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I am a few years post op girl. Post srs, i never had my hormones checked until four months ago when my endo thought I was my estrogens were too high. I was on <dosage not allowed>transdermal gel a day. I was advised to reduce to<dosage not allowed>day. I have been on this dose for the last 4 months -except the month of january when I had vfs.

I am due to have my hormones checked next month. During the last 2 months I have been experiencing extreme fatigue and muscle weakness, with daily breathlessness. My gp couldn't find anything wrong with my regular blood test results (not the hormones ones) . My iron levels came back normal and so did the rest.

I am wondering if low estrogen levels could be the culprit? Does anyone know the impact of low estrogen can have in post op girls?

Thanks in advance!

Low estrogen could be one factor.
Many endos strive for levels of 200 pg/ml or above.
The neovagina reacts to estrogen like a vagina.
Levels in the menopausal range might lead to some atrophy.
So higher levels might help.

Higher levels also might help with mood and energy. There are reports of women where it helped.

Testo levels should also be high enough, well in the female range.
Many endos strive for values below 60 ng/dl.
There are studies showing that too low levels can have an effect on orgasmic abilities.
And it can have an effect on feeling energized.
There are specifically low dose testo applications for this purpose.

Talk all of this through with your endo.


*hugs*

Quote from: Ritana on March 19, 2016, 04:13:11 PM
I am a few years post op girl. Post srs, i never had my hormones checked until four months ago when my endo thought I was my estrogens were too high. I was on (...) transdermal gel a day. I was advised to reduce (...). I have been on this dose for the last 4 months -except the month of january when I had vfs.

I am due to have my hormones checked next month. During the last 2 months I have been experiencing extreme fatigue and muscle weakness, with daily breathlessness. My gp couldn't find anything wrong with my regular blood test results (not the hormones ones) . My iron levels came back normal and so did the rest.

I am wondering if low estrogen levels could be the culprit? Does anyone know the impact of low estrogen can have in post op girls?

Why did your endo find levels too high? For what reason? Find out as I'm quite certain his reasons for reducing are not supported by actual science but rather by guidelines that don't account for differences in the type of estrogen that is administered, or route of administration or the several studies that show that higher levels of bio-identical estradiol aren't a problem healthwise but have plenty of benefits. I wouldn't be surprised that your symptoms are caused by too low estrogen.

P.S.: you can't post doses in this forum.

1) Cardiovascular and clotting risks

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

. Randomized controlled trials (the most reliable type of study), the Danish and WHI studies have shown estrogen taken alone or without medroxyprogesterone acetate (known to have deleterious effects on cardiovascular markers and oppose estrogen's beneficial effects on cardiovascular health) to DECREASE the cardiovascular complications (and death from). The Danish study (bio-identical estradiol w/progestin other than medroxyprogesterone acetate) did not observe an increase in stroke nor DVT/PE (deep vein thrombosis/pulmonary embolism) incidence.

. Transdermal and even oral bio-identical estradiol in women have shown to positively impact blood pressure with transdermal having an overall beneficial effect on several cardiovascular markers and negligibly affecting coagulation. Studies to support this.

. Studies in men with prostate cancer (ages 49-91) have shown that estradiol levels up to 700 pg/ml were safe. There were no cardiovascular complications or incidences of thrombosis. In fact, researchers stated high levels could be PROTECTIVE. Additionally, it was observed that estrogen improved lipid profiles, without cardiovascular deterioration and that it may improve cardiovascular disease and mortality, long-term. These men were treated with high dose injectable or transdermal (patches) estradiol. I can provide you those studies. 

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

. Four studies show circulating levels of estradiol not to be a useful criterion of risk of thrombosis, as despite high levels, no increased risk was found AND rather the route of administration/type of estrogen is more indicative of the risk.

. Arch Sex Behav. 1998 Oct;27(5):475-92. In this study, transsexual women were given high dose intramuscular E and some were prescribed medium-high doses of oral E. In spite of this, there was not one incidence of thrombosis.

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

2) Breast cancer risk

. In transsexual women, breast cancer incidence is very low, close to that of men not on HRT and significantly lower relative to ciswomen (as per Dr. Gooren and his team, leading specialists of HRT treatment in transwomen). Only 17 cases reported since 1968 (of which 3 are not likely to be related to estrogen use) despite decades of very aggressive, high doses of oral estrogens and non-oral estrogens (intramuscular). Only one proven case reported in Holland among Gooren's patients in decades of treatment despite high doses of E for several years. Studies to support this.

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

. High dose estrogen has actually been used to treat ciswomen afflicted with breast cancer, in one instance, with increased effectiveness relative to tamoxifen, one of the drugs of choice in its treatment. 

. In women with previous breast cancer, several different types of studies have shown HRT (with progestin or not) to either not increase recurrence, lead to relatively low rates of recurrences or even improve the rate of recurrence relative to non-HRT users.

. Randomized controlled trials showed estrogen to be either protective of breast cancer incidence or have no effect, even in women who had had breast cancer, when MPA (medroxyprogesterone acetate, linked to breast cancer) was NOT used or sparingly. I can provide studies. One randomized controlled trial, similar to the WHI, undertaken years earlier even showed that breast cancer was less in HRT users.

. Some epidemiological studies show no increased risk of cancer with the use of oral contraceptives, duration proving to not be a factor in one instance, while being a factor in another.

. The incidence of breast cancer from one country to another were not found to be correlated with levels of estrogens. In fact, the only significant finding was a higher level of estradiol in a subpopulation (adolescents) of the country (during the luteal phase) with the least incidence of breast cancer.

. The more childbirths a woman (hence, the more pregnancies when levels of E are sky high), the lower the risk of breast cancer. On the other hand, celibate nuns are historically known to have a higher incidence of breast cancer risk, going as far back as the 1700's.

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

. Studies in mice and observations that carcinoma incidence is increased post-pregnancy suggest high levels of estradiol are protective. 

. Based on all the evidence so far, we still cannot establish causation between HRT and breast cancer as there are too many conflicting data. Studies with estrogen taken alone or without MPA combined (and other observations) have so far been actually more suggestive of a protective effect while those with bio-identical progesterone or dydrogesterone suggest no increased risk.

3) Uterine cancer risk

. YOU HAVE NO UTERUS


4) Prolactinoma

. Ciswomen have very high levels of prolactin, up to 600 ng/ml (ug/L), during pregnancy and continue to have high levels during breastfeeding which can sometimes last a few years. Despite this, the fact that estradiol levels can also peak quite high during a menstrual cycle (up to 650 pg/ml) and women's history of taking birth control pills or HRT involving estrogens that strongly affect pituitary gland, the prevalence of prolactinoma has been estimated to be 0.1% in women.  Doctors/health authorities do not ask mothers to stop breastfeeding their children or not become pregnant again due to risk of prolactinoma.

. Causation has not been established between the use of estrogen or pregnancy and prolactinoma in women.  Association between OC/HRT use and prolactinoma may have more to do with the increased likelihood that women with prolactinoma use treatment to regulate menstrual cycle disrupted by prolactinoma.

. There is a negligible impact of either birth control pills, HRT or pregnancy (when E levels are very high) on small pituitary adenoma in women. Pregnancy has even shown to have a favorable effect on microadenomas with spontaneous remission ranging from 17-35% (Presse Med, 17 (1998), pp. 2117–2119) vs. 13-15% in those who have not undergone pregnancy. From J Clin Endocrinol Metab. 2007 Aug; 92( 8 ):2861-5.
"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)."

. Breastfeeding, despite higher than normal prolactin levels, has not been shown to cause or worsen prolactinomas.

. Arch Sex Behav. 1998 Oct;27(5):475-92. In this study, transsexual women were given high dose intramuscular E and some were on medium-high dose oral E. In spite of this, there was not one incidence of prolactinoma.
"we detected no prolactinoma as described by other authors (Asscheman et al., 1988, 1989; Kovacs et al., 1994; Gooren et al., 1980)."

. In my extensive search through incidences of prolactinoma in transsexual women, the only incidences reported were found to be in those women who took high doses of non bio-identical forms of estrogen orally (ethinyl estradiol, equine estrogens) most often with high doses of cyproterone acetate, OR a combination of estradiol enanthate and dihydroxyprogesterone acetophenide, all known to abnormally elevate prolactin levels (in the last case due to progestogen component). Incidences in women taking bio-identical estradiol without the above mentioned agents taken simultaneously have NEVER been reported to date. Incidences in male to female transsexuals are also RARE, only 8 cases reported in the literature as of 2015 despite sometimes very high doses of estrogen taken during several decades. Studies to support.

. All of the above therefore suggests that high doses of non-bio-identical estrogens and/or some progestogens may be slight risk factors for prolactinoma but causation has yet to be established.

I urge you to ask endo to provide studies (not statements made by an association) to support their assertions.

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

I read from many other transwomen pre and post-op who have taken high doses E and their blood test results always came back normal. Most were above 40 yrs old.

Thanks for the replies. My E levels came back at 900 pg/ml. He said i need to target the 600pg/ml level.

I feel totally handicapped. The extreme fatigue and muscle weakness have been killing me! Still not sure if this is due to E levels.

I know that in ciswomen, low estrogens can cause these symptoms. I am post op so I hardly have any testesterones left in my body. Until I have my blood tests checked, I am not sure I can cope!

Anyone willing to share their experience would be appreciated.

Mod editing.

I edited out the dosages from the original post.

KayXo, thanks for removing them in your quote.

Joanna

Quote from: Ritana on March 20, 2016, 12:12:05 PM
Thanks for the replies. My E levels came back at 900 pg/ml. He said i need to target the 600pg/ml level.

I feel totally handicapped. The extreme fatigue and muscle weakness have been killing me! Still not sure if this is due to E levels.

I know that in ciswomen, low estrogens can cause these symptoms. I am post op so I hardly have any testesterones left in my body. Until I have my blood tests checked, I am not sure I can cope!

Anyone willing to share their experience would be appreciated.

There are endos who specificaly look for estrogen and testosterone well in the female range, especially for post op people.

Your estrogen is well in the female range. There are many endos who would leave it at that.

There is a feedback loop to the endocrine system which lowers testosterone if estrogen is high.
This is a well known effect and used by endos to lower testosterone without anti androgens.
Its considered safe only with implants and injections pre op.

So its possible your endocrine system lowered production of testosterone.

The symptoms you describe were also described by other people after SRS where no HRT was used, and testosterone was very low.

You might talk with your endo about raising testosterone levels so they are readable again. Testosterone levels below 10ng/dl are usually unreadable . A level of 40-60 ng/dl might be tried as target. Usually for feminization levels of below 80 ng/dl are used by many endos, ideally below 60 ng/dl.

You could start quite quickly with a testosterone gel.
Dosage could be upped to a level you feel comfortable with.
You might simply see to it its all still in the female range.

This kind of treatment is also quite common for menopausal women.

Just talk with your endo about it.

*hugs* and hope you get better soon

You also had FFS.

There were chemicals for anaesthesia introduced which might take some time to get out of the body , possibly a few weeks more.
You might try a cleansing diet . Wild garlic for example is said to have some cleansing properties.

Additionally the stress from the OP might have burned up some reserves ... and have produced kind of a shock to the endocrine system.

So restoring testo levels as said before might help ...

Just talk it all through with your endo .


*hugs*

Thanks Laura, I've recently had vfs, not ffs. It has been 2.5 months since i had my surgery so not sure that's the cause. I personally think it might be low e consequences.

Quote from: Ritana on March 20, 2016, 03:20:45 PM
Thanks Laura, I've recently had vfs, not ffs. It has been 2.5 months since i had my surgery so not sure that's the cause. I personally think it might be low e consequences.

Usually chemicals from surgery might be in the system for up to 6 months ...


But you said e was at 900 ?

Well one possibility might be to try another form of application ... bioidentical estrogen sublingually for example...
it might be received better ... there are low dose pills which might for example be taken a few times a day ...
or even implants, for more steady levels and no hassle ...

Well fatigue and builddown of muscle might also be low testosterone symptoms ...
I'd say talk with your endo about it ....

*hugs*

Quote from: Ritana on March 20, 2016, 12:12:05 PM
Thanks for the replies. My E levels came back at 900 pg/ml. He said i need to target the 600pg/ml level.

I feel totally handicapped. The extreme fatigue and muscle weakness have been killing me! Still not sure if this is due to E levels.

I know that in ciswomen, low estrogens can cause these symptoms. I am post op so I hardly have any testesterones left in my body. Until I have my blood tests checked, I am not sure I can cope!

Anyone willing to share their experience would be appreciated.

I urge you to print out what I wrote, become familiar with it, understand it and then go see doctor with this information. I can provide studies, if need be. This should perhaps help him change his mind.

Another thing I noticed. Your levels are VERY high given your small dose of gel. Did you, by chance, happen to draw blood from the same area where gel was applied??! This could explain the high levels and give an inaccurate reading as to what is really going on all over the body or systemically.

Quote from: Laura_7 on March 20, 2016, 01:16:57 PM
There is a feedback loop to the endocrine system which lowers testosterone if estrogen is high.
This is a well known effect and used by endos to lower testosterone without anti androgens.
Its considered safe only with implants and injections pre op.

So its possible your endocrine system lowered production of testosterone.

Laura, she is post-op. This doesn't apply to her.

QuoteThe symptoms you describe were also described by other people after SRS where no HRT was used, and testosterone was very low.

You might talk with your endo about raising testosterone levels so they are readable again. Testosterone levels below 10ng/dl are usually unreadable . A level of 40-60 ng/dl might be tried as target. Usually for feminization levels of below 80 ng/dl are used by many endos, ideally below 60 ng/dl.

You could start quite quickly with a testosterone gel.
Dosage could be upped to a level you feel comfortable with.
You might simply see to it its all still in the female range.

This kind of treatment is also quite common for menopausal women.

My levels came back at 8 ng/dl, not unreadable. Estrogen increase gives women increased libido, energy and well-being. Ritana complained about extreme fatigue and muscle weakness after estrogen dosage was lowered and her dose is quite low. This is a sign the estrogen is the culprit and not the testosterone.

Adding T at this point or any point could lower her voice permanently, increase facial/body hair, increase scalp hair loss, increase acne and increase masculinization. It is a risky endeavor. Not worth it, in my opinion.

Think of CAIS women who don't respond to androgens. They do well.

Quote from: Laura_7 on March 20, 2016, 01:28:17 PM
You also had FFS.

VFS and you stopped estrogen for a whole month but you've been back on E, now almost 2 months and these symptoms should have receded by now. The estrogen seems to be the culprit rather than VFS, time off and recovery from operation. Perhaps, the stress from the whole surgery, not only physical but psychological could be responsible for symptoms. Estrogen and especially progesterone, in my case, helped me better cope with the stresses of life, have a more positive outlook.

Are you taking other medications for voice that might impact you physically, cause fatigue, muscle weakness? It's important to look at all factors.

VFS could be playing a major role in contributing to this, after all. Who knows? If it was estrogen, then symptoms should have occurred soon after change (which it didn't, only 2 months later, soon after VFS) in E so maybe I'm wrong to assume it is E. Still, I think it was not justified to decrease E, based solely on levels, as I explained earlier. E could help in coping with stress.

Quote from: Laura_7 on March 20, 2016, 03:26:38 PM
But you said e was at 900 ?

Well one possibility might be to try another form of application ... bioidentical estrogen sublingually for example...
it might be received better

I'd say if indeed her levels were 900 pg/ml at such a low dose, she is absorbing incredibly well but I strongly suspect it's a mistake. Her dose is low so I don't think it's a problem of absorption. If indeed her dose was higher, then perhaps, yes.

Quote from: KayXo on March 20, 2016, 04:58:29 PM

Laura, she is post-op. This doesn't apply to her.

It does.
The endocrime system post op still produces small amounts of testosterone. You can look that up.
There are even some people who need to take anti androgens up to more than a year post op because via a feedback loop the endocrne system produces as much testosterone as it can. It can take some time to even out.

Quote

I'd say if indeed her levels were 900 pg/ml at such a low dose, she is absorbing incredibly well but I strongly suspect it's a mistake.

I would presume its pmol/l .
The target level of 600 might hint to that.

So it would be 250 pg/ml .

Well ...
she might ask for another test of levels ...
she might ask for another form of application if she feels its not enough estrogen ...

and imo high enough estrogen levels lead to a good well being in some people.
There are additionally people who do better if testo levels are also not too low.
In Cis women its also present, and below 60 ng/dl there should be hardly any side effects.
After all cis women do not grow beards or have a lowered voice.

Imo testo is also part of the package, at least for some women.

But ... people are different ...

so OP  .. talk it all through with your doc ....

many *hugs*

Thank you so much to both of you for your helpful replies sisters.

I did take some medication after vfs but that was for two weeks that followed surgery. I genuinely believe the 50% reduction in estrogen dose is the culprit. My blood tests are usually taken fr 4 to 6 hours after the transdermal gel has been applied to areas other than the arms.

I would love to switch th bio-identical hormones but they are too expensive for me, alas. The extreme fatigue is killing me. I feel drowsy, lethargic, depressed (despite having had a life changing surgery recently) and my sleep is never deep enough.

Quote from: Laura_7 on March 20, 2016, 05:35:36 PM
It does.
The endocrime system post op still produces small amounts of testosterone. You can look that up.
There are even some people who need to take anti androgens up to more than a year post op because via a feedback loop the endocrne system produces as much testosterone as it can. It can take some time to even out.

The only amount of testosterone the body produces post-op comes from the adrenal glands, mostly through conversion from the precursor DHEA. That's all. The testicles are gone so even if LH and FSH are high which they shouldn't be if you are taking enough estrogen, it doesn't matter because there are no testicles. The apparent increase in androgenicity may be because pre-op, not only was androgen reduced to castrate levels but the anti-androgen taken also may have reduced androgen production through another mechanism and also blocked androgens at receptors. It may also be the case that because HRT was stopped for some time before and after SRS, there was some increase in androgenicity.

The adrenal glands will not produce more T post-op, even if LH and FSH were high because these don't affect adrenal gland output, only ACTH which is affected by the amount of corticosteroids in the body.

QuoteI would presume its pmol/l .
The target level of 600 might hint to that.

So it would be 250 pg/ml .

900 pmol/ml = 245 pg/ml. You could be right and it would make more sense. I think this level is quite good for the dose of gel she was taking, as expected. So, no absorption issues here.

Quoteshe might ask for another form of application if she feels its not enough estrogen ...

The problem is not the form, it's the doctor who refuses to have her levels above a certain range. The doctor reduced her dose.

Quoteand imo high enough estrogen levels lead to a good well being in some people.
There are additionally people who do better if testo levels are also not too low.

Testosterone is too risky, especially considering our situation and our past with this hormone. We had this conversation before. I think E+P suffice.

QuoteIn Cis women its also present, and below 60 ng/dl there should be hardly any side effects.
After all cis women do not grow beards or have a lowered voice.

I read from post-hysterectomy ciswomen where testosterone was taken and caused increase in acne, facial/body hair. From a few transwomen where T post-op actually lowered their voices and it was a disaster in one case. You want to risk this? Go ahead.

Post-op, due to lower T levels, we are overly sensitive to T so there is upregulation of receptors. Take this high sensitivity to T, add a little T and it can potentially do a lot more damage than intended. Ciswomen also did not go through male puberty like us, have a less masculine bone formation and physical shape, did not go bald, etc...so adding T, despite not affecting bones, can reduce body fat, making bone structure more apparent, can lead to increase in DHT and further balding which was not reversed (just stopped), can lead to further voice lowering...disaster!

You can advise transwomen to take T all you want, I doubt many will follow through with this and ask their doctors for some T. It's left too much of a bad impression on them to ever go back on it, even if it was a minute amount. They would rather feel ->-bleeped-<-ty (which they won't, if they take enough of the other hormones) then take T. Trust me!

Ciswomen have a very different history than ours. They can afford to take the risk. We can't, in my opinion.

Quote from: Ritana on March 20, 2016, 07:56:00 PM
My blood tests are usually taken fr 4 to 6 hours after the transdermal gel has been applied to areas other than the arms.

Can you confirm whether the units of estrogen are in pmol/L or pg/ml? I think Laura is right. Do you live outside the US? If so, then it most likely is pmol/L.

QuoteI would love to switch th bio-identical hormones but they are too expensive for me, alas.

Transdermal gel contains bio-identical estradiol.  ;D

QuoteThe extreme fatigue is killing me. I feel drowsy, lethargic, depressed (despite having had a life changing surgery recently) and my sleep is never deep enough.

I insist again. Take the info provided earlier on, read it, bring it to the attention of the doctor. Don't give up. You need to feel better. Progesterone can help with sleep, bio-identical progesterone, that is. Utrogestan or Prometrium.

I am rooting for you.  :angel:

The units are p/mol.

I was browsing the internet last night, and i found this info on a health website:
Surprisingly, caffeine intake can actually increase estrogen. As part of my post vfs instructions, i was asked to give up coffee and caffeine for two months. I wonder whether this might have had an effect?


I will go through the info you provided, kay. However,  I am unclear as to why I've been warned by doctors that estradiol can cause cancer, blood clotting and possible breast cancer in transwomen.

Here is a link on how caffeine affects estrogens effects
http://www.livestrong.com/article/494320-does-coffee-raise-estrogen-levels/

Quote from: Ritana on March 21, 2016, 03:21:47 AM
However,  I am unclear as to why I've been warned by doctors that estradiol can cause cancer, blood clotting and possible breast cancer in transwomen.

Cancer is very rare in trans women. There are studies showing its really rare.

This is a deduction from cis women probably.
Additionally imo its a deduction from non bioidentical estrogen.
Synthetic forms of estrogen indeed have more side effects than the bioidentical ones.

Clotting is a side effect of oral intake of estrogen.
It can be reduced by sublingual intake.
Specifically for risk groups intake through the skin with patches and gels is often used.

Other forms of internal intake are implants and injections.

Topical forms of intake should be safe so you might talk to your doc to raise the dose again since it made you feel better.
Blood levels are not that decisive since it shows only free substances and not substances absorbed.
There are reputable clinics who rarely do tests, or not at all.
They watch for general health and how the patient feels and in preop cases how feminization progesses. (treat the patient not the lab)


*hugs*

Quote from: KayXo on March 20, 2016, 08:16:31 PM

You can advise transwomen to take T all you want, I doubt many will follow through with this and ask their doctors for some T. It's left too much of a bad impression on them to ever go back on it, even if it was a minute amount. They would rather feel ->-bleeped-<-ty (which they won't, if they take enough of the other hormones) then take T. Trust me!

Ciswomen have a very different history than ours. They can afford to take the risk. We can't, in my opinion.

Well its a recipe experienced endos use.

Imo risk is not that high if they start out first with raising estrogen.
And then if necessary adding small doses of testo.
Usually its taken via topical gels so it can be stopped immediately if side effects show up.
And it can be started with very low doses.
But its up to the OP and their endo.

Adding bioidentical progesterone is as you suggested also something that might be talked through with an endo.
It compliments estrogen in cis people and has a variety of effects.
It might help even out some of the side effects the OP described.
Since it has so many functions it could be tried and watched which effects it has.


*hugs*

Quote from: Ritana on March 21, 2016, 04:33:48 AM
Here is a link on how caffeine affects estrogens effects
http://www.livestrong.com/article/494320-does-coffee-raise-estrogen-levels/

This is different for trans women.
Desired amounts of hormones are introduced via hrt.
Phytoestrogens compete with estrogen receptors, making for a weaker effect than estrogen.

http://www.precisionnutrition.com/coffee-and-hormones

In larger quantities its not healthy imo.

Please also be aware this is a huge market.
So studies showing benefits might not be as impartial as they may seem.


*hugs*

Thanks, Laura!  have increased my estrogen dose back to what it was four months ago as i started having throbbing headaches over the last few days. Not sure how long it will take to start seeing results (cessation of low estrogens side effects) -if any?

Did you have a change in diet recently ?
Too much coffee could also be a cause ...

Gels enter the bloodstream soon and should be soon in the system.

Just talk with your doctor about doses.


*hugs*

No i didn't change my diet, and I only have one cup of coffee a day.

I have been experiencing intense fatigue for the last two months so i don't think it's do with diet. As I previously said, my regular blood tests have come back normal. No iron, calcium, or vitamin deficiencies showed up. That is why i'm thinking it could be due to the reduction in the hormone dose.

I haven't been able to find.any studies on the effects of low  estrogen in post op girls. Anyone can help?

Quote from: Ritana on March 21, 2016, 07:34:14 AM
No i didn't change my diet, and I only have one cup of coffee a day.

I have been experiencing intense fatigue for the last two months so i don't think it's do with diet. As I previously said, my regular blood tests have come back normal. No iron, calcium, or vitamin deficiencies showed up. That is why i'm thinking it could be due to the reduction in the hormone dose.

Yes. As said many endos primarily ask how patients feel and look at overall health.
Topical intake is considered very safe, and bioidentical estrogen is considered to have very few adverse effects.
Additionally you were not on an excessive dose with gel.
You could discuss this with your endo.

Quote
I haven't been able to find.any studies on the effects of low  estrogen in post op girls. Anyone can help?

You can look at menopausal women.
They additionally have hot flashes.
But tiredness should be listed.


*hugs*

I am not sure i can compare myself to menopausal cis-xomen as my biology is not the same and the effects of the estrogen reduction might not be the same, even though I am a posop girl.

Quote from: Ritana on March 21, 2016, 07:50:30 AM
I am not sure i can compare myself to menopausal cis-women as my biology is not the same and the effects of the estrogen reduction might not be the same, even though I am a postop girl.

Well basically its similar.
Estrogen levels are receding and testosterone levels are not that high.
Progesterone also is not high in menopausal women.


*hugs*

Quote from: Ritana on March 21, 2016, 03:21:47 AM
The units are p/mol.

Laura was right. Made more sense.

QuoteI was browsing the internet last night, and i found this info on a health website:
Surprisingly, caffeine intake can actually increase estrogen. As part of my post vfs instructions, i was asked to give up coffee and caffeine for two months. I wonder whether this might have had an effect?

This effect is more likely when E is taken ORALLY as caffeine and estradiol are both metabolized via digestive tract by similar enzymes and affect each other's metabolism so that both end up increasing in the body. I definitely noticed this in the past, good and bad. Couldn't sleep at night, restless and hyperactive but breasts grew more.

I doubt it has had any impact on you.

QuoteI will go through the info you provided, kay. However,  I am unclear as to why I've been warned by doctors that estradiol can cause cancer, blood clotting and possible breast cancer in transwomen.

Because they haven't researched the matter thoroughly and they are:

- assuming that because HRT caused breast cancer in the 2003 WHI study (on ciswomen) that hormones cause breast cancer but when you look more closely, you realize that the WHI study used non-bio-identical forms, that estrogen alone without medroxyprogesterone acetate caused a non significant decrease in breast cancer, that another randomized controlled trial was done with bio-identical estradiol and another progestin with results opposite to the WHI...there was no increase in breast cancer and an actual significant decrease in women who started HRT before 50 or in women who used estrogen alone. They also probably don't know that unlike ciswomen, the rate of breast cancer (as per those reported in the literature) is significantly less (like way less) in transwomen (around 4/100,000 vs. 170/100,000) and much closer to that of men not on HRT (1 in 100,000), DESPITE prescribing high doses of estrogens and progestogens to this population for several decades. Then you have men with prostate cancer, who despite taking very high estrogen doses, have rarely been found to develop breast cancer. I explained the rest to you above...there are so many findings and observations that suggest this is not the case. Doctors just don't have the time to do and compile all this research. We, the patients, can help them. :) and by the way, in a recent paper on transsexuals, it is noted

J.D. Weinand, J.D. Safer / 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. Rates are lower relative to secular
trends of female breast cancer rates."

I researched breast cancer in transsexual women and so far noted a total of 17 cases since 1968. This is very little considering the tens of thousands treated.

- As far as clotting goes, the studies found to observe a significant increase in clotting were using non bio-identical forms of estrogens. It was found that bio-identical estradiol, being native to the body was much less adverse and if taken non-orally, even less so. My own blood tests confirm this. I have high levels, up to 14,000 pmol/L and my clotting factors remain normal. Need I say more? I will...

J Clin Endocrinol Metab. 2003 Dec;88(12):5723-9.
Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people

"The large differential effect of oral EE and oral E(2) indicates that the prothrombotic effect of EE is due to its molecular structure rather than to a first-pass liver effect (which they share)."

"In conclusion, we have shown that treatment of MtF transsexuals with sex steroid hormones (CPA combined with E2 or EE) affects the hemostatic balance with a very pronounced difference in the effects of oral EE compared with the effects of both td E2 or oral E2. Oral EE induces a clinically relevant prothrombotic state."

J Clin Endocrinol Metab. 2012 Dec;97(12):4422-8.

"Historically, high-dose estrogen in the form
of ethinyloestradiol or conjugated equine estrogen (CEE) was
used to suppress testicular function and induce feminization. In
view of the procoagulant nature of these older estrogens and the
inability to use plasma estradiol levels to guide treatment, this
protocol was changed in 2004 to oral estradiol valerate"

Minerva Ginecol. 2014 Feb;66(1):91-102.

"Micronized estradiol (E2) and its estere valerate (EV), is more easily metabolized by the liver than ethynylestradiol (EE). This causes minimal metabolic impact »

Obstet Gynecol. 1990 Apr;75(4 Suppl):9S-14S; discussion 15S-17S.

"Although oral conjugated equine estrogens have been used extensively, they introduce types of estrogen, such as equilin, that are not naturally found in humans and that can produce a pronounced hepatic response."

Maturitas. 2015 Mar 9.

"The hemostatic profile of women taking CEE was shown to be more prothrombotic than that of women using oral estradiol"

Andrologia. 2014 Sep;46(7):791-5.

« Ethinyl oestradiol, due to its chemical structure, was in 2003 identified as a major factor in the occurrence of VTE. Most clinics do not prescribe ethinyl oestradiol any longer"

J.D. Weinand, J.D. Safer / Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"Other compelling data suggest that
the incidence of venous thromboembolism (VTE) among transgender
women appears associated with the presence of a hypercoaguable
risk factor, including the use of an especially
thrombogenic estrogen (ethinyl estradiol) which is no longer used
[3]. Gooren et al. (2008), reported no increase in VTE among 2236
male-to-female (MTF) transgender individuals on HT from 1975 to
2006 compared with controls, with the exception of those who used
ethinyl estradiol, for which there was a 6e8% incidence [4]."

"Venous thrombosis events (VTE) were reported in MTF individuals
as early as 1976, when a 29-year old transgender woman
with no history or risk factors for VTE presented with pulmonary
embolism after beginning estrogen therapy of diethylstilbestrol
(DES) [7]. A 1978 paper also observed an occlusion of the middle
cerebral artery during estrogen therapy in a transgender woman,
where the patient was reported using mestranol, a 3-methyl ether
of ethinyl estradiol [8]."

So, remove conjugated equine estrogens (CEE), ethinyl estradiol (EE) and diethylstilbestrol (DES) from the mix and you end up with a much reduced incidence of clotting risks. You have studies in transsexual women where bio-identical estradiol is exclusively used or is the major estradiol component, in low, medium and high doses. And only once do we have an incidence of deep vein thrombosis, in someone with a GENETIC PREDISPOSITION/MUTATION.

Archives of Sexual Behavior, Vol. 27, No. 5, 1998

"The incidence of thromboembolic events during cross-
gender hormone treatment in our patients was zero."

Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):586-92.

"Sixty male-to-female transsexuals were treated with monthly injections of gonadotropin-releasing hormone agonist (GnRHa) and oral oestradiol-17beta valerate for 2 years to achieve feminisation until SRS."

"Two side effects were documented. One, venous thrombosis, occurred in a patient with a homozygous MTHFR mutation."

Two other studies, outside the transsexual realm.

Menopause. 2006 Jul-Aug;13(4):643-50.

"Oral E(2), with or without NETA, produced no net activation of coagulation but improved fibrinolysis."

Fertil Steril. 1997 Sep;68(3):449-53.

« Compared with placebo, oral E2 replacement therapy resulted in a significant decrease in fibrinogen and apo B and a significant increase in plasminogen."

Several studies also show that when estradiol is given non-orally, even in high doses, coagulation is not adversely affected. This shouldn't be surprising given pregnancy's low rate of DVT and pulmonary embolism.

Quote from: Ritana on March 21, 2016, 04:33:48 AM
Here is a link on how caffeine affects estrogens effects
http://www.livestrong.com/article/494320-does-coffee-raise-estrogen-levels/

Phytoestrogens are 1,000 x weaker than estradiol and could actually end up blocking it by binding to receptors. So, I doubt that coffee increases estrogenic effects through this mechanism.

The inverse relation between caffeine intake and estrogen levels, I strongly question until I actually see the data which I cannot due to non-access. Also, association is not causation. This is always important to remember.

J Lab Clin Med. 1980 Apr;95(4):603-8.
Impaired elimination of caffeine by oral contraceptive steroids.

"The effect of OCS on the disposition and elimination of caffeine was examined. Caffeine (250 mg) was administered orally to 13 healthy males, nine healthy females taking no OCS, and nine healthy females on OCS. The t1/2 (beta) was significantly prolonged in women on OCS (10.7 +/- 3.0 hr vs. 6.2 +/- 1.6) (p less than 0.001) as compared to women taking no OCS. Women on OCS had a significantly lower total plasma clearance (0.79 +/- 0.21 ml/min/kg vs. 1.3 +/- 0.35) and free clearance (1.12 +/- 0.28 ml/min/kg vs. 1.97 +/- 0.57) that women not taking OCS."

"We conclude that OCS impair the elimination of caffeine."

This is line with my experience. This is why I don't drink any more caffeine. Tobacco, by the way, has the opposite effect. BUT, if you aren't taking E orally, irrelevant unless you are taking high amounts (like me) which you aren't.

Quote from: Laura_7 on March 21, 2016, 04:47:45 AM
Clotting is a side effect of oral intake of estrogen.

More so, by non bio-identicals as these recirculate again and again through the portal vein. It's important to mention that not only is the route important but the type of estrogen is equally important such that two different types of estrogen taken orally can have widely different effects on coagulation, as studies have pointed out.

Quote from: Laura_7 on March 21, 2016, 05:09:36 AM
It might help even out some of the side effects the OP described.

In Ritana's case, if her side-effects are caused by lack of estrogen, bio-identical progesterone will, at best, mask symptoms temporarily, do nothing or make things worse because it is anti-estrogenic. Until her optimal estrogen is not figured out by doctor, I personally don't think it's a good idea to add P. I know I suggested it earlier for sleep but I should have added that it is best, first to determine what is causing what, determine the optimal E dose for her and then perhaps, if need be, add P if certain symptoms persist and can be improved by P. Her doctor need to determine this. All we can do is give some guidance which can then help her figure out things with her doctor.

Quote from: Ritana on March 21, 2016, 07:50:30 AM
I am not sure i can compare myself to menopausal cis-xomen as my biology is not the same and the effects of the estrogen reduction might not be the same, even though I am a posop girl.

It's the same. Symptoms of too little sex hormones in women and men are identical.

. headaches, following decrease of hormones but soon goes away
. hot flashes, night sweats
. dry skin, hair, and vagina, older looking skin, wrinkles, less elastic, heals slower, thinner hair and skin
. breast shrinkage, less firm, sags more
. weight increase, increase in appetite
. memory not as good
. insomnia
. moody, sad, angry, impatient, irritable, anxious
. low energy
. osteoporosis
. diabetes
. libido decrease
. increase in cardiovascular risks, etc.

Quote
. hot flashes, night sweats
. dry skin, hair, and vagina, older looking skin, wrinkles, less elastic, heals slower, thinner hair and skin
. breast shrinkage, less firm, sags more
. weight increase, increase in appetite
. memory not as good
. insomnia
. moody, sad, angry, impatient, irritable, anxious
. low energy
. osteoporosis
. diabetes
. libido decrease
. increase in cardiovascular risks, etc.

And I thought I had all this due to old age!   ;D  OK it's kind of a joke, but seriously, think about it -  it's mostly the exact same thing.