allowed.'

"women presenting microprolactinoma should be allowed to use current contraceptive pills"

Contraception. 1998 Aug;58(2):69-73.

"In conclusion, although the number of observations is limited, the data suggest that after 2 years of follow-up, no harmful effect of OC use was observed in these patients."

Pituitary. 2005;8(1):31-8.

"We followed 71 term pregnancies in women bearing microprolactinomas. Of the 22 patients with previous surgery, none presented symptoms of tumor growth. Of the 41 pregnant patients treated with bromocriptine alone, only one (2.4%) presented with headaches, which regressed with drug reintroduction."

To resume, HRT has not been shown to cause prolactinoma, is very rare in transsexual women and never been associated with the use of bio-identical estrogen AND women with preexisting condition such microadenomas are allowed to go through with HRT or pregnancy as these have rarely, if ever cause a deterioration.

Quote from: JessicaSondelli on March 12, 2016, 08:11:56 AM
My blood work also showed a high (33) Prolactin level pre-HRT and I will have to do another test after 1 month on HRT. He wants to make sure my prolactin doesn't boost over 100 with added estrogen.

My prolactin level started at 16 pre-HRT, which is relatively high, but yours was 33? That is extraordinary and I would definitely think you should ask a doctor whether you need to be screened for prolactinoma. My prolactin never reached 100, although it did get fairly close when I used injections. I no longer inject estrogen.

QuoteAfter doing some reading I found out that a high protein diet can boost your prolactin and since I'm on the slow carb diet for almost a year it could explain this.

Are u on a similar diet?

No. I have been on a plant-based diet for over 9 years and I usually get more than 50 percent of my calories from carbs. I do make sure I include enough protein, but it is never excessive. Furthermore, my creatinine is low, which usually indicates a diet with less protein than average.

Quote from: KayXo on March 09, 2016, 12:10:48 PM
Despite E and P levels dropping after pregnancy, their breasts remain big and can even become more so due to engorgement of milk as a result of high prolactin levels. It is only after prolactin levels drop for good, that breasts finally shrink and sag. Prolactin is an important hormone involved in the etiology of breast growth.

I would not be producing milk, though, right?

QuoteExercise may be good up to a certain point and it depends on the individual.

True. A total lack of exercise definitely increases my stress.

QuoteToo much exercise may actually stress the body and for some people who are already stressed, this threshold is reduced. I think it's best to not do more than you can. Know your limits.

I love food too much to eat only a normal amount. Prolonged exercise, even pushing my limit sometimes, is the only way to prevent unwanted weight gain. And yes, I have tried gaining weight, up to a BMI of 24 last year, and it had no benefit for my breasts. The weight came on all over the body, but my breasts did not grow. :(

QuoteCell death could be due to a drop in E levels, perhaps an increase in stress leading to other hormonal changes, it could be due to weight/fat loss, etc.

I think I suffer from all of those problems. My dosage of E is inconsistent. I try to bring my E level down sometimes to reduce side effects. I only sometimes use P. I have a high level of DHEA. And my weight and body fat have been fairly steady over the long-term but can fluctuate significantly in the short-term. I wonder if those inconsistencies could be preventing my girls from developing properly. :(
They are my second favorite part of feminizing and I want nothing but the best for them. :)

QuoteDehydration due to sodium/water loss.

Perhaps, but my sodium intake is usually above average.

QuoteIt's important to be proactive in one's treatment and read the actual studies, data as sometimes doctors are not familiar with them fully. Doctors are not infallible. I should know. ;)

I should know, too. My first HRT doctor, a board-certified endocrinologist, was actually a total quack who permanently masculinized my face by starting me on Lupron without an anti-androgen. With that said, cardiac arrest is NOT something to mess around and I HAVE had some irregular heartbeats when I exceed my prescribed dosage of domperidone. :-\

Quote from: KayXo on March 12, 2016, 10:05:37 AM
There has not been one report of transsexual woman developing a prolactinoma under treatment with exclusively bio-identical hormones.

Very few trans women use domperidone, though. Domperidone has prolactinoma as a rare, but potentially serious, side effect. Domperidone and estradiol both raise prolactin levels. Together, the two may cause problems that neither one causes alone.

QuoteHence, pregnancy and HRT use is NOT contraindicated in women with high prolactin levels or small pituitary tumors as they rarely, if ever, make things worse.

I have noticed a strong correlation between my E level and my prolactin level. On the one hand, that reassured my doctor that I do not need screening for a prolactinoma. On the other hand, my prolactin levels have consistently been much higher than one would expect based on my E dosage. My prolactin level has consistently been abnormally high when compared to the cis female range, sometimes greatly so, even though the same cannot be said of my E level. That would seem to suggest a hypersensitivity to E in stimulating prolactin production.

Quote from: Steph34 on March 17, 2016, 01:17:27 PM
I would not be producing milk, though, right?

High prolactin can lead to galactorrhea. Progesterone inhibits this though but can also increase prolactin production.

QuoteProlonged exercise, even pushing my limit sometimes, is the only way to prevent unwanted weight gain

More exercise  =  burning more calories = increased hunger = eating more. Everything balances out in the end.

QuoteI have a high level of DHEA.

What about your free/bio-available T levels? Are you taking an anti-androgen? I don't remember...

QuoteAnd my weight and body fat have been fairly steady over the long-term but can fluctuate significantly in the short-term. I wonder if those inconsistencies could be preventing my girls from developing properly.

Doubtful.

QuoteDomperidone has prolactinoma as a rare, but potentially serious, side effect.

I read that a prolactinoma is a contraindication to using domperidone but nowhere, have I come across domperidone causing a prolactinoma. Can you point to where this is stated and/or studies supporting this?

QuoteDomperidone and estradiol both raise prolactin levels. Together, the two may cause problems that neither one causes alone.

Maybe, maybe not. I would wager, very unlikely.

QuoteI have noticed a strong correlation between my E level and my prolactin level. On the one hand, that reassured my doctor that I do not need screening for a prolactinoma. On the other hand, my prolactin levels have consistently been much higher than one would expect based on my E dosage. My prolactin level has consistently been abnormally high when compared to the cis female range, sometimes greatly so, even though the same cannot be said of my E level. That would seem to suggest a hypersensitivity to E in stimulating prolactin production.

I will give you some numbers that could be an eye-opener for you.

E levels in pregnant women: 1,000 pg/ml-75,000 pg/ml (based on various sources)
Prolactin levels (based on my lab's ranges) in pregnant women: 9-349 ng/ml

More specifically:

1st trimester E levels (normal range in women): 1,000-5,000 pg/ml
1st trimester prolactin levels (normal range in women): 8.9-191.2 ng/ml

My levels range from 1,000-4,000. Prolactin levels were 130 on day 3 after injection, 87 on day 5 when E levels dropped. So, the raise in prolactin levels is deemed normal considering my E levels. Also, when E levels drop on day 5, so do prolactin levels. This indicates everything is as expected and the absence of a prolactinoma. :)

By the way, I have carefully studied each and every case of prolactinoma reported in transsexual women, except one. Prolactin levels ranged from 68 to 1,887 ng/ml! With bilateral galactorrhea being present 4 times out of 7.

Quote from: KayXo on March 17, 2016, 03:06:28 PM
High prolactin can lead to galactorrhea. Progesterone inhibits this though but can also increase prolactin production.

I have never had any external discharge. Is it possible for discharge to occur internally?

QuoteMore exercise  =  burning more calories = increased hunger = eating more. Everything balances out in the end.

I disagree. My binge eating has more to do with pleasure seeking than with hunger taming. I will overeat whether I exercise or not, perhaps slightly more when I exercise but not enough to offset the calories burned while exercising. Given my high calorie intake, exercise is the main reason I am not overweight like my female relatives.

QuoteWhat about your free/bio-available T levels? Are you taking an anti-androgen? I don't remember...

My free T was up to 3, as of last month. I no longer use any anti-androgens. My doctor tells me they are not necessary now that I have had my orchiectomy. They are also expensive and/or have bad side effects. However, I have read that high DHEA has androgenic effects (masculinizes appearance) in women, and my doctor tells me it causes female pattern hair loss. I fear that my problems, including lack of breast growth, are due to high DHEA. Sadly, I have no idea how to suppress it.

QuoteI read that a prolactinoma is a contraindication to using domperidone but nowhere, have I come across domperidone causing a prolactinoma. Can you point to where this is stated and/or studies supporting this?

Not really, but it stands to reason that anything that raises prolactin levels would be a risk factor.

QuoteMaybe, maybe not. I would wager, very unlikely.

I have read about numerous cases of symptomatic hyperprolactinemia in women taking domperidone, but much less so in men, suggesting that this is a bigger problem when domperidone is combined with estradiol. That makes sense, since both increase prolactin.

QuoteI will give you some numbers that could be an eye-opener for you.

E levels in pregnant women: 1,000 pg/ml-75,000 pg/ml (based on various sources)
Prolactin levels (based on my lab's ranges) in pregnant women: 9-349 ng/ml

More specifically:

1st trimester E levels (normal range in women): 1,000-5,000 pg/ml
1st trimester prolactin levels (normal range in women): 8.9-191.2 ng/ml

I already knew that levels during pregnancy are incredibly high. They are also irrelevant, since 1)I cannot become pregnant, 2)pregnancy is not required for normal breast growth or any other aspect of feminization in cis women, and 3)many women report unpleasant side effects of high hormone levels during pregnancy. Those are clearly not desirable levels for trans women.

QuoteMy levels range from 1,000-4,000. Prolactin levels were 130 on day 3 after injection, 87 on day 5 when E levels dropped. So, the raise in prolactin levels is deemed normal considering my E levels. Also, when E levels drop on day 5, so do prolactin levels. This indicates everything is as expected and the absence of a prolactinoma. :)

My doctor's concern was that my prolactin is disproportionately high relative to E, but I am not worried because that is to be expected based on my domperidone use. My prolactin level (always under 100 on E injections and always under 70 on E patches) is not high enough to suggest a prolactinoma, especially given its tight correlation with my E level.

QuoteBy the way, I have carefully studied each and every case of prolactinoma reported in transsexual women, except one. Prolactin levels ranged from 68 to 1,887 ng/ml!

My doctor said she has seen "problems" with prolactin levels as low as 60.

Quote from: Steph34 on March 20, 2016, 09:40:48 AM
I have never had any external discharge. Is it possible for discharge to occur internally?

When prolactin levels are high, there will be increased production of milk in breast glands so there will be "discharge" inside, as in milk inside the breasts. If breasts aren't well-developed, then perhaps engorgement with milk will be much less.

QuoteGiven my high calorie intake, exercise is the main reason I am not overweight like my female relatives.

Have you stopped exercising for one full year and compared weight? Perhaps, there is another reason you don't gain as much weight as them. Healthier eating habits? Less refined carbs?

QuoteMy free T was up to 3, as of last month.

If in ng/dl, it's close to low end of male range and above female range.
If in pg/ml, well within female range.
If in pmol/L, low to under female range.

It's important to indicate units of measure. I'm assuming it's pg/ml or perhaps pmol/L.

QuoteI fear that my problems, including lack of breast growth, are due to high DHEA. Sadly, I have no idea how to suppress it.

DHEA is a precursor to potent androgens such as T and DHT. DHEA in and of itself, if T and DHT are low, is not a problem as it is a very weak androgen and acts mostly as a precursor.

If your free T is indeed within female range or even low end to lower than (I don't know what units your levels are), I wouldn't be concerned. If T is low, then DHT is low too as T is a precursor to DHT.

QuoteNot really, but it stands to reason that anything that raises prolactin levels would be a risk factor.

So far, no prolactinoma has been observed from domperidone, used since 1974 (42 yrs existence) despite this drug raising prolactin levels. Pregnancy and breastfeeding increase prolactin levels significantly but have never been observed to cause/induce prolactinoma. Same for oral contraceptives and HRT in ciswomen, the association is strongly in favor of a reverse causation. In transwomen, there have been occurrences with non-bio-identical forms, at higher doses BUT causation remains to be established and one can argue that many more prolactinomas should have occurred given the tens of thousands exposed to such treatment. I'D still not take a chance using them since there have indeed been prolactinomas with them and there are many other potential side-effects as well.

In other words, it doesn't *necessarily* stand to reason. 

QuoteI have read about numerous cases of symptomatic hyperprolactinemia in women taking domperidone, but much less so in men, suggesting that this is a bigger problem when domperidone is combined with estradiol. That makes sense, since both increase prolactin.

Hyperprolactinemia in and of itself, is not a problem. It is a problem when a prolactinoma is present. In women, there are more cases of it because prolactin levels are more often high due to estradiol, as you state. But, like I stated earlier, higher prolactin levels don't necessarily mean more prolactinoma. No such incidence in the history of domperidone use in women or in men.

QuoteI already knew that levels during pregnancy are incredibly high. They are also irrelevant, since 1)I cannot become pregnant, 2)pregnancy is not required for normal breast growth or any other aspect of feminization in cis women, and 3)many women report unpleasant side effects of high hormone levels during pregnancy. Those are clearly not desirable levels for trans women.

Relevant if you have levels comparable to pregnant women so that you can see how prolactin levels rise in relation to estradiol levels, like me and some other women who are on injectable/pellets and who find they

1) have better breast growth and feminization (latter in my case)
2) feel better (also my case)

Some women feel especially good during pregnancy (my mom and many others). It depends. It's important not to generalize and assume pregnant levels are not required for any transwoman to feel good, have decent feminization and breast growth. My experience proves this to be wrong and that of many other women I have come into contact during my 10 yrs+ of exploring this matter.

Remember that ciswomen developed at a time when growth hormone levels were very high and genetic ageing did not begin so that lower levels sufficed, on top of no prior masculinization. Hence, most of us, being older, may indeed need quite high levels for good results. It DEPENDS.

QuoteMy doctor said she has seen "problems" with prolactin levels as low as 60.

What problems? In which population?

Quote from: KayXo on March 20, 2016, 11:36:38 AM
When prolactin levels are high, there will be increased production of milk in breast glands so there will be "discharge" inside, as in milk inside the breasts. If breasts aren't well-developed, then perhaps engorgement with milk will be much less.

Is milk production good or bad for growth?

QuoteHave you stopped exercising for one full year and compared weight? Perhaps, there is another reason you don't gain as much weight as them. Healthier eating habits? Less refined carbs?

I could never stop exercising for one full year, but I have noticed a correlation between short-term weight and exercise. It is not water weight since I really do not sweat much. It could be in part due to my higher metabolic heat production with prolonged exposure to cool air. Also, I use laxatives that may facilitate the flow of calories into the large intestine. Plus I consume less saturated fat, a nutrient that increases ghrelin levels. I also avoid sweets most of the time and never eat active yeast.

QuoteIf in ng/dl, it's close to low end of male range and above female range.
If in pg/ml, well within female range.
If in pmol/L, low to under female range.

It's important to indicate units of measure. I'm assuming it's pg/ml or perhaps pmol/L.

It is in pg/ml, so within female range. That makes sense, since my total T and SHBG are also within female range.

QuoteDHEA is a precursor to potent androgens such as T and DHT. DHEA in and of itself, if T and DHT are low, is not a problem as it is a very weak androgen and acts mostly as a precursor.

My doctor told me that 1)DHEA is the hormone that causes female pattern hair loss, which runs in my family, and 2)Taking estradiol raises DHEA levels. Worrisome, indeed...

QuoteHyperprolactinemia in and of itself, is not a problem.

It is a problem when women report side effects such as dizziness, etc.

QuoteRelevant if you have levels comparable to pregnant women so that you can see how prolactin levels rise in relation to estradiol levels, like me and some other women who are on injectable/pellets and who find they

1) have better breast growth and feminization (latter in my case)
2) feel better (also my case)

High estradiol will make people feel really great in the short term of a few months, but like anything else that produces a sensation of being high, tolerance will occur and then it will require a high level to maintain a normal mood. Not healthy. I did see somewhat of a tolerance effect from my past use of injections. Thankfully I got off of them before I became totally desensitized to its emotional effects. I also did not see any breast growth nor did I feminize any better on the injections, despite E levels 4 times as high as on patches. I DID however, have increased side effects, including scalp fungus, nausea/bloating, and extreme moodiness. More is not necessarily better.

QuoteSome women feel especially good during pregnancy (my mom and many others). It depends.

There are other explanations for feeling good during pregnancy besides high hormone levels. Excitement about having a baby, perhaps working less or not at all... so there is not necessarily a causative effect.

QuoteIt's important not to generalize and assume pregnant levels are not required for any transwoman to feel good, have decent feminization and breast growth.

Breast growth or breast swelling? It is important to distinguish between the two. If breasts require constant exposure to hormones to maintain their size, that is swelling and is not sustainable over the long-term.

QuoteRemember that ciswomen developed at a time when growth hormone levels were very high and genetic ageing did not begin so that lower levels sufficed, on top of no prior masculinization. Hence, most of us, being older, may indeed need quite high levels for good results. It DEPENDS.

I don't necessarily disagree, but sometimes I get the sense that you think higher levels could help most people with poor feminization, when clearly that was not true for me. Just saying.

QuoteWhat problems? In which population?

I would have to ask.

Quote from: Steph34 on March 23, 2016, 11:58:01 AM
Is milk production good or bad for growth?

I think neither. What matters is estrogen and progesterone. And of course, that androgens are low and/or inhibited to allow for growth.

QuotePlus I consume less saturated fat, a nutrient that increases ghrelin levels.

Saturated fat actually makes one less often hungry IF not eaten with very carby foods. People on high fat (moderately saturated), low carb diets end up eating much less. I should know. Eating bacon, eggs and butter (+ macadamias) in the morning, I sometimes don't get hungry until the next day. This is one of the benefits of eating this way. It's very satiating.

Eur J Nutr. 2013 Feb;52(1):1-24.

"The observational evidence does not support the hypothesis that dairy fat or high-fat dairy foods contribute to obesity or cardiometabolic risk, and suggests that high-fat dairy consumption within typical dietary patterns is inversely associated with obesity risk."

QuoteMy doctor told me that 1)DHEA is the hormone that causes female pattern hair loss

Because it can convert peripherally to testosterone and eventually to DHT (through 5 alpha-reductase) in tissues.

Quotewhich runs in my family

You could ask to be put on finasteride which reduces DHT levels. Even if T levels in the blood are low, DHT levels can be much higher in tissues and people like you, who are sensitive genetically, may still experience side-effects from this amount.

Prog Brain Res. 2010;182:321-41.

"after castration, the 95-97% fall in serum testosterone does not reflect the 40-50% testosterone (testo) and dihydrotestosterone (DHT) made locally in the prostate from DHEA of adrenal origin."

Quote2)Taking estradiol raises DHEA levels.

From a purely chemical standpoint, estradiol cannot convert back to DHEA (or T). DHEA can, however, raise estradiol levels because it converts to T which then can convert to estradiol. If indeed estradiol raised DHEA (and T) levels, mine should be quite high instead of near the low end of the female range, considering my E levels are VERY high. My androgen levels have actually been the lowest they've ever been since being on pregnancy levels of estradiol. My body hair is more sparse, thinner, grows slower while my head hair might be slightly thicker and more dense than before. Imagine the repercussions in pregnant women and in men with prostate cancer who are prescribed high dose estrogen whose lives depend on how much androgens are inhibited.

If indeed estradiol raised DHEA levels and thus raised T and DHT levels, we should be observing many more cases of women experiencing hair loss during their reproductive years. Women actually experience hair thinning/loss to a far greater extent after menopause, when E levels drop.

Androstenediol is the only androgen that can convert back to DHEA.

(notice the direction of the arrows)
http://www.angelfire.com/sc3/toxchick/images/S/steroidogenesis.gif
http://www.genome.jp/kegg/pathway/hsa/hsa00140.html
http://tau.amegroups.com/article/viewFile/2762/3634/49844

There is one way, however, that I could possibly see estradiol raising DHEA levels, now that I come to think of it. Estradiol, especially if taken orally or non-orally at higher levels, will stimulate the production of transcortin as it circulates through the portal vein. Transcortin binds cortisol (especially) and aldosterone. As a result, the levels of free circulating cortisol and aldosterone drop, negative feedback to ACTH drops and ACTH output increases, resulting in an increase in DHEA/DHEA-S. But, like I said, despite my high levels of estradiol, my DHEA and DHEA-S levels have remained low, more towards the low end of the female range and my T VERY low (free T undetectable, probably due to high SHBG). I even noticed that on the day when my E is the highest, my DHEA-S is the lowest. I think this could potentially happen when non bio-identical estrogens are taken as they circulate through the portal vein to a far greater extent due to the body's difficulty in metabolizing them so would stimulate transcortin to a far greater extent as well. In the end though, I think this is a non-issue because in both cases where DHEA levels may rise, either due to non bio-identical forms or VERY VERY high levels of estradiol during the second and third trimester of pregnancy, SHBG which is also very high would offset the potential androgenic effects of DHEA converting to T and DHT as the latter two bind strongly to SHBG.

QuoteIt is a problem when women report side effects such as dizziness, etc.

How is dizziness a side-effect of hyperprolactinemia? This would be indeed quite a problem for pregnant and breastfeeding women which I don't think it is.

QuoteHigh estradiol will make people feel really great in the short term of a few months, but like anything else that produces a sensation of being high, tolerance will occur and then it will require a high level to maintain a normal mood.

I think many, many women (trans and cis) will testify that being on estradiol for several years has not suddenly desensitized them to the mood-enhancing effects of E. There is some degree of fluctuation, especially on injections, which keeps cells responsive. In the case of pellets, levels may be indeed too steady and cause desensitization.

To illustrate just how much levels fluctuate on injections, my estradiol levels went from 2,500 pg/ml to 1,300 pg/ml in just 2 days!!! No possible desensitization from this.

QuoteI did see somewhat of a tolerance effect from my past use of injections. Thankfully I got off of them before I became totally desensitized to its emotional effects.

I can attest to the fact that I've been on high levels for 2 yrs now (on injectables) and my mood is still perfectly fine. I see no deterioration whatsoever. ;) The same can be said of several other women on this board and women I've come into contact with who have been on injectables for years! You seem to be the odd case.

QuoteI also did not see any breast growth nor did I feminize any better on the injections, despite E levels 4 times as high as on patches.

I must admit to seeing less breast growth on injections vs pills (I was taking a high dose orally) BUT as far as the rest of me, I've found I've feminized to a far greater extent than ever before and FEEL better and look HEALTHIER.

QuoteI DID however, have increased side effects, including scalp fungus, nausea/bloating, and extreme moodiness.

Moodiness will occur IF you don't inject frequently enough as levels may drop too much after a certain time. Usually, 7 days is best. The other symptoms, I've personally never experienced, thank goodness and have rarely, VERY rarely come across when reading about other women on injectables. Like I said, you may be the odd case.

QuoteMore is not necessarily better.

Sometimes, yes, sometimes, no. It depends. In my case, it turned out alright. :)

QuoteThere are other explanations for feeling good during pregnancy besides high hormone levels. Excitement about having a baby, perhaps working less or not at all... so there is not necessarily a causative effect.

I agree but I wouldn't discount the mood-enhancing effects of hormones either. I believe hormones, by improving mood, increase the odds of the mother's survival and hence her baby's survival. From an evolutionary standpoint, it makes a whole lot of sense. It's no coincidence that progesterone, a hormone found in high concentrations in pregnant women, converts to allopregnanolone, found to have a calming effect on the organism. Estradiol also positively impacts serotonin.

Maturitas. 1996 May;24(1-2):37-41.

"Serotonin, known for its beneficial action on mood and well-being, is also involved in cardiovascular functions. Thus the current work was undertaken to study the effect of hormone replacement therapy on serotonin turnover in postmenopausal women. Eighteen women received estradiol transdermally and 17 women estradiol valerate orally for 4 weeks. The serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) was determined in the urine before, and after 2 and 4 weeks' estradiol treatment. With both administration routes estradiol produced a significant increase in urinary 5-HIAA excretion, greatest with transdermal estradiol after 28 days of treatment. The enhancement of serotonin turnover may contribute not only to an improvement of mood and well-being but also to a cardioprotective effect of estradiol observed after hormone substitution in postmenopausal women."

J Clin Psychiatry. 2001 May;62(5):332-6.
Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study

"Most women recovered and did not have any depressive symptoms following treatment. There was rapid improvement in symptoms within first week and recovery thereafter. Neither psychotherapy or anti-depressants worked."

QuoteBreast growth or breast swelling? It is important to distinguish between the two. If breasts require constant exposure to hormones to maintain their size, that is swelling and is not sustainable over the long-term.

Breast glands will also shrink (cell apoptosis) in response to a drop in estrogen. In order to maintain glandular tissue and firmness, a certain amount of estrogen is usually needed. Increase in milk in the breast glands, and increase in water concentration can indeed temporarily cause breast swelling. Same with fat, if one gains or loses adipose tissue.

Quotesometimes I get the sense that you think higher levels could help most people with poor feminization, when clearly that was not true for me. Just saying.

It can help at times, yes. But there are many other factors as well. I'm not ignoring these factors at all.

Quote from: KayXo on March 23, 2016, 06:38:05 PM
I think neither. What matters is estrogen and progesterone. And of course, that androgens are low and/or inhibited to allow for growth.

Progesterone really makes mine swell; I think I found the missing ingredient! I think of it as "feeding the girls."
Is cortisol an androgen? I know it is the stress hormone.

QuoteSaturated fat actually makes one less often hungry IF not eaten with very carby foods. People on high fat (moderately saturated), low carb diets end up eating much less.

Actually, people on low fat diets end up eating less because weight loss has less of an unfavorable impact on leptin:ghrelin ratio when fat is restricted.
http://press.endocrine.org/doi/abs/10.1210/jc.2002-021262
That study also keeps protein intake constant, unlike most studies finding 'benefits' of low carb diets that are actually due to increased protein consumption rather than carbohydrate restriction.

Also, saturated fat is less satiating than unsaturated.
http://www.sciencedirect.com/science/article/pii/S0271531710001764

QuoteI should know. Eating bacon, eggs and butter (+ macadamias) in the morning, I sometimes don't get hungry until the next day. This is one of the benefits of eating this way. It's very satiating.

A whole food, plant based diet is also very satiating, perhaps more so because the fiber stops the fat and carbs from moving through too quickly. I am able to overeat because I do not follow my own advice: I am consuming too many added oils and refined grains.

Quote
Eur J Nutr. 2013 Feb;52(1):1-24.

"The observational evidence does not support the hypothesis that dairy fat or high-fat dairy foods contribute to obesity or cardiometabolic risk, and suggests that high-fat dairy consumption within typical dietary patterns is inversely associated with obesity risk."

Observational evidence is very weak evidence and does not prove causation.

QuoteYou could ask to be put on finasteride which reduces DHT levels. Even if T levels in the blood are low, DHT levels can be much higher in tissues and people like you, who are sensitive genetically, may still experience side-effects from this amount.

I am on dutasteride, which is better. Unfortunately, dutasteride may be for life if I want hair. I think dutasteride is making my skin drier and less soft because 5-alpha-reductase increases sebum production, and is suppressed by dutasteride.

QuoteIf indeed estradiol raised DHEA levels and thus raised T and DHT levels, we should be observing many more cases of women experiencing hair loss during their reproductive years.

Not necessarily. Small amounts of T and DHT may be insufficient to cause hair thinning/loss in most women, especially given the benefits of E for hair. Add genetic hypersensitivity to DHT, and things change. One of my close female relatives is already suffering from hair thinning in the front and she is under 30.

QuoteWomen actually experience hair thinning/loss to a far greater extent after menopause, when E levels drop.

Menopausal and post-menopausal hair thinning is caused by low E and not high DHT, since menopause actually decreases DHT levels in cis women.

QuoteHow is dizziness a side-effect of hyperprolactinemia? This would be indeed quite a problem for pregnant and breastfeeding women which I don't think it is.

They often complain of queasiness, morning sickness, etc. I am not sure why dizziness would occur, but I have read of it happening in women with domperidone-induced hyperprolactinemia.

QuoteI think many, many women (trans and cis) will testify that being on estradiol for several years has not suddenly desensitized them to the mood-enhancing effects of E. There is some degree of fluctuation, especially on injections, which keeps cells responsive. In the case of pellets, levels may be indeed too steady and cause desensitization.

What about patches? I do enjoy mood enhancement on the days when I apply a new patch, but I think my levels are fairly steady overall.

QuoteI can attest to the fact that I've been on high levels for 2 yrs now (on injectables) and my mood is still perfectly fine. I see no deterioration whatsoever. ;)

If you came down to a level of 400 (considered high by most women, cis or trans), you would probably feel horrible. Gotta stay high all the time...

I noticed bad desensitization with injections. I would feel rotten by the end of the week, despite still having a moderately high to high level of estradiol.

Quotemust admit to seeing less breast growth on injections vs pills (I was taking a high dose orally) BUT as far as the rest of me, I've found I've feminized to a far greater extent than ever before and FEEL better and look HEALTHIER.

People look healthier when they are happy so that makes sense. Looking healthier is mostly subjective, though. I find that my nipples are more often sensitive and erect on patches than they were on injections. The patches make me happier. They make my girls happier, too.

QuoteI agree but I wouldn't discount the mood-enhancing effects of hormones either. I believe hormones, by improving mood, increase the odds of the mother's survival and hence her baby's survival. From an evolutionary standpoint, it makes a whole lot of sense.

I do not see how the mother's survival would be affected much by improved mood. From an evolutionary standpoint, high hormone levels make much more sense as a mechanism to increase fertility at a time when it matters most.

QuoteIt's no coincidence that progesterone, a hormone found in high concentrations in pregnant women, converts to allopregnanolone, found to have a calming effect on the organism.

I would call it a sedative.

QuoteEstradiol also positively impacts serotonin.

Maturitas. 1996 May;24(1-2):37-41.

"Serotonin, known for its beneficial action on mood and well-being, is also involved in cardiovascular functions. Thus the current work was undertaken to study the effect of hormone replacement therapy on serotonin turnover in postmenopausal women. Eighteen women received estradiol transdermally and 17 women estradiol valerate orally for 4 weeks. The serotonin metabolite 5-hydroxyindole acetic acid (5-HIAA) was determined in the urine before, and after 2 and 4 weeks' estradiol treatment. With both administration routes estradiol produced a significant increase in urinary 5-HIAA excretion, greatest with transdermal estradiol after 28 days of treatment. The enhancement of serotonin turnover may contribute not only to an improvement of mood and well-being but also to a cardioprotective effect of estradiol observed after hormone substitution in postmenopausal women."

J Clin Psychiatry. 2001 May;62(5):332-6.
Estrogen deficiency in severe postpartum depression: successful treatment with sublingual physiologic 17beta-estradiol: a preliminary study

"Most women recovered and did not have any depressive symptoms following treatment. There was rapid improvement in symptoms within first week and recovery thereafter. Neither psychotherapy or anti-depressants worked."

Interesting. I wonder if that is why E is 'naturally rewarding.'

QuoteBreast glands will also shrink (cell apoptosis) in response to a drop in estrogen. In order to maintain glandular tissue and firmness, a certain amount of estrogen is usually needed.

Cis women have VERY low E for part of their cycle and it never seems to do them much harm.

Quote from: Steph34 on March 27, 2016, 09:41:11 AM
Progesterone really makes mine swell

Same here. :)

QuoteIs cortisol an androgen? I know it is the stress hormone.

Cortisol is not an androgen but a corticosteroid with potent glucocorticoid effects.

QuoteActually, people on low fat diets end up eating less because weight loss has less of an unfavorable impact on leptin:ghrelin ratio when fat is restricted.
http://press.endocrine.org/doi/abs/10.1210/jc.2002-021262
That study also keeps protein intake constant, unlike most studies finding 'benefits' of low carb diets that are actually due to increased protein consumption rather than carbohydrate restriction.

On a low carb, HIGH fat diet (protein at around 15-20%), my hunger significantly drops. I don't increase my protein, but increase my fat and reduce my carbs. This is how healthy low carb eating is done. Eating once daily suffices, sometimes twice, depending on how active I am. I have no desire to reduce fat as it is satiating, pleasurable, nutritious (fat soluble vitamins, omega 3), has not been shown (cause and effect) to adversely affect health or lead to obesity in humans (quite the contrary).

It is interesting to note in this study that the 15 % fat diet is not only lower in fat but more nutritious so other factors are also modified, not just one factor, which could have also influenced the results.

Menu for one day:
on 35% fat, for breakfast, twice as much jam as compared to the 15% fat group...jam is full of sugar
on 35% fat, for breakfast, 122 g of orange juice (full of sugar and very little nutrition) vs. 120 g of a banana which is relatively lower in overall carbs and more nutritious
on 35% fat, for snack, oreo cookies and mandarin oranges vs. non fat milk and granola bar, now it doesn't take a genius to figure which of the two is most nutritious and less sweet
Overall, you see a pattern of healthier, whole carb foods in the 15% fat group vs. in the 35% fat group which eats english muffins instead of bran flakes + whole wheat bread for breakfast and tends to eat more processed food.

Nutritious value of what each group ate should have been taken into consideration and is important. It has not and as such, this study proves to be strongly flawed. Did you even read the full study?

Anyone would feel more satiated on nutritious food versus less nutritious + more empty calorie foods.

QuoteAlso, saturated fat is less satiating than unsaturated.
http://www.sciencedirect.com/science/article/pii/S0271531710001764

This study is in rats, not in human beings. We cannot generalize these findings to us. We need to replicate this in humans. 

QuoteA whole food, plant based diet is also very satiating, perhaps more so because the fiber stops the fat and carbs from moving through too quickly.

More satiating than having to only eat once daily? Ok, sure.

QuoteI am able to overeat because I do not follow my own advice: I am consuming too many added oils and refined grains.

Is it the refined grains or the added oils making you overeat? Factors must be isolated to determine cause and effect.

And when you do follow your advice, do you end up having to eat even less than once daily, say, perhaps, once every 36 hours?

QuoteObservational evidence is very weak evidence and does not prove causation.

Correct but if we don't even observe any association, this suggests that we shouldn't also find a cause and effect association. At the very least, if something causes something else, we should begin to observe an association and if we don't, this is not a path worth investigating.

QuoteI am on dutasteride, which is better. Unfortunately, dutasteride may be for life if I want hair. I think dutasteride is making my skin drier and less soft because 5-alpha-reductase increases sebum production, and is suppressed by dutasteride.

J Am Acad Dermatol. 2006 Dec;55(6):1014-23.

In this study, only a very high dose of dutasteride (unlikely to be your case) proved superior to finasteride in terms of hair counts, expert and investigator assessment while subjects' assessments of improvement were pretty much the same for both high dose dutasteride and finasteride. So, if you are on the lower dose and finasteride costs you less, you might as well take finasteride. ;) More worthwhile for you.

Recently, I came across studies that suggest finasteride/dutasteride may cause depression in some. You should know this treatment reduces levels of allopregnanolone and tetradeoxycorticosterone which play a crucial role in mood enhancement, memory, learning, brain health. With that being said, I'm not sure I would take it at all, even if you noted no depression or anxiety, I would be worried of the impact this treatment would have on such important neurosteroids and would not want to compromise my well-being or brain health especially considering that with HRT, T is already significantly reduced anyways and hair loss will not get worse. Perhaps, you would get a slightly fuller head of hair with DHT inhibitors but at what cost? Your call...I thought you just needed to know this.

QuoteNot necessarily. Small amounts of T and DHT may be insufficient to cause hair thinning/loss in most women, especially given the benefits of E for hair.

So then who cares IF estrogen raised DHEA levels because of the protective effects of E. Take more E, higher DHEA but higher E too so what's the problem? Why even mention this?

QuoteOne of my close female relatives is already suffering from hair thinning in the front and she is under 30.

A rare case. No one will argue the fact that balding is MUCH more common in men than in women. DHEA levels are also lower in women than in men, on average.

QuoteMenopausal and post-menopausal hair thinning is caused by low E and not high DHT, since menopause actually decreases DHT levels in cis women.

Exactly my point that E drops so DHEA would also drop, DHT levels drop and yet we see more thinning due to the fact that E:A ratio is reduced. Your original concern was about E raising DHEA and yet we see women do better on high levels of E so this is a non issue. Why are we still talking about this? LOL.

QuoteThey often complain of queasiness, morning sickness, etc.

But who's to say this is because of high prolactin levels and not due to higher progesterone levels which slow down intestinal transit time. My prolactin levels are very high, up to 130 ng/ml and yet no dizziness, queasiness, morning sickness to speak of.

QuoteI am not sure why dizziness would occur, but I have read of it happening in women with domperidone-induced hyperprolactinemia.

Maybe it's not caused by the high prolactin levels but it's some other side-effect of the drug. Where is the cause and effect relationship between both high prolactin and dizziness? So far, you have not shown any.

QuoteWhat about patches? I do enjoy mood enhancement on the days when I apply a new patch, but I think my levels are fairly steady overall.

I would also be worried about patches due to too steady levels. But, this may also depend on other factors such as skin sweat, patch not staying on, etc which may make levels not as steady as they should.

QuoteIf you came down to a level of 400 (considered high by most women, cis or trans), you would probably feel horrible. Gotta stay high all the time...

If you also went down to a lower level, you would feel horrible too. This applies to all of us, regardless of our current levels. I have no reason to lower my dose or levels. I will stay high. :) And contrary to what you say, I have not become desensitized to E.

QuoteI noticed bad desensitization with injections. I would feel rotten by the end of the week, despite still having a moderately high to high level of estradiol.

This is not due to desensitization but rather due to levels dropping too much, even if still high but significantly lower relative to higher levels earlier during the week. Some, like me, may need to inject more frequently, every 5 days. Levels fluctuate quite a bit on injections and in some, due to fast metabolism, levels can drop too fast too soon.

QuoteLooking healthier is mostly subjective, though.

In my case, it's obvious and there is a big change that can't be missed. Face looks healthier, people have also noticed and even asked me...what did you do to your hair, your face, you look great, you are glowing, etc.

QuoteI find that my nipples are more often sensitive and erect on patches than they were on injections. The patches make me happier. They make my girls happier, too.

And I am happy for you. That's the most important. Stick with what makes you feel and look good.

QuoteI do not see how the mother's survival would be affected much by improved mood. From an evolutionary standpoint, high hormone levels make much more sense as a mechanism to increase fertility at a time when it matters most.

A pregnant woman is already pregnant, she doesn't need fertility. LOL. Being in a good mood, not stressed increases the chances that a woman will not miscarry, will not have an unhealthy baby, etc. A calmer, happier body is a healthier body. This is obvious to me.

QuoteI would call it a sedative.

Yes it is but it is also an anti-depressant and an anxiolytic agent. It raises allopregnanolone levels much like some anti-depressants and antipsychotics do. As a result, general mood is improved and one is more relaxed, sleeps better...sleep makes for a happier person. :)

QuoteCis women have VERY low E for part of their cycle and it never seems to do them much harm.

E levels drop but not long enough to make a significant difference in breasts. I think if you asked most women, they would tell you they would rather have higher E all the time than go through the hell of having lower E for even just one week. In some, the suffering is very significant and debilitating.

I thought of one other reason I may not be developing properly: acid/food reflux. Sometimes when I have reflux, I feel like the acid or food rises into my chest and spreads throughout the breasts. That can be painful, especially when it is acid. I cannot use acid suppressors because they interfere with domperidone and therefore make me nauseous.

Quote from: KayXo on March 27, 2016, 01:06:32 PM
Cortisol is not an androgen but a corticosteroid with potent glucocorticoid effects.

I still do not see why that would be harmful to breast growth.

QuoteOn a low carb, HIGH fat diet (protein at around 15-20%), my hunger significantly drops. I don't increase my protein, but increase my fat and reduce my carbs. This is how healthy low carb eating is done.

A diet composed predominately of fat cannot possibly be healthy because 1)it excludes the vast majority of nutritious foods, and 2)it would contain a low level of water-soluble vitamins.

QuoteIt is interesting to note in this study that the 15 % fat diet is not only lower in fat but more nutritious so other factors are also modified, not just one factor, which could have also influenced the results.

That is a problem with nearly all studies if you really look closely; it does not invalidate the results.

QuoteOverall, you see a pattern of healthier, whole carb foods in the 15% fat group vs. in the 35% fat group which eats english muffins instead of bran flakes + whole wheat bread for breakfast and tends to eat more processed food.

Again, supporting my belief that processed food (regardless of composition) is the problem, and not total carbs. Because IF carbs were really so evil like you often suggest, the 70% carb diet would not be superior to the 50% carb diet just because it is more nutritious.

QuoteMore satiating than having to only eat once daily? Ok, sure.

I only eat once a day.

QuoteIs it the refined grains or the added oils making you overeat? Factors must be isolated to determine cause and effect.

It is not possible for me to consume 5000+ calories unless I have plenty of BOTH. Either one alone is insufficient to enable such overeating.

QuoteAnd when you do follow your advice, do you end up having to eat even less than once daily, say, perhaps, once every 36 hours?

No; I always get grumpy if I pass 24 hours. However, when I eat more whole and less processed food, I am much less hungry before the next day's meal time.

QuoteCorrect but if we don't even observe any association, this suggests that we shouldn't also find a cause and effect association. At the very least, if something causes something else, we should begin to observe an association and if we don't, this is not a path worth investigating.

Human behavior is so complex with so many confounds that we cannot assume any association will stare us in the face.

Quote
J Am Acad Dermatol. 2006 Dec;55(6):1014-23.

In this study, only a very high dose of dutasteride (unlikely to be your case) proved superior to finasteride in terms of hair counts, expert and investigator assessment while subjects' assessments of improvement were pretty much the same for both high dose dutasteride and finasteride. So, if you are on the lower dose and finasteride costs you less, you might as well take finasteride. ;) More worthwhile for you.

I have much worse sensitivity to DHT than most people with hair loss, so the results of studies cannot be extended to me. Dutasteride has been shown to be superior to finasteride for reducing both serum and scalp levels of DHT. To imply that has no effect on hair is preposterous.

QuoteRecently, I came across studies that suggest finasteride/dutasteride may cause depression in some. You should know this treatment reduces levels of allopregnanolone and tetradeoxycorticosterone which play a crucial role in mood enhancement, memory, learning, brain health.

I really don't care about anything else if it is good for my hair. :)

QuoteWith that being said, I'm not sure I would take it at all, even if you noted no depression or anxiety, I would be worried of the impact this treatment would have on such important neurosteroids and would not want to compromise my well-being or brain health

If you were going bald, I think you would change your mind. ;)

Quoteespecially considering that with HRT, T is already significantly reduced anyways and hair loss will not get worse.

Hair loss can worsen even during transition. Women get hair loss, too, especially in my family. The difference between male and female ranges is much smaller for DHT than it is for T. I twice tried going off my dutasteride and the loss/thinning quickly resumed, only to stop once again upon resumption of dutasteride.

QuotePerhaps, you would get a slightly fuller head of hair with DHT inhibitors but at what cost? Your call...I thought you just needed to know this.

If living as a man and taking tons of T and steroids would save my hair, I would do it. And I love my femininity. I think that puts things in perspective. Hair is life, the catalyst for my transition in the first place.

QuoteSo then who cares IF estrogen raised DHEA levels because of the protective effects of E. Take more E, higher DHEA but higher E too so what's the problem? Why even mention this?

I mention this because, for me personally, the benefit of E for hair is offset by the fact that it worsens my scalp fungus, causing excessive and unsustainable shedding.

QuoteNo one will argue the fact that balding is MUCH more common in men than in women.

Not me, but some of the guys on hair loss boards are in total denial that male hormones are causing their hair loss.

QuoteDHEA levels are also lower in women than in men, on average.

True, but there is a large amount of overlap between the male and female ranges. In stark contrast to T and E, male and female levels of DHEA are fairly similar.

QuoteYour original concern was about E raising DHEA and yet we see women do better on high levels of E so this is a non issue. Why are we still talking about this?

Like I said, I do worse on high levels of E because of increased scalp fungus.

QuoteBut who's to say this is because of high prolactin levels and not due to higher progesterone levels which slow down intestinal transit time. My prolactin levels are very high, up to 130 ng/ml and yet no dizziness, queasiness, morning sickness to speak of.

Your progesterone is also high. Not everyone experiences those side effects. Some people, like my mother and perhaps you, are blessed with fast stomach emptying.

QuoteI would also be worried about patches due to too steady levels. But, this may also depend on other factors such as skin sweat, patch not staying on, etc which may make levels not as steady as they should.

I use waterproof bandages to make sure the patch stays on, but I do have some strategies (temporarily wearing no patch, overlapping patches, and altering the spacing between application days) to make my levels less steady. Still, I need some semblance of a steady level in order to be emotionally stable. I am a very emotional girl and wild swings are hard for me to handle.

QuoteIf you also went down to a lower level, you would feel horrible too. This applies to all of us, regardless of our current levels.

Yes; we become accustomed to a certain level of E and coming down is always hard. Now that my E level is typically 100-200, a level of 80 would feel bad. Back when I was accustomed to a level of 30-60, a level of 80 felt like getting high. On injections when my level was 400-1000, I actually felt bad when I came down to 400! That sounds like desensitization to me, but I think I have another explanation: A rising level feels good and a falling level feels bad, regardless of the actual level. I have tried topical, oral, sublingual, injections, and patches and have noticed that pattern regardless of what form I use and what my level is. That is why injections feel bad to me: the level reaches a peak fairly quickly and then spends the rest of the week declining. With patches, I enjoy a slower and steadier rise and therefore have more happy emotional days and fewer depressed days. Unlike oral and topical products when my level was too low, patches also work fairly well to give me a normal female level and have milder side effects compared to oral and injectable forms which gave me bad side effects for the digestive tract and the scalp. 

QuoteI have no reason to lower my dose or levels. I will stay high. :)

I am glad you found what works for you. I am a much more emotional person, though. High E levels from injections made my emotions so over-the-top that I became practically psychotic; my mother was "scared." I love being an emotional girl, but it is possible to have too much of a good thing.

QuoteAnd contrary to what you say, I have not become desensitized to E.

You might have become desensitized to normal levels of E; you certainly seem afraid of them. It is understandable to me that many doctors would be afraid to prescribe high-dose E because of this 'tolerance' effect. If a patient had to go completely off of E for medical reasons, extreme moodiness and physical distress would occur. It would be like menopause on steroids!

QuoteIn my case, it's obvious and there is a big change that can't be missed. Face looks healthier, people have also noticed and even asked me...what did you do to your hair, your face, you look great, you are glowing, etc.

Lucky you. With that said, I have received compliments for my skin and hair which were always in very poor condition before I discovered E. No need for psychosis-inducing megadoses.

QuoteAnd I am happy for you. That's the most important. Stick with what makes you feel and look good.

For me, that would be the "good stuff" patches. I love them!

QuoteA pregnant woman is already pregnant, she doesn't need fertility. LOL.

I disagree. A woman who becomes pregnant demonstrates that she is able to become pregnant and it makes sense that nature would give her hormones that would help her become pregnant again later. Also, higher female hormone levels to maintain fertility would reduce the risk of miscarriage.

QuoteA calmer, happier body is a healthier body. This is obvious to me.

I am not aware of any studies showing a cause-and-effect relationship between calmness and health or between happiness and health. This is not obvious to me. After all, old people who are too calm (due to lack of social interaction) are more likely to die. Likewise, bursts of happiness can shock the heart.

QuoteYes it is but it is also an anti-depressant and an anxiolytic agent. It raises allopregnanolone levels much like some anti-depressants and antipsychotics do. As a result, general mood is improved and one is more relaxed, sleeps better...sleep makes for a happier person. :)

Taking progesterone does help with sleep but I think that is due to the sedative effect of allopregnanolone rather than anything else. Progesterone itself can make my depression worse, though, because it is anti-estrogenic.

QuoteE levels drop but not long enough to make a significant difference in breasts.

A low level for even 24 hours makes a significant difference in my breasts.

QuoteI think if you asked most women, they would tell you they would rather have higher E all the time than go through the hell of having lower E for even just one week. In some, the suffering is very significant and debilitating.

I do not think most women think consciously about their E levels; they are lucky enough that they do not need to. Although mood can be correlated with E, I do not think there is usually a conscious process involved, like "I wish I did not have low E this week!"

Quote from: Steph34 on April 03, 2016, 09:19:01 AM
I still do not see why that would be harmful to breast growth.

Just something I personally noticed and makes sense intuitively. Perhaps not because of cortisol but because of impaired blood circulation.

QuoteA diet composed predominately of fat cannot possibly be healthy because 1)it excludes the vast majority of nutritious foods, and 2)it would contain a low level of water-soluble vitamins.

The Maasai people and the Inuit people, eating a diet predominantly composed of fat, were observed to be quite healthy, even healthier than us. They survived harsh environments for thousands of years and had their diet not been healthy, this would not have been possible. I highly recommend The Fat of the Land / Not By Bread Alone by Vilhjalmur Stefansson.

Also, as stated before,

http://www.jbc.org/content/87/3/651.full.pdf

"Two normal men volunteered to live solely on meat for one
year, which gave us an unusual opportunity of studying the
effects of this diet."

"25 per cent of the calories were derived from protein, 75 to 85 per cent from
fat, and 1 to 2 per cent from carbohydrate. Details concerning
the food eaten are presented in Table I."

In the summary and conclusions part:

"Vitamin deficiencies did not appear."

And earlier noted  "No clinical evidence of vitamin deficiency was noted."

QuoteThat is a problem with nearly all studies if you really look closely; it does not invalidate the results.

It may not invalidate your "beliefs" but it invalidates results because more than one factor was changed and so causation and effect may not established. Basic science. Only change one variable at a time. Some studies do indeed change ONLY one variable at a time. They are called randomized double blind placebo controlled trials.

QuoteAgain, supporting my belief that processed food (regardless of composition) is the problem, and not total carbs. Because IF carbs were really so evil like you often suggest, the 70% carb diet would not be superior to the 50% carb diet just because it is more nutritious.

Of course, it's better to eat more carbs that are more nutritious than less carbs that are mostly empty carbs BUT I take issue with eating little fat and meat which are nutritionally dense. I consider even a diet predominantly composed of nutritious whole carb foods less healthy, in my opinion (based on several well-designed studies and my understanding of the effect of insulin and sugar on the body), than a diet higher in fat and lower in carb because, over time, insulin will be overstimulated and cause metabolic problems + the fiber, so often touted as essential and healthy in a high carb whole grain diet irritates sensitive lining of digestive tract, why may form a callous over time which reduces one's ability to absorb nutrients. Fats in animals and the vitamins they contain appear to be superior to those found in vegetables (Vitamin A vs beta-carotene, DHA/EPA vs ALA, even Vitamin K) and the protein in more complete. There is no Vitamin D in the plant world and B12 is lacking.

QuoteI only eat once a day.

Not the impression I get from your messages.

QuoteI have much worse sensitivity to DHT than most people with hair loss, so the results of studies cannot be extended to me. Dutasteride has been shown to be superior to finasteride for reducing both serum and scalp levels of DHT. To imply that has no effect on hair is preposterous.

As shown, the dose of dutasteride you (probably) take, regardless of how much DHT is reduced, was equally effective to the highest dose of finasteride in terms of actual hair counts and overall assessment. What counts more: how much DHT is in your blood or scalp or actual hair results? I'm trying to help you save money while maintaining the same good results. :) That's all.

QuoteI really don't care about anything else if it is good for my hair. :)

QuoteIf you were going bald, I think you would change your mind. ;)

No because estrogen, other, safer anti-androgens will just as effectively reduce T and DHT to castrate levels, under those seen in premenopausal women who rarely go bald. Dutasteride is not the only option and can have adverse effects on the brain and mood.

QuoteHair loss can worsen even during transition. Women get hair loss, too, especially in my family. The difference between male and female ranges is much smaller for DHT than it is for T. I twice tried going off my dutasteride and the loss/thinning quickly resumed, only to stop once again upon resumption of dutasteride.

I'm sorry this happened but you may not be on an adequate HRT regimen then. Too little E perhaps or not enough anti-androgenic action. This should be discussed with your doctor.

http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81479
Range in males (after 19) is 112-955 pg/mL
In females (20-55 yrs old), 300 pg/ml or less

I consider this difference significant! Compared to males, females are MUCH, much less likely to suffer from baldness, hence why it's termed MALE pattern baldness.

QuoteHair is life, the catalyst for my transition in the first place.

I understand but what I'm saying is that there are possibly other safer ways to go about it. Don't dismiss them so quickly. There are blockers like bicalutamide or suppressors like lhRh agonists.

QuoteOn injections when my level was 400-1000, I actually felt bad when I came down to 400! That sounds like desensitization to me

Desensitization is not that but rather cells stop responding to the same level when earlier they responded. In your case, levels dropped and this is why you felt bad.

QuoteYou might have become desensitized to normal levels of E; you certainly seem afraid of them.

What is normal? Ciswomen's range varies so widely and they can go through pregnancy several times during their lives. Lowest can be around 20 pg/ml, highest during pregnancy can be 75,000.

Why would pregnancy levels not be considered normal when women go through this, some several times during their lives and when traditionally, it was considered the norm, was often experienced by women who had up to ten or more children during a lifetime? I am well within "norm".

QuoteIt is understandable to me that many doctors would be afraid to prescribe high-dose E because of this 'tolerance' effect.

There is no such effect. I intend to remain on high levels for my entire life. My doses need not be reduced. If I absolutely had to lower my dose because of (in my opinion) incompetent doctors, then I guess eventually, I would adapt to lower levels after going through menopausal symptoms for awhile. But, I am surrounded by several competent doctors that trust me and see eye to eye with me. My cousin's wife is also a gynecologist. :)

QuoteIf a patient had to go completely off of E for medical reasons, extreme moodiness and physical distress would occur. It would be like menopause on steroids!

I personally see no reason to go off of E for medical reasons (based on all that I've read) unless the E is taken orally or is non bio-identical. Ciswomen have E coursing through their veins and aren't told to remove ovaries because of medical reasons unless the reason is tumor or cyst on ovaries which does not apply to us.

QuoteNo need for psychosis-inducing megadoses.

For you. One study actually observed post-partum psychosis because of a drop in E levels following pregnancy so they gave these women E and it worked! Where antipsychotics didn't. The power of E.

QuoteA woman who becomes pregnant demonstrates that she is able to become pregnant

Obviously. That she is fertile, able to become pregnant.

Quoteand it makes sense that nature would give her hormones that would help her become pregnant again later.

This doesn't happen until after she enters ovulation again. Hormones produced during pregnancy, as far as I know, have no impact on the hormones that will be produced in her next cycle which may or may not be produced in sufficient amount.

QuoteAlso, higher female hormone levels to maintain fertility would reduce the risk of miscarriage.

Not to maintain fertility, fertility being the ability to conceive a child (which she already did) but rather to maintain, support the fetus that is already conceived so it does not die. Not exactly the same. Slight nuance.

QuoteI am not aware of any studies showing a cause-and-effect relationship between calmness and health or between happiness and health. This is not obvious to me. After all, old people who are too calm (due to lack of social interaction) are more likely to die. Likewise, bursts of happiness can shock the heart.

You really believe happiness or being calm has no positive (or any) effect on health? Really? It's obvious to me. Oh well...will not argue where I don't see the need to.

QuoteTaking progesterone does help with sleep but I think that is due to the sedative effect of allopregnanolone rather than anything else.

Of course.

QuoteI do not think there is usually a conscious process involved, like "I wish I did not have low E this week!"

I think some women realize they feel better at a time when their E increases while others remain ignorant as to the cause. Regardless, if we could offer them E at a stable level (but not too stable so as not to desensitize) and they could experience it for themselves, I doubt they would want to go back.

Quote from: KayXo on April 03, 2016, 12:54:02 PM
It may not invalidate your "beliefs" but it invalidates results because more than one factor was changed and so causation and effect may not established. Basic science. Only change one variable at a time. Some studies do indeed change ONLY one variable at a time. They are called randomized double blind placebo controlled trials.

Most of the studies you cite to support your "belief" that low carb diets are superior have similar problems: they also change protein content, vitamin levels, etc. without controls.

QuoteFats in animals and the vitamins they contain appear to be superior to those found in vegetables (Vitamin A vs beta-carotene, DHA/EPA vs ALA, even Vitamin K) and the protein in more complete.

The difference is moot because plant forms are more than adequate for good health for the vast majority of us.

QuoteThere is no Vitamin D in the plant world and B12 is lacking.

Vitamin D is not a real vitamin as it is produced endogenously in response to radiation, plus it is found in some mushrooms which are not animals. B12 is controversial but a rational vegan will supplement it just like a rational strict carnivore would supplement vitamin C. I could also argue that B12 is not necessary if one avoids B12 "killers" and/or uses unproven natural sources, but why bother?

QuoteNot the impression I get from your messages.

It is just a very long meal...

QuoteAs shown, the dose of dutasteride you (probably) take, regardless of how much DHT is reduced, was equally effective to the highest dose of finasteride in terms of actual hair counts and overall assessment. What counts more: how much DHT is in your blood or scalp or actual hair results? I'm trying to help you save money while maintaining the same good results. :) That's all.

I care more about hair than money. I maintain my position that actual hair count would be different in me even if no pattern was seen in a study because 1) I am more sensitive to DHT than most people, and 2)I have uncontrollable scalp fungus that further interacts with DHT to cause additional hair loss. Indeed, scalp fungus is main the reason I have not regrown hair despite transitioning with dutasteride.

QuoteNo because estrogen, other, safer anti-androgens will just as effectively reduce T and DHT to castrate levels, under those seen in premenopausal women who rarely go bald.

You do not seem to understand that I have genetic hypersensitivity to DHT and a female level of DHT will NOT stop my hair loss. I lose hair w/o dutasteride even when my T and free T are in the female range. Even a female relative in her 20s has some thinning in the front and on top. That is called female pattern hair loss and it does exist. Also I need to be extra vigilant due to past damage from DHT; I was actually balding on top and had little left elsewhere pre-transition.

QuoteDutasteride is not the only option and can have adverse effects on the brain and mood.

If not relevant to my feminization, I really don't care...

QuoteI'm sorry this happened but you may not be on an adequate HRT regimen then. Too little E perhaps or not enough anti-androgenic action. This should be discussed with your doctor.

I have already had my orchiectomy so I should not need anti-androgens.

QuoteI consider this difference significant! Compared to males, females are MUCH, much less likely to suffer from baldness, hence why it's termed MALE pattern baldness.

Males are MUCH less likely than females to suffer from breast cancer, but you would not tell that to a man with breast cancer; would you?

QuoteI understand but what I'm saying is that there are possibly other safer ways to go about it. Don't dismiss them so quickly. There are blockers like bicalutamide or suppressors like lhRh agonists.

Adding more E or bicalutamide would cause very real side effects for me, much worse than dutasteride. lhrh agonists are very expensive. And none of those three methods would suppress DHT as effectively as dutasteride.

QuoteDesensitization is not that but rather cells stop responding to the same level when earlier they responded.

True. I think that happened with me, too. After my 5 months on injections, I now require higher levels to see the same benefits for my mind and body as I did beforehand. Higher levels = worse side effects.

QuoteIn your case, levels dropped and this is why you felt bad.

Yes; my mood depends more on whether my level is rising or falling than on absolute levels. Injections = rapid decline for most of the week which is why my mood suffered despite high levels. Plus the high I experienced was TOO intense and my extreme emotions were crippling.

QuoteWhat is normal? Ciswomen's range varies so widely and they can go through pregnancy several times during their lives. Lowest can be around 20 pg/ml, highest during pregnancy can be 75,000.

Normal is the range of a menstruating cis woman.

QuoteWhy would pregnancy levels not be considered normal when women go through this, some several times during their lives and when traditionally, it was considered the norm, was often experienced by women who had up to ten or more children during a lifetime? I am well within "norm".

Pregnant women's levels do not crash by 1000 or more every week. Such rapid and frequent fluctuations of such large magnitude are not within the typical female experience and I think most women would not do well emotionally with such wild changes.

QuoteI personally see no reason to go off of E for medical reasons (based on all that I've read) unless the E is taken orally or is non bio-identical.

I can think of several: extreme constipation, candidiasis, blood clots, estrogen-positive cancer...

QuoteRegardless, if we could offer them E at a stable level (but not too stable so as not to desensitize) and they could experience it for themselves, I doubt they would want to go back.

Most people do not want to mess with their hormones unless they have to for medical reasons.

Quote from: Steph34 on April 10, 2016, 10:07:26 AM
Most of the studies you cite to support your "belief" that low carb diets are superior have similar problems: they also change protein content, vitamin levels, etc. without controls.

It depends. On a low carb diet, protein is not really changed (low carb should be a moderate protein diet) but carb content is reduced while fat content is increased. Of course, the nutrition one gets changes, as a result and indeed it is not perfect as more than one thing changes. I agree. Some studies have a control group whereas others don't. But, at least these studies aren't simply observations where people are followed, asked what they ate and then an association is made between what they ate and heart disease or cancer rate when so many factors can differ between these two groups. These studies are much more tightly controlled with much less confounding variables. Some of the studies I provided are indeed randomized controlled trials and these are much more solid than cohort or epidemiological studies for obvious reasons that I explained many times before.

The following 24 studies are all randomized controlled trials, one of which is a systematic review:

Obes Rev. 2009 Jan;10(1):36-50. Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities.
Hession M1, Rolland C, Kulkarni U, Wise A, Broom J.

Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.

Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 2003.

Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.

Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 2003.

Aude YW, et al. The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat. Archives of Internal Medicine, 2004.

Yancy WS Jr, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 2004.

JS Volek, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism (London), 2004.

Meckling KA, et al. Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women. The Journal of Clinical Endocrinology & Metabolism, 2004.

Nickols-Richardson SM, et al. Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. Journal of the American Dietetic Association, 2005.

Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes. Diabetic Medicine, 2006.

McClernon FJ, et al. The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood, hunger, and other self-reported symptoms. Obesity (Silver Spring), 2007.

Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007.

Halyburton AK, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. American Journal of Clinical Nutrition, 2007.

Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabetic Medicine, 2007.

Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrion & Metabolism (London), 2008.

Shai I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. New England Journal of Medicine, 2008.

Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. American Journal of Clinical Nutrition, 2008.

Tay J, et al. Metabolic effects of weight loss on a very-low-carbohydrate diet compared with an isocaloric high-carbohydrate diet in abdominally obese subjects. Journal of The American College of Cardiology, 2008.

Volek JS, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids, 2009.

Brinkworth GD, et al. Long-term effects of a very-low-carbohydrate weight loss diet compared with an isocaloric low-fat diet after 12 months. American Journal of Clinical Nutrition, 2009.

Hernandez, et al. Lack of suppression of circulating free fatty acids and hypercholesterolemia during weight loss on a high-fat, low-carbohydrate diet. American Journal of Clinical Nutrition, 2010.

Krebs NF, et al. Efficacy and safety of a high protein, low carbohydrate diet for weight loss in severely obese adolescents. Journal of Pediatrics, 2010.

Guldbrand, et al. In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia, 2012.

Quotea rational vegan will supplement it just like a rational strict carnivore would supplement vitamin C.

I earlier showed you a study where men ate an exclusively meat diet for one full year without Vitamin C supplement and showed no symptoms of vitamin deficiencies. You choose to ignore it. I provided information on the lack of scurvy in Inuits who practically eat only meat and fat all their lives and how raw meat cured some sailors and explorers of scurvy. I also myself lived on only meat and nothing else for more than one year and developed no Vitamin deficiency. This sort of deficiency would start kicking in quite quickly and it hasn't in people following a strict carnivore regimen.

QuoteMales are MUCH less likely than females to suffer from breast cancer, but you would not tell that to a man with breast cancer; would you?

Breast cancer is indeed much less likely in men. I never said ABSENT, or that scalp hair loss in women was unheard of but LESS LIKELY.

QuoteAdding more E or bicalutamide would cause very real side effects for me, much worse than dutasteride. lhrh agonists are very expensive. And none of those three methods would suppress DHT as effectively as dutasteride.

I didn't realize you had orchiectomy so LhRh agonists are useless. I understand about the estrogen. But, have you ever tried taking bicalutamide? What were the side-effects? Bicalutamide would block DHT very effectively, it is used in men with prostate cancer with castrate levels of T.

QuoteNormal is the range of a menstruating cis woman.

You don't consider pregnancy normal? Traditionally, women became pregnant several times during their lives and spent most their reproductive years being pregnant or breastfeeding. I consider pregnancy actually more normal than fluctuating levels every month and suspect women were traditionally exposed to much higher levels of E for a longer time than they do now.

I disagree. Pregnancy is indeed VERY normal.

QuotePregnant women's levels do not crash by 1000 or more every week. Such rapid and frequent fluctuations of such large magnitude are not within the typical female experience and I think most women would not do well emotionally with such wild changes.

Many transwomen report feeling BETTER on injections, usually taken weekly, than on orals where levels fluctuate much less. Most women actually do fine despite these fluctuations as long as interval is kept to about a week. You are deeply mistaken in that respect. I do well, have no emotional ups and downs. Your situation is not the norm.

QuoteI can think of several: extreme constipation, candidiasis, blood clots, estrogen-positive cancer...

I have high levels of E and my clotting times have remained perfect. Pregnant women have extremely high levels (up to 75,000 pg/ml) and despite this, their risk of thrombosis remains under 0.2% (largely in women predisposed) whereas risk increases post-partum when levels crash. Studies in men with prostate cancer (aged up to 91 yrs old, average age 75) have shown high levels (up to 700 pg/ml) not to increase risk of clots and to actually protect against it. A study found no incidences in transsexual women taking very high doses of IM EV. I have several times provided the references/studies for these. Just look back through my posts.

I have never heard of either a link between estrogen and constipation and candidiasis. I have neither of those despite very high levels and have never read any such report from transwomen on high levels, expect perhaps you. Can you provide actual scientific support for this?

Cancer is very low in transsexual women despite for decades, being prescribed sometimes VERY aggressive doses of estrogen. Pregnancy, a time of very high levels of E, has been inversely associated with breast cancer in ciswomen and in randomized controlled trials, estrogen taken alone or without progestogens known to increase risk of breast cancer, has actually neither increased the rate of cancer and even reduced incidence. Even in women with prior breast cancer, studies have shown either no recurrence, low recurrence or less recurrence on estrogen. High doses of estrogen are sometimes actually prescribed to women with advanced breast cancer and one such study even found E to be better than tamoxifen, an "anti-estrogen", in terms of survival rate. Overall, it seems that estrogen is more protective than anything else. Women get breast cancer after the age of 40 and especially 50 when their estrogen levels drop.

Pathol Oncol Res. 2012 Apr;18(2):123-33.

"even a slight decrease in their circulatory estrogen levels associated with insulin resistance may increase the risk for cancers, particularly in the organs having high estrogen demand (breast, endometrium and ovary). On the other hand, postmenopausal state with profound estrogen deficiency confers high risk for cancers in different organs with either high or moderate estrogen demand. After menopause, hormone replacement therapy improves insulin sensitivity and decreases the enhanced inclination to malignancies in postmenopausal women."

Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"There is no increase in cancer prevalence or mortality due to transgender HT."

"While some guidelines for transgender medical care express concerns for elevated cancer risk with certain hormone regimes, current data suggest that the risk of cancer may not rise."

"Although studies are small, overall cancer incidence in transgender men and transgender women to-date has not been found to be different than their respective male and female controls [5]. There are no reports of change in breast cancer specific risk among transgender individuals on estrogen compared to secular trends of male breast cancer incidence.[/u] Rates are lower relative to secular trends of female breast cancer rates."

After much research on the effects of Domperidone in conjunction with estradiol and progesterone in my case to induce lactation I have found that it works just the opposite, Estradiol and to a larger effect Progesterone will hinder the effects of Domperidone. As part of the process to induce lactation you need to run your E2 and Progesterone levels really high simulating that of a pregnant woman. Toward the end Domperidone is introduced to increase the prolactin levels. This alone does not induce lactation, lactation begins when after a period of taking all three you stop the E2 and progesterone, while continuing Domperidone, then a few days later lactation begins, in a week or two you have full flow.

I do take a micro-dose of each while lactation, but if I increased to my normal dosages, lactation stops.

Hope this helps....

Yes, progesterone, especially, strongly suppresses lactation.

Quote from: KayXo on July 14, 2017, 12:25:45 PM
Yes, progesterone, especially, strongly suppresses lactation.

Does this mean skipping progesterone for a day or two can make my breasts shrink by causing contents to be released, or does that only apply to women who are breastfeeding? Because I *do* feel like my breasts shrink if I skip my progesterone, and swell up almost overnight when I take a higher dose. I was wondering what could be the explanation for such noticeable short-term changes. My free T, DHT, and estradiol levels are all within female range.

With that said, in the 13 months since I added progesterone and bicalutamide, my girls have grown three sizes; they are not so little anymore like they were when I started this thread. This really took me and my family by surprise, and I will look back on this experience as one of the highlights of my life.

Quote from: Steph34 on October 30, 2017, 10:38:47 AMI *do* feel like my breasts shrink if I skip my progesterone, and swell up almost overnight when I take a higher dose. I was wondering what could be the explanation for such noticeable short-term changes.

I believe the reason why they swell up so fast is because of increased water retention in the breasts as well as milk glands being enlarged. But, yea, it also increases prolactin so could be increased milk secretion that's caught up in the milk glands, very possible!

Quote from: KayXo on October 30, 2017, 10:52:47 AM
But, yea, it also increases prolactin

What change in progesterone levels is it specifically that you are saying increases prolactin? The rise or the fall in progesterone levels? Because I know that a spike in my estradiol level or domperidone dosage (which are not correlated with my progesterone use) can raise prolactin.

Quote from: Steph34 on October 30, 2017, 11:02:29 AM
What change in progesterone levels is it specifically that you are saying increases prolactin? The rise or the fall in progesterone levels?

The rise in progesterone. Corroborated by studies and my own experience. When levels fall, expression of milk is possible as progesterone inhibits this.